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Table 5 Future directives

From: 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

General

 Standardization of transducer settings and technique is necessary

Basic science

 Histological changes caused by ventilation should be investigated (e.g. inflammation, fibrosis, oedema)

 The histological basis of the middle hyperechogenic layer should be determined

 Cut-offs for diaphragm dysfunction in various clinical settings should be determined

 The interaction with other respiratory muscles, e.g. the impact of expiratory muscle atrophy/dysfunction on diaphragm function, should be investigated

Indications in clinical practice

 Effective ultrasonographic parameter to accurately estimate work of breathing should be investigated

 The use of ultrasonography as screening tool to identify patient–ventilator asynchrony should be investigated

 The role of diaphragm ultrasonography to effectively titrate ventilator settings (i.e. diaphragm protective ventilation) should be investigated

 The role of diaphragm ultrasonography in non-invasive ventilation (e.g. as predictor of liberation from mechanical ventilation or to titrate support settings) should be investigated

 Automation of image acquisition

New techniques of interest for diaphragm ultrasonography

 Shear wave elastography

 Speckle tracking

 Diaphragm acceleration as parameter for (dys-)function

 Automated image collection for monitoring purposes