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@ARTICLE{Fritsch:1026011,
      author       = {Fritsch, Sebastian and Siemer, Anna Große and Dreher,
                      Michael and Simon, Tim-Philipp and Marx, Gernot and
                      Bickenbach, Johannes},
      title        = {{D}iaphragm ultrasound in patients with prolonged weaning
                      from mechanical ventilation},
      journal      = {Quantitative imaging in medicine and surgery},
      volume       = {14},
      number       = {5},
      issn         = {2223-4292},
      address      = {Hong Kong},
      publisher    = {AME Publ.},
      reportid     = {FZJ-2024-03267},
      pages        = {3248 - 3263},
      year         = {2024},
      abstract     = {Background: Several publications have examined
                      diaphragmatic ultrasound using two-dimensional (2D)
                      parameters in the context of weaning from mechanical
                      ventilation (MV) and extubation. However, the studied
                      cohorts had rather short duration of ventilation.
                      Examinations on patients with prolonged weaning after
                      long-term ventilation were missing. It was the aim of this
                      study to assess of the diaphragm and peripheral musculature
                      of patients undergoing prolonged weaning creating a
                      chronological sequence of ultrasonic parameters during the
                      course of weaning.Methods: This study was carried out as a
                      monocentric, prospective observational cross-sectional
                      study. Patients in prolonged weaning who were transferred to
                      a specialized weaning unit were eligible for inclusion if
                      they were ventilated invasively by means of an endotracheal
                      tube or tracheal cannula and if their expected treatment
                      period was at least 5 days. Diaphragmatic function and one
                      representative peripheral muscle were examined in 50
                      patients between March 2020 and April 2021. The 2D
                      sonographic parameters of diaphragm and diaphragmatic
                      function consisted of diaphragmatic thickness (Tdi) at the
                      end of inspiration and expiration, the fractional thickening
                      (FT) and the diaphragmatic excursion. Additionally, the M.
                      quadriceps femoris was sonographically assessed at two
                      locations. The difference of measurements between the first
                      and the last measuring timepoint were examined using the
                      Wilcoxon signed-rank test. For a longer chronological
                      sequence, the Friedman’s rank sum test with subsequent
                      Wilcoxon-Nemenyi-McDonald-Thompson test for multiple
                      comparisons was carried out.Results: Fifty patients with
                      prolonged weaning were included. The median duration of MV
                      before transfer to the weaning unit was 11.5 [interquartile
                      range (IQR) 10] days. Forty-one patients could be assessed
                      over the full course of weaning, with 38 successfully
                      weaned. Within these 41 patients, the sonographic parameters
                      of the diaphragm slightly increased over the course of
                      weaning indicating an increase in thickness and mobility.
                      Especially parameters which represented an active movement
                      reached statistical significance, i.e., inspiratory Tdi when
                      assessed under spontaneous breathing [begin 3.41 (0.99) vs.
                      end 3.43 (1.31) mm; P=0.01] and diaphragmatic excursion
                      [begin 0.7 (0.8) vs. end 0.9 (0.6) cm; P=0.01]. The presence
                      of positive end-expiratory pressure (PEEP) and pressure
                      support did not influence the sonographic parameters
                      significantly. The M. quadriceps femoris, in contrast,
                      decreased slightly but constantly over the time [lower
                      third: begin 1.36 (0.48) vs. end 1.28 (0.36) cm;
                      P=0.054].Conclusions: The present study is the first one to
                      longitudinally analyse diaphragmatic ultrasound in patients
                      with prolonged weaning. Sonographic assessment showed that
                      Tdi and excursion increased over the course of prolonged
                      weaning, while the diameter of a representative peripheral
                      muscle decreased. However, the changes are rather small, and
                      data show a wide dispersion. To allow a potential,
                      standardized use of diaphragm ultrasound for diagnostic
                      decision support in prolonged weaning, further studies in
                      this specific patient group are required.},
      cin          = {JSC / CASA},
      ddc          = {610},
      cid          = {I:(DE-Juel1)JSC-20090406 / I:(DE-Juel1)CASA-20230315},
      pnm          = {5112 - Cross-Domain Algorithms, Tools, Methods Labs (ATMLs)
                      and Research Groups (POF4-511) / SDI-S - SDI-S: Smart Data
                      Innovation Services - Experimentelle Erprobung und
                      Entwicklung von KI-Dienstverbünden für Innovationen auf
                      industriellen Daten (01IS22095D)},
      pid          = {G:(DE-HGF)POF4-5112 / G:(BMBF)01IS22095D},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {38720844},
      UT           = {WOS:001250132200002},
      doi          = {10.21037/qims-23-1712},
      url          = {https://juser.fz-juelich.de/record/1026011},
}