https://doi.org/10.4081/ecj.2023.11248
Ultrasound assessment of diaphragmatic dysfunction and its improvement with levosimendan in patients with chronic obstructive pulmonary disease
Submitted: 9 February 2023
Accepted: 27 February 2023
Published: 28 March 2023
Accepted: 27 February 2023
Abstract Views: 640
PDF: 264
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Diaphragmatic Dysfunction (DD) is a clinical condition in which the diaphragm becomes weak or paralyzed, because of muscle strength reduction. It can be due to muscular issues or loss of proper innervation, but, also, to pulmonary hyperinflation or air trapping, such as in Chronic Obstructive Pulmonary Disease (COPD). DD impacts on COPD induced dyspnea, determining its progressive worsening, but levosimendan, an inodilator better known as Ca2+ sensitizer, may limit this phenomenon and diaphragmatic ultrasound assessment can be useful in monitoring its effect. Here, we show the case of a 77-year-old woman admitted to the Emergency department for acute exacerbation of chronic dyspnea in COPD, related to right ventricular failure and DD, which did not respond to medical therapy and non-invasive mechanical ventilation but did experience a favorable outcome after intravenous administration of levosimendan.
Zhang B, Li P, Li J, et al. Effect of oxidative stress on diaphragm dysfunction and exercise intervention in chronic obstructive pulmonary disease. Front Physiol 2021;12:684453.
DOI: https://doi.org/10.3389/fphys.2021.684453
Dubé BP, Dres M. Diaphragm dysfunction: Diagnostic approaches and management strategies. J Clin Med 2016;5:113.
DOI: https://doi.org/10.3390/jcm5120113
Pan J, Yang YM, Zhu JY, Lu YQ. Multiorgan drug action of levosimendan in critical illnesses. Biomed Res Int 2019;2019:9731467.
DOI: https://doi.org/10.1155/2019/9731467
Herpain A, Bouchez S, Girardis M, et al. Use of Levosimendan in intensive care unit settings: An opinion paper. J Cardiovasc Pharmacol 2019;73:3-14.
DOI: https://doi.org/10.1097/FJC.0000000000000636
Boussuges A, Rives S, Finance J, Brégeon F. Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives. World J Clin Cases 2020;8:2408-24.
DOI: https://doi.org/10.12998/wjcc.v8.i12.2408
Boussuges A, Finance J, Chaumet G, Brégeon F. Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality. ERJ Open Res 2021;7:00714-2020.
DOI: https://doi.org/10.1183/23120541.00714-2020
Santana PV, Cardenas LZ, Albuquerque ALP, et al. Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses. J Bras Pneumol 2020;46:e20200064.
DOI: https://doi.org/10.36416/1806-3756/e20200064
Boon AJ, Harper CJ, Ghahfarokhi LS, et al. Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve 2013;47:884-9.
DOI: https://doi.org/10.1002/mus.23702
Boussuges A, Rives S, Finance J, et al. Ultrasound assessment of diaphragm thickness and thickening: Reference values and limits of normality when in a seated position. Front Med (Lausanne) 2021;8:742703.
DOI: https://doi.org/10.3389/fmed.2021.742703
Pathak A, Lebrin M, Vaccaro A, et al. Pharmacology of levosimendan: inotropic, vasodilatory and cardioprotective effects. J Clin Pharm Ther 2013;38:341-9.
DOI: https://doi.org/10.1111/jcpt.12067
Juguet W, Fard D, Faivre L, et al. Levosimendan plus dobutamine in acute decompensated heart failure refractory to dobutamine. J Clin Med 2020;9:3605.
DOI: https://doi.org/10.3390/jcm9113605
van Hees HW, Dekhuijzen PN, Heunks LM. Levosimendan enhances force generation of diaphragm muscle from patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;179:41-7.
DOI: https://doi.org/10.1164/rccm.200805-732OC
Licata G, Di Pasquale P, Parrinello G, et al. Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects. Am Heart J 2003;145:459-66.
DOI: https://doi.org/10.1067/mhj.2003.166
Griffin M, Soufer A, Goljo E, et al. Real world use of hypertonic saline in refractory acute decompensated heart failure: A U.S. center's experience. JACC Heart Fail 2020;8:199-208.
DOI: https://doi.org/10.1016/j.jchf.2019.10.012
Antila S, Sundberg S, Lehtonen LA. Clinical pharmacology of levosimendan. Clin Pharmacokinet 2007;46:535-52.
DOI: https://doi.org/10.2165/00003088-200746070-00001
Jonsson EN, Antila S, McFadyen L, et al. Population pharmacokinetics of levosimendan in patients with congestive heart failure. Br J Clin Pharmacol 2003;55:544-51.
DOI: https://doi.org/10.1046/j.1365-2125.2003.01778.x
Grześk G, Wołowiec Ł, Rogowicz D, et al. The importance of pharmacokinetics, pharmacodynamic and repetitive use of levosimendan. Biomed Pharmacother 2022;153:113391.
DOI: https://doi.org/10.1016/j.biopha.2022.113391
Doorduin J, Sinderby CA, Beck J, et al. The calcium sensitizer levosimendan improves human diaphragm function. Am J Respir Crit Care Med 2012;185:90-5.
DOI: https://doi.org/10.1164/rccm.201107-1268OC
Roesthuis L, van der Hoeven H, Sinderby C, et al. Effects of levosimendan on respiratory muscle function in patients weaning from mechanical ventilation. Intensive Care Med 2019;45:1372-81.
DOI: https://doi.org/10.1007/s00134-019-05767-y
How to Cite
De Rosa, C. A., Cristiano, G., & Guarino, M. (2023). Ultrasound assessment of diaphragmatic dysfunction and its improvement with levosimendan in patients with chronic obstructive pulmonary disease. Emergency Care Journal, 19(1). https://doi.org/10.4081/ecj.2023.11248
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