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Menis AA, Tsolaki V, Papadonta ME, Vazgiourakis V, Mantzarlis K, Zakynthinos E, Makris D. Diaphragmatic ultrasound and its relationship to breathing effort and load: a prospective observational study. Crit Care 2025; 29:190. [PMID: 40361191 PMCID: PMC12070521 DOI: 10.1186/s13054-025-05436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/26/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Failure to wean from invasive mechanical ventilation is multifactorial, with diaphragmatic dysfunction a significant contributing factor. Diaphragmatic function can be easily and non-invasively assessed by ultrasound. However, it remains unknown how ultrasound measurements of diaphragm function are affected by changes in apparent work of breathing. METHODS In patients undergoing weaning from mechanical ventilation, we evaluated diaphragmatic ultrasound measurements [diaphragmatic excursion (Dex), diaphragmatic thickening fraction (Tfdi)] simultaneously with manometric indices of breathing effort and load [esophageal pressure swings (ΔPes), transdiaphragmatic pressure swings (ΔPdi), and the pressure-time product of esophageal pressure (PTPes)]. These assessments were performed during two distinct phases; during an unassisted spontaneous breathing trial (phase SBT) and during an inspiratory resistive loading with 30 cmH2O/L/s (phase IRL), applied during the same SBT. Our primary aim was to evaluate the relationship between diaphragmatic ultrasound and breathing effort using the method of repeated measures correlation. RESULTS Forty-nine patients were enrolled. Dex correlated with ΔPes (r = 0.5, p < 0.001), ΔPdi (r = 0.55, p = < 0.001) and PTPes (r = 0.32, p = 0.031). Tfdi did not correlate with ΔPes (r = 0.27, p = 0.052), ΔPdi (r = 0.2, p = 0.235) and PTPes (r = 0.24, p = 0.110). Dex and Tfdi increased during IRL compared to SBT [1.44(0.89-1.96) vs. 1.05(0.7-1.59), p = 0.002], [0.55(± 0.32) vs 0.46(± 0.2), p = 0.019] as did Pes, Pdi and PTPes [(11.87 (7.86, 18.32) vs. 6.8 (4.6-10.23), p < 0.001), (10.89 (± 6.42) vs. 7.94 (± 3.81), p < 0.001), and (181.10 (108.34, 311.7) vs. 97.52 (55.96-179.87), p < 0.001), respectively]. CONCLUSION In critical care patients spontaneously breathing under resistive load, diaphragmatic excursion had a weak to moderate correlation with indices of breathing effort and differed between weaning success and failure.
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Affiliation(s)
- Apostolos-Alkiviadis Menis
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece.
- Medical School, University of Thessaly, Larissa, Greece.
| | - Vasiliki Tsolaki
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
- Medical School, University of Thessaly, Larissa, Greece
| | | | | | - Konstantinos Mantzarlis
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
- Medical School, University of Thessaly, Larissa, Greece
| | - Epaminondas Zakynthinos
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
- Medical School, University of Thessaly, Larissa, Greece
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
- Medical School, University of Thessaly, Larissa, Greece
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Vranich B, Lee R, Zapanta J, Shoen B, Houghton H, Ruelas C, Wahlfeldt ML, Kerr R, Pripotnev A, Goorahoo M, Baptiste JB, Elliot J. The Breathing IQ: an anthropometric index of diaphragmatic breathing efficiency. Front Physiol 2025; 15:1394109. [PMID: 40242838 PMCID: PMC11999984 DOI: 10.3389/fphys.2024.1394109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 12/12/2024] [Indexed: 04/18/2025] Open
Abstract
Background Breathing pattern disorders (BPDs) are becoming increasingly relevant due to the rise of respiratory illnesses but are often limited to diagnoses of hyperventilation syndrome and do not consider breathing dysfunction of mechanical origin. Impaired diaphragmatic and inefficient breathing patterns often evolve into downstream musculoskeletal and psychological consequences. Respiratory research has consistently called for the standardization of methods that can consider breathing as multifactorial and also consider breathing mechanics. Aim This paper aims to introduce the Breathing IQ (BIQ) as a novel anthropometric index of abdominothoracic flexibility for identifying biomechanical breathing patterns and assessing diaphragmatic breathing efficiency. Method A sample of N = 384 individuals was assessed with the BIQ pre- and post-intervention of five corrective exercises in a single 90-minute session to identify changes in the BIQ grade (A-F), as determined by measuring the breathing range of motion (ROM) and location of movement (LOM). Results Binary-grade improvement (yes/no) occurred in 331 of 370 without an A grade at baseline (89.5%), p < 0.001. Before the intervention, 249 (64.8%) were graded an F and only 14 (3.7%) were graded an A. After the intervention, only 20 (5.2%) were graded an F and 102 (26.6%) were graded an A. Breath hold (BH) improved from pre- to post-intervention, from 37.2 (18.7) to 66.0 (26.9), with a mean change 24.3 (15.3), which was highly significant (p < 0.001). Conclusion The BIQ shows preliminary potential as an effective screening tool for mechanical breathing dysfunction.
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Yang X, Wang H, Liu A, Ni Y, Wang J, Han Y, Xie B, Geng J, Ren Y, Zhang R, Liu M, Dai H. Evaluation of respiratory muscle dysfunction in patients with idiopathic pulmonary fibrosis: a prospective observational study with magnetic resonance imaging. BMC Pulm Med 2025; 25:118. [PMID: 40087606 PMCID: PMC11909878 DOI: 10.1186/s12890-025-03572-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 02/26/2025] [Indexed: 03/17/2025] Open
Abstract
OBJECTIVE Respiratory muscle dysfunction in patients with idiopathic pulmonary fibrosis (IPF) is a big challenge for treatment and rehabilitation. To quantitatively assess diaphragm and chest wall dysfunction using dynamic Magnetic Resonance Imaging (Dyn-MRI) in patients with IPF. METHODS Ninety-six patients with IPF and 50 gender- and age-matched controls were prospectively included and underwent D-MRI with a dynamic fast spoiled gradient-recalled echo sequence. Respiratory muscles function were assessed with thoracic anterior-posterior (AP), left-right (LR), cranial-caudal (CC) metrics. Moreover, lung area ratios, height (DH), and area (DA) of diaphragm curvature between end-inspiration and end-expiration during both quiet and deep breathing. RESULTS During quiet breathing, the functional metrics of the diaphragm and chest wall were comparable between IPF patients and controls. However, during deep breathing, IPF patients exhibited significantly reduced ratios of AP, CC, and lung area compared to controls. Moreover, the median ratios of DH and DA were higher in IPF patients than in controls (DH: 0.96 vs. 0.81, p < 0.001; DA: 1.00 vs. 0.90, p < 0.001). Furthermore, the ratios of AP, CC, and lung area during deep breathing were found to correlate with pulmonary function, total lung volume, and 6-minute walk distance. CONCLUSION D-MRI demonstrated dysfunction in the diaphragm and chest wall among IPF patients, with respiratory muscle dysfunction showing a correlation with the severity of disease. TRIAL REGISTRATION This article presents a prospective observational study that does not include the outcomes of any healthcare interventions on human participants. The study was registered on September 11, 2018, under the registration number NCT03666234.
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Affiliation(s)
- Xiaoyan Yang
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Hongyi Wang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Anqi Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghua Dong Street, Chao Yang District, Beijing, 100029, China
| | - Yifei Ni
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghua Dong Street, Chao Yang District, Beijing, 100029, China
| | - Jianping Wang
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghua Dong Street, Chao Yang District, Beijing, 100029, China
- China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, China
| | - Yueyin Han
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Bingbing Xie
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jing Geng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yanhong Ren
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Rongguo Zhang
- Academy for Multidisciplinary Studies, Capital Normal University, Beijing, 100080, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghua Dong Street, Chao Yang District, Beijing, 100029, China.
- China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, China.
| | - Huaping Dai
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, China.
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Department of Pulmonary and Critical Care Medicine, Friendship Hospital, 2 Yinghua Dong Street, Chao Yang District, Beijing, 100029, China.
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Kakuda A. Measuring Tidal Volume with Diaphragm Movement and Chest Circumference. Phys Ther Res 2025; 28:31-36. [PMID: 40321691 PMCID: PMC12047049 DOI: 10.1298/ptr.e10318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 01/21/2025] [Indexed: 05/08/2025]
Abstract
OBJECTIVE The movement of the diaphragm plays an important role in respiration. In this study, we proposed and validated a new method for estimating the volume of a single ventilation (representing the tidal volume [VT]) from the vertical distance of diaphragmatic movement and thoracic circumference. METHOD Diaphragm excursion (DE) was measured in healthy adult subjects via ultrasound, and the thoracic cavity volume change was estimated based on DE and thoracic circumference. Moreover, we measured the VT obtained by an expiratory gas analyzer and examined the relationships between DE and thoracic volume change (TVC) and between DE and VT. RESULTS The results showed that a correlation (ρ = 0.609) existed between DE and VT, and an even higher correlation existed between TVC and VT. TVC correlated better with the product of thoracic circumference squared and DE (ρ = 0.839) than with the product of thoracic circumference and DE as an alternative index (ρ = 0.746). CONCLUSION Our findings demonstrate that, taking into account body size in addition to DE, changes in thoracic cavity volume are useful predictors of VT and provide an alternative measure for assessing the respiratory function, which will improve clinical and research practice in respiratory care.
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Affiliation(s)
- Akihiro Kakuda
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Japan
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Li Q, Chen X, Han J, Xie Y, Gu C. Comparing C3, 4, and 5 nerve root block and interscalene with intermediate cervical plexus block in diaphragmatic motion for clavicle surgery. Sci Rep 2025; 15:289. [PMID: 39747872 PMCID: PMC11697284 DOI: 10.1038/s41598-024-80270-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 11/18/2024] [Indexed: 01/04/2025] Open
Abstract
Regional anesthesia is a popular method for surgical anesthesia in clavicular surgery. Selective blocking of the cervical 3, 4, and 5 nerve roots shows promise in clavicle surgery, with its fast onset, good anesthesia and less complications, necessitating evaluation of its impact on diaphragmatic function. The purpose of this study is to examine the safety of C3, 4, and 5 nerve root block for its application in clavicle surgery. We conducted a pragmatic, randomized trial to evaluate the effect of C3, 4, and 5 nerve root block as compared with interscalene with intermediate cervical plexus block in diaphragmatic motion. This study involved forty patients undergoing right clavicle surgery. Patients were assigned in a 1:1 ratio to either a C345 nerve root block (administered with 2, 3, and 5 ml of 0.5% ropivacaine) or an interscalene with intermediate cervical plexus block (ISB + ICPB, each receiving 10 ml of 0.5% ropivacaine). Diaphragmatic kinetics were quantitatively assessed using sonographic techniques. The primary outcome was the incidence of complete hemi-diaphragmatic paralysis, observed at 30 min post-blockade. Secondary outcomes included the rate of complete hemi-diaphragmatic paralysis at 15 min and the degree of diaphragmatic motion restoration at 2, 4, 6, and 8 h post-blockade, onset time of block, motor block score in upper extremity, and adverse events. Results showed that only one patient (5%) in the C345 group vs. fifteen (75%) in the ISB + ICPB group experienced complete hemi-diaphragmatic paralysis at 30 min during deep breathing (P = 0.001). No patients in the C345 group, compared to five (25%) in the ISB + ICPB group exhibited paradoxical movement at 30 min during voluntary sniffing (P = 0.0471). Additionally, the C345 group demonstrated significantly greater diaphragmatic motion and upper limb strength restoration at all measured intervals post-blockade. Moreover, faster onset time and less adverse events were observed in the C345 group vs. in the ISB + ICPB group. Benefit from low volume of local anesthetics, the C345 nerve root block not only significantly reduces the incidence of complete hemi-diaphragmatic paralysis but also facilitates better recovery from diaphragmatic paralysis compared to the ISB + ICPB. It can be inferred that C345 is a more beneficial anesthesia method for early recovery of clavicular patients.Trial registration number: ChiCTR2300078283 04/12/2023.
