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Intensive Care Medicine

, Volume 42, Issue 7, pp 1107–1117 | Cite as

Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung

  • P. MayoEmail author
  • G. Volpicelli
  • N. Lerolle
  • A. Schreiber
  • P. Doelken
  • A. Vieillard-Baron
Review

Abstract

Purpose

On a regular basis, the intensivist encounters the patient who is difficult to wean from mechanical ventilatory support. The causes for failure to wean from mechanical ventilatory support are often multifactorial and involve a complex interplay between cardiac and pulmonary dysfunction. A potential application of point of care ultrasonography relates to its utility in the process of weaning the patient from mechanical ventilatory support.

Methods

This article reviews some applications of ultrasonography that may be relevant to the process of weaning from mechanical ventilatory support.

Results

The authors have divided these applications of ultrasonography into four separate categories: the assessment of cardiac, diaphragmatic, and lung function; and the identification of pleural effusion; which can all be evaluated with ultrasonography during a dynamic process in which the intensivist is uniquely positioned to use ultrasonography at the point of care.

Conclusions

Ultrasonography may have useful application during the weaning process from mechanical ventilatory support.

Keywords

Echocardiography Ultrasonography Weaning Cardiac function 

Notes

Compliance with ethical standards

Conflicts of interest

The authors do not declare any conflict of interest.

