Association of diaphragm thickness and density measured on chest CT with disease severity in COVID-19 patients

Imaging Diagnosis for Intradiaphragmatic Pulmonary Sequestration: A Pilot Study

OBJECTIVES

Extrapulmonary sequestration (EPS) within the diaphragm (ID-EPS) is rare and requires additional procedures such as incision or detachment of the diaphragm from the lesion for diagnosis. This study aimed to describe the imaging findings and evaluate the diagnostic accuracy of ultrasonography and computed tomography (CT) for ID-EPS.

MATERIAL AND METHODS

Split diaphragm sign, shape of lesion edge, drainage vein into intra-abdomen on ultrasound and CT, and lesion characteristics on ultrasound were compared between patients with ID-EPS and with above-diaphragm EPS (AD-EPS) using Fisher's exact test.

RESULTS

Three and nine patients were diagnosed with ID-EPS and AD-EPS, respectively. Significant differences were observed between the two groups in the split diaphragm sign on ultrasound (presence/absence in patients with ID-EPS vs AD-EPS, 2/1 vs 0/9, P = .046), shape of lesion edge on ultrasound/CT (round/beak in patients with ID-EPS vs AD-EPS, 3/0 vs 0/9, P = .005 on both CT and ultrasound), lesion characteristics on ultrasound (presence/absence of cystic area within lesion in patients with ID-EPS vs AD-EPS, 0/3 vs 7/2, P = .046), and the drainage vein into the abdomen on CT (presence/absence in patients with ID-EPS vs AD-EPS; 2/1 vs 0/9, P = .046). No drainage veins were visualized in the abdomen on ultrasonography and no significant differences in the presence/absence of the split-diagram sign on CT (presence/absence in patients with ID-EPS vs AD-EPS and ID-EPS; 0/3 vs 0/9, P > .999; 1/2 vs 0/9, P = .250) were observed between the two groups.

CONCLUSION

A combination of postnatal ultrasonography and CT was useful in predicting EPS located within the diaphragm.

Effectiveness of a respiratory rehabilitation program including an inspiration training device versus traditional respiratory rehabilitation: a randomized controlled trial

Background

In the context of COVID-19, respiratory training is vital for the care and recuperation of individuals. Both exercise-based and instrumental respiratory training have been employed as interventions to enhance respiratory function, providing relief from symptoms in those impacted by the virus. The aim of this study was to evaluate the efficacy of two different respiratory rehabilitation programs.

Methods

A total of 200 participants affected with COVID-19 respiratory sequels were recruited, with a block randomization regarding sex to ensure equal and appropriate applicability of the results. An experimental controlled and randomized study was conducted, with participants engaging in a 31 days respiratory rehabilitation program, (a) experimental group, inspiratory training device combined with aerobic exercise and (b) traditional respiratory exercises combined with aerobic exercise.

Results

Both groups improved in cardiorespiratory parameters, with a decrease in systolic and diastolic pressure, dyspnea and lower limbs fatigue, and increased oxygen saturation, 6 min walking distance, diaphragmatic thickness, forced vital capacity, forced expiratory volume during the first second, peak expiratory flow rate, forced inspiratory vital capacity and maximal inspiratory pressure. Comparison between groups showed statistically significant differences in all variables except for oxygen saturation, 6 min walking distance and diaphragmatic thickness. The results of this study support the use of specific inspiration training devices for respiratory rehabilitation in COVID-19 sequels.

Assessment of the Diaphragm Thickness Decrease in Critically Ill COVID-19 Patients: Could Computed Tomography Be of Aid Regarding Diaphragm Muscle Mass?

INTRODUCTION

The diaphragm has a significant clinical value on respiratory performance. There is little literature on the use of thorax computed tomography for the purpose of identifying alterations in diaphragm thickness in critically ill patients diagnosed with COVID-19. The present study aims to investigate dynamic changes in muscle thickness and its association with clinical outcomes.

METHODS

A single-center retrospective observational study was conducted in a tertiary intensive care unit (ICU). The study comprised adult patients with severe COVID-19 who were admitted to the ICU and underwent two thorax CT scans. We measured diaphragmatic thickness at the level of the celiac truncus.

RESULTS

The average reduction in thickness of the dynamic diaphragm was found to be -0.58 mm for the right diaphragm and -0.54 mm for the left diaphragm. The diaphragm thickness exhibited a substantial decrease on both the right and left sides in both CT scans (p=0.02). A negative correlation coefficient was observed for both the right and left diaphragm. The criterion indicating a poor prognosis for the right diaphragm was a value greater than -0.175, whereas it was more significant for the left diaphragm than -0.435. The cut-off values indicated a high risk of prolonged mechanical ventilation and an increased risk of ICU mortality.

CONCLUSION

 CT diaphragm evaluation in mechanically ventilated COVID-19 patients has the possibility of becoming a reliable tool for predicting muscle modifications.

Prognostic Value of Diaphragm Diameter, Muscle Volume, and Bone Mineral Density in Critically Ill COVID-19 Patients

Objective: We aimed to analyze the prognostic value of muscle volume (MV), bone mineral density (BMD), and diaphragm diameter (DD) in COVID-19. Method: The study included 498 patients admitted to the intensive care unit (ICU) with a positive polymerase chain reaction test for COVID-19 from March 11, 2020, through August 31, 2022. The patients' laboratory and demographic data of the patients at the time of ICU admission were recorded. MV, DD, and BMD measurements were performed using computed tomography examinations. Muscle index (MI) was calculated as MV/height2. Quartiles were determined for all 4 measurements. Patients in the lowest quartile were recorded as having low MV, MI, DD, and BMD values. The parameters were evaluated for the whole group and compared according to gender and mortality. The multiple regression analysis was performed for the prediction of mortality. Results: In the mortality group, the male and female patients had significantly statistically lower values in MV (P < .001 and P = .002, respectively), MI (P < .001 and P = .005, respectively), DD (P < .001 and P < .001, respectively), and BMD (P = .002 and P < .001, respectively). In the multiple regression analysis, low MI (OR: 2.03, 95% CI: 1.14-3.61, P = .016) and DD (OR: 10.47, 95% CI: 5.59-19.59, P < .001) values remained significant for the prediction of mortality. Conclusion: BMD is a risk factor for mortality in patients with severe COVID-19, but cannot be used as an independent predictor. However, MI and DD can be used as independent predictors of mortality even in severe cases.