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RESEARCH PRODUCT

Assessment of diaphragm and lung ultrasound interest as a diagnostic and monitoring tool in acute respiratory diseases by the physiotherapist in critical care patients

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Thoracic ultrasound is a non-invasive, ionization-free and easily available tool at the bedside of the critical care patient. The aim of this thesis is to assess the lung and diaphragm ultrasound interest in the diagnosis and monitoring of the acute pulmonary disorders by the critical care physiotherapist.Our narrative review showed a high diagnostic accuracy of lung ultrasound to diagnose acute pulmonary disorders commonly encountered by the physiotherapist. The review of the lung ultrasound semiology allowed us to propose a chest physiotherapy strategy depending the ultrasound findings in the patients. Our multicenter clinical trial enrolled 151 ICU patients and highlighted the high impact of thoracic ultrasound on the physiotherapist’s decision-making process in chest physiotherapy. Agreement between clinical and ultrasound diagnosis was poor. Chest physiotherapy treatment was changed in the majority of cases after physiotherapists were presented with thoracic ultrasound findings, leading to major treatment changes in some cases. Diaphragm dysfunction is frequent in ICU, and sepsis is one of the major risk factor. Our single-center cohort study included 50 patients with sepsis or septic shock and showed a diaphragm dysfunction prevalence of 58% at onset of sepsis. Less than half of patients with diaphragm dysfunction at baseline recovered from during ICU stay.Diaphragm dysfunction was associated with the alteration of consciousness, origin of sepsis, mechanical ventilation and some drugs. The physiotherapist is widely involved in the mechanical ventilation weaning of the ICU patients. Our meta-analysis confirms and describes the role of diaphragm ultrasound in the prediction of extubation outcome, with a high sensitivity and moderate specificity. We identified factors affecting the predictive ability of diaphragm ultrasound like the extubation failure prevalence, the cut-off allowing to differentiate between negative and positive tests and study risk of bias.To conclude, this thesis showed the high impact of lung and diaphragm ultrasound on the choice of chest physiotherapy treatment in ICU patients. The low diagnostic accuracy of the usual physiotherapist’s tool may be one of the possible explanations. Diaphragm ultrasound may allow the physiotherapist to detect diaphragm dysfunction and to assess respiratory muscles before extubation, in appropriate conditions of measure. Further studies will be needed to assess the impact of thoracic ultrasound use in chest physiotherapy on the patient’s morbidity-mortality.