Association between histological diaphragm atrophy and ultrasound diaphragm expiratory thickness in ventilated patients

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• dc.contributor.author Dot Jordana, Irene, 1982-
• dc.contributor.author Pérez-Terán, Purificación
• dc.contributor.author Francés, Albert
• dc.contributor.author Díaz, Yolanda
• dc.contributor.author Vilà Vilardell, Clara
• dc.contributor.author Salazar Degracia, Anna
• dc.contributor.author Chalela Rengifo, Roberto José, 1985-
• dc.contributor.author Barreiro Portela, Esther
• dc.contributor.author Rodríguez-Fuster, Alberto
• dc.contributor.author Masclans Enviz, Joan Ramon
• dc.contributor.author Marin Corral, Judith
• dc.date.accessioned 2023-02-03T06:51:50Z
• dc.date.available 2023-02-03T06:51:50Z
• dc.date.issued 2022
• dc.description.abstract Background: Diaphragm fiber atrophy has been evidenced after short periods of mechanical ventilation (MV) and related to critical illness-associated diaphragm weakness. Atrophy is described as a decrease in diaphragm fiber cross-sectional area (CSA) in human diaphragm biopsy, but human samples are still difficult to obtain in clinics. In recent years, ultrasound has become a useful tool in intensive care to evaluate diaphragm anatomy. The present study aimed to evaluate the ability of diaphragm expiratory thickness (Tdi) measured by ultrasound to predict diaphragm atrophy, defined by a decrease in diaphragm fiber CSA obtained through diaphragm biopsy (the gold standard technique) in ventilated patients. Methods: Diaphragm biopsies and diaphragm ultrasound were performed in ventilated donors and in control subjects. Demographic variables, comorbidities, severity on admission, treatment, laboratory test results and evolution variables were evaluated. Immunohistochemical analysis to determine CSA and ultrasound measurements of Tdi at end-expiration were performed, and median values of the control group were used as thresholds to determine agreement between them in further analysis. Sensitivity, specificity, and positive and negative predictive values of an ultrasound Tdi cutoff for detecting histologic atrophy were calculated. Agreement between two ultrasound observers was also assessed. Results: Thirty-five ventilated organ donors and 5 ventilated controls were included, without differences in basic characteristics. CSA and Tdi were lower in donors than in controls. All donors presented lower CSA, but only 74% lower Tdi regarding control group thresholds. The cut-off value for lower diaphragm expiratory thickness (Tdi < 1.7 mm) presented a sensitivity of 73%, a specificity of 67%, a positive predictive value of 96% and a negative predictive value of 17% for determining the presence of diaphragm atrophy (CSA < 2851 μm2). Conclusions: Diaphragm atrophy and thickness reduction is associated to MV. While a lower Tdi in diaphragm ultrasound is a good tool for diagnosing atrophy, normal or increased Tdi cannot rule atrophy out showing that both parameters should not be considered as synonymous.
• dc.format.mimetype application/pdf
• dc.identifier.citation Dot I, Pérez-Terán P, Francés A, Díaz Y, Vilà-Vilardell C, Salazar-Degracia A, Chalela R, Barreiro E, Rodriguez-Fuster A, Masclans JR, Marin-Corral J. Association between histological diaphragm atrophy and ultrasound diaphragm expiratory thickness in ventilated patients. J Intensive Care. 2022 Aug 19;10(1):40. DOI: 10.1186/s40560-022-00632-5
• dc.identifier.doi http://dx.doi.org/10.1186/s40560-022-00632-5
• dc.identifier.issn 2052-0492
• dc.identifier.uri http://hdl.handle.net/10230/55600
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof J Intensive Care. 2022 Aug 19;10(1):40
• dc.rights © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Atrophy
• dc.subject.keyword Critical illness-associated diaphragm weakness
• dc.subject.keyword Diaphragm thickness
• dc.subject.keyword Diaphragm ultrasound
• dc.subject.keyword Dysfunction
• dc.subject.keyword Muscle
• dc.title Association between histological diaphragm atrophy and ultrasound diaphragm expiratory thickness in ventilated patients
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion