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Temporal evolution of diaphragm thickness and diaphragm excursion among subjects hospitalized with COVID-19: A prospective observational study - 06/06/23

Doi : 10.1016/j.resmer.2022.100960 
Vijay Hadda a, , Arun Raja b, Tejas Menon Suri c, Maroof Ahmad Khan d, Saurabh Mittal c, Karan Madan a, Anant Mohan e
a Additional Professor, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India 
b Senior Resident, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India 
c Assistant Professor, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India 
d Additional Professor, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India 
e Professor and Head, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India 

Corresponding author at: Additional Professor, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.Additional Professor, Department of PulmonaryCritical Care and Sleep Medicine, All India Institute of Medical SciencesNew Delhi110029India

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Highlights

The diaphragm has abundant ACE2 receptors making it susceptible to SARS-CoV-2.
We performed diaphragm ultrasound in hospitalized non-intubated COVID-19 patients.
We found decline in end-expiratory diaphragm thickness over 5 days of admission.
We found an increase in diaphragm thickening fraction over 5 days of admission.

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Abstract

Background

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has an affinity for the angiotensin-converting enzyme 2 (ACE2) receptors, which are present abundantly on the diaphragm. This study aims to describe temporal changes in diaphragmatic thickness and excursion using ultrasonography in subjects with acute COVID-19.

Methods

This prospective observational study included adults hospitalized with COVID-19 in the past 48 hours. The diaphragm thickness at end-expiration (DTE), diaphragm thickening fraction (DTF), and diaphragm excursion during tidal breathing (DE) and maximal inspiration (DEmax) were measured using ultrasonography daily for 5 days. The changes in DTE, DTF, DE, and Demax from day 1 to day 5 were assessed.

Results

This study included 64 adults (62.5% male) with a mean (SD) age of 50.2 (17.5) years. A majority (91%) of the participants had mild or moderate illness. The median (IQR) DTE, DTF (%), DE and Demax on day 1 were 2.2 (1.9, 3.0) mm, 21.5% (14.2, 31.0), 19.2 (16.5, 24.0) mm, and 26.7 (22.0, 30.2) mm, respectively. On day 5, there was a significant reduction in the DTE (p=0.002) with a median (IQR) percentage change of -15.7% (-21.0, 0.0). The DTF significantly increased on day 5 with a median (IQR) percentage change of 25.0% (-19.2, 98.4), p=0.03. There was no significant change in DE and Demax from day 1 to day 5, with a median (IQR) percentage change of 3.6% (-5.2, 15) and 0% (-6.7, 5.9), respectively.

Conclusions

Non-intubated patients with COVID-19 exhibited a temporal decline in diaphragm thickness with increase in thickening fraction over 5 days of hospital admission. Further research is warranted to assess the impact of COVID-19 pneumonia on diaphragmatic function.

El texto completo de este artículo está disponible en PDF.

Keywords : Ultrasonography, Diaphragm, Diaphragm atrophy, Diaphragm function, Respiratory muscle, SARS-CoV-2

Abbreviations : ACE2, APACHE, ARDS, DE, DEmax, DT, DTE, DTF, HFNC, LDH, MIP, NIV, PCFS, RT-PCR, SARS-CoV-2, SOFA, USG


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