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Affiliation(s)
- Qi Li
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Xiaoxiao Chen
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Junde Han
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Yaming Xie
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Chentao Gu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China.
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Li T, Wu XZ, Long D, Fu H, Guo S, Liu F. Ultrasonographic modeling of lung and diaphragm mechanics: clinical trial of a novel non-invasive method to evaluate pre-operative pulmonary function. PeerJ 2024; 12:e18677. [PMID: 39713148 PMCID: PMC11663399 DOI: 10.7717/peerj.18677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 11/19/2024] [Indexed: 12/24/2024] Open
Abstract
Background Pre-operative pulmonary function testing (PFT) plays a key role in predicting postoperative complications or functional impairment. However, PFT requires the subject and examiner to cooperate and the results are influenced by both technical and personal factors. In contrast, the use of ultrasound (US) for structural and functional assessments of the lungs and diaphragm is on the rise, as it requires minimal patient cooperation. Dyspnea is mainly caused by lung or pleural lesions but may also be caused by weak respiratory muscles. As the diaphragm is a primary respiratory muscle, combining lung ultrasonography (LUS) with diaphragm ultrasound (DUS) may enable a more comprehensive assessement of pulmonary function. This study aims to introduce a novel approach for assessing pulmonary function using a mathematical model based on LUS and DUS. Methods This prospective study was performed at the First Affiliated Hospital of Nanchang University between June 2021 and December 2021, 208 patients were recruited and underwent PFT, LUS, and DUS examinations. An experienced physician, blinded to the clinical history and PFT results, performed LUS and DUS and explored the correlations between a mathematical model (ultrasonographic modeling score (U-score)) using LUS combined with DUS and pulmonary function parameters. Univariate, multivariate, and logistic regression analyses were also performed. Results According to the univariate and multivariable analysis, diaphragm thickness fraction in deep breathing (D-DTF) (odds ratio (OR), 0.88; 95% confidence interval (CI) [0.83-0.94]; P < 0.001), and LUS score (OR, 1.44; 95% CI [1.16-1.80]; P < 0.001) were each independently associated with pulmonary function. According to the logistics equation, a U-score of -0.126 × D-DTF + 0.368 × LUS score was produced. The U-score showed a more significant negative correlation with forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) (r = -0.605, P < 0.001) than the LUS or DUS indices alone. The U-score (area under the curve (AUC) = 0.971) was greater than the other indices for assessing pulmonary function. Conclusions With validation, the U-score through both lung and diaphragm ultrasound measurements may assist in estimating pulmonary function. This approach facilitates the assessment of pulmonary function in patients who may be unable to reliably participate in PFT.
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Affiliation(s)
- Tianyuan Li
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xiong-zhi Wu
- Department of Anesthesiology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Dingde Long
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Huan Fu
- Department of Anesthesiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Suping Guo
- Department of Ultrasound Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Fen Liu
- Department of Intensive Care Unit, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
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Madeira LC, Dalcin PDT, Schuster GH, Conte B, Wolf JM, Schreiber A, Rouby JJ, Dexheimer-Neto FL. Lung ultrasound score and diaphragm ultrasound in weaning from mechanical ventilation: are they different in patients with and without COVID-19? J Bras Pneumol 2024; 50:e20240302. [PMID: 39661844 PMCID: PMC11601084 DOI: 10.36416/1806-3756/e20240302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 09/30/2024] [Indexed: 12/13/2024] Open
Abstract
OBJECTIVE To compare pre-extubation physiological characteristics and ultrasound variables between patients intubated for COVID-19 compared to a clinical population and those intubated for other reasons. METHODS This was a secondary analysis of a prospective cohort study of patients undergoing invasive mechanical ventilation (IMV) for more than 48 h. Patients were divided into two groups: those intubated for COVID-19-induced ARDS and those intubated for other clinical reasons. Ultrasound assessment of lung and diaphragm function was performed before extubation. The results were compared between the two groups of patients. RESULTS In comparison with the patients without COVID-19, those with the disease were younger (a median age of 58 [46-76] years vs. a median age of 75 [69-85] years; p = 0.01), had fewer comorbidities (a median Charlson Comorbidity Index of 2 [1-4] vs. a median Charlson Comorbidity Index of 5 [4-6]; p < 0.01), and were less severely ill at admission (a median APACHE II score of 9 [8-14] vs. a median APACHE II score of 18 [13-22]; p < 0.01). In addition, the median duration of IMV was longer in the COVID-19 patients (11 [9-23] days vs. 6 [3-8] days; p < 0.01). Although extubation success rates were similar between the COVID-19 and non-COVID-19 groups (22 [71%] vs. 35 [77.8%]), median lung ultrasound score differed between the two groups (23 [18-25] vs. 15 [11-18]; p < 0.01), as did median diaphragmatic excursion (2.1 [1.7-2.4] vs. 1.7 [1.2-2.0]; p < 0.01). CONCLUSIONS Although patients with COVID-19 requiring ventilatory support are younger and have fewer comorbidities than those intubated for other clinical reasons, they experience longer hospital stays. Although lung ultrasound score can differ between patients with and without COVID-19, these differences do not significantly translate into extubation success rates. Therefore, the utility of ultrasound scores in weaning COVID-19 patients from IMV needs further study.
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Affiliation(s)
- Laura Cordeiro Madeira
- . Centro de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
- . Programa de Pós-Graduação em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Paulo de Tarso Dalcin
- . Programa de Pós-Graduação em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Bruna Conte
- . Centro de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | - Jonas Michel Wolf
- . Escritório de Gestão da Prática Clínica, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | - Annia Schreiber
- . Unity Health Toronto, St. Michael's Hospital, Interdepartmental Division of Critical Care Medicine, Toronto (ON) Canada
| | - Jean-Jacques Rouby
- . Réanimation Polyvalente, Département d'Anesthésie-Réanimation, Universitè Pierre et Marie Curie - UPMC - Sorbonne Université, Paris, France
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Tashiro D, Oki Y, Nonomura N, Takeyama Y, Osaki T, Morimoto Y. Maximum abdominal excursion assessment using an abdominal excursion measuring device: Reliability and validity of a new device for simple and quantitative assessment of respiratory function. Med Eng Phys 2024; 124:104093. [PMID: 38418023 DOI: 10.1016/j.medengphy.2023.104093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024]
Abstract
This study aimed to verify the reliability and validity of abdominal expansion and respiratory function measurements. Forty healthy adult males underwent lung capacity, effort lung capacity, respiratory muscle strength, cough strength, diaphragm ultrasound, and abdominal expansion measurements. Abdominal expansion was measured using a device developed to accurately evaluate abdominal movements and calculate maximum abdominal expansion on the ventral side (AE-max: the difference between maximal abdominal contraction at the same time as maximal-effort expiration and maximal abdominal expansion at the same time as maximal-effort inspiration). Intra- and inter-rater reliabilities of the AE-max measurements were examined, the paired t-test was used for assessing the ratios of the expansion and contraction displacement components in AE-max, and regression analysis was used to obtain equations for predicting maximum inspiratory pressure (MIP) based on AE-max. Both intra- and inter-rater reliabilities were high. Criterion-related validity showed that AE-max was associated with all respiratory function parameters, especially MIP, and a high percentage of expansion displacement. Regression analysis showed that AE-max was significantly associated with MIP. Based on its association with MIP, the large proportion of expansion displacement in AE-max, and the results of the multiple regression analysis, we conclude that AE-max is a helpful measure for estimating MIP.
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Affiliation(s)
- Daisuke Tashiro
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan.
| | - Yutaro Oki
- Department of Public Health Kobe University Graduate School of Health Sciences, Kobe City, Hyogo, Japan
| | - Natsuha Nonomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Yuki Takeyama
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Tohmi Osaki
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Yosuke Morimoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan; Department of Rehabilitation, Nishi-Kinen Port-island Rehabilitation Hospital, Kobe City, Hyogo, Japan
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Lee Y, Kim Y, Kim D. Effects of Chest Mobilization and Breathing Exercises on Respiratory Function, Trunk Stability, and Endurance in Chronic Stroke Patients after Coronavirus Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2180. [PMID: 38138283 PMCID: PMC10744534 DOI: 10.3390/medicina59122180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: This study investigates the effects of chest mobilization and breathing exercises on respiratory function, trunk stability, and endurance in chronic stroke patients who have contracted coronavirus disease (COVID-19). Materials and Methods: Thirty inpatients of a tertiary hospital in South Korea, who had a history of COVID-19 and were diagnosed with stroke within the last 6 months, were randomly assigned to either chest mobilization exercise with breathing exercise (CMEBE) or conservative physical therapy with breathing exercise (CPTBE) groups. The respiratory function, trunk stability, and endurance were measured at baseline and 6 weeks after the interventions. Results: Both CMEBE and CPTBE groups showed improvements in respiratory function, trunk stability, and endurance after the intervention (p < 0.05). However, the CMEBE group showed significantly greater improvements in forced expiratory volume in 1 s (p < 0.05), trunk stability (p < 0.05), and endurance (p < 0.05) than the CPTBE group. No significant intergroup difference was observed in forced vital capacity and peak expiratory flow. Conclusions: The combination of chest mobilization and breathing exercises improved respiratory muscle mobility and endurance, stabilized the trunk, and enhanced balance and the transfer of weight. The findings suggest that this intervention could be beneficial in improving respiratory function and endurance in stroke patients.
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Affiliation(s)
- Yangjin Lee
- Department of Physical Therapy, Gyeongbuk College, 77 Daehang-ro, Yeongju-si 36133, Republic of Korea;
| | - Yoorim Kim
- Department of Physical Therapy, Gimcheon University, 214 Daehak-ro, Gimcheon 39528, Republic of Korea
| | - Donghoon Kim
- Department of Physical Therapy, Gimcheon University, 214 Daehak-ro, Gimcheon 39528, Republic of Korea
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Milesi J, Boussuges A, Habert P, Bermudez J, Reynaud-Gaubert M, Delliaux S, Bregeon F, Coiffard B. Ultrasound evaluation of diaphragmatic function in patients with idiopathic pulmonary fibrosis: a retrospective observational study. Respir Res 2023; 24:259. [PMID: 37898765 PMCID: PMC10613389 DOI: 10.1186/s12931-023-02577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION The diaphragm function assessed by ultrasound has been well-studied in COPD, asthma, and intensive care. However, there are only a few studies on diffuse interstitial lung disease, while dyspnea and quality of life are major issues in the management that may depend on the diaphragm. METHODS We retrospectively included idiopathic pulmonary fibrosis (IPF) patients followed in our center (Marseille, France) between January 2020 and February 2023 who underwent diaphragmatic ultrasound. Our objectives were to describe the diaphragmatic function of IPFs compared to healthy controls and to correlate with clinical, functional, and lung density on CT-scan. RESULTS 24 IPF patients and 157 controls were included. The diaphragmatic amplitude in IPF was increased at rest (median of 2.20 cm vs 1.88 cm on the right, p < 0.007, and 2.30 cm vs 1.91 cm on the left, p < 0.03, in IPF and controls respectively) and decreased in deep breathing (median of 4.85 cm vs 5.45 cm on the right, p < 0.009, and 5.10 cm vs 5.65 cm on the left, p < 0.046, in IPF and controls respectively). Diaphragmatic thickness was significantly reduced at rest on the right side (median of 1.75 mm vs 2.00 mm, p < 0.02, in IPF and controls respectively) and in deep breathing on both sides compared to controls (mean of 3.82 mm vs 4.15 mm on the right, p < 0.02, and 3.53 mm vs 3.94 mm, on the left, p < 0.009, in IPF and controls respectively). Diaphragmatic amplitude in deep breathing was moderate to strongly correlated with FVC, DLCO, and 6MWT and negatively correlated with the dyspnea and lung density on CT scan. CONCLUSION The diaphragmatic amplitude and thickness were impaired in IPF compared to controls. Diaphragmatic amplitude is the parameter best correlated with clinical, functional, and lung density criteria. Further studies are needed to determine if diaphragmatic amplitude can be a prognostic factor in IPF.
