When using ultrasound to assess diaphragm size and function, the potential effect of lung inflation should be taken into account.ĭiaphragm ultrasonography is a rapidly expanding field in pulmonology and intensive care. Conclusions: Different levels of PEEP significantly modified the diaphragmatic thickness and thickening fraction, showing a PEEP-induced decrease in the diaphragm contractile efficiency. The difference in the diaphragm thickening fraction during tidal breathing between PEEP 15 and PEEP 0 was negatively related to the change in the functional residual capacity and the change in alveolar dead space. For both measurements, the correlation was stronger at lower levels of PEEP. Both the diaphragm thickening fraction and displacement were significantly correlated with inspiratory effort in the whole dataset. The inspiratory effort, as evaluated by the esophageal pressure swing, was unchanged.
The tidal volume, diaphragm displacement and thickening fraction were significantly lower with higher levels of PEEP, while both the expiratory and inspiratory thickness increased with higher PEEP levels. At each step, the indices of respiratory effort were assessed, together with arterial blood and diaphragm ultrasound end-expiratory lung volume was measured.
#TIDAL FREE TRIAL TRIAL#
The patients underwent a PEEP-titration trial with the application of three random levels of PEEP: 0 cmH 2O (PEEP0), 8 cmH 2O (PEEP8) and 15 cmH 2O (PEEP15). Methods: An observational study in a mixed medical and surgical ICU was conducted. We aimed to assess the impact of the level of PEEP and lung inflation on diaphragm thickness, thickening fraction and displacement. The application of positive end-expiratory pressure (PEEP) and the varying end-expiratory lung volume cause changes in diaphragm geometry. Introduction: Diaphragm dysfunction is common in patients undergoing mechanical ventilation.
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