|
1
|
ter Haar EA, Slebos DJ, Bakker JT, Augustijn SW, Dijkstra LJ, Hartman JE. Endobronchial valve treatment improves diaphragm function in severe emphysema patients. ERJ Open Res 2025; 11:00858-2024. [PMID: 40356799 PMCID: PMC12067427 DOI: 10.1183/23120541.00858-2024] [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: 08/26/2024] [Accepted: 10/21/2024] [Indexed: 05/15/2025] Open
Abstract
Background Diaphragm dysfunction is common in severe emphysema patients, primarily due to hyperinflation, placing the diaphragm at a mechanical disadvantage. Endobronchial valve (EBV) treatment is a bronchoscopic procedure to reduce hyperinflation and thus potentially restore diaphragm function in this patient population. Our aim was to investigate the effect of EBV treatment on diaphragm function. Methods A prospective cohort study was performed in which diaphragm function was measured at baseline and 6 weeks after EBV treatment by ultrasonic assessment to measure diaphragm motion and diaphragm thickening fraction, surface electromyography (sEMG) to quantify diaphragm activity, and maximal inspiratory pressure to assess diaphragm strength. Results 25 patients were included, with a mean±sd age of 64±7 years. Mean±sd residual volume (-0.85±0.49 L; p<0.001) decreased significantly post-EBV treatment, with a significant increase in median (range) maximal inspiratory pressure (0.6 (-1.2-2.8) kPa; p=0.001). Median (range) diaphragm motion on the treated side during tidal breathing significantly decreased (-3.3 (-24.7-14.6) mm; p=0.023). There were no significant changes in diaphragm thickening fraction on the treated side. Median (range) diaphragm activity (sEMG) for tidal breathing (-1.7 (-8.8-5.8) µV; p=0.004), maximal inspiration (-4.1 (-42.3-16.0) µV; p=0.004) and sniff manoeuvre (-6.1 (-42.2-24.2) µV; p=0.027) all significantly decreased. Conclusions Our results show that diaphragm function significantly improves after EBV treatment in severe emphysema patients. This emphasises the physiological interaction between hyperinflation and diaphragm function, suggesting that reducing hyperinflation can at least partially reverse diaphragm dysfunction.
Collapse
Affiliation(s)
- Else A.M.D. ter Haar
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Jens T. Bakker
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Sonja W.S. Augustijn
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Linze J. Dijkstra
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Jorine E. Hartman
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| |
Collapse
|
|
2
|
Zhao H, Liu K, Yan Y, Muhetaer Y, Li L. Diaphragm excursion and diaphragm thickening fraction: commonality and conflict. Eur Respir Rev 2025; 34:240285. [PMID: 40174953 PMCID: PMC11962978 DOI: 10.1183/16000617.0285-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Accepted: 01/19/2025] [Indexed: 04/04/2025] Open
Abstract
We read with great interest the recent article by Poddighe et al . [1], which significantly improves our understanding of respiratory muscle function evaluation and its treatment strategies. We wish to share additional considerations that may further enhance the utility of diaphragmatic ultrasound. Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) are complementary but distinct parameters. There may be conflict between increased DTF with decreased DE and increased DE with decreased DTF in two specific clinical scenarios. https://bit.ly/4hzA4Xn
Collapse
Affiliation(s)
- Haotian Zhao
- Department of Ultrasound, Hebei General Hospital, Hebei, China
- These authors contributed equally to this work
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- These authors contributed equally to this work
| | - Yaru Yan
- Department of Ultrasound, Shijiazhuang People's Hospital, Hebei, China
- These authors contributed equally to this work
| | - Yaxiaerjiang Muhetaer
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Critical Care Medicine, Shanghai Geriatric Medical Center, Shanghai, China
| | - Li Li
- Department of Ultrasound, Hebei General Hospital, Hebei, China
| |
Collapse
|
|
3
|
Hermans G, Demoule A, Heunks L. Overcoming left diaphragm ultrasound challenges: exploring promising techniques. Intensive Care Med 2025; 51:438-439. [PMID: 39714618 DOI: 10.1007/s00134-024-07750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2024] [Indexed: 12/24/2024]
Affiliation(s)
- Greet Hermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
| | - Alexandre Demoule
- APHP Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation (Département R3S) and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris, Paris, France
| | - Leo Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
|
4
|
Boussuges M, Bregeon F, D’Journo XB, Boussuges A. Ultrasound analysis of hemidiaphragm function in case of pleural effusion. Front Med (Lausanne) 2025; 11:1532214. [PMID: 39895818 PMCID: PMC11782014 DOI: 10.3389/fmed.2024.1532214] [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: 11/21/2024] [Accepted: 12/27/2024] [Indexed: 02/04/2025] Open
Abstract
Background Diaphragm dysfunction is frequently observed in patients with pleural effusion. The aim of the study was to determine the criteria for estimating the impact of pleural fluid on diaphragm function and detecting impairment of diaphragmatic muscle. Methods This was a retrospective observational study carried out in a university hospital. Cases of free pleural effusion were recruited from the ultrasound consultation of the lung function test laboratory. The quantification of pleural effusion and analysis of diaphragmatic function were performed using chest ultrasound performed while sitting. In case of abnormal diaphragmatic motion, the examination was repeated in supine position. Results 109 pleural effusions (57 left, 52 right) were included in the analysis. Pleural effusions were detected after thoracic surgery in 89% of cases and in the context of medical disease in other cases. Excursion during deep inspiration was reduced by the amount of fluid (4.3 ± 2.1 cm for small effusions, 3.2 ± 1.7 cm for moderate effusions and 1.1 ± 1.8 cm for large effusions). In 23 cases of large pleural effusion, the excursions during deep inspiration were always below the lower limit of normal. In some cases, a paradoxical motion suggesting hemidiaphragm paralysis was observed. When the inspiratory thickening was normal, the paradoxical excursions disappeared in supine position. In moderate pleural effusion (53 cases), hemidiaphragm excursion was above lower limit of normal in 68% of cases. In cases of paradoxical motions, repeated ultrasound examinations were in favor of hemidiaphragm paralysis. In small pleural effusion (32 cases) the excursion was most often normal. Conclusion The ultrasound analysis of diaphragm excursion and thickening in sitting and supine positions is useful to assess the impact of pleural effusion and detect impairment in diaphragm muscle function.
Collapse
Affiliation(s)
- Martin Boussuges
- Service de Pneumologie, Centre Hospitalier Universitaire (CHU) de la Reunion Sud, Saint Pierre, France
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Fabienne Bregeon
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Unité d’Appui à la recherche (HIPE), Aix-Marseille Université, CNRS, Université de Toulon, Institut Paoli-Calmettes, Marseille, France
| | - Xavier Benoit D’Journo
- Service de Chirurgie thoracique et des maladies de l’œsophage, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Université, Marseille, France
| | - Alain Boussuges
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Centre de Recherche en Cardio-Vasculaire et Nutrition (C2VN), Aix Marseille Université, Marseille, France
| |
Collapse
|
|
5
|
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.
Collapse
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.
| |
Collapse
|
|
6
|
Jesus F, Hazenberg A, Duiverman M, Wijkstra P. Diaphragm dysfunction: how to diagnose and how to treat? Breathe (Sheff) 2025; 21:240218. [PMID: 40012556 PMCID: PMC11864072 DOI: 10.1183/20734735.0218-2024] [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: 08/26/2024] [Accepted: 11/05/2024] [Indexed: 02/28/2025] Open
Abstract
The diaphragm, crucial for respiratory function, is susceptible to dysfunction due to various pathologies that can affect the nervous system, neuromuscular junction or the muscle itself. Diaphragmatic dysfunction presents with symptoms ranging from exertional dyspnoea to respiratory failure, significantly impacting patients' quality of life. Diagnosis involves clinical evaluation complemented by imaging and pulmonary function tests. Chest radiography, fluoroscopy, and ultrasonography are pivotal in assessing diaphragmatic movement and excursion, offering varying sensitivities and specificities based on the type and severity of dysfunction. Ultrasonography emerges as a noninvasive bedside tool with high sensitivity and specificity, measuring diaphragm thickness, thickening fraction, and excursion, and enabling monitoring of disease progression and response to treatment over time. Treatment strategies depend on the underlying aetiology and severity, ranging from conservative management to interventions such as surgical plication or diaphragmatic pacing. Ventilatory support, particularly noninvasive ventilation, plays a pivotal role in treatment, enhancing lung function and patient outcomes across unilateral and bilateral dysfunction. Despite advances in diagnostic techniques, awareness and systematic evaluation of diaphragmatic function remain inconsistent across clinical settings. This review consolidates the current understanding of diaphragmatic dysfunction, highlighting diagnostic modalities and treatment options to facilitate early recognition and management of this entity.
Collapse
Affiliation(s)
- Filipa Jesus
- Department of Pulmonology, Unidade Local de Saúde da Guarda EPE, Guarda, Portugal
| | - Anda Hazenberg
- University of Groningen, University Medical Center Groningen, Department of Home Mechanical Ventilation, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Duiverman
- University of Groningen, University Medical Center Groningen, Department of Home Mechanical Ventilation, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Wijkstra
- University of Groningen, University Medical Center Groningen, Department of Home Mechanical Ventilation, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
|
7
|
Fernández-Pardo TE, Rodríguez-Nieto MJ, Furió-Valverde M, García-Arrabé M, Mallo-Lopez A, Mahillo-Fernández I, Peces-Barba Romero G. Inspiration Time: The Ultrasound Variable Necessary to Study the Diaphragm Functionality. A Cross-Sectional Controlled Study. SAGE Open Nurs 2025; 11:23779608251337591. [PMID: 40297479 PMCID: PMC12035299 DOI: 10.1177/23779608251337591] [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: 07/31/2024] [Revised: 03/19/2025] [Accepted: 03/25/2025] [Indexed: 04/30/2025] Open
Abstract
Introduction The diaphragm is considered the main inspiratory muscle, and as such, its assessment is crucial in patients with respiratory pathology. It is known that the contractile capacity of a muscle is determined by strength, length, and the duration of contraction. Although transdiaphragmatic pressure is the gold standard test for its study, ultrasound has been confirmed as a useful tool in clinical practice. Thanks to it, both the strength (diaphragmatic thickness) and the length of movement (diaphragmatic excursion) can be evaluated. This study aims to investigate the relationship between the inspiratory time and the diaphragmatic contraction. Design Cross-sectional controlled study. Methodology Eighty healthy subjects, yoga practitioners, with no previous respiratory pathology participated in this study. They were asked to take three different types of deep breaths: diaphragmatic with nasal inspiration, pursed-lip inspiration, and ujjayi (nasal inspiration with slight contraction of the glottis). The variables of thickness, excursion, and inspiratory contraction time were taken for each of them by ultrasound. Results Diaphragmatic contraction time is the only variable that shows a significant correlation with the other two. Thus, the correlation between inspiratory time and diaphragmatic thickness is significant (p < .001) for the three breaths: diaphragmatic (0.60), ujjayi (0.67), and pursed lips (0.39) and the correlation between inspiratory time and diaphragmatic excursion is significant for diaphragmatic breaths (-0.24, p = .035) and ujjayi (0.27, p = .017), but not in pursed lips (-0.01, p = .90). Conclusion The inspiratory contraction time and the diaphragmatic excursion are two essential variables in the dynamic functional evaluation of the diaphragm, compared to the diaphragmatic thickness measurement that only reports its strength.
