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Anesthesiology Mar 2023Monitoring and controlling lung stress and diaphragm effort has been hypothesized to limit lung injury and diaphragm injury. The occluded inspiratory airway pressure...
BACKGROUND
Monitoring and controlling lung stress and diaphragm effort has been hypothesized to limit lung injury and diaphragm injury. The occluded inspiratory airway pressure (Pocc) and the airway occlusion pressure at 100 ms (P0.1) have been used as noninvasive methods to assess lung stress and respiratory muscle effort, but comparative performance of these measures and their correlation to diaphragm effort is unknown. The authors hypothesized that Pocc and P0.1 correlate with diaphragm effort and lung stress and would have strong discriminative performance in identifying extremes of lung stress and diaphragm effort.
METHODS
Change in transdiaphragmatic pressure and transpulmonary pressure was obtained with double-balloon nasogastric catheters in critically ill patients (n = 38). Pocc and P0.1 were measured every 1 to 3 h. Correlations between Pocc and P0.1 with change in transdiaphragmatic pressure and transpulmonary pressure were computed from patients from the first cohort. Accuracy of Pocc and P0.1 to identify patients with extremes of lung stress (change in transpulmonary pressure > 20 cm H2O) and diaphragm effort (change in transdiaphragmatic pressure < 3 cm H2O and >12 cm H2O) in the preceding hour was assessed with area under receiver operating characteristic curves. Cutoffs were validated in patients from the second cohort (n = 13).
RESULTS
Pocc and P0.1 correlate with change in transpulmonary pressure (R2 = 0.62 and 0.51, respectively) and change in transdiaphragmatic pressure (R2 = 0.53 and 0.22, respectively). Area under receiver operating characteristic curves to detect high lung stress is 0.90 (0.86 to 0.94) for Pocc and 0.88 (0.84 to 0.92) for P0.1. Area under receiver operating characteristic curves to detect low diaphragm effort is 0.97 (0.87 to 1.00) for Pocc and 0.93 (0.81 to 0.99) for P0.1. Area under receiver operating characteristic curves to detect high diaphragm effort is 0.86 (0.81 to 0.91) for Pocc and 0.73 (0.66 to 0.79) for P0.1. Performance was similar in the external dataset.
CONCLUSIONS
Pocc and P0.1 correlate with lung stress and diaphragm effort in the preceding hour. Diagnostic performance of Pocc and P0.1 to detect extremes in these parameters is reasonable to excellent. Pocc is more accurate in detecting high diaphragm effort.
Topics: Humans; Diaphragm; Respiration, Artificial; Critical Illness; Respiratory Muscles; Lung
PubMed: 36520507
DOI: 10.1097/ALN.0000000000004467 -
Multimedia Manual of Cardiothoracic... Sep 2020Diaphragmatic paralysis with subsequent eventration and respiratory compromise has a huge impact on the quality of life of affected patients. Many different surgical...
Diaphragmatic paralysis with subsequent eventration and respiratory compromise has a huge impact on the quality of life of affected patients. Many different surgical approaches for correcting this problem have been described in the past, using both transabdominal and transthoracic pathways. Either way, since the procedure in general requires suturing of the diaphragm, minimally invasive techniques have only been adopted very slowly and most thoracic surgeons nowadays still use a minithoracotomy, even when adopting a video-assisted approach. We have developed a safe and simple completely thoracoscopic technique for diaphragmatic plication, and in this video tutorial we demonstrate our technique.
Topics: Diaphragm; Humans; Minimally Invasive Surgical Procedures; Respiratory Paralysis; Thoracic Surgery, Video-Assisted
PubMed: 33301244
DOI: 10.1510/mmcts.2020.054 -
Best Practice & Research. Clinical... Jul 2020Ovulation resumes as quickly as 21 days after birth in a non-fully breastfeeding woman. Traditionally, contraceptive services have been offered 6 weeks post-partum. This... (Review)
Review
Ovulation resumes as quickly as 21 days after birth in a non-fully breastfeeding woman. Traditionally, contraceptive services have been offered 6 weeks post-partum. This is far from ideal and results in unnecessary abortions or inadequate birth spacing which both carry an increased risk of morbidity to mother and potential newborn as well as costs to the health care service. It is now clear that contraception should be discussed during the pregnancy so that the method of choice can be offered immediately post pregnancy prior to discharge from hospital. Long acting reversible contraceptive methods such as implants and IUDs are highly effective as they are user-independent. Large studies have demonstrated that they can be safely inserted during the immediate post-partum period with no increase in complication rates. Policy makers should strive to overcome barriers to offering quality post pregnancy contraceptive services.
