Document Detail

Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery.
MedLine Citation:
PMID:  18753469     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Severe diaphragmatic dysfunction can prolong mechanical ventilation after cardiac surgery. An ultrasonographic criterion for diagnosing severe diaphragmatic dysfunction defined by a reference technique such as transdiaphragmatic pressure measurements has never been determined. METHODS: Twenty-eight patients requiring mechanical ventilation > 7 days postoperatively were studied. Esophageal and gastric pressures were measured to calculate transdiaphragmatic pressure during maximal inspiratory effort and the Gilbert index, which evaluates the diaphragm contribution to respiratory pressure swings during quiet ventilation. Ultrasonography allowed measuring right and left hemidiaphragmatic excursions during maximal inspiratory effort. Best E is the greatest positive value from either hemidiaphragm. Twenty cardiac surgery patients with uncomplicated postoperative course were also evaluated with ultrasonography preoperatively and postoperatively. Measurements were performed in semirecumbent position. RESULTS: Transdiaphragmatic pressure during maximal inspiratory effort was below normal value in 27 of the 28 patients receiving prolonged mechanical ventilation (median, 39 cm H(2)O; interquartile range [IQR] 28 cm H(2)O). Eight patients had Gilbert indexes <or= 0 indicating severe diaphragmatic dysfunction. Best E was lower in patients with Gilbert index <or= 0 than > 0 (30 mm; IQR, 10 mm; vs 19 mm; IQR, 7 mm, respectively; p = 0.001). Best E < 25 mm had a positive likelihood ratio of 6.7 (95% confidence interval [CI], 2.4 to 19) and a negative likelihood ratio of 0 (95% CI, 0 to 1.1) for having a Gilbert index <or= 0. None of the patients with uncomplicated course had Best E < 25 mm either preoperatively or postoperatively. CONCLUSIONS: Ultrasonographic-based determination of hemidiaphragm excursions in patients requiring prolonged mechanical ventilation after cardiac surgery may help identify those with and without severe diaphragmatic dysfunction as defined by the Gilbert index.
Nicolas Lerolle; Emmanuel Guérot; Saoussen Dimassi; Rachid Zegdi; Christophe Faisy; Jean-Yves Fagon; Jean-Luc Diehl
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Publication Detail:
Type:  Journal Article     Date:  2008-08-27
Journal Detail:
Title:  Chest     Volume:  135     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-09     Completed Date:  2009-04-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  401-7     Citation Subset:  AIM; IM    
Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Faculté de Médecine, Paris, France.
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MeSH Terms
Cardiac Surgical Procedures / adverse effects*,  methods
Confidence Intervals
Diaphragm / physiopathology,  ultrasonography*
Follow-Up Studies
Intensive Care Units
Postoperative Care / methods
Postoperative Complications / therapy,  ultrasonography
Prospective Studies
ROC Curve
Respiration, Artificial / methods
Respiratory Paralysis / etiology,  ultrasonography*
Sensitivity and Specificity
Severity of Illness Index
Statistics, Nonparametric
Treatment Outcome
Ultrasonography, Doppler*

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