Collapse
Affiliation(s)
- Teresa E Fernández-Pardo
- Escuela de Doctorado UAM, Ciudad Universitaria de Cantoblanco, Madrid, Spain
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
- Physiotherapy Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Maria Jesús Rodríguez-Nieto
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de neumología, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Mercedes Furió-Valverde
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - María García-Arrabé
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Ana Mallo-Lopez
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
- International Doctorate School, Rey Juan Carlos University, Madrid, Spain
| | | | - Germán Peces-Barba Romero
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de neumología, IIS Fundación Jiménez Díaz, Madrid, Spain
| |
Collapse
|
|
8
|
Mu H, Zhang Q. The Application of Diaphragm Ultrasound in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2024; 21:2331202. [PMID: 38634575 DOI: 10.1080/15412555.2024.2331202] [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: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition that poses a significant burden on individuals and society due to its high morbidity and mortality rates. The diaphragm is the main respiratory muscle, its function has a direct impact on the quality of life and prognosis of COPD patients. This article aims to review the structural measurement and functional evaluation methods through the use of diaphragmatic ultrasound and relevant research on its application in clinical practice for COPD patients. Thus, it serves to provide valuable insights for clinical monitoring of diaphragm function in COPD patients, facilitating early clinical intervention and aiding in the recovery of diaphragm function.
Collapse
Affiliation(s)
- Heng Mu
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
| | - Qunxia Zhang
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
| |
Collapse
|
|
9
|
Zhu M, Yuan L, Mei Z, Sheng Z, Ge Y, Zhang L, Liu G. Effect of Ropivacaine in Combined Costoclavicular Brachial Plexus - Cervical Plexus Blocks on Hemidiaphragmatic Paralysis for Humeral Fracture Surgery: A Prospective Single - Centre Cohort Study. Drug Des Devel Ther 2024; 18:5473-5483. [PMID: 39628957 PMCID: PMC11612563 DOI: 10.2147/dddt.s483358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 11/16/2024] [Indexed: 12/06/2024] Open
Abstract
Background The brachial plexus block is conducive to providing postoperative analgesia for patients with humeral fractures. The commonly used brachial plexus block techniques have a high incidence rate of hemidiaphragmatic paralysis (HDP), which may lead to respiratory problems. The combined costoclavicular brachial plexus - cervical plexus blocks (CCB-CPBs) had demonstrated favorable analgesic effects and had reduced the incidence of HDP in shoulder surgeries. However, the clinical experience regarding CCB-CPBs is rather limited. Consequently, our study aims to evaluate its various effects, such as the diaphragmatic and pulmonary functions, as well as the analgesia for humeral fracture surgeries. Patients and Methods We enrolled 30 patients who were slated to undergo surgery for humeral fractures under the combined use of nerve block and general anesthesia. All the patients underwent CCB-CPBs under the guidance of an ultrasound and a nerve simulator. The anesthetic dosage consisted of 20 ml and 10 ml of 0.5% ropivacaine respectively. Following the operation, all the patients were transferred to the Post-Anesthesia Care Unit (PACU). The diaphragmatic excursion, spirometry outcomes, pain score, along with the sensory and motor block, were evaluated. Results The diaphragmatic excursion was significantly reduced during the post-block period in contrast to the pre-block period. The mean change in diaphragmatic excursion (with the mean value [SD]) was -25.3 [48.6] %, accompanied by a P-value of 0.001. The forced vital capacity (FVC) during the post-block period was approximately 7% lower compared to that during the pre-block period, with a P-value of 0.032. The numerical rating scale (NRS) scores of the patients in the PACU were 0 (0-0). Conclusion CCB-CPBs can result in a reduction in hemidiaphragm excursion and may slightly affect lung function to some extent. Nevertheless, they can provide a favorable analgesic effect for humeral fracture surgery. Therefore, patients with poor respiratory reserve should exercise caution when using it.
Collapse
Affiliation(s)
- Miao Zhu
- Department of Anesthesiology, Ningbo No.6 hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, People’s Republic of China
| | - Liyong Yuan
- Department of Anesthesiology, Ningbo No.6 hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, People’s Republic of China
| | - Zhong Mei
- Department of Anesthesiology, Zhejiang Xiaoshan Hospital, Hangzhou, People’s Republic of China
| | - Zhimin Sheng
- Department of Anesthesiology, Wenling Maternity and Child Health Care Hospital, Taizhou, People’s Republic of China
| | - Yeying Ge
- Department of Anesthesiology, Ningbo No.6 hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, People’s Republic of China
| | - Long Zhang
- Department of Anesthesiology, Ningbo No.6 hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, People’s Republic of China
| | - Guanyi Liu
- Department of Orthopedics, Ningbo No.6 hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, People’s Republic of China
| |
Collapse
|
|
10
|
Banauch GI, Raj S. When You Cannot Catch Your Breath after a Cold. Ann Am Thorac Soc 2024; 21:1600-1604. [PMID: 39485166 DOI: 10.1513/annalsats.202403-281cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/29/2024] [Indexed: 11/03/2024] Open
Affiliation(s)
- Gisela I Banauch
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts; and
| | - Sarang Raj
- Graduate School of Nursing, Chan Medical School, University of Massachusetts, Worcester, Massachusetts
| |
Collapse
|
|
11
|
Formenti P, Ruzza F, Pederzolli Giovanazzi G, Sabbatini G, Galimberti A, Gotti M, Pezzi A, Umbrello M. Exploring ultrasonographic diaphragmatic function in perioperative anesthesia setting: A comprehensive narrative review. J Clin Anesth 2024; 97:111530. [PMID: 38986431 DOI: 10.1016/j.jclinane.2024.111530] [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: 02/28/2024] [Revised: 05/16/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
The ultrasound study of diaphragm function represents a valid method that has been extensively studied in recent decades in various fields, especially in intensive care, emergency, and pulmonology settings. Diaphragmatic function is pivotal in these contexts due to its crucial role in respiratory mechanics, ventilation support strategies, and overall patient respiratory outcomes. Dysfunction or weakness of the diaphragm can lead to respiratory failure, ventilatory insufficiency, and prolonged mechanical ventilation, making its assessment essential for patient management and prognosis in critical care and emergency medicine. While several studies have focused on diaphragmatic functionality in the context of intensive care, there has been limited attention within the field of anesthesia. The ultrasound aids in assessing diaphragmatic dysfunction (DD) by measuring muscle mass and contractility and their potential variations over time. Recent advancements in ultrasound imaging allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily. In the context of anesthesia, early studies have shed light on the patho-physiological mechanisms of diaphragm function during general anesthesia. In contrast, more recent research has centered on evaluating diaphragmatic functionality at various phases of general anesthesia and by comparing diverse types of procedures or anatomical position during surgery. The objectives of this current review are to highlight the use of diaphragm ultrasound for the evaluation of diaphragmatic function during perioperative anesthesia and surgery. Specifically, we aim to examine the effects of anesthetic agents, surgical techniques, and anatomical positioning on diaphragmatic function. We explore how ultrasound aids in assessing DD by measuring muscle mass and contractility, as well as their potential variations over time. Additionally, we will discuss recent advancements in ultrasound imaging that allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily.
Collapse
Affiliation(s)
- Paolo Formenti
- SC Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo 20097, Milan, Italy.