Topics: Abortion, Induced; Contraception; Contraceptive Agents; Family Planning Services; Female; Humans; Infant, Newborn; Intrauterine Devices; Postpartum Period; Pregnancy
PubMed: 32217053
DOI: 10.1016/j.bpobgyn.2020.01.004 -
Pneumologie (Stuttgart, Germany) Aug 2019
Topics: Diaphragm; Humans; Practice Guidelines as Topic; Ultrasonography
PubMed: 31412399
DOI: 10.1055/a-0760-7136 -
Kyobu Geka. the Japanese Journal of... Sep 2022Traumatic diaphragmatic injury( TDI) is rare in traumas, however TDI is associated with high mortality. We follow the notation method by The Japanese Association for The...
Traumatic diaphragmatic injury( TDI) is rare in traumas, however TDI is associated with high mortality. We follow the notation method by The Japanese Association for The Surgery of Trauma. There are blunt trauma and penetrating trauma of TDI;blunt trauma causes mainly traffic accidents, and penetrating trauma is induced stub or gunshot. Penetrating trauma is more frequent than blunt trauma in Western countries, however there are mainly blunt traumas in Japan. The timing of diagnosis are three points;acute phase, subacute phase and delayed phase. In acute phase we often experienced unstable vital sign, so the patients of TDI need treatment immediately, however in delayed phase the patients of TDI are stable in vital signs. In order to diagnose for TDI, we use chest X-ray and computed tomography (CT), which is useful to diagnose by multi-planar reconstruction of multi-detector row CT. The ways to approach to TDI are from thoracotomy, laparotomy or both. When we repair the diaphragmatic injury, usually interrupted or horizontal mattress suture was applied with non-absorbable string. The mortality is about 8.8 to 19.8% by TDI, so we need to carefully diagnose TDI as soon as possible whether complication and abdominal viscera injury exist or not.
Topics: Diaphragm; Humans; Respiration Disorders; Retrospective Studies; Thoracic Injuries; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 36155585
DOI: No ID Found -
Journal of Visualized Experiments : JoVE Nov 2023The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes affected...
The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes affected individuals to respiratory failure. In mechanically ventilated patients, the diaphragm is susceptible to atrophy and dysfunction through disuse and other mechanisms. This contributes to failure to wean and poor long-term clinical outcomes. Point-of-care ultrasound provides a valid and reproducible method for evaluating diaphragm thickness and contractile activity (thickening fraction during inspiration) that can be readily employed by clinicians and researchers alike. This article presents best practices for measuring diaphragm thickness and quantifying diaphragm thickening during tidal breathing or maximal inspiration. Once mastered, this technique can be used to diagnose and prognosticate diaphragm dysfunction, and guide and monitor response to treatment over time in both healthy individuals and acute or chronically ill patients.
Topics: Humans; Diaphragm; Point-of-Care Systems; Thorax; Respiratory Muscles; Point-of-Care Testing
PubMed: 37982511
DOI: 10.3791/65431 -
Internal Medicine Journal Dec 2022Although the diaphragm represents a critical component of the respiratory pump, the clinical presentations of diaphragm dysfunction are often non-specific and can be... (Review)
Review
Although the diaphragm represents a critical component of the respiratory pump, the clinical presentations of diaphragm dysfunction are often non-specific and can be mistaken for other more common causes of dyspnoea. While acute bilateral diaphragm dysfunction typically presents dramatically, progressive diaphragm dysfunction associated with neuromuscular disorders and unilateral hemidiaphragm dysfunction may be identified incidentally or by recognising subtle associated symptoms. Diaphragm dysfunction should be considered in individuals with unexplained dyspnoea, restrictive respiratory function tests or abnormal diaphragm position on plain chest imaging. A higher index of suspicion should occur for individuals with profound orthopnoea, those who have undergone procedures in proximity to the phrenic nerve(s) or those with co-morbid conditions that are associated with diaphragm dysfunction, particularly neuromuscular disorders. A systematic approach to the evaluation of diaphragm function using non-invasive diagnostic techniques such as respiratory function testing and diaphragm imaging can often confirm a diagnosis. Neurophysiological assessment may confirm diaphragm dysfunction and assist in identifying an underlying cause. Identifying those with or at risk of respiratory failure can allow institution of respiratory support, while specific cases may also benefit from surgical plication or phrenic nerve pacing techniques.
