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1. Ultrasound Versus Computed Tomography for Diaphragmatic Thickness and Skeletal Muscle Index during Mechanical Ventilation

Author

Stefano Gatti, Chiara Abbruzzese, Davide Ippolito, Sophie Lombardi, Andrea De Vito, Davide Gandola, Veronica Meroni, Vittoria Ludovica Sala, Sandro Sironi, Antonio Pesenti, Giuseppe Foti, Emanuele Rezoagli, and Giacomo Bellani

Subjects
ultrasound, mechanical ventilation, computed tomography, diaphragm, skeletal muscle index, critical care, Medicine (General), R5-920
Abstract

Background: Diaphragmatic alterations occurring during mechanical ventilation (MV) can be monitored using ultrasound (US). The performance of computed tomography (CT) to evaluate diaphragmatic thickness is limited. Further, the association between muscle mass and outcome is increasingly recognized. However, no data are available on its correlation with diaphragmatic thickness. We aimed to determine correlation and agreement of diaphragmatic thickness between CT and US; and its association with muscle mass and MV parameters. Methods: Prospective observational study. US measurements of the diaphragmatic thickness were collected in patients undergoing MV within 12 h before or after performing a CT scan of the thorax and/or upper abdomen. Data on skeletal muscle index (SMI), baseline, and ventilatory data were recorded and correlated with US and CT measures of diaphragmatic thickness. Agreement was explored between US and CT data. Results: Twenty-nine patients were enrolled and the diaphragm measured by CT resulted overall thicker than US-based measurement of the right hemidiaphragm. The US thickness showed the strongest correlation with the left posterior pillar at CT (r = 0.49, p = 0.008). The duration of the controlled MV was negatively correlated with US thickness (r = −0.45, p = 0.017), the thickness of the right anterior pillar (r = −0.41, p = 0.029), and splenic dome by CT (r = −0.43, p = 0.023). SMI was positively correlated with US diaphragmatic thickness (r = 0.50, p = 0.007) and inversely correlated with the duration of MV before enrollment (r = −0.426, p = 0.027). Conclusions: CT scan of the left posterior pillar can estimate diaphragmatic thickness and is moderately correlated with US measurements. Both techniques show that diaphragm thickness decreases with MV duration. The diaphragmatic thickness by US showed a good correlation with SMI.

Published
2022
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2. Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Author

Wahlster, Sarah, Sharma, Monisha, Taran, Shaurya, Town, James A, Stevens, Robert D, Cinotti, Raphaël, Asehoune, Karim, Pelosi, Paolo, Robba, Chiara, Paër-Sélim Abback, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal, Julio Cesar Mijangos, Mattias Haënggi, Mohan Gurjar, Marcus J Schultz, Callum Kaye, Daniela Agustin Godoy, Pablo Alvarez, Aikaterini Ioakeimidou, Yoshitoyo Ueno, Rafael Badenes, Abdurrahmaan Ali Suei Elbuzidi, Michaël Piagnerelli, Muhammed Elhadi, Jean Catherine Digitale, Nicholas Fong, Ricardo Campos Cerda, Norma de la Torre Peredo, Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster, Sarah, Sharma, Monisha, Taran, Shaurya, Town, James A, Stevens, Robert D, Cinotti, Raphaël, Asehoune, Karim, Pelosi, Paolo, Robba, Chiara, and Paër-Sélim Abback, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Gilberto Adrian Gasca, Alfredo Arellano, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Job van Steenkiste, Mathieu van der Jagt, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal, Julio Cesar Mijangos, Mattias Haënggi, Mohan Gurjar, Marcus J Schultz, Callum Kaye, Daniela Agustin Godoy, Pablo Alvarez, Aikaterini Ioakeimidou, Yoshitoyo Ueno, Rafael Badenes, Abdurrahmaan Ali Suei Elbuzidi, Michaël Piagnerelli, Muhammed Elhadi, Syed Tariq Reza, Jean Catherine Digitale, Nicholas Fong, Ricardo Campos Cerda, Norma de la Torre Peredo

Subjects
Mechanical power, Mechanical ventilation, Traumatic brain injury, Acute respiratory distress syndrome, Acute ischemic stroke, Acute brain injury, Intracranial hemorrhage, Subarachnoid hemorrhage
Abstract

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9J/min [IQR 9.2-15.1], 13J/min [IQR 10-17], and 14J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9J/min, aRR at 17J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation.

Published
2023

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