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Affiliation(s)
- Jules Milesi
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Alain Boussuges
- Pulmonary Function Testing Laboratory, APHM, Aix-Marseille University, Marseille, France
| | - Paul Habert
- Department of Radiology, APHM, Aix-Marseille University, Marseille, France
- LIIE, Aix-Marseille University, Marseille, France
- CERIMED, Aix-Marseille University, Marseille, France
| | - Julien Bermudez
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Stéphane Delliaux
- Pulmonary Function Testing Laboratory, APHM, Aix-Marseille University, Marseille, France
| | - Fabienne Bregeon
- Pulmonary Function Testing Laboratory, APHM, Aix-Marseille University, Marseille, France
| | - Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France.
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11
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Janssen ML, Jonkman AH, Wennen M, Wils EJ, Endeman H, Heunks L. Diaphragm excursions as proxy for tidal volume during spontaneous breathing in invasively ventilated ICU patients. Intensive Care Med Exp 2023; 11:73. [PMID: 37891413 PMCID: PMC10611662 DOI: 10.1186/s40635-023-00553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
There is a need to monitor tidal volume in critically ill patients with acute respiratory failure, given its relation with adverse clinical outcome. However, quantification of tidal volume in non-intubated patients is challenging. In this proof-of-concept study, we evaluated whether ultrasound measurements of diaphragm excursion could be a valid surrogate for tidal volume in patients with respiratory failure. Diaphragm excursions and tidal volumes were simultaneously measured in invasively ventilated patients (N = 21) and healthy volunteers (N = 20). Linear mixed models were used to estimate the ratio between tidal volume and diaphragm excursion. The tidal volume-diaphragm excursion ratio was 201 mL/cm in ICU patients [95% confidence interval (CI) 161-240 mL/cm], and 361 (294-428) mL/cm in healthy volunteers. An excellent association was shown within participants (R2 = 0.96 in ICU patients, R2 = 0.90 in healthy volunteers). However, the differences between observed tidal volume and tidal volume as predicted by the linear mixed models were considerable: the 95% limits of agreement in Bland-Altman plots were ± 91 mL in ICU patients and ± 396 mL in healthy volunteers. Likewise, the variability in tidal volume estimation between participants was large. This study shows that diaphragm excursions measured with ultrasound correlate with tidal volume, yet quantification of absolute tidal volume from diaphragm excursion is unreliable.
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Affiliation(s)
- Matthijs L Janssen
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Annemijn H Jonkman
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Myrte Wennen
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
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12
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Gupta R, Bandyopadhyay T, Yadav B, Guleria M, Maria A. Sonographic assessment of diaphragmatic thickness and excursion to predict CPAP failure in neonates below 34 weeks of gestation: A prospective cohort study. Pediatr Pulmonol 2023; 58:2889-2898. [PMID: 37530492 DOI: 10.1002/ppul.26608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND To evaluate the diagnostic accuracy of sonographic assessment of diaphragmatic dimensions and excursions in predicting Continuous Positive Airway Pressure (CPAP) failure in preterm neonates with respiratory distress. METHODS Prospective cohort study among preterm neonates less than 34 weeks of gestation who were hemodynamically stable and either admitted with respiratory distress or who developed respiratory distress shortly after admission to the NICU and having Silverman-Anderson Score (SAS) ≥ 3/10 were included. We performed sonographic assessment of diaphragmatic dimensions and excursions before and one hour ±30 minutes after application of CPAP. 'CPAP failure' was defined as combined outcome of the need of surfactant and/or upgradation of respiratory support within first 72 hours after a trial of CPAP. Clinical parameters and diaphragmatic measurements were compared between CPAP failure and success groups. RESULTS Of 62 participants, 20 (32%) failed CPAP. On binomial logistic regression (after adjustment for gestational age and birth weight), initial SAS, higher diaphragmatic excursion (both left and right, before and after CPAP application), lower left hemidiaphragm diaphragmatic thickness fraction (DTF) (before CPAP application) and lower right DTF (after CPAP application) were independent predictors of CPAP failure. However, the receiver-operating characteristics curves showed that excursions of right and left hemi-diaphragm both before and after CPAP application, had highest accuracies in predicting CPAP failure (AUC 0.84, 0.80 and 0.86, 0.78, respectively; p < .001). CONCLUSION Diaphragmatic excursion can be a useful parameter to predict the failure of CPAP in preterm neonates with respiratory distress.
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Affiliation(s)
- Rashi Gupta
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | | | - Bharti Yadav
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Munish Guleria
- Department of Radiodiagnosis, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Arti Maria
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
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13
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Suttapanit K, Wongkrasunt S, Savatmongkorngul S, Supatanakij P. Ultrasonographic evaluation of the diaphragm in critically ill patients to predict invasive mechanical ventilation. J Intensive Care 2023; 11:40. [PMID: 37726832 PMCID: PMC10507830 DOI: 10.1186/s40560-023-00690-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Diaphragm dysfunction is common in critically ill patients and associated with poorer outcomes. The function of the diaphragm can be evaluated at the bedside by measuring diaphragmatic excursion using ultrasonography. In this study, we investigated the ability of right-sided diaphragmatic excursion (RDE) to predict the need for invasive mechanical ventilation (IMV). METHODS Critically ill patients aged 18 years and older who presented to our emergency department between May 20, 2021 and May 19, 2022 and underwent measurement of RDE within 10 min of arrival were enrolled in this prospective study. The ability of RDE to predict the need for IMV was assessed by multivariable logistic regression and analysis of the area under the receiver-operating characteristic curve (AUROC). RESULTS A total of 314 patients were enrolled in the study; 113 (35.9%) of these patients required IMV. An increase of RDE value per each 0.1 cm was identified to be an independent predictor of IMV (adjusted odds ratio 0.08, 95% confidence interval [CI] 0.04-0.17, p < 0.001; AUROC 0.850, 95% CI 0.807-0.894). The RDE cutoff value was 1.2 cm (sensitivity 82.3%, 95% CI 74.0-88.8; specificity 78.1%, 95% CI 71.7-83.6). Time on a ventilator was significantly longer when the RDE was ≤ 1.2 cm (13 days [interquartile range 5, 27] versus 5 days [interquartile range 3, 8], p = 0.006). CONCLUSIONS In this study, RDE had a good ability to predict the need for IMV in critically ill patients. The optimal RDE cutoff value was 1.2 cm. Its benefit in patient management requires further investigation.
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Affiliation(s)
- Karn Suttapanit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Supawit Wongkrasunt
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Sorravit Savatmongkorngul
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Praphaphorn Supatanakij
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand.
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14
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Gao Y, Yin H, Wang MH, Gao YH. Accuracy of lung and diaphragm ultrasound in predicting infant weaning outcomes: a systematic review and meta-analysis. Front Pediatr 2023; 11:1211306. [PMID: 37744441 PMCID: PMC10511769 DOI: 10.3389/fped.2023.1211306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Although lung and diaphragm ultrasound are valuable tools for predicting weaning results in adults with MV, their relevance in children is debatable. The goal of this meta-analysis was to determine the predictive value of lung and diaphragm ultrasound in newborn weaning outcomes. Methods For eligible studies, the databases MEDLINE, Web of Science, Cochrane Library, PubMed, and Embase were thoroughly searched. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) method was used to evaluate the study's quality. Results were gathered for sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve of summary receiver operating characteristic curves (AUSROC). To investigate the causes of heterogeneity, subgroup analyses and meta-regression were conducted. Results A total of 11 studies were suitable for inclusion in the meta-analysis, which included 828 patients. The pooled sensitivity and specificity of lung ultrasound (LUS) were 0.88 (95%CI, 0.85-0.90) and 0.81 (95%CI, 0.75-0.87), respectively. The DOR for diaphragmatic excursion (DE) is 13.17 (95%CI, 5.65-30.71). The AUSROC for diaphragm thickening fraction (DTF) is 0.86 (95%CI, 0.82-0.89). The most sensitive and specific method is LUS. The DE and DTF were the key areas where study heterogeneity was evident. Conclusions Lung ultrasonography is an extremely accurate method for predicting weaning results in MV infants. DTF outperforms DE in terms of diaphragm ultrasound predictive power.
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Affiliation(s)
- Yang Gao
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Hong Yin
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Mei-Huan Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yue-Hua Gao
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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15
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Güngör Ş, Doğan A. Diaphragm thickness by ultrasound in pediatric patients with primary malnutrition. Eur J Pediatr 2023:10.1007/s00431-023-05024-x. [PMID: 37178359 PMCID: PMC10182341 DOI: 10.1007/s00431-023-05024-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Skeletal muscle atrophy is known to be a marker for nutritional deficiency. The diaphragm is both a skeletal muscle and a respiratory muscle. There is not enough data in the literature about the change in diaphragm thickness (DT) in children with malnutrition. We think that malnutrition may have negative effects on diaphragm thickness. Therefore, in this study, we aimed to compare the diaphragm thicknesses of pediatric patients with primary malnutrition and a healthy control group. The DT of pediatric patients diagnosed with primary malnutrition by a pediatric gastroenterologist was prospectively evaluated by a radiology specialist by ultrasonography (USG). The obtained data were statistically compared with the data of the healthy control group. There was no statistically significant difference between the groups in terms of age and gender (p = 0.244, p = 0.494). We found that right and left diaphragm thicknesses were significantly thinner in the malnourished group than in the healthy control group (p = 0.001, p = 0.009, respectively). We found that right and left diaphragm thicknesses were thinner in those with moderate and severe malnutrition compared to the normal group (p < 0.001, p = 0.003, respectively). We found a significant weak positive correlation between weight and height Z score and right and left diaphragm thickness (respectively, r: 0.297, p < 0.001; r: 0.301, p < 0.001). Conclusion: Malnutrition is a disease that affects all systems. Our study shows that the DT is thinner in patients with malnutrition. What is Known: •Malnutrition causes skeletal muscle atrophy. What is New: •Diaphragm muscle thickness decreases in malnutrition. •There is a significant positive correlation between diaphragm muscle thickness and height, weight and BMI z scores.
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Affiliation(s)
- Şükrü Güngör
- Department of Pediatric Gastroenterology, School of Medicine, Kahramanmaras Sütcü İmam University, Kahramanmaras, Turkey
| | - Adil Doğan
- Department of Radiology, School of Medicine, Kahramanmaras Sütcü İmam University, 46010, Kahramanmaras, Turkey.