References

  1. 1.
    De Backer D, El Haddad P, Preiser JC, Vincent JL (2000) Hemodynamic response to a successful weaning from mechanical ventilation after cardiovascular surgery. Intensive Care Med 26:1201–1206CrossRefPubMedGoogle Scholar
  2. 2.
    Jubran A, Mathru M, Dries D, Tobin M (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158:1763–1769CrossRefPubMedGoogle Scholar
  3. 3.
    Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056CrossRefPubMedGoogle Scholar
  4. 4.
    Cabello B, Thille AW, Roche-Campo F, Brochard L, Gomez FJ, Mancebo J (2010) Physiological comparison of the three spontaneous breathing trials in difficult-to-wean patients. Intensive Care Med 36:1171–1179CrossRefPubMedGoogle Scholar
  5. 5.
    Buda AJ, Pinsky MR, Ingels Jr NB, Daughters 2nd GT, Stinson EB, Alderman EL (1979) Effect of intrathoracic pressure on left ventricular performance. N Engl J Med 30:453–459CrossRefGoogle Scholar
  6. 6.
    Richard C, Teboul JL, Archambaud F, Hebert JL, Michaut P, Auzepy P (1994) Left ventricular function during weaning of patients with chronic obstructive pulmonary disease. Intensive Care Med 20:181–186CrossRefPubMedGoogle Scholar
  7. 7.
    Hurford WE, Favorito F (1995) Association of myocardial ischemia with failure to wean from mechanical ventilation. Crit Care Med 23:1475–1480CrossRefPubMedGoogle Scholar
  8. 8.
    Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179CrossRefPubMedGoogle Scholar
  9. 9.
    Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P (2009) American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest 135:1050–1060CrossRefPubMedGoogle Scholar
  10. 10.
    Saleh M, Vieillard-Baron A (2012) On the role of left ventricular diastolic function in the critically ill patient. Intensive Care Med 38:189–191CrossRefPubMedGoogle Scholar
  11. 11.
    Expert Round Table on Ultrasound in ICU (2011) International expert statement on training standards for critical care ultrasonography. Intensive Care Med 37:1077–1083CrossRefGoogle Scholar
  12. 12.
    Expert Round Table on Echocardiography in ICU (2014) International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med 40:654–666CrossRefGoogle Scholar
  13. 13.
    Caille V, Amiel JB, Charron C, Belliard G, Vieillard-Baron A, Vignon P (2010) Echocardiography: a help in the weaning process. Crit Care 14:R120CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ait-Oufella H, Tharaux PL, Baudel JL, Vandermeersch S, Meyer P, Tonnelier M, Dussaule JC, Guidet B, Offenstadt G, Maury E (2007) Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study. Intensive Care Med 33:1183–1186CrossRefPubMedGoogle Scholar
  15. 15.
    Moschietto S, Doyen D, Grech L, Dellamonica J, Hyvernat H, Bernardin G (2012) Transthoracic echocardiography with Doppler tissue imaging predicts weaning failure from mechanical ventilation: evolution of the left ventricle relaxation rate during a spontaneous breathing trial is a key factor in weaning outcome. Crit Care 16:R81CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gerbaud E, Erickson M, Grenouillet-Delacre M, Beauvieux MC, Coste P, Durrieu-Jaïs C, Hilbert G, Castaing Y, Vargas F (2012) Echocardiographic evaluation and N-terminal pro-brain natriuretic peptide measurement of patients hospitalized for heart failure during weaning from mechanical ventilation. Minerva Anestesiol 78:415–425PubMedGoogle Scholar
  17. 17.
    Papanikolaou J, Makris D, Saranteas T, Karakitsos D, Zintzaras E, Karabinis A, Kostopanagiotou G, Zakynthinos E (2011) New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med 37:1976–1985CrossRefPubMedGoogle Scholar
  18. 18.
    Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193CrossRefPubMedGoogle Scholar
  19. 19.
    Dres M, Teboul JL, Anguel N, Guerin L, Richard C, Monnet X (2015) Passive leg raising performed before a spontaneous breathing trial predicts weaning-induced cardiac dysfunction. Intensive Care Med 41:487–494CrossRefPubMedGoogle Scholar
  20. 20.
    Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259CrossRefPubMedGoogle Scholar
  21. 21.
    Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C, Teboul JL (2009) Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Critical Care Med 37:1696–1701CrossRefGoogle Scholar
  22. 22.
    Adamopoulos C, Tsagourias M, Arvaniti K, Veroniki F, Matamis D (2005) Weaning failure from mechanical ventilation due to hypertrophic obstructive cardiomyopathy. Intensive Care Med 31:734–737CrossRefPubMedGoogle Scholar
  23. 23.
    Lerolle N, Guérot E, Zegdi R, Faisy C, Fagon J-Y, Diehl J-L (2009) Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 135(2):401–407CrossRefPubMedGoogle Scholar
