Temporal evolution of diaphragm thickness and diaphragm excursion among subjects hospitalized with COVID-19: A prospective observational study

• Published in: Respiratory medicine and research Vol. 83; p. 100960
• Main Authors: Hadda, Vijay, Raja, Arun, Suri, Tejas Menon, Khan, Maroof Ahmad, Mittal, Saurabh, Madan, Karan, Mohan, Anant
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.06.2023; SPLF and Elsevier Masson SAS
• Subjects: Adult; COVID-19; Diaphragm; Diaphragm - diagnostic imaging; Diaphragm atrophy; Diaphragm function; Female; Humans; Male; Middle Aged; Original; Respiration, Artificial; Respiratory muscle; SARS-CoV-2; Thorax; Ultrasonography; Diaphragm atrophy; DE; PCFS; USG; DT; ACE2; LDH; SOFA; SARS-CoV-2; HFNC; Respiratory muscle; DTE; MIP; RT-PCR; Ultrasonography; Diaphragm function; DTF; NIV; Diaphragm; DEmax; APACHE; ARDS
• ISSN: 2590-0412; 2590-0412
• DOI: 10.1016/j.resmer.2022.100960

•The diaphragm has abundant ACE2 receptors making it susceptible to SARS-CoV-2.•We performed diaphragm ultrasound in hospitalized non-intubated COVID-19 patients.•We found decline in end-expiratory diaphragm thickness over 5 days of admission.•We found an increase in diaphragm thickening fraction over 5 days of admission. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has an affinity for the angiotensin-converting enzyme 2 (ACE2) receptors, which are present abundantly on the diaphragm. This study aims to describe temporal changes in diaphragmatic thickness and excursion using ultrasonography in subjects with acute COVID-19. This prospective observational study included adults hospitalized with COVID-19 in the past 48 hours. The diaphragm thickness at end-expiration (DTE), diaphragm thickening fraction (DTF), and diaphragm excursion during tidal breathing (DE) and maximal inspiration (DEmax) were measured using ultrasonography daily for 5 days. The changes in DTE, DTF, DE, and Demax from day 1 to day 5 were assessed. This study included 64 adults (62.5% male) with a mean (SD) age of 50.2 (17.5) years. A majority (91%) of the participants had mild or moderate illness. The median (IQR) DTE, DTF (%), DE and Demax on day 1 were 2.2 (1.9, 3.0) mm, 21.5% (14.2, 31.0), 19.2 (16.5, 24.0) mm, and 26.7 (22.0, 30.2) mm, respectively. On day 5, there was a significant reduction in the DTE (p=0.002) with a median (IQR) percentage change of -15.7% (-21.0, 0.0). The DTF significantly increased on day 5 with a median (IQR) percentage change of 25.0% (-19.2, 98.4), p=0.03. There was no significant change in DE and Demax from day 1 to day 5, with a median (IQR) percentage change of 3.6% (-5.2, 15) and 0% (-6.7, 5.9), respectively. Non-intubated patients with COVID-19 exhibited a temporal decline in diaphragm thickness with increase in thickening fraction over 5 days of hospital admission. Further research is warranted to assess the impact of COVID-19 pneumonia on diaphragmatic function.