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

AbstractLittle 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) %, respectivel y. 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’ srho 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 charac...
Source: Journal of Clinical Monitoring and Computing - Category: Information Technology Source Type: research