EXpert consensus On Diaphragm UltraSonography in the critically ill (EXODUS): a Delphi consensus statement on the measurement of diaphragm ultrasound-derived parameters in a critical care setting
Mark E. Haaksma,
Jasper M. Smit,
Alain Boussuges,
Alexandre Demoule,
Martin Dres,
Giovanni Ferrari,
Paolo Formenti,
Ewan C. Goligher,
Leo Heunks,
Endry H. T. Lim,
Lidwine B. Mokkink,
Eleni Soilemezi,
Zhonghua Shi,
Michele Umbrello,
Luigi Vetrugno,
Emmanuel Vivier,
Lei Xu,
Massimo Zambon,
Pieter R. Tuinman
Affiliations
Mark E. Haaksma
Department of Intensive Care Medicine, Amsterdam University Medical Centers
Jasper M. Smit
Department of Intensive Care Medicine, Amsterdam University Medical Centers
Alain Boussuges
Aix Marseille Université, Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, and Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique Des Hôpitaux de Marseille
Alexandre Demoule
AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive Et Réanimation (Département R3S), and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique
Martin Dres
AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive Et Réanimation (Département R3S), and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique
Giovanni Ferrari
Pneumologia E Unità Di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano
Paolo Formenti
SC Anestesia E Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo eCarlo
Ewan C. Goligher
Interdepartmental Division of Critical Care Medicine, University of Toronto
Leo Heunks
Department of Intensive Care Medicine, Erasmsus University Medical Center
Endry H. T. Lim
Department of Intensive Care Medicine, Amsterdam University Medical Centers
Lidwine B. Mokkink
Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam
Eleni Soilemezi
Department of Intensive Care Medicine, Papageorgiou General Hospital
Zhonghua Shi
Departement of Intensive Care Medicine, Beijing Sanbo Brain Hospital, Capital Medical University
Michele Umbrello
SC Anestesia E Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo E Carlo Polo Universitario
Luigi Vetrugno
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara
Emmanuel Vivier
Médecine Intensive Réanimation, Centre Hospitalier Saint Joseph Saint Luc
Lei Xu
Department of Neurosurgery and Neurosurgical Intensive Care Unit, Chongqing Emergency Medical Centre, Chongqing University Central Hospital
Massimo Zambon
Department of Anaesthesia and Intensive Care, Ospedale Di Cernusco Sul Naviglio, ASST Melegnano-Martesana
Pieter R. Tuinman
Department of Intensive Care Medicine, Amsterdam University Medical Centers
Abstract Background Diaphragm ultrasonography is rapidly evolving in both critical care and research. Nevertheless, methodologically robust guidelines on its methodology and acquiring expertise do not, or only partially, exist. Therefore, we set out to provide consensus-based statements towards a universal measurement protocol for diaphragm ultrasonography and establish key areas for research. Methods To formulate a robust expert consensus statement, between November 2020 and May 2021, a two-round, anonymous and online survey-based Delphi study among experts in the field was performed. Based on the literature review, the following domains were chosen: “Anatomy and physiology”, “Transducer Settings”, “Ventilator Impact”, “Learning and expertise”, “Daily practice” and “Future directions”. Agreement of ≥ 68% (≥ 10 panelists) was needed to reach consensus on a question. Results Of 18 panelists invited, 14 agreed to participate in the survey. After two rounds, the survey included 117 questions of which 42 questions were designed to collect arguments and opinions and 75 questions aimed at reaching consensus. Of these, 46 (61%) consensus was reached. In both rounds, the response rate was 100%. Among others, there was agreement on measuring thickness between the pleura and peritoneum, using > 10% decrease in thickness as cut-off for atrophy and using 40 examinations as minimum training to use diaphragm ultrasonography in clinical practice. In addition, key areas for research were established. Conclusion This expert consensus statement presents the first set of consensus-based statements on diaphragm ultrasonography methodology. They serve to ensure high-quality and homogenous measurements in daily clinical practice and in research. In addition, important gaps in current knowledge and thereby key areas for research are established. Trial registration The study was pre-registered on the Open Science Framework with registration digital object identifier https://doi.org/10.17605/OSF.IO/HM8UG .
