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. 2023 Aug;68(8):1106-1111.
doi: 10.4187/respcare.09491. Epub 2023 Apr 25.

Respiratory Musculature Evaluated by Computed Tomography in the Setting of Prolonged Mechanical Ventilation

Connor J Wakefield  1 , Sarah B Jochum  2 , Emily E Hejna  2 , Sarah B Peterson  3 , David L Vines  4 , Palmi N Shah  5 , Dana M Hayden  2 , Robert A Balk  6
Affiliations

Respiratory Musculature Evaluated by Computed Tomography in the Setting of Prolonged Mechanical Ventilation

Connor J Wakefield et al. Respir Care. 2023 Aug.

Abstract

Background: Diaphragm atrophy has been observed in subjects who undergo invasive mechanical ventilation. We propose a new method to assess for respiratory muscle (RM) changes in subjects who undergo invasive mechanical ventilation by assessing for changes in respiratory muscles through computed tomography (CT).

Methods: A retrospective case series study was conducted on subjects who underwent invasive mechanical ventilation and received at least 2 chest CT scans during admission. Exclusion criteria included history of chronic mechanical ventilation dependence and neuromuscular disease. Respiratory muscle cross-sectional area (CSA) was measured at the T6 vertebrae.

Results: Fourteen subjects were included: mean (± SD) age, BMI, and admission APACHE II scores were 54.0 y (± 14.9), 32.6 kg/m2 (± 10.9), and 23.5 (± 6.0), respectively. Ten (71%) subjects were male. Mean length of time between CT chest scans was 7.5 d (± 3.3). Mean duration of invasive mechanical ventilation was 4.5 d (± 3.4). The percentage change in TM CSA among those who underwent invasive mechanical ventilation was 10.5% (± 6.1).

Conclusions: We demonstrated that serial analysis of respiratory muscle CSA through CT chest scans can be a method to assess for respiratory muscle atrophy in subjects undergoing mechanical ventilation. Future prospective studies involving larger populations are needed to better understand how this method can be used to predict outcomes in mechanically ventilated patients.

Keywords: acute respiratory failure; mechanical ventilation; respiratory muscle wasting.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Admission respiratory muscle cross-sectional area (CSA) of 97.3 cm2 (A) compared to subsequent computed tomography scan 15 d later with respiratory muscle CSA of 67.52 cm2 in the same subject (B).
Fig. 2.
Fig. 2.
Cross-sectional area of the respiratory muscle groups at the sixth thoracic vertebra, including pectoralis major and minor muscles (red), serratus anterior and intercostal muscles (orange), and subscapularis, trapezius, and erector spinae muscles (green).
See this image and copyright information in PMC

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