| | - Francesca Ruzza
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy
| | | | - Giovanni Sabbatini
- SC Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo 20097, Milan, Italy
| | - Andrea Galimberti
- SC Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo 20097, Milan, Italy
| | - Miriam Gotti
- SC Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo 20097, Milan, Italy
| | - Angelo Pezzi
- SC Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo 20097, Milan, Italy
| | - Michele Umbrello
- Department of Intensive Care, New Hospital of Legnano: Ospedale Nuovo di Legnano, 20025, Legnano, Milan, Italy
| |
Collapse
|
|
12
|
Saisawart P, Sutthigran S, Kasemsuwan T, Sakulsirajit R, Ritthikulprasert S, Tachampa K, Thanaboonnipat C, Choisunirachon N. Efficacy of ultrasonographic diaphragmatic parameters in distinguishing diaphragmatic dysfunction in cats. J Feline Med Surg 2024; 26:1098612X241275290. [PMID: 39451117 PMCID: PMC11523170 DOI: 10.1177/1098612x241275290] [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] [Accepted: 06/19/2024] [Indexed: 10/26/2024]
Abstract
OBJECTIVES Diaphragmatic dysfunction (DD) is often underdiagnosed in veterinary medicine. Various ultrasonographic diaphragmatic parameters, including diaphragmatic excursion (DE), diaphragmatic thickness (Tdi) and diaphragmatic thickening fraction (DTF), can be used to identify DD. We aimed to establish normal reference intervals in healthy cats, examine the effects of intrinsic factors on diaphragmatic parameters and evaluate the efficacy of these parameters in identifying DD in healthy and diseased cats. METHODS This prospective observational study was conducted on 22 healthy cats and 12 diseased cats using ultrasonographic techniques to evaluate DE, Tdi and DTF. The correlation between diaphragmatic parameters and intrinsic factors, including sex, age, body weight and body condition score, was analysed using Pearson correlation analysis. Cut-off values for healthy and diseased cats were established using receiver operating characteristic curve analysis. RESULTS The mean DEs of the left and right hemidiaphragms were 0.66 ± 0.16 and 0.64 ± 0.18 cm, respectively. The mean Tdis in the end-inspiration phase were 0.13 ± 0.03 and 0.12 ± 0.03 cm for the left and right hemidiaphragms, respectively, whereas in the end-expiration phase the mean Tdi was 0.07 ± 0.03 cm for both hemidiaphragms. The DTF ranges for the left and right hemidiaphragms were 23.90-122.1% and 38.80-107%, respectively. Intrinsic factors had no significant impact on DE, Tdi and DTF. The DE measurements for the left hemidiaphragm were more accurate for evaluating diaphragmatic function. To distinguish between healthy and diseased cats, the cut-off value, sensitivity and specificity were 0.458 cm (area under the curve [AUC] 0.846), 75.00% and 86.36%, respectively, for the left hemidiaphragm and 0.423 cm (AUC 0.704), 41.67% and 100%, respectively, for the right hemidiaphragm. CONCLUSIONS AND RELEVANCE Normal reference values for DE, Tdi and DTF were established for healthy cats. DE, particularly in the left hemidiaphragm, obtained using routine ultrasonography, improves the efficacy of identifying DD and assists clinicians in the diagnosis and treatment of cats with cardiorespiratory disease.
Collapse
Affiliation(s)
- Phasamon Saisawart
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Somchin Sutthigran
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Tanya Kasemsuwan
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Run Sakulsirajit
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Sukullaya Ritthikulprasert
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Kittipong Tachampa
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Chutimon Thanaboonnipat
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
|
13
|
Figueira Silva BC, Abreu DC, Souza YR, Figueiredo M, Macêdo JF, Mafort TT, Rufino R, da Costa CH. Ultrasonography as a way of evaluating the diaphragm muscle in patients with chronic obstructive pulmonary disease. Medicine (Baltimore) 2024; 103:e39795. [PMID: 39312326 PMCID: PMC11419516 DOI: 10.1097/md.0000000000039795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024] Open
Abstract
The respiratory muscles in chronic obstructive pulmonary disease (COPD) patients have reduced strength and resistance, leading to loss of the functional ability of these muscles. Lung hyperinflation is one of the main alterations, and air trapping is the main factor limiting diaphragmatic mobility (DM) in these patients; however, its correlation with functional parameters, exercise capacity, and indicators of disease severity remains underexplored. This study aimed to assess DM in stable COPD patients and relate the findings with parameters such as the 6-minute walk test distance, forced expiratory volume in 1 second (FEV1) %predicted, residual volume (RV) %predicted, and dyspnea. An observational cohort study was conducted to measure DM using ultrasound both at rest (DMrest) and during deep inspiration (DMmax). Forty-nine patients with stable COPD were included in this study. There was a correlation between DMmax and FEV1 %predicted (R = 0.36; P = .012), RV %predicted (r = -0.42; P = .01), RV/total lung capacity (r = -0.61; P < .001), and distance reached in the 6MWT (R = 0.46; P = .001). Patients with a modified Medical Research Council score <2 exhibited greater DM than those with a score ≥2 (mean difference = 13.20 ± 4.6 mm; P = .0059). Similarly, patients with a Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity index ≤4 showed greater DM (61.95 mm) than those with a Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity index >4 (47.89 mm; mean difference = 14.05 ± 5.3 mm; 95% confidence interval = 25.09-3.01 mm). DM is correlated with bronchial obstruction (FEV1), lung hyperinflation (RV and RV/total lung capacity), exercise capacity, and dyspnea in patients with COPD, suggesting its utility as an evaluative tool in this population.
Collapse
|
|
14
|
Zhang T, Liu Y, Xu D, Dong R, Song Y. Diaphragm Assessment by Multimodal Ultrasound Imaging in Healthy Subjects. Int J Gen Med 2024; 17:4015-4024. [PMID: 39290234 PMCID: PMC11406537 DOI: 10.2147/ijgm.s478136] [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: 05/14/2024] [Accepted: 09/04/2024] [Indexed: 09/19/2024] Open
Abstract
Background In recent years, diaphragm ultrasound (DUS) has been used to identify diaphragm dysfunction in the intensive care unit (ICU). However, there are few studies on DUS parameters to evaluate function, normal ranges, and influencing factors in population. The aim of this study is to provide a methodological reference for clinical evaluation of diaphragm function by measuring different DUS parameters in a healthy population. Methods A descriptive study was conducted 212 (105 males, 107 females) subjects with normal spirometry underwent ultrasound imaging in this study. The diaphragm contraction and motion related parameters and shear wave velocity (SWV) were measured in the supine position. The effects of gender, age, body mass index (BMI) and lifestyle on diaphragm ultrasound parameters were analyzed. Results The diaphragm thickness at end-expiration (DT-exp) was 0.14 ±0.05 cm, the diaphragm thickness at end- inspiration (DT-insp) was 0.29±0.10 cm, with thickening fraction (TF) was 1.11±0.54. The diaphragm excursion (DE) was 1.68±0.37cm and diaphragm velocity was 1.45±0.41 cm/s during calm breathing. During deep breathing, the DE was 5.06±1.40cm and diaphragm velocity was 3.20±1.18 cm/s. The Diaphragm shear modulus-longitudinal view were Mean16.72±4.07kPa, Max25.04±5.58kPa, Min11.06±3.88kPa, SD2.56±0.98. The results of diaphragmatic measurement showed that the DT of males was significantly greater than that of females (P< 0.05), but there was no significant difference in TF. The DT-insp (r=0.155, P= 0.024) and the DT-exp (r=0.252, P=0.000) were positively correlated with age, and the DE during calm breathing was negatively correlated with age (r=-0.218, P= 0.001) and BMI (r=-00.280, P= 0.000). The DE (R=0.371, P=0.000) and velocity (R=0.368, P=0.000) during deep breathing were correlated with lifestyle. Conclusion Our study provides normal reference values of the diaphragm and evaluates the influence of gender, age, body mass index and lifestyle on diaphragmatic morphology.
Collapse
Affiliation(s)
- Tianjie Zhang
- Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People's Republic of China
| | - Yan Liu
- Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People's Republic of China
| | - Dongwei Xu
- Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China
| | - Rui Dong
- Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People's Republic of China
| | - Ye Song
- Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People's Republic of China
| |
Collapse
|
|
15
|
Chung E, Leem AY, Lee SH, Kang YA, Kim YS, Chung KS. Predicting Successful Weaning through Sonographic Measurement of the Rapid Shallow Breathing Index. J Clin Med 2024; 13:4809. [PMID: 39200951 PMCID: PMC11355280 DOI: 10.3390/jcm13164809] [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: 07/02/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Diaphragmatic dysfunction correlates with weaning failure, highlighting the need to independently assess the diaphragm's effects on weaning. We modified the rapid shallow breathing index (RSBI), a predictor of successful weaning, by incorporating temporal variables into existing ultrasound-derived diaphragm index to create a simpler index closer to tidal volume. Methods: We conducted a prospective observational study of patients who underwent a spontaneous breathing trial in the medical intensive care unit (ICU) at Severance Hospital between October 2022 and June 2023. Diaphragmatic displacement (DD) and diaphragm inspiratory time (Ti) were measured using lung ultrasonography. The modified RSBI was defined as follows: respiratory rate (RR) divided by DD was defined as D-RSBI, and RR divided by the sum of the products of DD and Ti on both sides was defined as DTi-RSBI. Results: Among the sonographic indices, DTi-RSBI had the highest area under the receiver operating characteristic (ROC) curve of 0.774 in ROC analysis, and a correlation was found between increased DTi-RSBI and unsuccessful extubation in a multivariable logistic regression analysis (adjusted odds ratio 0.02, 95% confidence interval 0.00-0.97). Conclusions: The DTi-RSBI is beneficial in predicting successful weaning in medical ICU patients.
Collapse
Affiliation(s)
- Eunki Chung
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
- Department of Internal Medicine, Yonsei University Graduate School of Medicine, Seoul 03722, Republic of Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| |
Collapse
|
|
16
|
Yao XY, Li HM, Sun BW, Zhang YY, Feng JG, Jia J, Liu L. Ultrasound assessment of diaphragmatic dysfunction in non-critically ill patients: relevant indicators and update. Front Med (Lausanne) 2024; 11:1389040. [PMID: 38957305 PMCID: PMC11217340 DOI: 10.3389/fmed.2024.1389040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Diaphragm dysfunction (DD) can be classified as mild, resulting in diaphragmatic weakness, or severe, resulting in diaphragmatic paralysis. Various factors such as prolonged mechanical ventilation, surgical trauma, and inflammation can cause diaphragmatic injury, leading to negative outcomes for patients, including extended bed rest and increased risk of pulmonary complications. Therefore, it is crucial to protect and monitor diaphragmatic function. Impaired diaphragmatic function directly impacts ventilation, as the diaphragm is the primary muscle involved in inhalation. Even unilateral DD can cause ventilation abnormalities, which in turn lead to impaired gas exchange, this makes weaning from mechanical ventilation challenging and contributes to a higher incidence of ventilator-induced diaphragm dysfunction and prolonged ICU stays. However, there is insufficient research on DD in non-ICU patients, and DD can occur in all phases of the perioperative period. Furthermore, the current literature lacks standardized ultrasound indicators and diagnostic criteria for assessing diaphragmatic dysfunction. As a result, the full potential of diaphragmatic ultrasound parameters in quickly and accurately assessing diaphragmatic function and guiding diagnostic and therapeutic decisions has not been realized.
