ArticleJournal of intensive care2022
Association between histological diaphragm atrophy and ultrasound diaphragm expiratory thickness in ventilated patients.
Article in Journal of intensive care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Respiratory muscle dysfunction in mechanical ventilation: a systematic review and meta-analysis of biological mechanisms.Journal of applied physiology (Bethesda, Md. : 1985) · 2026Pooled it
- Diaphragmatic Ultrasound Parameters as Predictors of Weaning Success in Cervical Spinal Cord Injury.Medical science monitor : international medical journal of experimental and clinical research · 2026Article
- Beyond feasibility: standardization and reproducibility as the next frontier for respiratory muscle ultrasound.Critical care (London, England) · 2025Article
- Advancements in imaging techniques for monitoring the respiratory muscles.Critical care (London, England) · 2025Review
- Diaphragm Function in Health and Disease.Advances in experimental medicine and biology · 2025Review
- Respiratory muscle dysfunction in acute and chronic respiratory failure: how to diagnose and how to treat?European respiratory review : an official journal of the European Respiratory Society · 2024Review
- Inspiratory muscle training facilitates liberation from mechanical ventilation in subacute critically ill patients-a randomized controlled trial.Frontiers in medicine · 2024Article
- Diaphragm Ultrasound in Critically Ill Patients on Mechanical Ventilation-Evolving Concepts.Diagnostics (Basel, Switzerland) · 2023Review
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundDiaphragm fiber atrophy has been evidenced after short periods of mechanical ventilation (MV) and related to critical illness-associated diaphragm weakness. Atrophy is described as a decrease in diaphragm fiber cross-sectional area (CSA) in human diaphragm biopsy, but human samples are still difficult to obtain in clinics. In recent years, ultrasound has become a useful tool in intensive care to evaluate diaphragm anatomy. The present study aimed to evaluate the ability of diaphragm expiratory thickness (Tdi) measured by ultrasound to predict diaphragm atrophy, defined by a decrease in diaphragm fiber CSA obtained through diaphragm biopsy (the gold standard technique) in ventilated patients.
methodsDiaphragm biopsies and diaphragm ultrasound were performed in ventilated donors and in control subjects. Demographic variables, comorbidities, severity on admission, treatment, laboratory test results and evolution variables were evaluated. Immunohistochemical analysis to determine CSA and ultrasound measurements of Tdi at end-expiration were performed, and median values of the control group were used as thresholds to determine agreement between them in further analysis. Sensitivity, specificity, and positive and negative predictive values of an ultrasound Tdi cutoff for detecting histologic atrophy were calculated. Agreement between two ultrasound observers was also assessed.
resultsThirty-five ventilated organ donors and 5 ventilated controls were included, without differences in basic characteristics. CSA and Tdi were lower in donors than in controls. All donors presented lower CSA, but only 74% lower Tdi regarding control group thresholds. The cut-off value for lower diaphragm expiratory thickness (Tdi < 1.7 mm) presented a sensitivity of 73%, a specificity of 67%, a positive predictive value of 96% and a negative predictive value of 17% for determining the presence of diaphragm atrophy (CSA < 2851 μm
conclusionsDiaphragm atrophy and thickness reduction is associated to MV. While a lower Tdi in diaphragm ultrasound is a good tool for diagnosing atrophy, normal or increased Tdi cannot rule atrophy out showing that both parameters should not be considered as synonymous.
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Registered trials
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