Ultrasound variations of diaphragm activity between prone position versus supine position in ventilated patients: a cross-sectional comparative study
| Autor: | Yosr Touil, Sami Abdellatif, Salah Ben Lakhal, Cyrine Abdennebi, Foued Daly, Ahlem Trifi |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Supine position Diaphragm Posterior region Diaphragmatic breathing Prone position 03 medical and health sciences 0302 clinical medicine Ultrasound Supine Position Internal Medicine Humans Medicine Radiology Nuclear Medicine and imaging Original Paper business.industry 030208 emergency & critical care medicine General Medicine Respiration Artificial Invasive ventilation Diaphragm (structural system) Cross-Sectional Studies 030228 respiratory system Breathing Thickening Nuclear medicine business |
| Zdroj: | Journal of Ultrasound |
| ISSN: | 1876-7931 |
| Popis: | Purpose To evaluate the effect of the positioning from the supine position (SP) to the prone position (PP) on the diaphragm activity in ventilated patients; using the ultrasound (US) imaging. Methods A cross-sectional comparative study before/after PP was conducted on 40 ICU patients over 18 years who received invasive ventilation (IV) for at least 48 h. The considered ventilator modes were: assisted control volume with a low trigger flow (between − 2 and 2 L/mn) and pressure support mode. US diaphragmatic assessments were performed at SP and at 60 min of PP. Both End-inspiratory and End-expiratory diameters (EID/EED) were taken at 3 levels of axillary lines and determined by the average values of multiple measures. Diaphragmatic thickening fraction (DTF) was calculated as: DTF = (EID − EED/EED) × 100. Pairing and ANOVA tests were used for comparisons. Results Forty ventilated patients (42 years of median age) at 4 days [2–7] of median duration of ventilation were examined during the two positions: SP versus PP. EID decreased from the SP to the PP (2.8 mm in SP vs. 2.4 mm in PP, p = 0.001). No difference was showed regarding the expiratory thickness. Overall, DTF didn’t change in PP (37.4 vs. 42.05%, p = 0.36). When the patient was placed in PP, the best DTF value was showed at the posterior part of diaphragm (posterior: 45%, median: 31% and anterior: 38%, p = 0.049). Conclusion The ventral placement in ventilated patients reduced end-inspiratory diameter and tended to decrease DTF. In PP, the best contractile activity was detected at the posterior region of diaphragm. |
| Databáze: | OpenAIRE |
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