  24. 24.
    Pasero D, Koeltz A, Placido R, Fontes Lima M, Haun O, Rienzo M et al (2015) Improving ultrasonic measurement of diaphragmatic excursion after cardiac surgery using the anatomical M-mode: a randomized crossover study. Intensive Care Med 41(4):650–656CrossRefPubMedGoogle Scholar
  25. 25.
    Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F et al (2013) Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 39(5):801–810CrossRefPubMedGoogle Scholar
  26. 26.
    Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD (2008) Monitoring recovery from diaphragm paralysis with ultrasound. Chest J 133(3):737Google Scholar
  27. 27.
    Beaumont M, Lejeune D, Marotte H, Harf A, Lofaso F (1997) Effects of chest wall counterpressures on lung mechanics under high levels of CPAP in humans. J Appl Physiol 83(2):591–598PubMedGoogle Scholar
  28. 28.
    Cohn D, Benditt JO, Eveloff S, McCool FD (1997) Diaphragm thickening during inspiration. J Appl Physiol 83(1):291–296PubMedGoogle Scholar
  29. 29.
    Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW et al (2012) Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med 38(5):796–803CrossRefPubMedGoogle Scholar
  30. 30.
    Umbrello M, Formenti P, Longhi D, Galimberti A, Piva I, Pezzi A et al (2015) Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. Crit Care 19:161Google Scholar
  31. 31.
    Powers SK, Kavazis AN, Levine S (2009) Prolonged mechanical ventilation alters diaphragmatic structure and function. Crit Care Med 37:S347–S353CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Doorduin J, van Hees HWH, van der Hoeven JG, Heunks LMA (2013) Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med 187(1):20–27CrossRefPubMedGoogle Scholar
  33. 33.
    Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C et al (2013) Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med 188(2):213–219CrossRefPubMedGoogle Scholar
  34. 34.
    DiNino E, Gartman EJ, Sethi JM, McCool FD (2014) Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 69(5):431–435CrossRefGoogle Scholar
  35. 35.
    Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F (2014) Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J 6(1):8CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Kim WY, Suh HJ, Hong S-B, Koh Y, Lim C-M (2011) Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med 39(12):2627–2630CrossRefPubMedGoogle Scholar
  37. 37.
    Jiang J-R, Tsai T-H, Jerng J-S, Yu C-J, Wu H-D, Yang P-C (2004) Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest 126(1):179–185CrossRefPubMedGoogle Scholar
  38. 38.
    Valette X, Seguin A, Daubin C, Brunet J, Sauneuf B, Terzi N et al (2015) Diaphragmatic dysfunction at admission in intensive care unit: the value of diaphragmatic ultrasonography. Intensive Care Med 41(3):557–559CrossRefPubMedGoogle Scholar
  39. 39.
    Mariani LF, Bedel J, Gros A, Lerolle N, Milojevic K, Laurent V et al (2015) Ultrasonography for screening and follow-up of diaphragmatic dysfunction in the ICU: a pilot study. J Intensive Care Med. doi: 10.1177/088506661558363910.1177/0885066615583639
  40. 40.
    Grosu HB, Lee YI, Lee J, Eden E, Eikermann M, Rose KM (2012) Diaphragm muscle thinning in patients who are mechanically ventilated. Chest J 142(6):1455CrossRefGoogle Scholar
  41. 41.
    Ahmed SH, Ouzounian SP, Dirusso S, Sullivan T, Savino J, Del Guercio L (2004) Hemodynamic and pulmonary changes after drainage of significant pleural effusions in critically ill, mechanically ventilated surgical patients. J Trauma 57:1184–1188CrossRefPubMedGoogle Scholar
  42. 42.
    Doelken P, Abreu R, Sahn S, Mayo PH (2006) Effects of thoracentesis on respiratory mechanics and gas exchange in the mechanically ventilated patient. Chest 130:1354–1361CrossRefPubMedGoogle Scholar
  43. 43.
    Razazi K, Thille AW, Carteaux G, Beji O, Brun-Buisson C, Brochard L, Dessap AM (2014) Effects of pleural effusion drainage on oxygenation, respiratory mechanics, and hemodynamics in mechanically ventilated patients. Ann Am Thorac Soc 11:1018–1024CrossRefPubMedGoogle Scholar
  44. 44.
    Graf J (2009) Pleural effusion in the mechanically ventilated patient. Curr Opin Crit Care 15:10–17CrossRefPubMedGoogle Scholar
  45. 45.
    Mongodi S, Via G, Bouhemad B, Storti E, Mojoli F, Braschi A (2013) Usefulness of combined bedside lung ultrasound and echocardiography to assess weaning failure from mechanical ventilation: a suggestive case. Crit Care Med 41(8):e182–e185CrossRefPubMedGoogle Scholar
  46. 46.
