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Intensive Care Medicine

, Volume 43, Issue 1, pp 29–38 | Cite as

Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review

  • Massimo ZambonEmail author
  • Massimiliano Greco
  • Speranza Bocchino
  • Luca Cabrini
  • Paolo Federico Beccaria
  • Alberto Zangrillo
Systematic Review

Abstract

Purpose

Diaphragmatic dysfunction (DD) has a high incidence in critically ill patients and is an under-recognized cause of respiratory failure and prolonged weaning from mechanical ventilation. Among different methods to assess diaphragmatic function, diaphragm ultrasonography (DU) is noninvasive, rapid, and easy to perform at the bedside. We systematically reviewed the current literature assessing the usefulness and accuracy of DU in intensive care unit (ICU) patients.

Methods

Pubmed, Cochrane Database of Systematic Reviews, Embase, Scopus, and Google Scholar Databases were searched for pertinent studies. We included all original, peer-reviewed studies about the use of DU in ICU patients.

Results

Twenty studies including 875 patients were included in the final analysis. DU was performed with different techniques to measure diaphragmatic inspiratory excursion, thickness of diaphragm (Tdi), and thickening fraction (TF). DU is feasible, highly reproducible, and allows one to detect diaphragmatic dysfunction in critically ill patients. During weaning from mechanical ventilation and spontaneous breathing trials, both diaphragmatic excursion and diaphragmatic thickening measurements have been used to predict extubation success or failure. Optimal cutoffs ranged from 10 to 14 mm for excursion and 30–36 % for thickening fraction. During assisted mechanical ventilation, diaphragmatic thickening has been found to be an accurate index of respiratory muscles workload. Observational studies suggest DU as a reliable method to assess diaphragm atrophy in patients undergoing mechanical ventilation.

Conclusions

Current literature suggests that DU could be a useful and accurate tool to detect diaphragmatic dysfunction in critically ill patients, to predict extubation success or failure, to monitor respiratory workload, and to assess atrophy in patients who are mechanically ventilated.

Keywords

Diaphragm Ultrasonography Diaphragmatic dysfunction Thoracic ultrasound Respiratory monitoring Critically ill 

Abbreviations

DD

Diaphragmatic dysfunction

DU

Diaphragm ultrasonography

ICU

Intensive care unit

RSBI

Rapid shallow breathing index

MV

Mechanical ventilation

Notes

Compliance with ethical standards

Funding

None.

Conflicts of interest

All authors report no financial or other conflict of interest relevant to the subject of this article.

Supplementary material

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Supplementary material 1 (DOCX 19 kb)
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Supplementary material 2 (DOCX 57 kb)
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Supplementary material 3 (DOC 28 kb)
134_2016_4524_MOESM4_ESM.docx (15 kb)
Supplementary material 4 (DOCX 14 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Massimo Zambon
    • 1
    Email author
  • Massimiliano Greco
    • 2
  • Speranza Bocchino
    • 2
  • Luca Cabrini
    • 2
  • Paolo Federico Beccaria
    • 2
  • Alberto Zangrillo
    • 2
    • 3
  1. 1.Department of Anesthesia and Intensive CareASST Melegnano-Martesana, Presidio di Cernusco sul NaviglioCernusco sul NaviglioItaly
  2. 2.Department of Anesthesia and Intensive CareSan Raffaele Scientific InstituteMilanItaly
  3. 3.Università Vita-Salute San RaffaeleMilanItaly

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