Collapse
Affiliation(s)
- Xin-Yu Yao
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Hong-Mei Li
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Anesthesiology, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Bo-Wen Sun
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Ying-Ying Zhang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Jian-Guo Feng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Jing Jia
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Li Liu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| |
Collapse
|
|
17
|
Skala Kavanagh H, Aksentijević J, Grubišić F, Grazio S, Gomerčić Palčić M. Thoracic manifestations and respiratory function alterations in axial spondyloarthritis and newest possibilities of ultrasound to detect changes in diaphragm-a narrative review. J Thorac Dis 2024; 16:3441-3449. [PMID: 38883670 PMCID: PMC11170431 DOI: 10.21037/jtd-23-1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 06/18/2024]
Abstract
Background and Objective Axial spondyloarthritis (axSpA) includes thoracic manifestations and changes in respiratory function that require a comprehensive understanding for effective treatment. This review aims to investigate these manifestations and evaluate the role of ultrasound in detecting diaphragmatic changes to provide insights for improved diagnosis and treatment strategies in axSpA patients. Methods A systematic search was conducted in Index Medicus and Scopus from 2003 to 2023. Inclusion criteria included primary and secondary publications, with a focus on high-quality evidence such as randomised controlled trials and systematic reviews with or without meta-analysis. Keywords spondyloarthritis, respiratory, chest, thoracic, diaphragm and ultrasound were used in the search. A total of 22 articles were identified after duplicates, and inadequate papers were removed. Key Content and Findings The review included the prevalence, classification and extra-articular manifestations of axSpA, highlighting the impact on respiratory function. Thoracic manifestations and the potential impact of pharmacological interventions were detailed, and various conditions affecting respiratory dynamics were discussed. In addition, the utility of ultrasonography in assessing diaphragmatic function was explained and the techniques, parameters and measurements used to assess diaphragmatic movement, muscle thickness and respiratory mobility were described. The results illustrate the changes in diaphragmatic function in axSpA patients and their correlation with disease activity. Conclusions This narrative review highlights the intricate relationship between axSpA and respiratory manifestations and emphasises the significant impact on thoracic function and diaphragmatic dynamics. The utility of ultrasound in assessing diaphragmatic function offers a promising avenue for objective evaluation that provides insight into disease activity and potential therapeutic responses. This review emphasises the critical role of early diagnosis and vigilant monitoring, and advocates a multidisciplinary approach that integrates non-pharmacological interventions, particularly tailored physical activity, to maintain and improve respiratory function in axSpA patients. Increased research initiatives and awareness of pulmonary complications in axSpA are essential to optimise medical care and improve treatment outcomes in this patient group.
Collapse
Affiliation(s)
- Hana Skala Kavanagh
- University Department of Rheumatology, Physical and Rehabilitation Medicine, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Jan Aksentijević
- Department of Physical and Rehabilitation Medicine with Rheumatology, University Hospital Dubrava, Zagreb, Croatia
| | - Frane Grubišić
- University Department of Rheumatology, Physical and Rehabilitation Medicine, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Simeon Grazio
- University Department of Rheumatology, Physical and Rehabilitation Medicine, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Marija Gomerčić Palčić
- Division of Pulmonology, University Department for Internal Diseases, University Clinical Centre Sestre Milosrdnice, Zagreb, Croatia
| |
Collapse
|
|
18
|
Boussuges A, Fourdrain A, Leone M, Brioude G, Menard A, Zieleskiewicz L, Delliaux S, Gouitaa M, Dutau H, Brégeon F. Diagnosis of hemidiaphragm paralysis: refine ultrasound criteria. Front Med (Lausanne) 2024; 11:1416520. [PMID: 38846144 PMCID: PMC11153810 DOI: 10.3389/fmed.2024.1416520] [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: 04/12/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Background Ultrasound has demonstrated its interest in the analysis of diaphragm function in patients with respiratory failure. The criteria used to diagnose hemidiaphragm paralysis are not well defined. Methods The aim of this observational retrospective study was to describe the ultrasound findings in 103 patients with diaphragm paralysis, previously diagnosed by conventional methods after various circumstances such as trauma or surgery. The ultrasound study included the recording of excursions of both diaphragmatic domes and the measurement of inspiratory thickening. Results On paralyzed hemidiaphragm, thickening was less than 20% in all patients during deep inspiration. Thinning was recorded in 53% of cases. In some cases, the recording of the thickening could be difficult. The study of motion during voluntary sniffing reported a paradoxical excursion in all but one patient. During quiet breathing, an absence of movement or a paradoxical displacement was observed. During deep inspiration, a paradoxical motion at the beginning of inspiration followed by a reestablishment of movement in the cranio-caudal direction was seen in 82% of cases. In some patients, there was a lack of movement followed, after an average delay of 0.4 s, by a cranio-caudal excursion. Finally, in 4 patients no displacement was recorded. Evidence of hyperactivity (increased inspiratory thickening and excursion) of contralateral non-paralyzed hemidiaphragm was observed. Conclusion To accurately detect hemidiaphragm paralysis, it would be interesting to combine the ultrasound study of diaphragm excursion and thickening. The different profiles reported by our study must be known to avoid misinterpretation.
Collapse
Affiliation(s)
- Alain Boussuges
- Centre de Recherche en Cardio-Vasculaire et Nutrition, C2VN (Université Aix Marseille, INSERM 1263, INRAE 1260), Faculté de Médecine, Marseille, France
- Laboratoire d’Exploration Fonctionnelle Respiratoire, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Alex Fourdrain
- Département de Chirurgie Thoracique, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Marc Leone
- Service d’Anesthésie et Réanimation, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Geoffrey Brioude
- Département de Chirurgie Thoracique, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Amelie Menard
- Service de Médecine Interne, Unité Post COVID, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Laurent Zieleskiewicz
- Service d’Anesthésie et Réanimation, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Stephane Delliaux
- Centre de Recherche en Cardio-Vasculaire et Nutrition, C2VN (Université Aix Marseille, INSERM 1263, INRAE 1260), Faculté de Médecine, Marseille, France
- Laboratoire d’Exploration Fonctionnelle Respiratoire, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Marion Gouitaa
- Département des Maladies Respiratoires et Transplantation Pulmonaire, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Hervé Dutau
- Département des Maladies Respiratoires et Transplantation Pulmonaire, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Fabienne Brégeon
- Laboratoire d’Exploration Fonctionnelle Respiratoire, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Unité d’Appui à la recherche (HIPE), Aix-Marseille Université, CNRS, Université de Toulon, Institut Paoli-Calmettes, Marseille, France
| |
Collapse
|
|
19
|
Yamada T, Minami T, Yoshino S, Emoto K, Mabuchi S, Hanazawa R, Hirakawa A, Hashimoto M. Relationship Between Diaphragm Thickness, Thickening Fraction, Dome Excursion, and Respiratory Pressures in Healthy Subjects: An Ultrasound Study. Lung 2024; 202:171-178. [PMID: 38520532 PMCID: PMC11009751 DOI: 10.1007/s00408-024-00686-2] [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: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Diaphragm ultrasonography is used to identify causes of diaphragm dysfunction. However, its correlation with pulmonary function tests, including maximal inspiratory (MIP) and expiratory pressures (MEP), remains unclear. This study investigated this relationship by measuring diaphragm thickness, thickening fraction (TF), and excursion (DE) using ultrasonography, and their relationship to MIP and MEP. It also examined the influence of age, sex, height, and BMI on these measures. METHODS We recruited healthy Japanese volunteers and conducted pulmonary function tests and diaphragm ultrasonography in a seated position. Diaphragm ultrasonography was performed during quiet breathing (QB) and deep breathing (DB) to measure the diaphragm thickness, TF, and DE. A multivariate analysis was conducted, adjusting for age, sex, height, and BMI. RESULTS Between March 2022 and January 2023, 109 individuals (56 males) were included from three facilities. The mean (standard deviation) MIP and MEP [cmH2O] were 72.2 (24.6) and 96.9 (35.8), respectively. Thickness [mm] at the end of expiration was 1.7 (0.4), TF [%] was 50.0 (25.9) during QB and 110.7 (44.3) during DB, and DE [cm] was 1.7 (0.6) during QB and 4.4 (1.4) during DB. Multivariate analysis revealed that only DE (DB) had a statistically significant relationship with MIP and MEP (p = 0.021, p = 0.008). Sex, age, and BMI had a statistically significant influence on relationships between DE (DB) and MIP (p = 0.008, 0.048, and < 0.001, respectively). CONCLUSION In healthy adults, DE (DB) has a relationship with MIP and MEP. Sex, age, and BMI, but not height, are influencing factors on this relationship.
Collapse
Affiliation(s)
- Toru Yamada
- Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Taro Minami
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Health System, Providence, RI, 02906, USA
| | - Shumpei Yoshino
- General Internal Medicine, Iizuka Hospital, Iizuka, Fukuoka, 135-0041, Japan
| | - Ken Emoto
- General Internal Medicine, Kaita Hospital, Iizuka, Fukuoka, 820-1114, Japan
| | - Suguru Mabuchi
- Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masayoshi Hashimoto
- Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| |
Collapse
|
|
20
|
Boussuges M, Blanc P, Bregeon F, Boussuges A. Interest of thoracic ultrasound after cardiac surgery or interventional cardiology. World J Cardiol 2024; 16:118-125. [PMID: 38576518 PMCID: PMC10989224 DOI: 10.4330/wjc.v16.i3.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
Thoracic ultrasound has attracted much interest in detecting pleural effusion or pulmonary consolidation after cardiac surgery. In 2016, Trovato reported, in the World Journal of Cardiology, the interest of using, in addition to echocardiography, thoracic ultrasound. In this editorial, we highlight the value of assessing diaphragm function after cardiac surgery and interventional cardiology procedures. Various factors are able to impair diaphragm function after such interventions. Diaphragm motion may be decreased by chest pain secondary to sternotomy, pleural effusion or impaired muscle function. Hemidiaphragmatic paralysis may be secondary to phrenic nerve damage complicating cardiac surgery or atrial fibrillation ablation. Diagnosis may be delayed. Indeed, respiratory troubles induced by diaphragm dysfunction are frequently attributed to pre-existing heart disease or pulmonary complications secondary to surgery. In addition, elevated hemidiaphragm secondary to diaphragm dysfunction is sometimes not observed on chest X-ray performed in supine position in the intensive care unit. Analysis of diaphragm function by ultrasound during the recovery period appears essential. Both hemidiaphragms can be studied by two complementary ultrasound methods. The mobility of each hemidiaphragms is measured by M-mode ultrasonography. In addition, recording the percentage of inspiratory thickening provides important information about the quality of muscle function. These two approaches make it possible to detect hemidiaphragm paralysis or dysfunction. Such a diagnosis is important because persistent diaphragm dysfunction after cardiac surgery has been shown to be associated with adverse respiratory outcome. Early respiratory physiotherapy is able to improve respiratory function through strengthening of the inspiratory muscles i.e. diaphragm and accessory inspiratory muscles.
