Poor Correlation between Diaphragm Thickening Fraction and Transdiaphragmatic Pressure in Mechanically Ventilated Patients and Healthy Subjects

Author:

Poulard Thomas1ORCID,Bachasson Damien2,Fossé Quentin3,Niérat Marie-Cécile4,Hogrel Jean-Yves2,Demoule Alexandre3,Gennisson Jean-Luc5,Dres Martin3

Affiliation:

1. Institute of Myology, Neuromuscular Investigation Center, Neuromuscular Physiology and Evaluation Laboratory, Paris, France; Biomedical Multimodal Imaging Laboratory, BioMaps, Paris-Saclay University, French Alternative Energies and Atomic Energy Commission, National Center for Scientific Research, Research unit 9011, Inserm Research Unit 1281, Frédéric Joliot Hospital, Orsay, France

2. Institute of Myology, Neuromuscular Investigation Center, Neuromuscular Physiology and Evaluation Laboratory, Paris, France

3. Sorbonne University, Experimental and Clinical Neurophysiology Research Unit, INSERM (Institut national de la santé et de la recherche médicale) UMRS_1158, Paris, France; Public Assistance – Paris Hospital, Sorbonne University, Pitie Salpetriere Hospital, Critical Care Department, Paris, France

4. Sorbonne University, Experimental and Clinical Neurophysiology Research Unit, INSERM (Institut national de la santé et de la recherche médicale) UMRS_1158, Paris, France

5. Biomedical Multimodal Imaging Laboratory, BioMaps, Paris-Saclay University, French Alternative Energies and Atomic Energy Commission, National Center for Scientific Research, Research unit 9011, Inserm Research Unit 1281, Frédéric Joliot Hospital, Orsay, France

Abstract

Background The relationship between the diaphragm thickening fraction and the transdiaphragmatic pressure, the reference method to evaluate the diaphragm function, has not been clearly established. This study investigated the global and intraindividual relationship between the thickening fraction of the diaphragm and the transdiaphragmatic pressure. The authors hypothesized that the diaphragm thickening fraction would be positively and significantly correlated to the transdiaphragmatic pressure, in both healthy participants and ventilated patients. Methods Fourteen healthy individuals and 25 mechanically ventilated patients (enrolled in two previous physiologic investigations) participated in the current study. The zone of apposition of the right hemidiaphragm was imaged simultaneously to transdiaphragmatic pressure recording within different breathing conditions, i.e., external inspiratory threshold loading in healthy individuals and various pressure support settings in patients. A blinded offline breath-by-breath analysis synchronously computed the changes in transdiaphragmatic pressure, the diaphragm pressure-time product, and diaphragm thickening fraction. Global and intraindividual relationships between variables were assessed. Results In healthy subjects, both changes in transdiaphragmatic pressure and diaphragm pressure-time product were moderately correlated to diaphragm thickening fraction (repeated measures correlation = 0.40, P < 0.0001; and repeated measures correlation = 0.38, P < 0.0001, respectively). In mechanically ventilated patients, changes in transdiaphragmatic pressure and thickening fraction were weakly correlated (repeated measures correlation = 0.11, P = 0.008), while diaphragm pressure-time product and thickening fraction were not (repeated measures correlation = 0.04, P = 0.396). Individually, changes in transdiaphragmatic pressure and thickening fraction were significantly correlated in 8 of 14 healthy subjects (ρ = 0.30 to 0.85, all P < 0.05) and in 2 of 25 mechanically ventilated patients (ρ = 0.47 to 0.64, all P < 0.05). Diaphragm pressure-time product and thickening fraction correlated in 8 of 14 healthy subjects (ρ = 0.41 to 0.82, all P < 0.02) and in 2 of 25 mechanically ventilated patients (ρ = 0.63 to 0.66, all P < 0.01). Conclusions Overall, diaphragm function as assessed with transdiaphragmatic pressure was weakly related to diaphragm thickening fraction. The diaphragm thickening fraction should not be used in healthy subjects or ventilated patients when changes in diaphragm function are evaluated. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

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