Journal Article

Serial ultrasound assessment of diaphragmatic function and clinical outcome in patients with amyotrophic lateral sclerosis

Pellegrino, Maria Rosaria, Ruggieri, Valentina, Fantini, Riccardo, Fini, Nicola, Giaroni, Francesco, Tabbì, Luca, Monelli, Marco, Livrieri, Francesco, Mandrioli, Jessica, Tonelli, Roberto, Cerri, Stefania, Castaniere, Ivana, Clini, Enrico, Marchioni, Alessandro

2019

Overview

Background Diaphragmatic assessment by ultrasound (US) is a non-invasive and useful method in the clinical management of patients with Amyotrophic Lateral Sclerosis (ALS). The aim of our observational study was to evaluate the impact of serial assessment of the diaphragmatic function by US on long-term outcomes in a series of patients suffering from ALS and to correlate US indices of diaphragmatic function and respiratory function tests with these outcomes. Methods A cohort of 39 consecutive patients has been followed up to 24 months. Both lung volume (forced vital capacity, FVC) and diaphragmatic pressure generating capacity (by sniff inspiratory nasal pressure (SNIP) and by both US thickening fraction, ΔTdi, and the ratio of the thickening fraction between tidal volume and maximal lung capacity, ΔTmax) were recorded at baseline and every 3 months. Parameters were then correlated with outcomes (nocturnal hypoventilation, daily hypercapnia, start of ventilatory support (NIV), and death at 1 year) over time. Results The occurrence of ΔTmax > 0.75 increased the risk to start NIV (HR = 5.6, p  = 0.001) and to die (HR = 3.7, p  = 0.0001) compared with patients maintaining lower values. Moreover, compared with the occurrence of FVC < 50% of predicted, ΔTmax > 0.75 appeared slightly better correlated with NIV commencement within 6 months. Conclusions Serial diaphragmatic assessment by ultrasound is a useful and accurate method to predict the initiation of NIV earlier in patients with ALS.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Amyotrophic lateral sclerosis / Amyotrophic Lateral Sclerosis - complications / Amyotrophic Lateral Sclerosis - diagnostic imaging / Amyotrophic Lateral Sclerosis - physiopathology / Care and treatment / Collaboration / Critical Care Medicine / Dementia / Diagnosis / Diaphragm - diagnostic imaging / Diaphragm - physiopathology / Diaphragm dysfunction / Diaphragm ultrasound / Electric power generation / Female / Humans / Hypercapnia / Hypoventilation / Intensive / Internal Medicine / Kaplan-Meier Estimate / Linear Models / Lung volume measurement / Male / Mechanical ventilation / Medicine / Medicine & Public Health / Middle Aged / Neurophysiology / Noninvasive Ventilation / Ostomy / Patients / Pneumology/Respiratory System / Pressure / Prospective Studies / Pulmonary function tests / Pulmonology / Research Article / Respiration / Respiratory critical care / Respiratory failure / Respiratory function / Respiratory insufficiency / Respiratory Insufficiency - etiology / Respiratory Insufficiency - physiopathology / Time-to-Treatment / Ultrasonic imaging / Ultrasonography / Ultrasound / Ultrasound imaging / Ventilation / Vital Capacity