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16
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Kalbaran Kısmet G, Okutan O, Ayten Ö, Samancı C, Yeşildal M, Kartaloğlu Z. Diaphragmatic ultrasonography in patients with IPF: Is diaphragmatic structure and mobility related to fibrosis severity and pulmonary functional changes? Tuberk Toraks 2023; 71:13-23. [PMID: 36912405 PMCID: PMC10795268 DOI: 10.5578/tt.20239903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Introduction There is evidence to suggest that dyspnea and impaired exercise capacity are associated with respiratory muscle dysfunction in idiopathic pulmonary fibrosis (IPF) patients. We aimed to evaluate the functions of the diaphragm with ultrasonography (US) and to determine the correlation of the data obtained with the pulmonary function parameters of the patients, exercise capacity, and the extent of fibrosis radiologically. Materials and Methods Diaphragmatic mobility, thickness, and thickening fraction (TF) were measured by ultrasonography in IPF patients and the control group. The correlation between these measurements, pulmonary function tests (PFT), six-minute walking test (6MWT), mMRC score, and total fibrosis score (TFS) was evaluated. Result Forty-one IPF patients and twenty-one healthy volunteers were included in the study. No difference was found between the patient and control groups in diaphragmatic mobility during quiet breathing (QB) on ultrasound (2.35 cm and 2.56 cm; p= 0.29). Diaphragmatic mobility during deep breathing (DB) was found to be lower in the patient group when compared to the control group (5.02 cm and 7.66 cm; p<0.0001). Diaphragmatic thickness was found to be higher during QB and DB in IPF patients (0.33 cm and 0.31 cm, p= 0.043; 0.24 cm and 0.22 cm, p= 0.045). No difference was found between the two groups in terms of thickening fraction (39.37%, 44.16%; p= 0.49). No significant correlation was found between US measurements and PFT, 6MWT, mMRC score, and TFS in IPF patients (p> 0.05). Conclusions The functions of the diaphragm do not appear to be affected in patients with mild-to-moderate restrictive IPF. This study showed that there was no relationship between diaphragmatic functions and respiratory function parameters and the extent of fibrosis. Further studies, including advanced stages of the disease, are needed to understand the changes in diaphragmatic functions in IPF and to determine whether this change is associated with respiratory function parameters and the extent of fibrosis.
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Affiliation(s)
- Gözde Kalbaran Kısmet
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Oğuzhan Okutan
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Ömer Ayten
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Cesur Samancı
- Department of Radiology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Türkiye
| | - Melike Yeşildal
- Clinic of Radiology, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Zafer Kartaloğlu
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
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Mahrous RSS, Ismail TI. Comparison of subomohyoid plane block and interscalene nerve block for arthroscopic shoulder surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2131348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rabab S. S Mahrous
- Department of Anesthesia and Surgical Intensive Care, Alexandria University, Alexandria, Egypt
| | - Tarek I Ismail
- Department of Anesthesia and Surgical Intensive Care, Helwan University, Cairo, Egypt
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18
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Pałac M, Rutka M, Wolny T, Podgórski M, Linek P. Ultrasonography in Assessment of Respiratory Muscles Function: A Systematic Review. Respiration 2022; 101:878-892. [PMID: 35760051 DOI: 10.1159/000524785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the potential utility of respiratory muscles ultrasound (US) imaging for assessing respiratory function and identify US variables that best correlate with pulmonary parameters. MATERIALS AND METHODS A search of 5 databases was conducted. Initially, there was no language, study design, or time frame restrictions. All studies assessing the relationship between pulmonary and US parameters were included. Two reviewers independently extracted and documented data regarding to examined population, age, gender, health condition, methodology, US, and pulmonary function measurements. All studies were qualitative synthesis. RESULTS A total of 1,272 participants from 31 studies were included. Diaphragm thickness, diaphragm thickening ratio, and diaphragm excursion amplitude were mainly used as US parameters. Forced vital capacity, forced expiratory volume1sec, and maximal inspiratory pressure were mainly used as pulmonary parameters. The relationships between pulmonary and US parameters varied from negligible to strong (depend on examined population and methodology used). Data were not quantitatively synthesis due to high heterogeneity in terms of study design, population examined, and various pulmonary and US parameters. CONCLUSION A strong relationship between US measurements and pulmonary parameters was demonstrated in some studies but not others. This review confirmed that US measurements can complement spirometry, but the exact role of the US remains to be confirmed. Further studies using standardized methodology are needed to obtain more conclusive evidence on the usefulness of US for assessing respiratory function.
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Affiliation(s)
- Małgorzata Pałac
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Magdalena Rutka
- Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Tomasz Wolny
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Michał Podgórski
- Department of Radiology, Diagnostic Imaging and Interventional Radiology, Medical University of Lodz, Łódź, Poland
| | - Paweł Linek
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Fayssoil A, Mansencal N, Nguyen LS, Orlikowski D, Prigent H, Bergounioux J, Annane D, Lofaso F. Diaphragm Ultrasound in Cardiac Surgery: State of the Art. MEDICINES 2022; 9:medicines9010005. [PMID: 35049938 PMCID: PMC8779362 DOI: 10.3390/medicines9010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
In cardiac surgery, patients are at risk of phrenic nerve injury, which leads to diaphragm dysfunction and acute respiratory failure. Diaphragm dysfunction (DD) is relatively frequent in cardiac surgery and particularly affects patients after coronary artery bypass graft. The onset of DD affects patients’ prognosis in term of weaning from mechanical ventilation and hospital length of stay. The authors present a narrative review about diaphragm physiology, techniques used to assess diaphragm function, and the clinical application of diaphragm ultrasound in patients undergoing cardiac surgery.
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Affiliation(s)
- Abdallah Fayssoil
- Echo Lab, CHU de Raymond-Poincaré, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- INSERM U1179, END-ICAP, Université de Versailles-Saint Quentin, University of Paris-Saclay, 78180 Montigny-le-Bretonneux, France; (H.P.); (F.L.)
- Raymond Poincaré Hospital, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Versailles-Saint Quentin, 92100 Boulogne, France;
- Correspondence:
| | - Nicolas Mansencal
- Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Versailles-Saint Quentin, 92100 Boulogne, France;
- INSERM U-1018, CESP, Épidémiologie Clinique, 94807 Villejuif, France
| | - Lee S. Nguyen
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, AP-HP, Centre, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France;
- France Research and Innovation Department, CMC Ambroise Paré, RICAP, 27 bd Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - David Orlikowski
- Service de Réanimation Médicale, CHU Raymond Poincaré, AP-HP, Université de Versailles Saint Quentin en Yvelines, 92380 Garches, France;
- Centre d’Investigation Clinique et Innovation Technologique CIC 14.29, INSERM, 92380 Garches, France
| | - Hélène Prigent
- INSERM U1179, END-ICAP, Université de Versailles-Saint Quentin, University of Paris-Saclay, 78180 Montigny-le-Bretonneux, France; (H.P.); (F.L.)
- Raymond Poincaré Hospital, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest—Site Raymond Poincaré—AP-HP, 92380 Garches, France
| | - Jean Bergounioux
- Pediatric Neurology and ICU, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, 92380 Garches, France;
| | - Djillali Annane
- Laboratory Infection and Inflammation, Department of Critical Care, Raymond Poincaré Hospital (AP-HP), U1173, Faculty of Health Science Simone Veil, Université de Versailles-Saint Quentin, University Paris Saclay, INSERM, FHU SEPSIS, RHU RECORDS, 78180 Montigny-le-Bretonneux, France;
| | - Frédéric Lofaso
- INSERM U1179, END-ICAP, Université de Versailles-Saint Quentin, University of Paris-Saclay, 78180 Montigny-le-Bretonneux, France; (H.P.); (F.L.)
- Raymond Poincaré Hospital, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest—Site Raymond Poincaré—AP-HP, 92380 Garches, France
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Rives S, Schmid B, Chaumet G, Brégeon F, Boussuges A. Changes in Diaphragmatic Function Induced by an Increased Inspiratory Load Experienced by Military Divers: An Ultrasound Study. Front Physiol 2021; 12:756533. [PMID: 34916955 PMCID: PMC8670941 DOI: 10.3389/fphys.2021.756533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Inspiratory loading is experienced by military divers when they use rebreather device. Our objective was to assess the changes in diaphragm function induced by an increase in inspiratory load at values similar to those experienced by divers in real life. Methods: We recorded the excursion and the thickness of the right hemidiaphragm in 22 healthy male volunteers under inspiratory load conditions, using ultrasound in B- and M-mode. The measurements were performed at tidal volume and during breathing at 50% of inspiratory capacity. The breathing rate was regulated and similar in the various sessions with and without load. Results: The rebreather device used by French military divers leads to an increase in inspiratory load of close to 30 cmH2O. Consequently, the session under load was performed using a device set to this threshold. Significant increases in the excursion and the thickening fraction of the diaphragm were observed between the sessions at tidal volume and at high volume. With addition of the inspiratory load, the excursion of the right hemidiaphragm increased significantly from 2.3 to 3.4cm at tidal volume and from 3.9 to 4.7cm at high volume. The thickening fraction increased significantly from 30.4 to 76.6% at tidal volume and from 70 to 123% at high volume. The statistical analysis demonstrated that assessment of the changes of the thickening fraction during breathing at tidal volume was the most relevant marker to assess the impact of the inspiratory load on the diaphragm. Conclusion: Diaphragm ultrasound can be used to assess the changes in the diaphragm contraction pattern secondary to an increase in the respiratory load that can be generated by use a diving apparatus. The recording of the changes of the motion, and more importantly of the thickness of the diaphragm, during the breathing cycle is able to provide relevant information regarding the inspiratory load.
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Affiliation(s)
- Sarah Rives
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Bruno Schmid
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | | | - Fabienne Brégeon
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
| | - Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France.,Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
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21
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Saisawart P, Sutthigran S, Soontornvipart K, Thanaboonnipat C, Darawiroj D, Choisunirachon N. The Feasibility of Ultrasonographic Diaphragmatic Excursion in Healthy Dogs: Effect of Positioning, Diaphragmatic Location, and Body Weight of Dogs. Front Vet Sci 2021; 8:763556. [PMID: 34859091 PMCID: PMC8631322 DOI: 10.3389/fvets.2021.763556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Diaphragmatic excursion (DE) has been utilized for detecting respiratory related problems in humans. However, several factors should be considered such as the ultrasound technique and factors intrinsic to patients. Nevertheless, knowledge of the effect of these factors on DE in dogs is still lacking. The aim of this study was to evaluate the proper ultrasound technique by varying postures and diaphragmatic locations for DE measurement and to explore intrinsic factors such as diaphragmatic sides, sex, and body weight of dogs on DE. The prospective, analytic, cross-sectional study included 44 healthy dogs; 12 beagles and 32 dogs of other breeds. The experiment was divided into (i) an exploration of the proper ultrasound technique by varying postures (supine, standing, and recumbent in each of the right and left lateral positions), diaphragmatic locations (middle crus and proximal to the last rib), and diaphragmatic sublocations (xiphoid, mid, and proximal rib) for detection of DE and (ii) the evaluation of canine intrinsic factors affecting DE. The results show that the mid-diaphragmatic sublocation in the middle crus area in almost all positions revealed the highest percentage DE detection. However, DEs were revealed to be more accessible in the supine position. There was no significant difference in DE between the right and the left diaphragms or between the sexes of beagle dogs. However, body weight was significantly correlated with the DE among dogs of various sizes. In conclusion, the posture of the dogs and the diaphragmatic location can affect DE evaluation. Neither sex nor diaphragmatic side had an influence, but body weight was revealed as a major factor in DE in dogs.