Collapse
Affiliation(s)
- Martin Boussuges
- Service de Pneumologie, Centre Hospitalier Universitaire Sud Reunion, Saint Pierre 97410, Ile de la Reunion, France
| | - Philippe Blanc
- Department of Cardiac and Pulmonary Rehabilitation, Ste Clotilde & YlangYlang Rehabilitation Center, Sainte Clotilde 97491, Ile de la Reunion, France
| | - Fabienne Bregeon
- Service d'Explorations Fonctionnelles Respiratoires, Centre Hospitalier Universitaire Nord, Assistance Publique des Hôpitaux de Marseille, Marseille 13015, France
- Institut Hospitalo-Universitaire-Méditerranée Infection, Aix Marseille Université, Marseille 13005, France
| | - Alain Boussuges
- Service d'Explorations Fonctionnelles Respiratoires, Centre Hospitalier Universitaire Nord, Assistance Publique des Hôpitaux de Marseille, Marseille 13015, France
- Center for Cardiovascular and Nutrition Research, Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Marseille 13005, France.
| |
Collapse
|
|
21
|
Lallement P, Boussuges A, Habert P, Bermudez J, Reynaud-Gaubert M, Delliaux S, Bregeon F, Coiffard B. Evaluation of computed tomography in the diagnosis of ultrasound-proven diaphragm dysfunction. Respir Res 2024; 25:135. [PMID: 38509592 PMCID: PMC10956268 DOI: 10.1186/s12931-024-02770-w] [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: 12/07/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Computed tomography (CT) is routinely employed on the evaluation of dyspnea, yet limited data exist on its assessment of diaphragmatic muscle. This study aimed to determine the capability of CT in identifying structural changes in the diaphragm among patients with ultrasound-confirmed diaphragmatic dysfunction. METHODS Diaphragmatic ultrasounds conducted between 2018 and 2021 at our center in Marseille, France, were retrospectively collected. Diaphragmatic pillars were measured on CT scans at the L1 level and the celiac artery. Additionally, the difference in height between the two diaphragmatic domes in both diaphragmatic dysfunction cases and controls was measured and compared. RESULTS A total of 65 patients were included, comprising 24 with diaphragmatic paralysis, 13 with diaphragmatic weakness, and 28 controls. In the case group (paralysis and weakness) with left dysfunctions (n = 24), the CT thickness of the pillars at the level of L1 and the celiac artery was significantly thinner compared with controls (2.0 mm vs. 7.4 mm and 1.8 mm vs. 3.1 mm, p < 0.001 respectively). Significantly different values were observed for paralysis (but not weakness) in the right dysfunction subgroup (n = 15) (2.6 mm vs. 7.4 mm and 2.2 mm vs. 3.8 mm, p < 0.001 respectively, for paralysis vs. controls). Regardless of the side of dysfunction, a significant difference in diaphragmatic height was observed between cases and controls (7.70 cm vs. 1.16 cm and 5.51 cm vs. 1.16 cm, p < 0.001 for right and left dysfunctions, respectively). Threshold values determined through ROC curve analyses for height differences between the two diaphragmatic domes, indicative of paralysis or weakness in the right dysfunctions, were 4.44 cm and 3.51 cm, respectively. Similarly for left dysfunctions, the thresholds were 2.70 cm and 2.48 cm, respectively, demonstrating good performance (aera under the curve of 1.00, 1.00, 0.98, and 0.79, respectively). CONCLUSION In cases of left diaphragmatic dysfunction, as well as in paralysis associated with right diaphragmatic dysfunction, CT revealed thinner pillars. Additionally, a notable increase in the difference in diaphragmatic height demonstrated a strong potential to identify diaphragmatic dysfunction, with specific threshold values.
Collapse
Affiliation(s)
- Pauline Lallement
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Alain Boussuges
- Pulmonary Function Testing Laboratory, Aix-Marseille University, APHM, Marseille, France
| | - Paul Habert
- Department of Radiology, Aix-Marseille University, APHM, Marseille, France
- LIIE, Aix Marseille University, Marseille, France
- CERIMED, Aix Marseille University, Marseille, France
| | - Julien Bermudez
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Stéphane Delliaux
- Pulmonary Function Testing Laboratory, Aix-Marseille University, APHM, Marseille, France
| | - Fabienne Bregeon
- Pulmonary Function Testing Laboratory, Aix-Marseille University, APHM, Marseille, France
| | - Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Chemin des Bourrely, 13015, Marseille, France.
| |
Collapse
|
|
22
|
Maiorano A, Lupia C, Montenegro N, Neri G, Bruni A, Garofalo E, Longhini F, Crimi C, Maglio A, Vatrella A, Pelaia G, Pelaia C. Effects of inhaled beclomethasone dipropionate/formoterol fumarate/glycopyrronium on diaphragmatic workload and lung function in uncontrolled asthma: a case report. Front Med (Lausanne) 2024; 11:1357362. [PMID: 38504920 PMCID: PMC10948428 DOI: 10.3389/fmed.2024.1357362] [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: 12/18/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024] Open
Abstract
Beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G) single inhaler extrafine triple therapy is effective for the treatment of uncontrolled asthma. Nevertheless, there is a lack of data about the use of diaphragmatic ultrasonography to monitor adult asthmatics while they are receiving inhaled treatment. We took into consideration a 78-year-old woman complaining of asthma, treated with inhaled corticosteroid/long-acting β2-adrenergic agonist (ICS/LABA), characterized by an asthma control questionnaire-5 (ACQ-5) score and a lung function test suggestive of uncontrolled asthma. Moreover, a diaphragmatic ultrasound showed signs of high diaphragm workload. Because of these findings, we proposed to our patient a shift toward triple inhaled therapy with BDP/FF/G, and she underwent a second evaluation after 7 days of treatment. Improvements in the diaphragmatic ultrasound parameters, lung function test, and ACQ-5 score were found. In particular, we detected a reduction of thickening fraction (TF), and a normalization of the other diaphragmatic measures, indicative of a decrease in diaphragmatic workload. To our knowledge, this is the first literature report showing concomitant improvements of both lung function tests and diaphragmatic ultrasonography parameters, observed in an adult patient with uncontrolled asthma after short-term treatment with the single inhaler triple therapy BDP/FF/G.
Collapse
Affiliation(s)
- Antonio Maiorano
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Chiara Lupia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Nicola Montenegro
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giuseppe Neri
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| |
Collapse
|
|
23
|
Cè M, Oliva G, Rabaiotti FL, Macrì L, Zollo S, Aquila A, Cellina M. Portable Dynamic Chest Radiography: Literature Review and Potential Bedside Applications. Med Sci (Basel) 2024; 12:10. [PMID: 38390860 PMCID: PMC10885043 DOI: 10.3390/medsci12010010] [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: 01/06/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
Dynamic digital radiography (DDR) is a high-resolution radiographic imaging technique using pulsed X-ray emission to acquire a multiframe cine-loop of the target anatomical area. The first DDR technology was orthostatic chest acquisitions, but new portable equipment that can be positioned at the patient's bedside was recently released, significantly expanding its potential applications, particularly in chest examination. It provides anatomical and functional information on the motion of different anatomical structures, such as the lungs, pleura, rib cage, and trachea. Native images can be further analyzed with dedicated post-processing software to extract quantitative parameters, including diaphragm motility, automatically projected lung area and area changing rate, a colorimetric map of the signal value change related to respiration and motility, and lung perfusion. The dynamic diagnostic information along with the significant advantages of this technique in terms of portability, versatility, and cost-effectiveness represents a potential game changer for radiological diagnosis and monitoring at the patient's bedside. DDR has several applications in daily clinical practice, and in this narrative review, we will focus on chest imaging, which is the main application explored to date in the literature. However, studies are still needed to understand deeply the clinical impact of this method.
Collapse
Affiliation(s)
- Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Giancarlo Oliva
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy; (G.O.); (M.C.)
| | - Francesca Lucrezia Rabaiotti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Laura Macrì
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Sharon Zollo
- Konica Minolta Business Solutions Europe GmbH, Capellalaan 65, 2132 JL Hoofddorp, The Netherlands;
| | - Alessandro Aquila
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy; (G.O.); (M.C.)
| |
Collapse
|
|
24
|
Yamada T, Minami T, Yoshino S, Emoto K, Mabuchi S, Hanazawa R, Hirakawa A, Hashimoto M. Diaphragm Ultrasonography: Reference Values and Influencing Factors for Thickness, Thickening Fraction, and Excursion in the Seated Position. Lung 2024; 202:83-90. [PMID: 38019290 PMCID: PMC10896853 DOI: 10.1007/s00408-023-00662-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Measurements of diaphragm function by ultrasonography are affected by body position, but reference values in the seated position have not been established for an Asian population. This study aimed to determine reference values for diaphragm thickness, thickening fraction, and dome excursion by ultrasonography and to investigate the effects of sex, height, and body mass index. METHODS Diaphragm ultrasonography was performed on 109 seated Japanese volunteers with normal respiratory function who were enrolled between March 2022 and January 2023. Thickness, thickening fraction, and excursion were measured. Reference values and the measurement success rate were calculated. Multivariate analysis adjusted for sex, height, and body mass index was performed. RESULTS The measurement success rate was better for thickness than for excursion. The mean (lower limit of normal) values on the right/left sides were as follows. During quiet breathing, thickness at end expiration(mm) was 1.7 (0.9)/1.6 (0.80), thickening fraction(%) was 50 (0.0)/52 (0.0), and excursion(cm) was 1.7 (0.5)/1.9 (0.5). During deep breathing, the thickening fraction was 111 (24)/107 (22), and the excursion was 4.4 (1.7)/4.1 (2.0). In multivariate analysis, body mass index was positively associated with thickness but not with the thickening fraction. CONCLUSION The reference values in this study were smaller than those in previous reports from Europe. Considering that thickness is influenced by body mass index, using Western reference values in Asia, where the average body mass index is lower, might not be appropriate. The thickening fraction in deep breathing is unaffected by other items and can be used more universally.
