Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring
The clinical research described in this case report was initiated because of the recognized need for early identification of Covid-19 patients at risk of respiratory failure. We used point of care ultrasound to identify diaphragm dysfunction in a spontaneously breathing Covid-19 patient. Measurement...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-01-01
|
| Series: | Respiratory Medicine Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213007120304986 |
| _version_ | 1818438404825677824 |
|---|---|
| author | Alfred L. van Steveninck Leonie M. Imming |
| author_facet | Alfred L. van Steveninck Leonie M. Imming |
| author_sort | Alfred L. van Steveninck |
| collection | DOAJ |
| description | The clinical research described in this case report was initiated because of the recognized need for early identification of Covid-19 patients at risk of respiratory failure. We used point of care ultrasound to identify diaphragm dysfunction in a spontaneously breathing Covid-19 patient. Measurements of diaphragm thickness and thickening fraction indicated diaphragm dysfunction prior to intubation while respiratory failure was not yet evident from arterial blood gas analysis. Recovery of diaphragm contractility was demonstrated within two days of controlled mechanical ventilation when the patient was switched to a pressure support mode. With recovery of the diaphragm very large fractional shortening was seen after discontinuation of rocuronium, which was associated with a reduced dynamic compliance. In conclusion, this case report illustrates the need to be aware of potential diaphragm dysfunction in spontaneously breathing Covid-19 patients. With recovery, point of care ultrasound allows repeated evaluation of diaphragm function which appears to be responsive to changes in pulmonary compliance. |
| first_indexed | 2024-12-14T17:40:02Z |
| format | Article |
| id | doaj.art-7e6f5af9096a41f5bac4bc682f298256 |
| institution | Directory Open Access Journal |
| issn | 2213-0071 |
| language | English |
| last_indexed | 2024-12-14T17:40:02Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj.art-7e6f5af9096a41f5bac4bc682f2982562022-12-21T22:52:53ZengElsevierRespiratory Medicine Case Reports2213-00712020-01-0131101284Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoringAlfred L. van Steveninck0Leonie M. Imming1Department of Intensive Care, Deventer Hospital, Deventer, the Netherlands; Corresponding author.Department of Pulmonary Medicine, Deventer Hospital, Deventer, the NetherlandsThe clinical research described in this case report was initiated because of the recognized need for early identification of Covid-19 patients at risk of respiratory failure. We used point of care ultrasound to identify diaphragm dysfunction in a spontaneously breathing Covid-19 patient. Measurements of diaphragm thickness and thickening fraction indicated diaphragm dysfunction prior to intubation while respiratory failure was not yet evident from arterial blood gas analysis. Recovery of diaphragm contractility was demonstrated within two days of controlled mechanical ventilation when the patient was switched to a pressure support mode. With recovery of the diaphragm very large fractional shortening was seen after discontinuation of rocuronium, which was associated with a reduced dynamic compliance. In conclusion, this case report illustrates the need to be aware of potential diaphragm dysfunction in spontaneously breathing Covid-19 patients. With recovery, point of care ultrasound allows repeated evaluation of diaphragm function which appears to be responsive to changes in pulmonary compliance.http://www.sciencedirect.com/science/article/pii/S2213007120304986COVID-19Respiratory failureDiaphragmDiaphragm dysfunctionMechanical ventilationUltrasound |
| spellingShingle | Alfred L. van Steveninck Leonie M. Imming Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring Respiratory Medicine Case Reports COVID-19 Respiratory failure Diaphragm Diaphragm dysfunction Mechanical ventilation Ultrasound |
| title | Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring |
| title_full | Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring |
| title_fullStr | Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring |
| title_full_unstemmed | Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring |
| title_short | Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring |
| title_sort | diaphragm dysfunction prior to intubation in a patient with covid 19 pneumonia assessment by point of care ultrasound and potential implications for patient monitoring |
| topic | COVID-19 Respiratory failure Diaphragm Diaphragm dysfunction Mechanical ventilation Ultrasound |
| url | http://www.sciencedirect.com/science/article/pii/S2213007120304986 |
| work_keys_str_mv | AT alfredlvansteveninck diaphragmdysfunctionpriortointubationinapatientwithcovid19pneumoniaassessmentbypointofcareultrasoundandpotentialimplicationsforpatientmonitoring AT leoniemimming diaphragmdysfunctionpriortointubationinapatientwithcovid19pneumoniaassessmentbypointofcareultrasoundandpotentialimplicationsforpatientmonitoring |