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Schreiber AF, Bertoni M, Coiffard B, et al. Abdominal Muscle Use During Spontaneous Breathing and Cough in Patients Who Are Mechanically Ventilated: A Bi-center Ultrasound Study. Chest. 2021;160(4):1316-1325doi: 10.1016/j.chest.2021.05.053.
Schreiber, A. F., Bertoni, M., Coiffard, B., Fard, S., Wong, J., Reid, W. D., Brochard, L. J., Piva, S., & Goligher, E. C. (2021). Abdominal Muscle Use During Spontaneous Breathing and Cough in Patients Who Are Mechanically Ventilated: A Bi-center Ultrasound Study. Chest, 160(4), 1316-1325. https://doi.org/10.1016/j.chest.2021.05.053
Schreiber, Annia F, et al. "Abdominal Muscle Use During Spontaneous Breathing and Cough in Patients Who Are Mechanically Ventilated: A Bi-center Ultrasound Study." Chest vol. 160,4 (2021): 1316-1325. doi: https://doi.org/10.1016/j.chest.2021.05.053
Schreiber AF, Bertoni M, Coiffard B, Fard S, Wong J, Reid WD, Brochard LJ, Piva S, Goligher EC. Abdominal Muscle Use During Spontaneous Breathing and Cough in Patients Who Are Mechanically Ventilated: A Bi-center Ultrasound Study. Chest. 2021 Oct;160(4):1316-1325. doi: 10.1016/j.chest.2021.05.053. Epub 2021 Jun 06. PMID: 34090872.
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Chest. 2021 Oct;160(4):1316-1325. doi: 10.1016/j.chest.2021.05.053. Epub 2021 Jun 06.

Abdominal Muscle Use During Spontaneous Breathing and Cough in Patients Who Are Mechanically Ventilated: A Bi-center Ultrasound Study.

Chest

Annia F Schreiber, Michele Bertoni, Benjamin Coiffard, Samira Fard, Jenna Wong, W Darlene Reid, Laurent J Brochard, Simone Piva, Ewan C Goligher

Affiliations

  1. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre and Li Ka Shing Knowledge Institute, Unity Health Toronto (St. Michael's Hospital) Toronto, ON, Canada.
  2. Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, Italy.
  3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Intensive Care Medicine, Hôpital Nord, Aix-Marseille University, Marseille, France.
  4. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  5. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
  6. Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
  7. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada. Electronic address: [email protected].

PMID: 34090872 DOI: 10.1016/j.chest.2021.05.053

Abstract

BACKGROUND: Ultrasound may be useful to assess the structure, activity, and function of the abdominal muscles in patients who are mechanically ventilated.

RESEARCH QUESTION: Does measurement of abdominal muscle thickening on ultrasound in patients who are mechanically ventilated provide clinically relevant information about abdominal muscle function and weaning outcomes?

STUDY DESIGN AND METHODS: This study consisted of two parts, a physiological study conducted in healthy subjects and a prospective observational study in patients who were mechanically ventilated. Abdominal muscle thickness and thickening fraction were measured during cough and expiratory efforts in 20 healthy subjects, and prior to and during a spontaneous breathing trial in 57 patients being ventilated.

RESULTS: In healthy subjects, internal oblique and rectus abdominis thickening fraction correlated with pressure generated during expiratory efforts (P < .001). In patients being ventilated, abdominal muscle thickness and thickening fraction were feasible to measure in all patients, and reproducibility was moderately acceptable. During a failed spontaneous breathing trial, thickening fraction of transversus abdominis and internal oblique increased substantially from baseline (13.2% [95% CI, 0.9-24.8] and 7.2% [95% CI, 2.2-13.2], respectively). The combined thickening fraction of transversus abdominis, internal oblique, and rectus abdominis measured during cough was associated with an increased risk of reintubation or reconnection to the ventilator following attempted liberation (OR, 2.1; 95% CI, 1.1-4.4 per 10% decrease in thickening fraction).

INTERPRETATION: Abdominal muscle thickening on ultrasound was correlated to the airway pressure generated by expiratory efforts. In patients who were mechanically ventilated, abdominal muscle ultrasound measurements are feasible and moderately reproducible. Among patients who passed a spontaneous breathing trial, reduced abdominal muscle thickening during cough was associated with a high risk of liberation failure.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT03567564; URL: www.clinicaltrials.gov.

Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Keywords: abdominal muscles; artificial respiration; ultrasonography; weaning

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