    Talmor M, Hydo L, Gershenwald JG, Barie PS (1998) Beneficial effects of chest tube drainage of pleural effusion in acute respiratory failure refractory to positive end-expiratory pressure ventilation. Surgery 123:137–143CrossRefPubMedGoogle Scholar
  47. 47.
    Lichtenstein D, Hulot JS, Rabiller A, Tostivint I, Mezière G (1999) Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Intensive Care Med 25:955–958CrossRefPubMedGoogle Scholar
  48. 48.
    Mayo PH, Goltz HR, Tafreshi M, Doelken P (2004) Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation. Chest 125:1059–1062CrossRefPubMedGoogle Scholar
  49. 49.
    Vignon P, Chastagner C, Berkane V, Chardac E, François B, Normand S, Bonnivard M, Clavel M, Pichon N, Preux PM, Maubon A, Gastinne H (2005) Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med 33:1757–1763CrossRefPubMedGoogle Scholar
  50. 50.
    Begot E, Grumann A, Duvoid T, Dalmay F, Pichon N, François B, Clavel M, Vignon P (2014) Ultrasonographic identification and semiquantitative assessment of unloculated pleural effusions in critically ill patients by residents after a focused training. Intensive Care Med 40:1475–1480CrossRefPubMedGoogle Scholar
  51. 51.
    Kupfer Y, Seneviratne C, Chawla K, Ramachandran K, Tessler S (2011) Chest tube drainage of transudative pleural effusions hastens liberation from mechanical ventilation. Chest 139:519–523CrossRefPubMedGoogle Scholar
  52. 52.
    Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, Rouby JJ, The Lung Ultrasound Study Group (2012) Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med 40:2064–2072CrossRefPubMedGoogle Scholar
  53. 53.
    Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, Girard M, Lu Q, Rouby JJ (2010) Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 38:84–92CrossRefPubMedGoogle Scholar
  54. 54.
    Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ (2011) Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 183(3):341–347CrossRefPubMedGoogle Scholar
  55. 55.
    Arbelot C, Ferrari F, Bouhemad B, Rouby JJ (2008) Lung ultrasound in acute respiratory distress syndrome and acute lung injury. Curr Opin Crit Care 14:70–74CrossRefPubMedGoogle Scholar
  56. 56.
    Bouhemad B, Zhang M, Lu Q, Rouby JJ (2007) Clinical review: bedside lung ultrasound in critical care practice. Crit Care 11:205CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound (ILC-LUS) for the International Consensus Conference on Lung Ultrasound (ICC-LUS) (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591CrossRefPubMedGoogle Scholar
  58. 58.
    Via G, Storti E, Gulati G, Neri L, Mojoli F, Braschi A (2012) Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol 78:1282–1296PubMedGoogle Scholar
  59. 59.
    Perbet S, Gerst A, Chabanne R, Soummer A, Faure JS, Pascal J, Pereira B, Rouby JJ, Constantin JM (2014) High-flow nasal oxygen cannula versus conventional oxygen therapy to prevent postextubation lung aeration loss: a multicentric randomized control lung ultrasound study. Oral session 0446. Abstracts ESICM LIVES 2014 27th Annual Congress Barcelona, Spain. Intensive Care Med 40(Suppl 1)Google Scholar
  60. 60.
    Oropello J, Rahamanian M (2013) Can chest sonography predict and facilitate successful ventilator weaning? Crit Care Med 41(8):2065–2067CrossRefPubMedGoogle Scholar
  61. 61.
    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324:1445–1450CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • P. Mayo
    • 1
    Email author
  • G. Volpicelli
    • 2
  • N. Lerolle
    • 3
  • A. Schreiber
    • 4
  • P. Doelken
    • 5
  • A. Vieillard-Baron
    • 6
    • 7
    • 8
  1. 1.North Shore/LIJ Medical Center, Division of Pulmonary, Critical Care, and Sleep MedicineHofstra NorthShore-LIJ School of MedicineHempsteadUSA
  2. 2.Department of Emergency MedicineSan Luigi Gonzaga University HospitalOrbassanoItaly
  3. 3.Département de Réanimation Médicale et de Médecine HyperbareCHU Angers et UFR Santé Angers, Université AngersAngersFrance
  4. 4.Respiratory Intensive Care UnitSalvatore Maugeri FoundationPaviaItaly
  5. 5.Division of Pulmonary and Critical Care MedicineAlbany Medical CenterAlbanyUSA
  6. 6.Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Service de RéanimationPôle Thorax-Maladies Cardiovasculaires-Abdomen-MétabolismeBoulogne-BillancourtFrance
  7. 7.INSERM U-1018CESP, Equipe 5 (EpReC, Epidémiologie Rénale et Cardiovasculaire)VillejuifFrance
  8. 8.Université de Versailles Saint-Quentin en YvelinesUFR des Sciences de la Santé Simone VeilSaint-Quentin en YvelinesFrance

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