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Intensive Care Medicine

, Volume 41, Issue 4, pp 642–649 | Cite as

Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity

  • Ewan C. Goligher
  • Franco Laghi
  • Michael E. Detsky
  • Paulina Farias
  • Alistair Murray
  • Deborah Brace
  • Laurent J. Brochard
  • Steffen Sebastien-Bolz
  • Gordon D. Rubenfeld
  • Brian P. Kavanagh
  • Niall D. Ferguson
Original

Abstract

Purpose

Ultrasound measurements of diaphragm thickness (T di) and thickening (TFdi) may be useful to monitor diaphragm activity and detect diaphragm atrophy in mechanically ventilated patients. We aimed to establish the reproducibility of measurements in ventilated patients and determine whether passive inflation by the ventilator might cause thickening apart from inspiratory effort.

Methods

Five observers measured T di and TFdi in 96 mechanically ventilated patients. The probe site was marked in 66 of the 96 patients. TFdi was measured at peak and end-inspiration (airway occluded and diaphragm relaxed) in nine healthy volunteers inhaling to varying lung volumes. The association with diaphragm electrical activity was quantified.

Results

Right hemidiaphragm thickness was obtained on 95 % of attempts; left hemidiaphragm measurements could not be obtained consistently. Right hemidiaphragm thickness measurements were highly reproducible (mean ± SD 2.4 ± 0.8 mm, repeatability coefficient 0.2 mm, reproducibility coefficient 0.4 mm), particularly after marking the location of the probe. TFdi measurements were only moderately reproducible (median 11 %, IQR 3–17 %, repeatability coefficient 17 %, reproducibility coefficient 16 %). TFdi and diaphragm electrical activity were positively correlated, r 2 = 0.32, p < 0.01). At inspiratory volumes below 50 % of inspiratory capacity, passive inflation did not cause diaphragm thickening. TFdi was considerably lower in patients on either partially assisted or controlled ventilation compared to healthy subjects (median 11 vs. 35 %, p < 0.001).

Conclusions

Ultrasound measurements of right hemidiaphragm thickness are feasible and highly reproducible in ventilated patients. At clinically relevant inspiratory volumes, diaphragm thickening reflects muscular contraction and not passive inflation. This technique can be reliably employed to monitor diaphragm thickness, activity, and function during mechanical ventilation.

Keywords

Diaphragm Artificial respiration Ultrasonography Ventilator weaning 

Notes

Acknowledgments

This study was funded by an operating grant from the Physician Services Incorporated Foundation (Toronto, Canada). E.G. is supported by a Post-Doctoral Fellowship from the Canadian Institutes of Health Research.

Conflicts of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2015_3687_MOESM1_ESM.docx (2.7 mb)
Supplementary material 1 (DOCX 2,794 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Ewan C. Goligher
    • 1
    • 2
    • 3
  • Franco Laghi
    • 4
  • Michael E. Detsky
    • 1
    • 5
  • Paulina Farias
    • 2
  • Alistair Murray
    • 2
  • Deborah Brace
    • 2
  • Laurent J. Brochard
    • 1
    • 6
  • Steffen Sebastien-Bolz
    • 3
  • Gordon D. Rubenfeld
    • 1
    • 7
    • 10
  • Brian P. Kavanagh
    • 1
    • 3
    • 8
    • 9
  • Niall D. Ferguson
    • 1
    • 2
    • 3
    • 10
    • 11
    • 12
  1. 1.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  2. 2.Division of Respirology, Department of MedicineUniversity Health NetworkTorontoCanada
  3. 3.Department of PhysiologyUniversity of TorontoTorontoCanada
  4. 4.Department of MedicineStritch School of Medicine, Edward Hines Jr. VAH and Loyola University ChicagoHinesUSA
  5. 5.Department of MedicineMount Sinai HospitalTorontoCanada
  6. 6.Keenan Research Centre for Biomedical ScienceSt. Michael’s HospitalTorontoCanada
  7. 7.Department of Critical Care MedicineSunnybrook Health Sciences CentreTorontoCanada
  8. 8.Department of AnesthesiaUniversity of TorontoTorontoCanada
  9. 9.Department of Critical Care MedicineSick Children’s HospitalTorontoCanada
  10. 10.Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  11. 11.Toronto General Research InstituteTorontoCanada
  12. 12.Toronto General HospitalTorontoCanada

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