title: Ultrasonography for Screening and Follow-Up of Diaphragmatic Dysfunction in the ICU: A Pilot Study.
abstract: OBJECTIVE
  Reversibility and impact of diaphragmatic dysfunction (DD) are unknown. The principal aim was to describe diaphragmatic function as assessed by ultrasonography during weaning trials.
  
  
  METHODS
  The present study is a 6-month single-center prospective study. All patients under mechanical ventilation for more than 7 days and eligible for a spontaneous breathing trial (SBT) were enrolled prospectively.
  
  
  METHODS
  Two blinded ultrasonographers evaluated each hemidiaphragm during SBT. Prevalence of DD among weaning failure and death and interobserver reproducibility have been evaluated.
  
  
  RESULTS
  The 34 included patients had a mean Simplified Acute Physiology Score version II of 55.7 ± 14 and a median intensive care unit (ICU) stay length of 17 days (13-30). Diaphragmatic dysfunction was found in 13 (38%) patients, on both sides in 8. Bilateral DD resolved before ICU discharge in 5 of the 7 reevaluated patients. No weaning failures were recorded. The ICU mortality was higher in patients with DD (37% vs 5%, P = .048). Mean interobserver agreement rate was 91%. Reproducibility was better with M-mode.
  
  
  CONCLUSIONS
  The ICU-acquired DD usually improves before ICU discharge but might constitute a marker for greater disease severity. The present preliminary results require confirmation in a larger prospective multicenter study.
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France luciefenet84@gmail.com.
authors.forename: Lucie Fenet
authors.initials: LF
authors.lastname: Mariani
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France.
authors.forename: Jêrome
authors.initials: J
authors.lastname: Bedel
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gros
authors.affiliation: Réanimation Médicale et Médicine Hyperbare, Centre Hospitalier Universitaire Angers, Faculté de Médecine, Université d'Angers, Angers, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lerolle
authors.affiliation: SAMU 78 SMUR de Versailles, Le Chesnay, France.
authors.forename: Kolia
authors.initials: K
authors.lastname: Milojevic
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France.
authors.forename: Virgine
authors.initials: V
authors.lastname: Laurent
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Hilly
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Troché
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Bedos
authors.affiliation: Service de réanimation polyvalente, Versailles-Le Chesnay, France Service de pneumologie et de soins intensifs, Hôpital Européen Georges Pompidou-20 rue Leblanc, 75015 Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Planquette
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000293:injuries / Q000503:physiopathology; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013997:Time Factors; D014463:Ultrasonography; D015300:Ventilator Weaning
keywords: diaphragm; diaphragmatic dysfunction; mechanical ventilation; prognosis; ultrasonography; weaning failure