PMC7654235_01
Frontal section of CT-image on admission showing a mixture of bilateral ground glass attenuation and consolidations. In retrospect, the highly convex diaphragm contours may have been an indication of poor function.
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A chest CT showed extensive bilateral ground glass attenuation and consolidations (Fig. 1) with a CT severity score of 22.
B-mode ultrasound image of the diaphragm at the opposition zone. Borders of the diaphragm are indicated by white arrows. The central fibrous layer is indicated by the horizontal gray arrow.
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An ultrasound examination indicated bilateral diaphragm dysfunction prior to intubation and the start of lung protective mechanical ventilation (Fig. 2, Fig. 3).
M-mode images of the right and left hemidiaphragm with pressure support ventilation on day four following admission. Measures of diaphragm thickness during expiration and inspiration: 2.2/3.0 mm (36% thickening fraction) on the right side and 2.2/3.1 mm (41% thickening fraction) on the left side. Note that there is no vertical movement of subcutaneous tissue with interrupted activity of auxiliary respiratory muscles.
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Two days later similar contractions of the diaphragm were observed(Fig. 4).
M-mode image of the right hemidiaphragm on day 6 following intubation. Diaphragm thickness: 1.8 mm in expiration and 3.5 mm during inspiration (thickening fraction 0.94). Measurements were made during a brief switch from pressure control to pressure support ventilation.
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An additional measurement of the right hemidiaphragm taken in recumbent position on 10-04-2020 showed an increase in thickening fraction to 0.94 (Fig. 5).