PMID- 36980465
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230331
IS  - 2075-4418 (Print)
IS  - 2075-4418 (Electronic)
IS  - 2075-4418 (Linking)
VI  - 13
IP  - 6
DP  - 2023 Mar 17
TI  - The Effects of Positive End Expiratory Pressure and Lung Volume on Diaphragm 
      Thickness and Thickening.
LID - 10.3390/diagnostics13061157 [doi]
LID - 1157
AB  - Introduction: Diaphragm dysfunction is common in patients undergoing mechanical 
      ventilation. The application of positive end-expiratory pressure (PEEP) and the 
      varying end-expiratory lung volume cause changes in diaphragm geometry. We aimed 
      to assess the impact of the level of PEEP and lung inflation on diaphragm 
      thickness, thickening fraction and displacement. Methods: An observational study 
      in a mixed medical and surgical ICU was conducted. The patients underwent a 
      PEEP-titration trial with the application of three random levels of PEEP: 0 
      cmH(2)O (PEEP0), 8 cmH(2)O (PEEP8) and 15 cmH(2)O (PEEP15). At each step, the 
      indices of respiratory effort were assessed, together with arterial blood and 
      diaphragm ultrasound; end-expiratory lung volume was measured. Results: 14 
      patients were enrolled. The tidal volume, diaphragm displacement and thickening 
      fraction were significantly lower with higher levels of PEEP, while both the 
      expiratory and inspiratory thickness increased with higher PEEP levels. The 
      inspiratory effort, as evaluated by the esophageal pressure swing, was unchanged. 
      Both the diaphragm thickening fraction and displacement were significantly 
      correlated with inspiratory effort in the whole dataset. For both measurements, 
      the correlation was stronger at lower levels of PEEP. The difference in the 
      diaphragm thickening fraction during tidal breathing between PEEP 15 and PEEP 0 
      was negatively related to the change in the functional residual capacity and the 
      change in alveolar dead space. Conclusions: Different levels of PEEP 
      significantly modified the diaphragmatic thickness and thickening fraction, 
      showing a PEEP-induced decrease in the diaphragm contractile efficiency. When 
      using ultrasound to assess diaphragm size and function, the potential effect of 
      lung inflation should be taken into account.
FAU - Formenti, Paolo
AU  - Formenti P
AUID- ORCID: 0000-0001-8081-7480
AD  - SC Anestesia e Rianimazione I, ASST Santi Paolo e Carlo-Polo Universitario, 
      Ospedale San Paolo, 20142 Milan, Italy.
FAU - Miori, Sara
AU  - Miori S
AD  - SC Anestesia e Rianimazione I, Ospedale Santa Chiara, APSS, 30014 Trento, Italy.
FAU - Galimberti, Andrea
AU  - Galimberti A
AD  - SC Anestesia Rianimazione e Terapia Intensiva ASST Nord Milano Ospedale Bassini, 
      20092 Cinisello Balsamo, Italy.
FAU - Umbrello, Michele
AU  - Umbrello M
AUID- ORCID: 0000-0003-4356-3543
AD  - SC Anestesia e Rianimazione II, ASST Santi Paolo e Carlo-Polo Universitario, 
      Ospedale San Carlo Borromeo, 20148 Milan, Italy.
LA  - eng
PT  - Journal Article
DEP - 20230317
PL  - Switzerland
TA  - Diagnostics (Basel)
JT  - Diagnostics (Basel, Switzerland)
JID - 101658402
PMC - PMC10047794
OTO - NOTNLM
OT  - ARDS
OT  - PEEP
OT  - diaphragm
OT  - lung volume
OT  - ultrasound
COIS- The authors declare no conflict of interest.
EDAT- 2023/03/30 06:00
MHDA- 2023/03/30 06:01
PMCR- 2023/03/17
CRDT- 2023/03/29 01:24
PHST- 2023/02/20 00:00 [received]
PHST- 2023/03/13 00:00 [revised]
PHST- 2023/03/14 00:00 [accepted]
PHST- 2023/03/30 06:01 [medline]
PHST- 2023/03/29 01:24 [entrez]
PHST- 2023/03/30 06:00 [pubmed]
PHST- 2023/03/17 00:00 [pmc-release]
AID - diagnostics13061157 [pii]
AID - diagnostics-13-01157 [pii]
AID - 10.3390/diagnostics13061157 [doi]
PST - epublish
SO  - Diagnostics (Basel). 2023 Mar 17;13(6):1157. doi: 10.3390/diagnostics13061157.