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Affiliation(s)
- Phasamon Saisawart
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Somchin Sutthigran
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Kumpanart Soontornvipart
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Chutimon Thanaboonnipat
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Damri Darawiroj
- Department of Anatomy, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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Barbariol F, Deana C, Guadagnin GM, Cammarota G, Vetrugno L, Bassi F. Ultrasound diaphragmatic excursion during non-invasive ventilation in ICU: a prospective observational study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021269. [PMID: 34212900 PMCID: PMC8343726 DOI: 10.23750/abm.v92i3.11609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
Background and Aim: Diaphragmatic dysfunction is seen in up to 60% of critically ill patients with respiratory failure, and it is associated with worse outcomes. The functionality of the diaphragm can be studied with simple and codified bedside ultrasound evaluation. Diaphragm excursion is one of the most studied parameters. The aim of this study was to assess the prevalence of diaphragmatic dysfunction in critically ill non-intubated patients admitted to a general intensive care unit with acute respiratory failure. Methods: We collected data, including ultrasound diaphragm excursion, at 2 time points: at T0 (at the time of recruitment, just before starting NIV) and at T1 (after one hour of NIV). Results: A total of 47 patients were enrolled. The prevalence of diaphragm dysfunction was 42.5% (95% CI 28, 3 - 57,8). Surgical patients showed a higher incidence (relative risk of 1.97) than medical patients. Mean DE was not significantly different between NIV responders (1,35 ± 0.78 cm) and non-responders (1.21 ± 0.85 cm, p 0,6). Patients with diaphragmatic dysfunction responded positively to NIV in 60% (95% CI 36.0 - 80.9%) of cases, while patients without diaphragmatic dysfunction responded positively to the NIV trial in 70.4% (95% CI 49.8 - 86.2%) of cases (p = 0.54). Taking the use of ultrasound diaphragm excursion as a potential predictor of NIV response, the corresponding ROC curve had an area under the curve of 0.53; the best balance between sensitivity (58.1%) and specificity (62.5%) was obtained with a cut-off diaphragm excursion of 1.37 cm. Conclusions: Diaphragm dysfunction is particularly frequent in critically ill patients with respiratory failure. The functionality of the diaphragm can be effectively and easily tested by bedside ultrasound examination. Overall, our results point towards tentative evidence of a trend of a different response to NIV in patients with vs without diaphragmatic dysfunction. (www.actabiomedica.it)
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Affiliation(s)
- Federico Barbariol
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | - Cristian Deana
- Anesthesia and Intensive Care Unit 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | - Giovanni Maria Guadagnin
- Anesthesia and Intensive Care, Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | | | - Luigi Vetrugno
- Department of Medical Area, University of Udine, Udine, Italy..
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
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23
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Azour L, Mendelson DS, Rogers L, Salvatore MM. Diaphragmatic excursion: Quantitative measure to assess adequacy of expiratory phase CT chest images. Eur J Radiol 2021; 136:109527. [PMID: 33460955 DOI: 10.1016/j.ejrad.2021.109527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/03/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate diaphragmatic excursion as a quantitative metric for change in lung volume between inspiratory and expiratory chest computed tomography (CT) images. METHODS A 12-month retrospective review identified 226 chest CT exams with inspiratory and expiratory phase imaging, 63 in individuals referred with diagnosis of asthma by ICD9/10 code. Exams acquired in the supine position at 1.25 mm slice thickness in each phase were included (n = 30, mean age = 62, M = 15, F = 15). Diaphragmatic excursion was calculated as the difference between axial slices through the lungs on inspiration and expiration, using the lung apex as the cranial bound, and the hemidiaphragm caudally. Inspiratory and expiratory lung and tracheal volumes were calculated through volumetric segmentation. Tracheal morphology was assessed at 1 cm above the level of the aortic arch, and 1 cm above the carina. RESULTS Inspiratory and expiratory lung volumes were higher in men (mean I = 5 + 1.6 L, E = 3.1 + 1.2 L) than women (mean I = 3.6 + 0.8 L, E = 2.4 + 0.7 L), p = .005 and p = .047, respectively. Average inspiratory and expiratory tracheal volumes were higher in men (I = 61 + 17 mL, E = 43 + 14) than women (I = 44 + 14, E = 30 + 8), p = .006 and p = .005. Average change in lung and tracheal volume between inspiratory and expiratory scans did not significantly differ between men and women. Average diaphragmatic excursion was 2.5 cm between inspiratory and expiratory scans (2.7 cm in men, 2.3 cm in women; p = .5). There was a strong positive correlation between diaphragmatic excursion and change in lung (r = .84) and tracheal volume (r = .79). A moderate correlation was also found between change in tracheal volume and change in lung volume (r = 0.67). Change in tracheal morphology between inspiratory and expiratory imaging was associated with change in tracheal volume at both 1 cm above the aortic arch (p = .04) and 1 cm above the carina (p = .008); there was no association with diaphragmatic excursion or lung volume. CONCLUSIONS Diaphragmatic excursion is a quantitative measure of expiratory effort as validated by both lung and tracheal volumes in asthma patients, and may be more accurate than qualitative assessment based on tracheal morphology.
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Affiliation(s)
- Lea Azour
- Department of Radiology, Icahn School of Medicine at Mount Sinai, United States; Department of Radiology, NYU Langone Health, United States.
| | - David S Mendelson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, United States
| | - Linda Rogers
- Department of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Mary M Salvatore
- Department of Radiology, Icahn School of Medicine at Mount Sinai, United States; Department of Radiology, Columbia University Medical Center, United States
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24
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Loizou CP, Chrysostomou C, Minas G, Pattichis CS. Ultrasound diaphragmatic manual and semi-automated motion measurements: Application in simulated and in vivo data of critically ill subjects. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 194:105517. [PMID: 32446038 DOI: 10.1016/j.cmpb.2020.105517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound diaphragmatic muscle motion characteristics may provide useful information about normal or abnormal diaphragmatic function and indicate diaphragmatic weakness, or paralysis. In the present work we propose and evaluate an integrated semi-automated analysis system for the quantitative analysis of ultrasonic motion from ultrasound diaphragmatic videos. METHODS The proposed system was evaluated in simulated videos and in 13 patients, four of whom patients were mechanically ventilated. The major steps of the methodology were as follows: video normalization, despeckle filtering, generation of an M-Mode image, snakes segmentation, and motion measurements. RESULTS The following manual (-/) vs semi-automated (/-), (median±IQR) measurements, which are routinely carried out by the experts, for assessing the severity of the disease, were computed. For the simulated videos the diaphragmatic excursion was 1.80±0.00 cm / 1.76±0.03 cm. For all the real ultrasound videos investigated in this study the following measurements were computed: (i) diaphragmatic excursion: 0.84±0.15 cm / 0.83±0.14 cm, (ii) inspiration time (Tinsp): 0.71±0.18 sec / 0.70±0.15 sec, (iii) total breathing time for one cycle (Ttot): 1.71±0.37 sec / 1.67±0.37 sec, (iv) diaphragmatic curve slope: 1.29±0.36 cm/sec / 1.27±0.36 cm/sec, and (v) relaxation rate (RR): 0.82±0.17 cm/sec / 0.82±0.18 cm/sec. CONCLUSIONS Manual and semi-automated measurements were very close with non-statistical significant differences and strong correlations between them. It is anticipated that the proposed system might be useful in the clinical practice in the assessment and follow up of patients with diaphragmatic weakness or paralysis and aid in the separation of normal and abnormal diaphragmatic motion. Further validation and additional experimentation in a larger sample of videos and different patient groups is required.
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Affiliation(s)
- Christos P Loizou
- Department of Electrical Engineering, Computer Engineering and Informatics at the Cyprus University of Technology, 3036 Limassol, Cyprus.
| | | | - Giorgos Minas
- Intensive Care Unit, General Hospital, Nicosia, Cyprus.
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Zheng Y, Zhang Y, Li H, Qiao L, Fu W, Yu L, Li G, Yang J, Ni W, Yong Z, Wang Y, Fan H. Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:423-430. [PMID: 32795561 DOI: 10.1016/j.apmr.2020.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To compare the effects of Liuzijue Qigong and conventional respiratory training on trunk control ability and respiratory muscle functions in patients at an early recovery stage from stroke. DESIGN A single-blind, randomized controlled trial. SETTING A hospital. PARTICIPANTS Patients (N=60) within 2 months poststroke. INTERVENTIONS The experimental group (n=30) received conventional rehabilitation training combined with Liuzijue exercise, and the control group (n=30) received conventional rehabilitation training combined with conventional respiration training. The training in the 2 groups was conducted 5 times per week for 3 weeks. MAIN OUTCOME MEASURES Trunk Impairment Scale (TIS), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximum expiratory mid-flow (MMEF), diaphragmatic movement, the change of intra-abdominal pressure (IAP), Berg Balance Scale (BBS), and Modified Barthel Index (MBI). All outcome measures were assessed twice (at baseline and 3 weeks). RESULTS Both groups significantly improved in TIS, MIP, FVC, PEF, and the change of IAP, BBS, and MBI when pre- and postassessments (P<.05) were compared. Compared with the control group, there was a significant difference in the experimental group in the static sitting balance subscale (P=.014), dynamic balance subscale (P=.001), coordination subscale (P<.001), TIS total scores (P<.001; effect size [ES]=0.9), MIP (P=.012; 95% confidence interval [CI], 2.23-17.69; ES=0.67), MEP (P=.015; 95% CI, 1.85-16.57; ES=0.65), change of IAP (P=.001), and MBI (P=.016; 95% CI, 1.51-14.16; ES=0.64). No significant differences were found between the 2 groups in FEV1 (P=.24), FVC (P=.43), PEF (P=.202), MMEF (P=.277), the diaphragmatic movement of quiet breathing (P=.146), deep breathing (P=.102), and BBS (P=.124). CONCLUSIONS Liuzijue exercise showed more changes than conventional respiratory training in improving trunk control ability, respiratory muscle functions, and activities of daily living ability in patients at an early recovery stage from stroke.
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Affiliation(s)
- Yanan Zheng
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China; School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China.
| | - Hongli Li
- Shanghai Shenyuan Rehabilitation Hospital, Shanghai, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianzhong Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weidong Ni
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Zhijie Yong
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yanmin Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hang Fan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
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26
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Boussuges A, Rives S, Finance J, Brégeon F. Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives. World J Clin Cases 2020; 8:2408-2424. [PMID: 32607319 PMCID: PMC7322428 DOI: 10.12998/wjcc.v8.i12.2408] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
This article reports the various methods used to assess diaphragmatic function by ultrasonography. The excursions of the two hemidiaphragms can be measured using two-dimensional or M-mode ultrasonography, during respiratory maneuvers such as quiet breathing, voluntary sniffing and deep inspiration. On the zone of apposition to the rib cage for both hemidiaphragms, it is possible to measure the thickness on expiration and during deep breathing to assess the percentage of thickening during inspiration. These two approaches make it possible to assess the quality of the diaphragmatic function and the diagnosis of diaphragmatic paralysis or dysfunction. These methods are particularly useful in circumstances where there is a high risk of phrenic nerve injury or in diseases affecting the contractility or the motion of the diaphragm such as neuro-muscular diseases. Recent methods such as speckle tracking imaging and ultrasound shear wave elastography should provide more detailed information for better assessment of diaphragmatic function.
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Affiliation(s)
- Alain Boussuges
- Institut de Recherche Biomédicale des Armées, ERRSO, Toulon 83800, France
- Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM (1260), INRAE (1263), Toulon 83800, France
| | - Sarah Rives
- Institut de Recherche Biomédicale des Armées, ERRSO, Toulon 83800, France
| | - Julie Finance
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille 13015, France
| | - Fabienne Brégeon
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille 13015, France
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Calheiros J, Charco-Mora P. Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:316-324. [PMID: 32143822 DOI: 10.1016/j.redar.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest.
