الفهرس 
Anatomy and function of the diaphragmOnly 14 pages are availabe for public view
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Abstract
Abstract:
Background:
Although mechanical ventilation (MV) is life-saving in a patient with acute respiratory distress which is more prevalent in the elderly age group, it is also one of the most important causes of diaphragmatic dysfunction and thus MV weaning failure. Diaphragmatic function assessment has a crucial role in the assessment of the weaning outcome. Bedside diaphragmatic ultrasound (US) has an important role in the assessment of diaphragmatic thickness and function with recently used multifunction indices such as diaphragmatic excursion and velocity. Few studies concerned with studying the diaphragmatic function indices in the elderly age group and also concerned with studying the relation between the time of mechanical ventilation and sonographic indices. We aim to evaluate the role of ultrasonographic function indices of the diaphragm in the weaning of mechanically ventilated elderly patient and study the relationship between the ultrasonographic indices, time for mechanical ventilation and weaning time.
Results:
Bedside diaphragmatic ultrasonographic examination was performed on 60 patients Aged ≥ 60 years old. The percentage of patients with Diaphragmatic dysfunction (DD) compared to non-diaphragmatic dysfunction (non-DD) was 3:1. The percentage of weaning success was higher in the non-DD group than the DD group (76.9% and 28.9% respectively). Diaphragmatic function indices had statistical significance in differentiating both DD and non-DD groups. The cutoff value for diaphragmatic thickness was 10mm at both sides of the diaphragm with that showed area under the curve of 0.891 and 0.771 at the right diaphragm and left diaphragm respectively. The cutoff value for the diaphragmatic excursion was 13mm and 12 mm showed an area under the curve of 0.794 and 0.771 at the right diaphragm and left diaphragm respectively and the cutoff value for diaphragmatic velocity below which DD is considered was 16 mm/s on the right and 15 on the left. There was a moderate negative correlation between duration of mechanical ventilation and diaphragmatic function indices while a strong negative correlation with left velocity and there was also a moderate negative correlation between duration of weaning and the indices.
Conclusion:
Bedside diaphragmatic ultrasound including multifunction indices has an important role in detecting diaphragmatic dysfunction and thus weaning failure as well as the duration of the mechanical ventilation negatively correlated with the sonographic indices.