Collapse
Affiliation(s)
- Toru Yamada
- Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Taro Minami
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Syumpei Yoshino
- General Internal Medicine, Iizuka Hospital, Iizuka, 135-0041, Fukuoka, Japan
| | - Ken Emoto
- General Internal Medicine, Kaita Hospital, Iizuka, 820-1114, Fukuoka, Japan
| | - Suguru Mabuchi
- Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masayoshi Hashimoto
- Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| |
Collapse
|
|
25
|
Beyoglu R. Radiological imaging and interventional procedures of the thorax in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S10-S20. [PMID: 38584789 PMCID: PMC10995680 DOI: 10.5606/tgkdc.dergisi.2024.25707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/29/2023] [Indexed: 04/09/2024]
Abstract
The thoracic region in pediatric patients poses unique diagnostic and interventional challenges, necessitating specialized approaches in radiological imaging and procedures. This review provides an overview of the key considerations, techniques, and clinical significance in the field of pediatric thoracic radiology and interventions. We discuss the importance of age-appropriate imaging modalities and the application of advanced technologies in assessing a wide range of thoracic conditions in children, including congenital anomalies, infections, neoplasms, and trauma. Furthermore, we highlight the evolving role of minimally invasive interventional procedures in the management of pediatric thoracic disorders. As the understanding of pediatric thoracic pathology continues to expand, this review aims to guide healthcare professionals, radiologists, and pediatricians in delivering optimal care to children with thoracic concerns.
Collapse
Affiliation(s)
- Rana Beyoglu
- Department of Pediatric Radiology, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| |
Collapse
|
|
26
|
Schenesse D, Mouillot P, Rabec C, Barnestein R, Tankere P, Giboulot M, Bonniaud P, Georges M. [Diaphragmatic ultrasonography for the pulmonologist: Technique and clinical use]. Rev Mal Respir 2024; 41:1-17. [PMID: 37980184 DOI: 10.1016/j.rmr.2023.10.005] [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: 03/29/2023] [Accepted: 09/29/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Ultrasonography is an emerging tool that helps to assess diaphragmatic function. It is now widely used in ICUs to predict weaning from mechanical ventilation. Ultrasonography is readily available, harmless (no radiation), and repeatable with good interoperator reproducibility. Over the past few years, ultrasonography has seen increasing use in patients with chronic pulmonary pathologies. STATE OF THE ART The aim of this review is (1) to describe the ultrasound techniques used to assess diaphragmatic excursion and thickening, (2) to indicate the expected, normal values in healthy patients, and (3) to summarize the main findings and clinical applications in treatment of chronic respiratory disorders. CONCLUSIONS Chronic pulmonary diseases are associated with diaphragmatic dysfunction that can be assessed with ultrasound. Diaphragmatic dysfunction is primary in neuromuscular disorders and secondary to respiratory disease in other chronic pulmonary conditions (COPD, ILD). Ultrasound is correlated with the severity of the underlying disease (functional and clinical parameters). PERSPECTIVES The prognostic interest of diaphragm ultrasonography remains to be established, after which its utilization should become routine.
Collapse
Affiliation(s)
- D Schenesse
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Mouillot
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - C Rabec
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - R Barnestein
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Tankere
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - M Giboulot
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Inserm, LNC UMR 1231, LipSTIC LabEx Team, Dijon, France
| | - M Georges
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; UMR 6265 CNRS 1234 INRA, centre des sciences du goût et de l'alimentation, université Bourgogne-Franche-Comté, Dijon, France.
| |
Collapse
|
|
27
|
Saisawart P, Sutthigran S, Suksangvoravong H, Thanaboonnipat C, Ritthikulprasert S, Tachampa K, Choisunirachon N. Computed tomographic diaphragmatic thickness: a promising method for the evaluation of diaphragmatic muscle in cardiopulmonary diseased cats. Front Vet Sci 2023; 10:1247531. [PMID: 38164391 PMCID: PMC10757920 DOI: 10.3389/fvets.2023.1247531] [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: 06/26/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
Diaphragmatic dysfunction (DD) is defined as a weakening of the diaphragmatic muscle and can be an undetected cause of dyspnea. The objectives of this study were to explore the appropriate diaphragmatic location, measure diaphragmatic thickness (DT), evaluate the effect of intrinsic factors on DT, and compare DT between healthy and diseased cats, using 33 healthy cats and 15 diseased cats. A retrospective, analytical, case-control study using thoraco-abdominal feline computed tomography (CT) was performed. Two radiologists independently reviewed all images to verify inter- and intra-observer reliabilities and the best position for measuring DT. The effects of sex, age, and body weight were also studied, and cutoff values for detecting DT abnormalities were established. The results showed that the appropriate location for DT measurement was at the ventral border of the cranial endplate of the first lumbar vertebral body (L1) due to its highest intra- and inter-observer reliabilities. At this location, a significant difference in DT between the right and left hemidiaphragms (p = 0.01) was observed. Only sex had an impact on DT values. Interestingly, the DTs of cardiorespiratory-affected cats, both on the right and left sides, were significantly thinner than those of healthy cats. In conclusion, CT imaging is a reliable imaging method for determining diaphragmatic muscular atrophy. The ventral border of the cranial endplate of L1 is recommended for measuring the DT, and sex was the only factor affecting the DT measurement.
Collapse
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
| | | | - Chutimon Thanaboonnipat
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | | | - Kittipong Tachampa
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
|
28
|
Rustagi PS, Yadav A, Nellore SS. Ultrasonographic evaluation of diaphragmatic excursion changes after major laparoscopic surgeries in the Trendelenburg position under general anaesthesia: A prospective observational study. Indian J Anaesth 2023; 67:S274-S280. [PMID: 38187984 PMCID: PMC10768898 DOI: 10.4103/ija.ija_643_23] [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: 07/06/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Laparoscopic surgeries result in increased intra abdominal pressure and cephalad displacement of the diaphragm. The Trendelenburg position can augment these respiratory changes. The primary objective of this study was to compare diaphragmatic excursions before and after a major laparoscopic pelvic surgery under general anaesthesia in the Trendelenburg position using ultrasonography (USG). Methods This prospective observational study included 90 patients of either gender, aged 20-60 years, with American Society of Anesthesiologists physical status I/II. M-mode USG was used to assess diaphragm inspiratory amplitude (DIA) before induction of anaesthesia and 10 minutes after tracheal extubation. Factors such as age, gender, body mass index, positive end-expiratory pressure (PEEP), pain, peak airway pressures, duration of pneumoperitoneum, duration and degree of Trendelenburg position and duration of anaesthesia were recorded. Pearson's correlation and multiple linear regression were used to analyse the factors affecting change in DIA (ΔDIA). Results The mean difference (95% confidence interval (CI)) of measured DIA was 0.70 (0.598-0.809), P < 0.001. ΔDIA had a weak positive significant correlation with age, anaesthesia duration, pneumoperitoneum, and visual analogue scale (VAS) score 10 minutes after extubation. Multiple linear regression analysis showed 14.86% of the variance in DIA. Age (β = 0.008, P = 0.049), duration of anaesthesia (β = 0.002, P = 0.02) and VAS score 10 minutes after extubation (β = 0.128, P = 0.001) were significant independent predictors. Conclusion DIA decreased significantly after pelvic laparoscopic surgeries performed in the Trendelenburg position. Age, duration of anaesthesia and pain after the procedure were significant independent predictors.
Collapse
Affiliation(s)
- Preeti Sachin Rustagi
- Department of Anaesthesiology, 4 Floor, Lokmanya Tilak Municipal Medical College Building, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| | - Akshay Yadav
- Department of Anaesthesiology, 4 Floor, Lokmanya Tilak Municipal Medical College Building, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| | - Shalaka Sandeep Nellore
- Department of Anaesthesiology, 4 Floor, Lokmanya Tilak Municipal Medical College Building, Sulochana Shetty Road, Sion, Mumbai, Maharashtra, India
| |
Collapse
|
|
29
|
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.
Collapse
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.
| |
Collapse
|
|
30
|
Fernández-Pardo TE, Furió-Valverde M, García-Arrabé M, Valcárcel-Linares D, Mahillo-Fernández I, Peces-Barba Romero G. Effects of usual yoga practice on the diaphragmatic contractility: A cross-sectional controlled study. Heliyon 2023; 9:e21103. [PMID: 37916088 PMCID: PMC10616329 DOI: 10.1016/j.heliyon.2023.e21103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
Objectives The aim of this study is to observe and compare the effects of regular yoga practice on the main inspiratory muscle, the diaphragm, by analyzing its thickness, excursion, velocity and contraction time, using ultrasound. Design A Cross-Sectional Controlled Study. Participants 80 healthy subjects (40 habitual yoga practitioners and 40 non-practitioners), without previous respiratory pathology participated in this study. During maximum diaphragmatic breathing, the diaphragmatic thickness (at rest and after maximum inspiration), excursion, velocity and contraction time were measured by ultrasound. Results in the experimental group, practicing yoga, statistically significant differences (p < 0.001) were observed compared to the control group, not practicing, in the thickness of the diaphragm at rest (0.26 ± 0.02 vs 0.22 ± 0.01 cm); the diaphragmatic thickness in maximum inspiration (0.34 ± 0.03 vs 0.28 ± 0.03 cm); contraction velocity (1.54 ± 0.54 vs 2.23 ± 0.86 cm/s), contraction time (3.28 ± 0.45 vs 2.58 ± 0.49 s) and Borg scale of perceived exertion (1.05 ± 1.6 vs 1.70 ± 1.34), p = 0.05. However, the diaphragmatic excursion was greater in the control group (5.45 ± 1.42 vs 4.87 ± 1.33 cm) with no statistically significant differences (p = 0.06). Conclusions the regular practice of yoga improves the parameters of diaphragm thickness, speed and contraction time measured in ultrasound and the sensation of perceived exertion during a maximum inspiration. So it can be considered as another method for training the inspiratory muscles in clinical practice.