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Affiliation(s)
- J Calheiros
- Departamento de Anestesia, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal.
| | - P Charco-Mora
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Valencia, Valencia, España
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Vetrugno L, Guadagnin GM, Brussa A, Orso D, Garofalo E, Bruni A, Longhini F, Bove T. Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1. Ultrasound J 2020; 12:9. [PMID: 32166566 PMCID: PMC7067937 DOI: 10.1186/s13089-020-00161-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/06/2020] [Indexed: 12/11/2022] Open
Abstract
Although mechanical ventilation may be a patient’s vital ally during acute illness, it can quickly transform into an enemy during chronic conditions. The weaning process is the fundamental phase that enables the resumption of physiological respiratory function; however, it is also associated with a number of life-threatening complications, and a large percentage of critically ill patients never achieve airway device removal or require the resumption of mechanical ventilation just a few days post-weaning. Indeed, the weaning process is, at present, more of an art than a science. As such, there is urgent need for novel contributions from the scientific literature to abate the growing rates of morbidity and mortality associated with weaning failure. The physician attempting to wean a patient must integrate clinical parameters and common-sense criteria. Numerous studies have striven to identify single predictive factors of weaning failure and sought to standardize the weaning process, but the results are characterized by remarkable heterogeneity. Despite the lack of benchmarks, it is clear that the analysis of respiratory function must include a detailed overview of the five situations described below rather than a single aspect. The purpose of this two-part review is to provide a comprehensive description of these situations to clarify the “arena” physicians are entering when weaning critically ill patients from mechanical ventilation.
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Affiliation(s)
- Luigi Vetrugno
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy.
| | - Giovanni Maria Guadagnin
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy.
| | - Alessandro Brussa
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Daniele Orso
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Eugenio Garofalo
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Andrea Bruni
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Tiziana Bove
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
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Catalá-Ripoll JV, Monsalve-Naharro JÁ, Hernández-Fernández F. Incidence and predictive factors of diaphragmatic dysfunction in acute stroke. BMC Neurol 2020; 20:79. [PMID: 32138697 PMCID: PMC7057624 DOI: 10.1186/s12883-020-01664-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. Results An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cut-off point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). Conclusions There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.
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Affiliation(s)
- José Vicente Catalá-Ripoll
- Department of Anesthesiology and Critical Care Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - José Ángel Monsalve-Naharro
- Department of Anesthesiology and Critical Care Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Francisco Hernández-Fernández
- Department of Neurology, Unit of Interventional Neuroradiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Xia J, Qian CY, Yang L, Li MJ, Liu XX, Yang T, Lu Q. Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study. J Intensive Care 2019; 7:54. [PMID: 31827802 PMCID: PMC6886226 DOI: 10.1186/s40560-019-0409-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/17/2019] [Indexed: 12/29/2022] Open
Abstract
Background A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. Methods This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS ≥ 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS ≥ 14 were assessed. Results Forty-nine patients were analyzed; 33 had LUS ≥ 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS ≥ 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) (p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) (p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. Conclusions During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.
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Affiliation(s)
- Jing Xia
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Chuan-Yun Qian
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Li Yang
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Mei-Ju Li
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Xiao-Xue Liu
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Ting Yang
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Qin Lu
- 2Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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31
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Santana PV, Cardenas LZ, de Albuquerque ALP, de Carvalho CRR, Caruso P. Diaphragmatic ultrasound findings correlate with dyspnea, exercise tolerance, health-related quality of life and lung function in patients with fibrotic interstitial lung disease. BMC Pulm Med 2019; 19:183. [PMID: 31638951 PMCID: PMC6802109 DOI: 10.1186/s12890-019-0936-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fibrotic interstitial lung disease (FILD) patients are typically dyspneic and exercise-intolerant with consequent impairment of health-related quality of life (HRQoL). Respiratory muscle dysfunction is among the underlying mechanisms of dyspnea and exercise intolerance in FILD but may be difficult to diagnose. Using ultrasound, we compared diaphragmatic mobility and thickening in FILD cases and healthy controls and correlated these findings with dyspnea, exercise tolerance, HRQoL and lung function. METHODS We measured diaphragmatic mobility and thickness during quiet (QB) and deep breathing (DB) and calculated thickening fraction (TF) in 30 FILD cases and 30 healthy controls. We correlated FILD cases' diaphragmatic findings with dyspnea, exercise tolerance (six-minute walk test), lung function and HRQoL (St. George's Respiratory Questionnaire). RESULTS Diaphragmatic mobility was similar between groups during QB but was lower in FILD cases during DB when compared to healthy controls (3.99 cm vs 7.02 cm; p < 0.01). FILD cases showed higher diaphragm thickness during QB but TF was lower in FILD when compared to healthy controls (70% vs 188%, p < 0.01). During DB, diaphragmatic mobility and thickness correlated with lung function, exercise tolerance and HRQoL, but inversely correlated with dyspnea. Most FILD cases (70%) presented reduced TF, and these patients had higher dyspnea and exercise desaturation, lower HRQoL and lung function. CONCLUSION Compared to healthy controls, FILD cases present with lower diaphragmatic mobility and thickening during DB that correlate to increased dyspnea, decreased exercise tolerance, worse HRQoL and worse lung function. FILD cases with reduced diaphragmatic thickening are more dyspneic and exercise-intolerant, have lower HRQoL and lung function.
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Affiliation(s)
- Pauliane Vieira Santana
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. .,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Leticia Zumpano Cardenas
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro Caruso
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
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32
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Maurizio R, Rinaldi VE, Camerini PG, Salvatori C, Leonardi A, Bini V. Right Diaphragmatic Peak Motion Velocities on Pulsed Wave Tissue Doppler Imaging in Neonates: Method, Reproducibility, and Reference Values. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2695-2701. [PMID: 30793336 DOI: 10.1002/jum.14974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/04/2019] [Accepted: 01/27/2019] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To test the reproducibility and report the reference ranges of the right diaphragmatic excursion's peak velocities recorded by pulsed wave tissue Doppler imaging in healthy term neonates. METHODS We formerly assessed intraobserver and interobserver variability of the method for the right hemidiaphragm in a small group of neonates, including ventilated neonates. We did not attempt to test the approach for the left hemidiaphragm because of the recognized high failure rate of visualization. Next, we recorded the peak velocities of both hemidiaphragms throughout inspiration and expiration in 229 healthy term neonates near birth to establish weight-dependent reference ranges for the measurements. RESULTS The study population included 116 male and 113 female neonates. The reproducibility of the technique was excellent even in neonates supported by ventilation. We always recorded the right diaphragmatic peak velocities in the normative study group, whereas the left ones were only recorded in 110 of 229 (48%) and 148 of 229 (65%) neonates from the anterior and lateral views, respectively. The modality of delivery and sex showed no influence on diaphragmatic kinetics. The mean inspiratory peak velocities ± SD were 1.4 ± 0.2 cm/s for the right hemidiaphragm and 1.5 ± 0.3 cm/s for the left hemidiaphragm. The mean expiratory peak velocities were 1.3 ± 0.2 cm/s for the right hemidiaphragm and 1.4 ± 0.3 cm/s for the left hemidiaphragm. CONCLUSIONS Measurement of right diaphragmatic kinetics as assessed by pulsed wave tissue Doppler imaging was found to be a reliable technique. Its clinical applicability for the prompt diagnosis and effective management of neonatal respiratory failure deserves further investigation.
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Affiliation(s)
- Radicioni Maurizio
- Neonatal Intensive Care Unit, Santa Maria Della Misericordia Hospital of Perugia, Perugia, Italy
| | | | - Pier Giorgio Camerini
- Neonatal Intensive Care Unit, Santa Maria Della Misericordia Hospital of Perugia, Perugia, Italy
| | | | | | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
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Abstract
The ultrasound method is a non-invasive and safe diagnostic method. Ultrasound examination (ultrasound) of the diaphragm allows you to conduct a direct study of its structure and function. Using stationary and portable ultrasound scanners, the study of the diaphragm can be carried out in specialized laboratories, in outpatient departments, in various departments of the clinic, including in intensive care units, in patients in different clinical conditions. Ultrasound of the diaphragm can be implemented on devices of different technical levels. Despite the fact that at present the diaphragm ultrasound method is not standardized, nevertheless, it provides clinically important information for solving various clinical studies, including when conducting dynamic observation.
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Affiliation(s)
- G V Nekludova
- Pulmonology Scientific Research Institute under Federal Medical and Biological Agency of Russsian Federation, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - S N Avdeev
- Pulmonology Scientific Research Institute under Federal Medical and Biological Agency of Russsian Federation, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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34
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Sferrazza Papa GF, Pellegrino GM, Shaikh H, Lax A, Lorini L, Corbo M. Respiratory muscle testing in amyotrophic lateral sclerosis: a practical approach. Minerva Med 2019; 109:11-19. [PMID: 30642145 DOI: 10.23736/s0026-4806.18.05920-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure and death. Non-invasive positive pressure ventilation (NIPPV) appears to reduce lung function decline, thus improving survival and quality-of-life of patients affected by the disease. Unfortunately, clinical features and timing to start NIPPV are not well defined. Starting from recent findings, we examine established and novel tests of respiratory muscle function that could help clinicians decide whether and when to start NIPPV in ALS. Non-invasive tests estimate the function of inspiratory, expiratory, and bulbar muscles, whereas clinical examination allows to assess the overall neurologic and respiratory symptoms and general conditions. Most of the studies recommend that together with a thorough clinical evaluation of the patient according to current guidelines, vital capacity, maximal static and sniff nasal inspiratory pressures, maximal static expiratory pressures and peak cough expiratory flow, and nocturnal pulse oximetry be measured. A sound understanding of physiology can guide the physician also through the current armamentarium for additional supportive treatments for ALS, such as symptomatic drugs and new treatments to manage sialorrhea and thickened saliva, cough assistance, air stacking, and physiotherapy. In conclusion, careful clinical and functional evaluation of respiratory function and patient's preference are key determinants to decide "when" and "to whom" respiratory treatments can be provided.
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Affiliation(s)
- Giuseppe F Sferrazza Papa
- Department of Neurorehabilitation Sciences, Casa di Cura Privata del Policlinico, Milan, Italy - .,Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy -
| | - Giulia M Pellegrino
- Department of Neurorehabilitation Sciences, Casa di Cura Privata del Policlinico, Milan, Italy.,Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine, Maywood, IL, USA.,Edward Hines Jr. Veterans Administration Hospital Hines, Chicago, IL, USA
| | - Agata Lax
- IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
| | - Luca Lorini
- Unit of Neurosurgical Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Privata del Policlinico, Milan, Italy
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35
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Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. Effect of forward head posture on thoracic shape and respiratory function. J Phys Ther Sci 2019; 31:63-68. [PMID: 30774207 PMCID: PMC6348172 DOI: 10.1589/jpts.31.63] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/07/2018] [Indexed: 01/16/2023] Open
Abstract
[Purpose] This study investigated the effect of forward head posture on upper and lower
thoracic shape in adults to better understand the relationship between a forward head
posture and respiratory function. [Participants and Methods] Fifteen healthy males were
recruited after obtaining informed consent from all participants. All participants were
instructed to respire in both the forward and neutral head postures while seated.
Respiratory function was assessed using spirometry. Thoracic shape during respiration was
assessed using 23 markers on both the upper and the lower thorax and compared between the
2 postures. [Results] Forced vital capacity, expiratory and inspiratory reserve volumes,
forced expiratory volume at 1 second, and the peak flow rate observed with the forward
head posture were significantly lower than that with the neutral head posture. The upper
thorax showed a greater forward shift and the lower thorax showed a greater forward and
inward shift with the forward head posture than with the neutral head posture. No
significant difference in upper thoracic mobility was observed during respiration between
the forward head posture and the neutral head posture. However, mobility of the lower
thorax during respiration was significantly reduced with the forward head posture.
[Conclusion] The forward head posture causes expansion of the upper thorax and contraction
of the lower thorax, and these morphological changes cause decreased respiratory
function.