Topics: Humans; Diaphragm; Respiratory Insufficiency; Dyspnea; Respiratory Function Tests
PubMed: 34402156
DOI: 10.1111/imj.15491 -
Journal of Pediatric and Adolescent... Sep 2019Unplanned or unwanted pregnancy among adolescents is a worldwide public health issue. In many countries unmarried young women are denied contraceptive services.... (Review)
Review
Unplanned or unwanted pregnancy among adolescents is a worldwide public health issue. In many countries unmarried young women are denied contraceptive services. Long-acting reversible contraceptive methods such as the intrauterine devices (IUDs) have been shown to be more effective than short-acting such as the pill, and safe also for adolescents. The popularity has varied a lot with time and between populations. Health care providers, health system, and user factors all influence IUD use. A good sexuality education through school provides a foundation, and health care providers give specific individual counseling. International and country-specific guidelines have been published during the past decade indicating the advantage of IUDs. New smaller size devices make placement easier for nulliparous adolescents. Still the uptake has remained rather low in most regions, cost being one barrier. Several municipalities have started to provide long-acting reversible contraceptive methods for adolescents free of charge, and this has led to a significant increase in IUD use, accompanied by a reduction in abortion rates. Adolescent-friendly services should offer low-cost or free contraception, including male and female condoms, emergency contraception, and a full range of modern methods, including long-acting reversible methods, according to adolescents' preferences and needs.
Topics: Adolescent; Contraception; Counseling; Female; Global Health; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Intrauterine Devices; Male; Practice Guidelines as Topic; Pregnancy; Reproductive Health; Young Adult
PubMed: 31585617
DOI: 10.1016/j.jpag.2019.04.009 -
Pediatric Pulmonology Aug 2021The use of point of care ultrasound (POCUS) at the bedside has increased dramatically within emergency medicine and in critical care. Applications of POCUS have spread... (Review)
Review
The use of point of care ultrasound (POCUS) at the bedside has increased dramatically within emergency medicine and in critical care. Applications of POCUS have spread to include diaphragmatic assessments in both adults and children. Diaphragm POCUS can be used to assess for diaphragm dysfunction (DD) and atrophy or to guide ventilator titration and weaning. Quantitative, semi-quantitative and qualitative measurements of diaphragm thickness, diaphragm excursion, and diaphragm thickening fraction provide objective data related to DD and atrophy. The potential for quick, noninvasive, and repeatable bedside diaphragm assessments has led to a growing amount of literature on diaphragm POCUS. To date, there are no reviews of the current state of diaphragm POCUS in pediatric critical care. The aims of this narrative review are to summarize the current literature regarding techniques, reference values, applications, and future innovations of diaphragm POCUS in critically ill children. A summary of current practice and future directions will be discussed.
Topics: Adult; Child; Critical Care; Diaphragm; Humans; Reference Values; Ultrasonography; Ventilators, Mechanical
PubMed: 34081825
DOI: 10.1002/ppul.25518 -
Journal of Biomechanics Jun 2022A theoretical framework is developed for mechanics of the diaphragm. The diaphragm is modeled as an anisotropic elastic material surface with activation functionality. A...
A theoretical framework is developed for mechanics of the diaphragm. The diaphragm is modeled as an anisotropic elastic material surface with activation functionality. A constitutive function is formulated that relates the stresses in the diaphragm to the surface deformation gradient, the anisotropy vector, and the muscle activation parameter. The equilibrium equations for the diaphragm are derived to determine the deformed shape of the diaphragm in the process of respiration with the associated transdiaphragmatic pressures. A numerical solution is presented, that demonstrates the capability of the model to recover the experimental observations and to predict the shape and stresses of the diaphragm.
Topics: Anisotropy; Diaphragm; Pressure; Respiratory Mechanics; Thorax
PubMed: 35526434
DOI: 10.1016/j.jbiomech.2022.111090