Collapse
Affiliation(s)
- Teresa E. Fernández-Pardo
- Escuela de Doctorado UAM. Ciudad Universitaria de Cantoblanco, Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Physiotherapy Department. Ramón y Cajal University Hospital, Madrid, Spain
| | - Mercedes Furió-Valverde
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - María García-Arrabé
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - David Valcárcel-Linares
- Unidad Técnica de Apoyo a Programas Europeos. Fundación para la Investigación e Innovación Biomédica en Atención Primaria, Madrid, Spain
| | | | | |
Collapse
|
|
31
|
Molina-Hernández N, Chicharro JL, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Vicente-Campos D, Marugán-Rubio D, Gutiérrez-Torre SE, Calvo-Lobo C. Ultrasonographic reliability and repeatability of simultaneous bilateral assessment of diaphragm muscle thickness during normal breathing. Quant Imaging Med Surg 2023; 13:6656-6667. [PMID: 37869345 PMCID: PMC10585514 DOI: 10.21037/qims-23-329] [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: 03/15/2023] [Accepted: 08/03/2023] [Indexed: 10/24/2023]
Abstract
Background The diaphragm is considered the main muscle involved in breathing and also linked to trunk stabilization functions. Up to date, rehabilitative ultrasound imaging (RUSI) has been the most used technique to evaluate unilaterally the transcostal diaphragm thickness. Nevertheless, the inspiratory activity of both hemi-diaphragms is bilaterally performed at the same time, and its simultaneous evaluation with a thoracic orthosis could improve its assessment as well as its re-education with visual biofeedback of both hemi-diaphragms at the same time. The purpose was to evaluate the reliability and repeatability of simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing using a thoracic orthosis that allowed bilateral fixation of both right and left ultrasound probes. Methods The study was conducted in 46 healthy subjects, whose diaphragm thickness was measured bilaterally and simultaneously in the anterior axillary line during relaxed breathing with a designed thoracic orthosis and 2 ultrasound tools. Intra-examiner (same examiner), inter-examiner (2 examiners), intra-session (1 hour) and inter-session (1 week) reliability and repeatability between each pair of measurements of diaphragm muscle thickness were analyzed during normal breathing. Results Reliability and repeatability for intra-session evaluations using the thoracic orthosis were excellent to evaluate simultaneous thickness of both hemi-diaphragms by bilateral probes fixation (intraclass correlation coefficient =0.919-0.997; standard error of measurement =0.002-0.007 cm; minimum detectable change =0.006-0.020 cm), without systematic errors (P>0.05) between each pair of measurements. Nevertheless, inter-session evaluations varied from good to excellent using the bilateral probes fixation (intraclass correlation coefficient =0.614-0.984; standard error of measurement =0.006-0.028 cm; minimum detectable change =0.017-0.079 cm), although some systematic errors were presented (P<0.05). Conclusions Good to excellent reliability and repeatability was shown for simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing. Despite systematic errors were presented for some inter-examiner assessments, the use of the thoracic orthosis that allowed bilateral fixation of ultrasound probes could be recommended for simultaneous hemi-diaphragms breathing re-education by visual biofeedback.
Collapse
Affiliation(s)
- Nerea Molina-Hernández
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Daniel Marugán-Rubio
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
|
32
|
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.
Collapse
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.
| |
Collapse
|
|
33
|
YETKİN NA, YETKİN MF, BARAN KETENCİOĞLU B, OYMAK FS, GÜLMEZ İ, YILMAZ İ, TUTAR N. Evaluation of diaphragm functions with diaphragm ultrasound and pulmonary function tests in individuals with Friedreich's ataxia. Turk J Med Sci 2023; 53:1301-1311. [PMID: 38812999 PMCID: PMC10763816 DOI: 10.55730/1300-0144.5696] [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: 02/16/2023] [Revised: 10/26/2023] [Accepted: 09/07/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim It is known that the correlation of pulmonary function tests (PFT) with muscle dysfunction is insufficient. Here, we aimed to evaluate the diaphragm functions in individuals with Friedreich's ataxia (FRDA) and to examine its relationship with respiratory parameters and disease severity. Materials and methods This prospective study, conducted between November and December 2022, at Erciyes University, included 14 individuals with genetically confirmed FRDA and an age- and gender-matched healthy control group of eight individuals. We examined pulmonary functions with spirometric methods and evaluated diaphragm excursion, and diaphragm thickness-expiratory (Tde) and - end of inspiration (Tdi) with ultrasonography during calm breathing. Thickening fraction (TF) calculated. Also, we examined PaCO2 at rest. The neurological status of individuals was assessed using the Scale for the Assessment and Rating of Ataxia (SARA). Results The mean values of FEV1(lt), FEV1(%), FVC (lt), and FVC (%) were higher in the control group (p; <0.001, 0.013, <0.001, and 0.009, respectively). Also, mean Tdi, Tde, excursion and TF were lower in the FRDA group compared to the control group (p = 0.005, 0.294,0.005, and 0.019, respectively). The mean excursion value was 1.13 ± 0.54cm in the FRDA group and 1.71 ± 0.49cm in the control group. There is a strong, negative, and statistically significant correlation between SARA total score with excursion and TF (r = -0.7432, p = 0.002; r = -0.697, p = 0.008). There is no statistically significant relationship between excursion and BMI, standing-to-supine decrease in FVC, FEV1, and PaCO2. Also, the relationship between maximal inspiratory pressure (PImax) and excursion was moderate. Conclusion Diaphragm ultrasound may reveal respiratory dysfunction better than PFT. Diaphragm excursion and TF are associated with disease scores in individuals with FDRA. Further studies are needed regarding the detection of alveolar hypoventilation.
Collapse
Affiliation(s)
- Nur Aleyna YETKİN
- Department of Chest Diseases, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | - Mehmet Fatih YETKİN
- Department of Neurology, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | | | - Fatma Sema OYMAK
- Department of Chest Diseases, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | - İnci GÜLMEZ
- Department of Chest Diseases, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | - İnsu YILMAZ
- Department of Chest Diseases, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | - Nuri TUTAR
- Department of Chest Diseases, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| |
Collapse
|
|
34
|
Freigang M, Langner S, Hermann A, Günther R. Impaired diaphragmatic motility in treatment-naive adult patients with spinal muscular atrophy improved during nusinersen treatment. Muscle Nerve 2023; 68:278-285. [PMID: 37466180 DOI: 10.1002/mus.27938] [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: 10/23/2022] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION/AIMS The leading clinical feature of 5q-associated spinal muscular atrophy (SMA) is symmetric, proximal muscle weakness. Muscles involved in ventilation exhibit a specific pattern of denervation: intercostal muscles are severely atrophic, whereas the diaphragm muscle is less affected. The aim of this study was to investigate the involvement of diaphragmatic function by ultrasound imaging in adult patients with SMA and to quantify dynamics of diaphragmatic function during nusinersen treatment. METHODS Diaphragmatic thickness, thickening, and excursion during quiet breathing were assessed in 24 adult patients with SMA type 2 and 3 by diaphragm ultrasound imaging before and during nusinersen treatment and were correlated with spirometric parameters. RESULTS Diaphragm thickness was not reduced, but increased in a remarkable proportion of patients, whereas diaphragm thickening and excursion were reduced in about 20% to 30% of nusinersen-naive, adult patients with SMA types 2 and 3. During 26 months of nusinersen treatment, diaphragm thickening fraction and excursion improved. DISCUSSION Diaphragm ultrasound imaging can provide disease- and treatment-relevant information that is not identified during routine clinical assessments and may therefore be a valuable complementary outcome measure.
Collapse
Affiliation(s)
- Maren Freigang
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Simona Langner
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht-Kossel," Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen Rostock/Greifswald, Rostock, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen Dresden, Dresden, Germany
| |
Collapse
|
|
35
|
YEGİN D, OSKAY A, OSKAY T, ENVER DİNÇ S, ŞENOL H, ÖZEN M, ÇAKMAK V, SEYİT M, YILMAZ A, TÜRKÇÜER İ. Emergency ultrasound of respiratory muscles: a promising tool for determining the outcomes of COPD exacerbations. Turk J Med Sci 2023; 53:1001-1011. [PMID: 38031950 PMCID: PMC10760574 DOI: 10.55730/1300-0144.5664] [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: 11/03/2022] [Revised: 08/18/2023] [Accepted: 05/25/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The respiratory muscles of patients with chronic obstructive pulmonary disease (COPD) exhibit structural and functional changes that can be evaluated and monitored by ultrasonography. METHODS This single-center, prospective study was conducted in the emergency department (ED) of a tertiary care hospital over an eight-month period (September 2020-May 2021). Diaphragmatic excursions, end-expiratory thickness, and thickening fractions, as well as right and left intercostal muscle thicknesses, of all adult subjects manifesting COPD exacerbation, were assessed. The data were analyzed regarding ward/intensive care unit (ICU) hospitalization or discharge from the ED, mortality, and readmission within 15 days. RESULTS Sixty-three subjects were recruited for the study. Diaphragmatic excursion, end-expiratory diaphragmatic thickness, and intercostal muscle thickness measurements were significantly different between the ward, ICU, and discharge groups (p < 0.001) but lower in the deceased subjects (all p < 0.05). The diaphragmatic excursion value of 3.25 cm was the threshold value measured for distinguishing discharge from ED, and 1.82 cm was measured for admission to the ICU, both with 100% sensitivity and selectivity (AUC = 1). DISCUSSION Diaphragmatic excursion, diaphragmatic end-expiratory thickness, and right and left intercostal muscle thicknesses vary in the prognosis of subjects presenting with COPD exacerbation.