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Affiliation(s)
- Taiichi Koseki
- Department of Anatomy, Tokyo Medical University, Japan.,Department of Rehabilitation, Hiroo Orthopedics, Japan
| | - Fujiyasu Kakizaki
- Graduate School of Health Care Sciences, Bunkyo Gakuin University, Japan
| | - Shogo Hayashi
- Department of Anatomy, School of Medicine, International University of Health and Welfare: 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
| | - Naoya Nishida
- Department of Anatomy, Tokyo Medical University, Japan.,Department of Rehabilitation, Sonoda Second Hospital, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, Japan
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36
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Mancini D, Cesari M, Lunghi C, Benigni AM, Antonelli Incalzi R, Scarlata S. Ultrasound Evaluation of Diaphragmatic Mobility and Contractility After Osteopathic Manipulative Techniques in Healthy Volunteers: A Prospective, Randomized, Double-Blinded Clinical Trial. J Manipulative Physiol Ther 2019; 42:47-54. [DOI: 10.1016/j.jmpt.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 06/06/2018] [Accepted: 08/16/2018] [Indexed: 10/27/2022]
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Skaarup SH, Løkke A, Laursen CB. The Area method: a new method for ultrasound assessment of diaphragmatic movement. Crit Ultrasound J 2018; 10:15. [PMID: 29946769 PMCID: PMC6019663 DOI: 10.1186/s13089-018-0092-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/02/2018] [Indexed: 01/01/2023] Open
Abstract
Background Ultrasound can be used to assess diaphragm movement. Existing methods focus on movement at a single point at the hemidiaphragm and may not consider the anatomic and functional complexity. We aimed to develop an ultrasound method, the Area method, to assess movement of the entire hemidiaphragm dome and to compare it with existing methods to evaluate accuracy, inter-rater agreement, and feasibility. Methods Movement of the diaphragm was evaluated by ultrasonography in 19 healthy subjects and correlated with simultaneously performed spirometry. Two existing methods, the M-mode excursion at the posterior part of diaphragm and the B-mode at the top of the diaphragm, were compared with the Area method. Two independent raters reviewed film clips to analyze inter-rater agreement. Feasibility was tested by novice ultrasound operators. Results Correlation with expired lung volume was higher with the Area method, 0.88 (95% CI 0.81–0.95), p < 0.001, and with the M-mode measurement, 0.84 (95% CI 0.75–0.92), p < 0.001, than with the B-mode measurement, 0.71 (95% CI 0.59–0.83), p < 0.001. Inter-rater agreement was highest with the Area method, 0.9, p < 0.001, and M-mode measurement 0.9, p < 0.001, and lower with the B-mode measurement, 0.8, p < 0.001. The M-mode measurement could be done in only 20% at the left side. The Area method could be performed in all participants at both hemidiaphragms, and novice operators found it easy to perform. Conclusion A new method to evaluate diaphragm movement is introduced. Accuracy and inter-rater agreement are high. The Area method is equally feasible at both hemidiaphragms in contrast to existing methods. However, additional studies should include more participants, different types of pulmonary diseases, and investigate the role of patient position to validate the Area method fully. Electronic supplementary material The online version of this article (10.1186/s13089-018-0092-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Søren Helbo Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
| | - Anders Løkke
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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38
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Fayssoil A, Behin A, Ogna A, Mompoint D, Amthor H, Clair B, Laforet P, Mansart A, Prigent H, Orlikowski D, Stojkovic T, Vinit S, Carlier R, Eymard B, Lofaso F, Annane D. Diaphragm: Pathophysiology and Ultrasound Imaging in Neuromuscular Disorders. J Neuromuscul Dis 2018; 5:1-10. [PMID: 29278898 PMCID: PMC5836400 DOI: 10.3233/jnd-170276] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Respiratory muscles are classically involved in neuromuscular disorders, leading to a restrictive respiratory pattern. The diaphragm is the main respiratory muscle involved during inspiration. Ultrasound imaging is a noninvasive, radiation-free, accurate and safe technique allowing assessment of diaphragm anatomy and function. The authors review the pathophysiology of diaphragm in neuromuscular disorders, the methodology and indications of diaphragm ultrasound imaging as well as possible pitfalls in the interpretation of results.
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Affiliation(s)
- Abdallah Fayssoil
- APHP, Raymond Poincare University Hospital, Garches, France.,Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Anthony Behin
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Adam Ogna
- Lausanne University Hospital, Lausanne, Switzerland
| | | | - Helge Amthor
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Bernard Clair
- APHP, Raymond Poincare University Hospital, Garches, France
| | - Pascal Laforet
- Myology Institute, Pitié Salpetrière Hospital, Paris, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Arnaud Mansart
- APHP, Raymond Poincare University Hospital, Garches, France
| | - Helene Prigent
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | | | - Tanya Stojkovic
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Stéphane Vinit
- INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Robert Carlier
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Bruno Eymard
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Frederic Lofaso
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
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Cardenas LZ, Santana PV, Caruso P, Ribeiro de Carvalho CR, Pereira de Albuquerque AL. Diaphragmatic Ultrasound Correlates with Inspiratory Muscle Strength and Pulmonary Function in Healthy Subjects. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:786-793. [PMID: 29373153 DOI: 10.1016/j.ultrasmedbio.2017.11.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
Diaphragm ultrasound (DUS) has been used to identify diaphragm dysfunction. However, its correlations with respiratory strength and lung function are unclear, even in healthy patients. A total of 64 healthy patients (30 males) had lung function and inspiratory strength (maximal inspiratory pressure and sniff nasal inspiratory pressure) measured. Gastric and oesophageal pressures were measured in a subgroup (n = 40). DUS was characterized by mobility (quiet breathing [QB] and deep breathing [DB]) and thickness (at functional residual capacity [ThFRC] and total lung capacity [ThTLC]). We calculated the thickening fraction (TF). During QB, DUS was similar between sexes. However, during DB, females had lower mobility, thickness and TF than males. Mobility at DB, ThTLC and TF significantly correlated with lung function and inspiratory strength. These correlations were affected by sex. DUS correlated with inspiratory gastric pressure. In healthy patients, DUS correlated with lung function and inspiratory strength during DB. Significant differences between genders were noticeable when DUS was performed during DB.
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Affiliation(s)
- Letícia Zumpano Cardenas
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Pinheiros, São Paulo, Brazil; AC Camargo Cancer Center, Intensive Care Department, Liberdade, São Paulo, Brazil.
| | - Pauliane Vieira Santana
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Pinheiros, São Paulo, Brazil; AC Camargo Cancer Center, Intensive Care Department, Liberdade, São Paulo, Brazil
| | - Pedro Caruso
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Pinheiros, São Paulo, Brazil; AC Camargo Cancer Center, Intensive Care Department, Liberdade, São Paulo, Brazil
| | | | - André Luís Pereira de Albuquerque
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Pinheiros, São Paulo, Brazil; Sírio-Libanês Teaching and Research Institute, Bela Vista, São Paulo, Brazil
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40
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Jung JH, Kim NS. The correlation between diaphragm thickness, diaphragmatic excursion, and pulmonary function in patients with chronic stroke. J Phys Ther Sci 2017; 29:2176-2179. [PMID: 29643599 PMCID: PMC5890225 DOI: 10.1589/jpts.29.2176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the correlation between the diaphragm thickness
and diaphragm excursion, and pulmonary function in individuals with stroke. [Subjects and
Methods] One hundred fourteen patients who were clinically diagnosed with ischemic or
hemorrhagic stroke were included. The diaphragm thickness and excursion were assessed
using ultrasonography, and the diaphragm thickening ratio was standardized using a
formula. To analyze pulmonary function, we measured the forced vital capacity, forced
expiratory volume in one second, and peak expiratory flow. [Results] A statistically
significant correlation was found between the diaphragm thickness, thickness ratio, and
diaphragm excursion; and the forced vital capacity, forced expiratory volume in one
second, and peak expiratory flow. [Conclusion] This study demonstrated that there is a
relationship between respiratory function and diaphragm thickness and diaphragm excursion,
especially in the paretic side of the diaphragm. Therefore, the role of the respiratory
muscles of the paretic side is important in rehabilitation programs to improve the
respiratory function of stroke patients.
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Affiliation(s)
- Ju-Hyeon Jung
- Department of Physical Therapy, Gimhae College, Republic of Korea
| | - Nan-Soo Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan: 9 Bugok 3-dong, Geumjung-gu, Busan 609-757, Republic of Korea
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41
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Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and Lung Ultrasound to Predict Weaning Outcome. Chest 2017; 152:1140-1150. [DOI: 10.1016/j.chest.2017.08.028] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/24/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022] Open
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42
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Santos R, Armada-da-Silva P. Reproducibility of ultrasound-derived muscle thickness and echo-intensity for the entire quadriceps femoris muscle. Radiography (Lond) 2017; 23:e51-e61. [DOI: 10.1016/j.radi.2017.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 01/05/2023]
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43
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Richard P. [Exploring the diaphragm: Ultrasound is essential]. Rev Mal Respir 2017; 34:645-660. [PMID: 28502520 DOI: 10.1016/j.rmr.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
The diaphragm is the muscle most implicated in breathing. Its morphological exploration usually depends on pulmonary radiography, fluoroscopy, CT-scanning and MRI. Its function is evaluated by the classical respiratory functional tests, the measurement of maximum inspiratory and expiratory pressures, the transdiaphragmatic pressure and even an electromyogram. Ultrasound is a technique still insufficiently used in respiratory medicine. It offers, however, many advantages: it is easy to implement, there is no irradiation, it is usable at the bedside, particularly when the patient is immobile or in intensive care. The results of the examination are immediately available. It allows morphological and dynamic study of each hemidiaphragm as well as providing invaluable information on the thoracic and subdiaphragmatic environment. Its field of exploration is extremely wide: raised hemidiaphragm, dyspnea following a stroke or a surgical procedure (thoracic or abdominal), road accident trauma, diagnosis and follow-up of a paresis or paralysis, evaluation of diaphragmatic mobility during the course of COPD (Chronic Obstructive Pulmonary Disease) and many other pathologies. Ultrasound is insufficiently used in pleural disease and even less so in the evaluation of the morphology and function of the diaphragm.
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Affiliation(s)
- P Richard
- Service de pneumologie, centre hospitaliser de la région de Saint-Omer, route de Blendecques, BP 60357, 62570 Helfaut, France.
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Santana PV, Prina E, Albuquerque ALP, Carvalho CRR, Caruso P. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging. J Bras Pneumol 2017; 42:88-94. [PMID: 27167428 PMCID: PMC4853060 DOI: 10.1590/s1806-37562015000000266] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/27/2016] [Indexed: 12/20/2022] Open
Abstract
Objective: To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). Methods: Using ultrasound, we compared ILD patients and healthy volunteers (controls) in terms of diaphragmatic mobility during quiet and deep breathing; diaphragm thickness at functional residual capacity (FRC) and at total lung capacity (TLC); and the thickening fraction (TF, proportional diaphragm thickening from FRC to TLC). We also evaluated correlations between diaphragmatic dysfunction and lung function variables. Results: Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 ± 1.7 cm vs. 7.6 ± 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at FRC (p = 0.05), although, due to lower diaphragm thickness at TLC, they also showed a lower TF (p < 0.01). The FVC as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. Conclusions: Using ultrasound, we were able to show that diaphragmatic mobility and the TF were lower in ILD patients than in healthy controls, despite the greater diaphragm thickness at FRC in the former. Diaphragmatic mobility correlated with ILD functional severity, and an FVC% cut-off value of < 60% was found to be highly accurate for indentifying diaphragmatic dysfunction on ultrasound.
