Ultrasonography for Screening and Follow-Up of Diaphragmatic Dysfunction in the ICU: A Pilot Study

J Intensive Care Med. 2016 Jun;31(5):338-43. doi: 10.1177/0885066615583639. Epub 2015 May 14.


Purpose: Reversibility and impact of diaphragmatic dysfunction (DD) are unknown. The principal aim was to describe diaphragmatic function as assessed by ultrasonography during weaning trials.

Materials and methods: The present study is a 6-month single-center prospective study. All patients under mechanical ventilation for more than 7 days and eligible for a spontaneous breathing trial (SBT) were enrolled prospectively.

Intervention: Two blinded ultrasonographers evaluated each hemidiaphragm during SBT. Prevalence of DD among weaning failure and death and interobserver reproducibility have been evaluated.

Results: The 34 included patients had a mean Simplified Acute Physiology Score version II of 55.7 ± 14 and a median intensive care unit (ICU) stay length of 17 days (13-30). Diaphragmatic dysfunction was found in 13 (38%) patients, on both sides in 8. Bilateral DD resolved before ICU discharge in 5 of the 7 reevaluated patients. No weaning failures were recorded. The ICU mortality was higher in patients with DD (37% vs 5%, P = .048). Mean interobserver agreement rate was 91%. Reproducibility was better with M-mode.

Conclusion: The ICU-acquired DD usually improves before ICU discharge but might constitute a marker for greater disease severity. The present preliminary results require confirmation in a larger prospective multicenter study.

Keywords: diaphragm; diaphragmatic dysfunction; mechanical ventilation; prognosis; ultrasonography; weaning failure.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Critical Care / methods*
  • Critical Illness / therapy*
  • Diaphragm / diagnostic imaging*
  • Diaphragm / injuries
  • Diaphragm / physiopathology
  • Female
  • France
  • Humans
  • Intensive Care Units
  • Male
  • Mass Screening
  • Middle Aged
  • Pilot Projects
  • Prospective Studies
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods*
  • Risk Assessment
  • Time Factors
  • Ultrasonography*
  • Ventilator Weaning