Early changes in diaphragmatic function evaluated using ultrasound in cardiac surgery patients: a cohort study

• Published in: Journal of clinical monitoring and computing Vol. 34; no. 3; pp. 559 - 566
• Main Authors: Tralhão, António, Cavaleiro, Pedro, Arrigo, Mattia, Lopes, Jean-Paul, Lebrun, Marion, Rivas-Lasarte, Mercedes, Le Pimpec-Barthes, Françoise, Latrémouille, Christian, Achouh, Paul, Pirracchio, Romain, Cholley, Bernard
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.06.2020; Springer Nature B.V
• Subjects: Anesthesiology; Cohort analysis; Critical Care Medicine; Evolution; Health Sciences; Heart surgery; Intensive; Medicine; Medicine & Public Health; Original Research; Statistics for Life Sciences; Surgery; Thickening; Ultrasonic imaging; Excursion, thickening; Diaphragm; Cardiac surgery; Ultrasound
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-019-00350-8

Little is known about the evolution of diaphragmatic function in the early post-cardiac surgery period. The main purpose of this work is to describe its evolution using ultrasound measurements of muscular excursion and thickening fraction (TF). Single-center prospective study of 79 consecutive uncomplicated elective cardiac surgery patients, using motion-mode during quiet unassisted breathing. Excursion and TF were measured sequentially for each patient [pre-operative (D1), 1 day (D2) and 5 days (D3) after surgery]. Pre-operative median for right and left hemidiaphragmatic excursions were 1.8 (IQR 1.6 to 2.1) cm and 1.7 (1.4 to 2.0) cm, respectively. Pre-operative median right and left thickening fractions were 28 (19 to 36) % and 33 (22 to 51) %, respectively. At D2, there was a reduction in both excursion (right: 1.5 (1.1 to 1.8) cm, p < 0.001, left: 1.5 (1.1 to 1.8), p = 0.003) and thickening fractions (right: 20 (15 to 34) %, p = 0.021, left: 24 (17 to 39) %, p = 0.002), followed by a return to pre-operative values at D3. A positive moderate correlation was found between excursion and thickening fraction (Spearman’s rho 0.518 for right and 0.548 for left hemidiaphragm, p < 0.001). Interobserver reliability yielded a bias below 0.1 cm with limits of agreement (LOA) of ± 0.3 cm for excursion and − 2% with LOA of ± 21% for thickening fractions. After cardiac surgery, the evolution of diaphragmatic function is characterized by a transient impairment followed by a quick recovery. Although ultrasound diaphragmatic excursion and thickening fraction are correlated, excursion seems to be a more feasible and reproducible method in this population.