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Affiliation(s)
| | - Elena Prina
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Pedro Caruso
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Abstract
Electromyographers are often asked to evaluate patients presenting with dyspnea or respiratory failure, to rule out an underlying neuromuscular cause for those symptoms. Available tools for diagnosing such patients include pulmonary function tests, transdiaphragmatic pressure testing, various imaging modalities, phrenic nerve conduction studies, and diaphragm electromyography. Phrenic nerve conduction studies and diaphragm electromyography are technically challenging and can be limited by both false positive and false negative results. Integration of diagnostic ultrasound can enhance the accuracy and safety of diaphragm electromyography, and improve sensitivity and specificity of phrenic nerve conduction studies. In addition, brightness-mode ultrasound imaging of the diaphragm allows for measurement of muscle thickness and contractility, and is a very sensitive and specific diagnostic test in this setting. This article will review the electromyographer's approach to patients presenting with respiratory symptoms, with a focus on neuromuscular ultrasound.
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Ishizuka T, Nishida N, Homma Y, Hirayama T, Ishida Y, Kakizaki F, Konishi M. Instantaneous changes in respiratory function induced by passive pelvic suspension in the supine position in relation to increased diaphragm excursion. J Phys Ther Sci 2017; 29:432-437. [PMID: 28356625 PMCID: PMC5361004 DOI: 10.1589/jpts.29.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to introduce an approach of pelvic suspension (PS) using sling
cords and to obtain evidence for changes in respiratory function of healthy subjects.
[Subjects and Methods] Subjects were 25 healthy men. In the supine position, with hip and
knee joints flexed at 90°, the subjects’ pelvises were suspended with sling belts.
Diaphragm excursion, respiratory function, and respiratory comfort in these postures were
measured using ultrasonography, respirometry, and visual analog scale (VAS), respectively.
[Results] When the pelvis was passively suspended with sling cords, the diaphragm moved
5 mm cranially and diaphragm excursion showed an instantaneous increase compared with the
control. The tidal volume (VT) showed an increase and the
respiration rate (RR) showed a decrease. The extent of diaphragm excursion was correlated
with changes in VT under the control and PS conditions.
Independent measurements of pulmonary function revealed that PS reduced the expiratory
reserve volume, being correlated positively and negatively to increases in vital and
inspiratory capacities, respectively. Furthermore, VAS values for respiratory ease were
greater with PS than with the control. [Conclusion] These results suggest that PS
effectively changed diaphragm excursion and respiratory function, leading to ease of
breathing (i.e., deep and slow respiration).
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Affiliation(s)
- Tatsuya Ishizuka
- Department of Physiology, Graduate School of Medicine, Tokyo Medical University: 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
- Department of Rehabilitation, IMS group I-Tower Clinic, Japan
| | - Naoya Nishida
- Department of Anatomy, Graduate School of Medicine, Tokyo Medical University, Japan
- Department of Rehabilitation, Sonoda Second Hospital, Japan
| | - Yuuki Homma
- Department of Physiology, Graduate School of Medicine, Showa University, Japan
- Department of Rehabilitation, IMS group Clover no Sato IMS Care Kaupili Itabashi, Japan
| | - Tetsuro Hirayama
- Department of Physiology, Graduate School of Medicine, Showa University, Japan
- Department of Rehabilitation, Hiroo Orthopedics, Japan
| | - Yukisato Ishida
- Graduate School of Health Care Sciences, Bunkyo Gakuin University, Japan
| | - Fujiyasu Kakizaki
- Graduate School of Health Care Sciences, Bunkyo Gakuin University, Japan
| | - Masato Konishi
- Department of Physiology, Graduate School of Medicine, Tokyo Medical University: 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
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Spadaro S, Grasso S, Mauri T, Dalla Corte F, Alvisi V, Ragazzi R, Cricca V, Biondi G, Di Mussi R, Marangoni E, Volta CA. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:305. [PMID: 27677861 PMCID: PMC5039882 DOI: 10.1186/s13054-016-1479-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/06/2016] [Indexed: 01/09/2023]
Abstract
Background The rapid shallow breathing index (RSBI), which is the ratio between respiratory rate (RR) and tidal volume (VT), is one of the most widely used indices to predict weaning outcome. Whereas the diaphragm plays a fundamental role in generating VT, in the case of diaphragmatic dysfunction the inspiratory accessory muscles may contribute. If this occurs during a weaning trial, delayed weaning failure is likely since the accessory muscles are more fatigable than the diaphragm. Hence, we hypothesised that the traditional RSBI could be implemented by substituting VT with the ultrasonographic evaluation of diaphragmatic displacement (DD). We named the new index the diaphragmatic-RSBI (D-RSBI). The aim of this study was to compare the ability of the traditional RSBI and D-RSBI to predict weaning failure in ready-to-wean patients. Methods We performed a prospective observational study. During a T-tube spontaneous breathing trial (SBT) we simultaneously evaluated right hemidiaphragm displacement (i.e., DD) by using M-mode ultrasonography as well as the RSBI. Outcome of the weaning attempt, length of mechanical ventilation, length of intensive care unit and hospital stay, and hospital mortality were recorded. Receiver operator characteristic (ROC) curves were used to evaluate the diagnostic accuracy of D-RSBI and RSBI. Results We enrolled 51 patients requiring mechanical ventilation for more than 48 h who were ready to perform a SBT. Most of the patients, 34 (66 %), were successfully weaned from mechanical ventilation. When considering the 17 patients that failed the weaning attempt, 11 (64 %) had to be reconnected to the ventilator during the SBT, three (18 %) had to be re-intubated within 48 h of extubation, and three (18 %) required non-invasive ventilation support within 48 h of extubation. The areas under the ROC curves for D-RSBI and RSBI were 0.89 and 0.72, respectively (P = 0.006). Conclusions D-RSBI (RR/DD) was more accurate than traditional RSBI (RR/VT) in predicting the weaning outcome. Trial registration Our clinical trial was retrospectively registered with ClinicalTrials.gov (identifier: NCT02696018). ClinicalTrials.gov processed our record on 25 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1479-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy.
| | - Salvatore Grasso
- Department of Emergency and Organ Transplant (DETO), "Aldo Moro" University of Bari, Bari, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Dalla Corte
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Valentina Alvisi
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Valentina Cricca
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Giulia Biondi
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Rossella Di Mussi
- Department of Emergency and Organ Transplant (DETO), "Aldo Moro" University of Bari, Bari, Italy
| | - Elisabetta Marangoni
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
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Gignon L, Roger C, Bastide S, Alonso S, Zieleskiewicz L, Quintard H, Zoric L, Bobbia X, Raux M, Leone M, Lefrant JY, Muller L. Influence of Diaphragmatic Motion on Inferior Vena Cava Diameter Respiratory Variations in Healthy Volunteers. Anesthesiology 2016; 124:1338-46. [PMID: 27003619 DOI: 10.1097/aln.0000000000001096] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The collapsibility index of inferior vena cava (cIVC) is widely used to decide fluid infusion in spontaneously breathing intensive care unit patients. The authors hypothesized that high inspiratory efforts may induce false-positive high cIVC values. This study aims at determining a value of diaphragmatic motion recorded by echography that could predict a high cIVC (more than or equal to 40%) in healthy volunteers. METHODS The cIVC and diaphragmatic motions were recorded for three levels of inspiratory efforts. Right and left diaphragmatic motions were defined as the maximal diaphragmatic excursions. Receiver operating characteristic curves evaluated the performance of right diaphragmatic motion to predict a cIVC more than or equal to 40% defining the best cutoff value. RESULTS Among 52 included volunteers, interobserver reproducibility showed a generalized concordance correlation coefficient (ρc) above 0.9 for all echographic parameters. Right diaphragmatic motion correlated with cIVC (r = 0.64, P < 0.0001). Univariate analyses did not show association between cIVC and age, sex, weight, height, or body mass index. The area under the receiver operating characteristic curves for cIVC more than or equal to 40% was 0.87 (95% CI, 0.81 to 0.93). The best diaphragmatic motion cutoff was 28 mm (Youden Index, 0.65) with sensitivity of 89% and specificity of 77%. The gray zone area was 25 to 43 mm. CONCLUSIONS Inferior vena cava collapsibility is affected by diaphragmatic motion. During low inspiratory effort, diaphragmatic motion was less than 25 mm and predicted a cIVC less than 40%. During maximal inspiratory effort, diaphragmatic motion was more than 43 mm and predicted a cIVC more than 40%. When diaphragmatic motion ranged from 25 to 43 mm, no conclusion on cIVC value could be done.
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Affiliation(s)
- Lucile Gignon
- From the Departments of Anesthesiology (L.G., C.R., L. Zoric, X.B., J.-Y.L., L.M.), Critical Care (L.G., C.R., L. Zoric, X.B., J.-Y.L., L.M.), and Biostatistics and Clinical Epidemiology (S.B., S.A.), CHU Caremeau, Nîmes, France; EA2992 Laboratory of Dysfunction of Vascular Interfaces, Nîmes Medicine University, Nîmes, France (C.R., J.-Y.L., L.M.); Department of Anesthesiology and Critical Care, CHU Pitié-Salpêtrière, Paris, France (M.R.); Department of Anesthesiology and Critical Care, CHU Nord, Marseille, France (L. Zieleskiewicz, M.L.); and Department of Anesthesiology and Critical Care, CHU Saint Roch, Nice, France (H.Q.)
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49
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Chrysostomou C, Loizou CP, Minas G, Delibasis K, Pattichis CS. Measurement of ultrasonic diaphragmatic motion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6358-61. [PMID: 26737747 DOI: 10.1109/embc.2015.7319847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The motion characteristics of the diaphragmatic muscle may provide useful information about normal and abnormal diaphragmatic function and indicate diaphragmatic weakness. The objective of this paper was to introduce a simple system for the quantitative analysis of ultrasonic diaphragmatic motion. The measurements routinely carried out by the experts were computed and these include: (i) excursion, (ii) inspiration time (Tinsp) and (iii) cycle duration (Ttot). The system was evaluated on four simulated videos and one real video. Manual and automated measurements were very close. Further work in a larger number of videos is needed for validating the proposed method.
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50
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Carrié C, Bonnardel E, Vally R, Revel P, Marthan R, Marthan R. Vital Capacity Impairment due to Neuromuscular Disease and its Correlation with Diaphragmatic Ultrasound: A Preliminary Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:143-149. [PMID: 26620221 DOI: 10.1016/j.ultrasmedbio.2015.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this pilot study was to evaluate the correlation between diaphragmatic excursion measured by a right sub-costal ultrasound approach and forced vital capacity in patients with amyotrophic lateral sclerosis (ALS) or myotonic dystrophy (MD). All patients referred for pulmonary function testing underwent ultrasonic measurement of diaphragmatic excursion during quiet breathing, voluntary sniffing (Esniff) and forced breathing (EDEmax). Forty-five patients were included, mainly for amyotrophic lateral sclerosis or myotonic dystrophy. There was a significant correlation between EDEmax values and forced vital capacity (FVC) values (r = 0.68 [0.46–0.90], p < 0.0001) and between EDEmax values and percentage of predicted FVC values (r = 0.75 [0.55–0.95], p < 0.0001). At a threshold of EDEmax < 5.5 cm, the sensitivity and specificity of ultrasonic diaphragmatic excursion in predicting FVC ≤ 50% of theoretical values were 100% [66%–100%] and 69% [52%–84%] respectively, without any significant difference between males and females. There was no statistical correlation between maximal inspiratory pressure and Esniff.
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Affiliation(s)
- Cédric Carrié
- Emergency Department, CHU de Bordeaux, Bordeaux, France
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