Changes in Respiratory Muscle Thickness during Mechanical Ventilation: Focus on Expiratory Muscles
The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproduc...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2021-05, Vol.134 (5), p.748-759 |
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| creator | Shi, Zhong-Hua de Vries, Heder de Grooth, Harm-Jan Jonkman, Annemijn H. Zhang, Yingrui Haaksma, Mark van de Ven, Peter M. de Man, Angelique A. M. E. Girbes, Armand Tuinman, Pieter R. Zhou, Jian-Xin Ottenheijm, Coen Heunks, Leo |
| description | The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproducibility of expiratory muscle (i.e., lateral abdominal wall muscles and rectus abdominis muscle) ultrasound and the impact of tidal volume on expiratory muscle thickness, to evaluate changes in expiratory muscle thickness during mechanical ventilation, and to compare this to changes in diaphragm thickness.
Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation.
The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332).
Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae. |
| doi_str_mv | 10.1097/ALN.0000000000003736 |
| format | Article |
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Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation.
The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332).
Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/ALN.0000000000003736</identifier><identifier>PMID: 33711154</identifier><language>eng</language><publisher>United States: the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc</publisher><subject>Abdominal Muscles - anatomy & histology ; Exhalation ; Female ; Humans ; Male ; Middle Aged ; Netherlands ; Observer Variation ; Prospective Studies ; Rectus Abdominis - anatomy & histology ; Reproducibility of Results ; Respiration, Artificial ; Respiratory Muscles - anatomy & histology ; Ultrasonography - methods</subject><ispartof>Anesthesiology (Philadelphia), 2021-05, Vol.134 (5), p.748-759</ispartof><rights>the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Copyright © 2021, the American Society of Anesthesiologists, Inc. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4496-4819f703708a70258ef74558a5e8375592d26c8897e7c14d704a63a3c61d8fc53</citedby><cites>FETCH-LOGICAL-c4496-4819f703708a70258ef74558a5e8375592d26c8897e7c14d704a63a3c61d8fc53</cites><orcidid>0000-0001-6331-0397</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27911,27912</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33711154$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shi, Zhong-Hua</creatorcontrib><creatorcontrib>de Vries, Heder</creatorcontrib><creatorcontrib>de Grooth, Harm-Jan</creatorcontrib><creatorcontrib>Jonkman, Annemijn H.</creatorcontrib><creatorcontrib>Zhang, Yingrui</creatorcontrib><creatorcontrib>Haaksma, Mark</creatorcontrib><creatorcontrib>van de Ven, Peter M.</creatorcontrib><creatorcontrib>de Man, Angelique A. M. E.</creatorcontrib><creatorcontrib>Girbes, Armand</creatorcontrib><creatorcontrib>Tuinman, Pieter R.</creatorcontrib><creatorcontrib>Zhou, Jian-Xin</creatorcontrib><creatorcontrib>Ottenheijm, Coen</creatorcontrib><creatorcontrib>Heunks, Leo</creatorcontrib><title>Changes in Respiratory Muscle Thickness during Mechanical Ventilation: Focus on Expiratory Muscles</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproducibility of expiratory muscle (i.e., lateral abdominal wall muscles and rectus abdominis muscle) ultrasound and the impact of tidal volume on expiratory muscle thickness, to evaluate changes in expiratory muscle thickness during mechanical ventilation, and to compare this to changes in diaphragm thickness.
Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation.
The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332).
Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae.</description><subject>Abdominal Muscles - anatomy & histology</subject><subject>Exhalation</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Observer Variation</subject><subject>Prospective Studies</subject><subject>Rectus Abdominis - anatomy & histology</subject><subject>Reproducibility of Results</subject><subject>Respiration, Artificial</subject><subject>Respiratory Muscles - anatomy & histology</subject><subject>Ultrasonography - methods</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUNtKw0AQXUTRWv0DkX30JXWv2Y1vUuoFqoJUX8N2MzGr26TuJlT_3pTWCw4MwxnOOcMchE4oGVGSqfPL6f2I_CmueLqDBlQynVCq5C4arLcJJ4wdoMMYX3uoJNf76IBzRSmVYoDm48rULxCxq_EjxKULpm3CJ77rovWAZ5WzbzXEiIsuuPoF34HtBc4aj5-hbp03rWvqC3zV2C7ipsaTj38e8QjtlcZHON7OIXq6mszGN8n04fp2fDlNrBBZmghNs1L1bxBtFGFSQ6mElNpI0FxJmbGCpVbrTIGyVBSKCJNyw21KC11ayYfobOO7DM17B7HNFy5a8N7U0HQxZ5JQlgqhWU8VG6oNTYwBynwZ3MKEz5ySfJ1u3qeb_0-3l51uL3TzBRQ_ou84f31XjW8hxDffrSDkFRjfVhs_KVjCCKNE9iDpm6b8C6ehg8M</recordid><startdate>20210501</startdate><enddate>20210501</enddate><creator>Shi, Zhong-Hua</creator><creator>de Vries, Heder</creator><creator>de Grooth, Harm-Jan</creator><creator>Jonkman, Annemijn H.</creator><creator>Zhang, Yingrui</creator><creator>Haaksma, Mark</creator><creator>van de Ven, Peter M.</creator><creator>de Man, Angelique A. M. E.</creator><creator>Girbes, Armand</creator><creator>Tuinman, Pieter R.</creator><creator>Zhou, Jian-Xin</creator><creator>Ottenheijm, Coen</creator><creator>Heunks, Leo</creator><general>the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6331-0397</orcidid></search><sort><creationdate>20210501</creationdate><title>Changes in Respiratory Muscle Thickness during Mechanical Ventilation: Focus on Expiratory Muscles</title><author>Shi, Zhong-Hua ; de Vries, Heder ; de Grooth, Harm-Jan ; Jonkman, Annemijn H. ; Zhang, Yingrui ; Haaksma, Mark ; van de Ven, Peter M. ; de Man, Angelique A. M. 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M. E.</creatorcontrib><creatorcontrib>Girbes, Armand</creatorcontrib><creatorcontrib>Tuinman, Pieter R.</creatorcontrib><creatorcontrib>Zhou, Jian-Xin</creatorcontrib><creatorcontrib>Ottenheijm, Coen</creatorcontrib><creatorcontrib>Heunks, Leo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shi, Zhong-Hua</au><au>de Vries, Heder</au><au>de Grooth, Harm-Jan</au><au>Jonkman, Annemijn H.</au><au>Zhang, Yingrui</au><au>Haaksma, Mark</au><au>van de Ven, Peter M.</au><au>de Man, Angelique A. M. E.</au><au>Girbes, Armand</au><au>Tuinman, Pieter R.</au><au>Zhou, Jian-Xin</au><au>Ottenheijm, Coen</au><au>Heunks, Leo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in Respiratory Muscle Thickness during Mechanical Ventilation: Focus on Expiratory Muscles</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>134</volume><issue>5</issue><spage>748</spage><epage>759</epage><pages>748-759</pages><issn>0003-3022</issn><eissn>1528-1175</eissn><abstract>The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproducibility of expiratory muscle (i.e., lateral abdominal wall muscles and rectus abdominis muscle) ultrasound and the impact of tidal volume on expiratory muscle thickness, to evaluate changes in expiratory muscle thickness during mechanical ventilation, and to compare this to changes in diaphragm thickness.
Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation.
The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332).
Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae.</abstract><cop>United States</cop><pub>the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc</pub><pmid>33711154</pmid><doi>10.1097/ALN.0000000000003736</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-6331-0397</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abdominal Muscles - anatomy & histology Exhalation Female Humans Male Middle Aged Netherlands Observer Variation Prospective Studies Rectus Abdominis - anatomy & histology Reproducibility of Results Respiration, Artificial Respiratory Muscles - anatomy & histology Ultrasonography - methods |
| title | Changes in Respiratory Muscle Thickness during Mechanical Ventilation: Focus on Expiratory Muscles |
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