Predictive Value of Diaphragm Muscle Ultrasound for Ventilator Weaning Outcomes After Cervical Spinal Cord Injury: A Retrospective Case Series

Natasha S. Bhatia, Stephany Kunzweiler, Christopher Conley, Ki H. Kim, Adenike A. Adewuyi, Antonio Mondriguez-Gonzalez, Lisa F Wolfe, Mary Kwasny, Colin K. Franz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Neuromuscular respiratory failure after cervical spinal cord injury (cSCI) can lead to dependence on an invasive mechanical ventilator. Ventilator-free breathing after cSCI is associated with improved morbidity, mortality, and quality of life. We investigated the use of diaphragm muscle ultrasound to predict ventilator weaning outcomes after cSCI. Methods: This is a retrospective case series conducted at a university-affiliated freestanding inpatient rehabilitation facility. We identified patients with cSCI who had a tracheostomy and were dependent on an invasive mechanical ventilator at the time of admission to inpatient rehabilitation. A diaphragm muscle ultrasound was performed, which included measurements of the thickness of the diaphragm and a calculation of the thickening ratio (TR), which reflects diaphragm muscle contraction. The primary outcome measure was the need for mechanical ventilation at time of discharge from the inpatient rehabilitation facility. Successful ventilator weaning was defined as either daytime or full 24-hour ventilator-free breathing. Results: Of the 21 patients enrolled, 11 (52%) were able to wean successfully (partially or fully) from the ventilator. Of the ultrasound measurements that were taken, the TR was the optimal predictor for ventilator weaning outcomes. A threshold of TR ≥ 1.2 as the maximum hemidiaphragm measurement had a sensitivity of 1.0 and specificity of 0.90 for predicting ventilator weaning. Conclusion: Normal diaphragm contractility (TR ≥ 1.2) as determined by diaphragm muscle ultrasound is a strong positive predictor for successful ventilator weaning in patients with cSCI. Utilizing diaphragm ultrasound, rehabilitation physicians can set precision rehabilitation goals regarding ventilator weaning for inpatients with respiratory failure after cSCI, potentially improving both outcomes and quality of life.

Original languageEnglish (US)
Pages (from-to)119-126
Number of pages8
JournalJournal of Ultrasound in Medicine
Volume44
Issue number1
DOIs
StatePublished - Jan 2025

Funding

C.K.F. acknowledge support from the Belle Carnell Regenerative Neurorehabilitation Fund. S.K. acknowledge support from the Catalyst Grant Program at Shirley Ryan AbilityLab. The authors acknowledge Dom D'Andrea for artwork used in Figure 4. The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Keywords

  • diaphragm muscle
  • neuromuscular
  • spinal cord injury
  • ultrasound
  • ventilator weaning

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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