Associate Professor, Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
Consultant, Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
Heart Lung. 2021 Mar-Apr;50(2):284-291. doi: 10.1016/j.hrtlng.2020.12.014. Epub 2020 Dec 28.
The decline in the diaphragm thickness is common among patients with sepsis. The purpose of this study is to examine the relationship between the decline in diaphragm thickness as assessed by ultrasonography and various outcomes in septic patients.
This prospective study included patients with sepsis whose diaphragm thickness was measured during inspiration (DTinsp) and expiration (DTexp) using ultrasonography on days 1, 3, 5, 7, 10, and 14 of admission in the ICU and thereafter weekly measurements until discharge or death.
The study included 70 (45 male) patients with sepsis [mean (SD) age = 55.91(14.08) years]. The mean (SD) DTinsp and DTexp (mm) on day-1 were 2.84 (0.32) and 2.33(0.27), respectively. During the hospital stay, there was a decline in DTinsp and DTexp. The decline in DTinsp and DTexp on days 3, 5, and 7 was significantly higher among patients with difficult weaning, non-survivors, and worse 90-day outcomes. Early decline (from day-1 to day-3) in diaphragm thickness predicted difficult weaning, in-hospital mortality, and worse 90-day outcome.
Among patients with sepsis, the decline in diaphragm thickness detected by ultrasonography is associated with worse in-hospital and short-term post-discharge outcomes. The role of early decline in diaphragm thickness on ultrasonography as a marker of worse outcomes needs further evaluation.
超声检查发现，脓毒症患者的膈肌厚度会下降。本研究旨在探讨超声检查评估的膈肌厚度下降与脓毒症患者各种结局之间的关系。
这是一项前瞻性研究，纳入了入住 ICU 期间每天（第 1、3、5、7、10 和 14 天，以及此后每周）通过超声检查测量膈肌吸气厚度（DTinsp）和膈肌呼气厚度（DTexp）的脓毒症患者。
本研究纳入了 70 名（45 名男性）脓毒症患者[平均（SD）年龄=55.91（14.08）岁]。第-1 天的平均（SD）DTinsp 和 DTexp（mm）分别为 2.84（0.32）和 2.33（0.27）。住院期间，DTinsp 和 DTexp 均下降。在第 3、5 和 7 天，难以撤机、非幸存者和预后更差的 90 天患者的 DTimsp 和 DTexp 下降幅度明显更高。膈肌厚度的早期下降（从第-1 天到第-3 天）可预测难以撤机、住院死亡率和预后更差的 90 天结局。
在脓毒症患者中，超声检查发现的膈肌厚度下降与住院期间和出院后短期结局更差相关。超声检查上膈肌厚度的早期下降作为预后更差的标志物的作用需要进一步评估。