Collapse
Affiliation(s)
- Dinçer YEGİN
- Department of Emergency Medicine, Ardahan State Hospital, Ardahan,
Turkiye
| | - Alten OSKAY
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Tülay OSKAY
- Department of Cardiology, Bucak State Hospital, Burdur,
Turkiye
| | - Selcan ENVER DİNÇ
- Department of Emergency Medicine, Kepez State Hospital, Antalya,
Turkiye
| | - Hande ŞENOL
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Mert ÖZEN
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Vefa ÇAKMAK
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Murat SEYİT
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Atakan YILMAZ
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - İbrahim TÜRKÇÜER
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| |
Collapse
|
|
36
|
Fyles F, FitzMaurice TS, Robinson RE, Bedi R, Burhan H, Walshaw MJ. Dynamic chest radiography: a state-of-the-art review. Insights Imaging 2023; 14:107. [PMID: 37332064 DOI: 10.1186/s13244-023-01451-4] [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: 02/15/2023] [Accepted: 05/14/2023] [Indexed: 06/20/2023] Open
Abstract
Dynamic chest radiography (DCR) is a real-time sequential high-resolution digital X-ray imaging system of the thorax in motion over the respiratory cycle, utilising pulsed image exposure and a larger field of view than fluoroscopy coupled with a low radiation dose, where post-acquisition image processing by computer algorithm automatically characterises the motion of thoracic structures. We conducted a systematic review of the literature and found 29 relevant publications describing its use in humans including the assessment of diaphragm and chest wall motion, measurement of pulmonary ventilation and perfusion, and the assessment of airway narrowing. Work is ongoing in several other areas including assessment of diaphragmatic paralysis. We assess the findings, methodology and limitations of DCR, and we discuss the current and future roles of this promising medical imaging technology.Critical relevance statement Dynamic chest radiography provides a wealth of clinical information, but further research is required to identify its clinical niche.
Collapse
Affiliation(s)
- Fred Fyles
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas S FitzMaurice
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Ryan E Robinson
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ram Bedi
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hassan Burhan
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Martin J Walshaw
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
|
37
|
Boussuges A, Chaumet G, Boussuges M, Menard A, Delliaux S, Brégeon F. Ultrasound assessment of the respiratory system using diaphragm motion-volume indices. Front Med (Lausanne) 2023; 10:1190891. [PMID: 37275363 PMCID: PMC10235454 DOI: 10.3389/fmed.2023.1190891] [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: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
Background Although previous studies have determined limit values of normality for diaphragm excursion and thickening, it would be beneficial to determine the normal diaphragm motion-to-inspired volume ratio that integrates the activity of the diaphragm and the quality of the respiratory system. Methods To determine the normal values of selected ultrasound diaphragm motion-volume indices, subjects with normal pulmonary function testing were recruited. Ultrasound examination recorded diaphragm excursion on both sides during quiet breathing and deep inspiration. Diaphragm thickness was also measured. The inspired volumes of the corresponding cycles were systematically recorded using a spirometer. The indices were calculated using the ratio excursion, or percentage of thickening, divided by the corresponding breathing volume. From this corhort, normal values and limit values for normality were determined. These measurements were compared to those performed on the healthy side in patients with hemidiaphragm paralysis because an increase in hemidiaphragm activity has been previously demonstated in such circumstances. Results A total of 122 subjects (51 women, 71 men) with normal pulmonary function were included in the study. Statistical analysis revealed that the ratio of excursion, or percentage of thickening, to inspired volume ratio significantly differed between males and females. When the above-mentioned indices using excursion were normalized by body weight, no gender differences were found. The indices differed between normal respiratory function subjects and patients with hemidiaphragm paralysis (27 women, 41 men). On the paralyzed side, the average ratio of the excursion divided by the inspired volume was zero. On the healthy side, the indices using the excursion and the percentage of thickening during quiet breathing or deep inspiration were significantly increased comparedto patients with normal lung function. According to the logistic regression analysis, the most relevant indice appeared to be the ratio of the excursion measured during quiet breathing to the inspired volume. Conclusion The normal values of the diaphragm motion-volume indices could be useful to estimate the performance of the respiratory system. Proposed indices appear suitable in a context of hyperactivity.
Collapse
Affiliation(s)
- Alain Boussuges
- Center for Cardiovascular and Nutrition Research, C2VN (Aix Marseille University, INSERM 1263, INRAE 1260), Faculté de Médecine, Marseille, France
- APHM, Hôpital Nord, Explorations Fonctionnelles Respiratoires, Marseille, France
| | | | - Martin Boussuges
- Aix Marseille University, APHM, Département de Pneumologie, Hôpital Nord, Marseille, France
| | - Amelie Menard
- APHM, Hôpital Nord, Unité Post COVID, Service de Médecine Interne, Marseille, France
| | - Stephane Delliaux
- Center for Cardiovascular and Nutrition Research, C2VN (Aix Marseille University, INSERM 1263, INRAE 1260), Faculté de Médecine, Marseille, France
- APHM, Hôpital Nord, Explorations Fonctionnelles Respiratoires, Marseille, France
| | - Fabienne Brégeon
- APHM, Hôpital Nord, Explorations Fonctionnelles Respiratoires, Marseille, France
- Aix Marseille University, APHM, Microbes Evolution Phylogeny and Infections Department, IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
|
38
|
De Rosa CA, Cristiano G, Guarino M. Ultrasound assessment of diaphragmatic dysfunction and its improvement with levosimendan in patients with chronic obstructive pulmonary disease. EMERGENCY CARE JOURNAL 2023. [DOI: 10.4081/ecj.2023.11248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Diaphragmatic Dysfunction (DD) is a clinical condition in which the diaphragm becomes weak or paralyzed, because of muscle strength reduction. It can be due to muscular issues or loss of proper innervation, but, also, to pulmonary hyperinflation or air trapping, such as in Chronic Obstructive Pulmonary Disease (COPD). DD impacts on COPD induced dyspnea, determining its progressive worsening, but levosimendan, an inodilator better known as Ca2+ sensitizer, may limit this phenomenon and diaphragmatic ultrasound assessment can be useful in monitoring its effect. Here, we show the case of a 77-year-old woman admitted to the Emergency department for acute exacerbation of chronic dyspnea in COPD, related to right ventricular failure and DD, which did not respond to medical therapy and non-invasive mechanical ventilation but did experience a favorable outcome after intravenous administration of levosimendan.
Collapse
|
|
39
|
Ultrasonographic Assessment of Diaphragmatic Function and Its Clinical Application in the Management of Patients with Acute Respiratory Failure. Diagnostics (Basel) 2023; 13:diagnostics13030411. [PMID: 36766515 PMCID: PMC9914801 DOI: 10.3390/diagnostics13030411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Acute respiratory failure (ARF) is a common life-threatening medical condition, with multiple underlying etiologies. In these cases, many factors related to systemic inflammation, prolonged use of steroids, and lung mechanical abnormalities (such as hyperinflation or increased elastic recoil due to pulmonary oedema or fibrosis) may act as synergic mechanisms leading to diaphragm dysfunction. The assessment of diaphragm function with ultrasound has been increasingly investigated in the emergency department and during hospital stay as a valuable tool for providing additional anatomical and functional information in many acute respiratory diseases. The diaphragmatic ultrasound is a noninvasive and repeatable bedside tool, has no contraindications, and allows the physician to rapidly assess the presence of diaphragmatic dysfunction; this evaluation may help in estimating the need for mechanical ventilation (and the risk of weaning failure), as well as the risk of longer hospital stay and higher mortality rate. This study presents an overview of the recent evidence regarding the evaluation of diaphragmatic function with bedside ultrasound and its clinical applications, including a discussion of real-life clinical cases.
Collapse
|
|
40
|
Postural-respiratory function of the diaphragm assessed by M-mode ultrasonography. PLoS One 2022; 17:e0275389. [PMID: 36215306 PMCID: PMC9550028 DOI: 10.1371/journal.pone.0275389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or breathing with simultaneous voluntary contraction of the abdominal muscles (VCAM). This study analyzed diaphragm motion in healthy individuals during various postural-respiratory situations. METHODS 31 healthy participants underwent examination of the diaphragm using M-mode ultrasonography, spirometry, and abdominal wall tension (AWT) measurements. All recordings were performed simultaneously during three consecutive scenarios, i.e., 1. Lifting a load without breathing; 2. Lifting a load and breathing naturally; 3. Lifting a load and breathing with simultaneous VCAM. RESULTS Using paired-samples t-tests, lifting a load without breathing displaced the diaphragm's expiratory position more caudally (P < .001), with no change noted in the inspiratory position (P = .373). During lifting a load breathing naturally, caudal displacement of the diaphragm's inspiratory position was presented (P < .001), with no change noted in the expiratory position (P = 0.20) compared to tidal breathing. Total diaphragm excursion was greater when loaded (P = .002). Lifting a load and breathing with VCAM demonstrated no significant changes in diaphragm position for inspiration, expiration, or total excursion compared to natural loaded breathing. For all scenarios, AWT measures were greater when lifting a load (P < .001). CONCLUSION In healthy individuals, caudal displacement and greater excursions of the diaphragm occurred when lifting a load. The postural function of the diaphragm is independent of its respiratory activity and is not reduced by the increase in AWT.
Collapse
|
|
41
|
Boussuges A, Habert P, Chaumet G, Rouibah R, Delorme L, Menard A, Million M, Bartoli A, Guedj E, Gouitaa M, Zieleskiewicz L, Finance J, Coiffard B, Delliaux S, Brégeon F. Diaphragm dysfunction after severe COVID-19: An ultrasound study. Front Med (Lausanne) 2022; 9:949281. [PMID: 36091672 PMCID: PMC9448976 DOI: 10.3389/fmed.2022.949281] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSARS-CoV-2 infection can impair diaphragm function at the acute phase but the frequency of diaphragm dysfunction after recovery from COVID-19 remains unknown.Materials and methodsThis study was carried out on patients reporting persistent respiratory symptoms 3–4 months after severe COVID-19 pneumonia. The included patients were selected from a medical consultation designed to screen for recovery after acute infection. Respiratory function was assessed by a pulmonary function test, and diaphragm function was studied by ultrasonography.ResultsIn total, 132 patients (85M, 47W) were recruited from the medical consultation. During the acute phase of the infection, the severity of the clinical status led to ICU admission for 58 patients (44%). Diaphragm dysfunction (DD) was detected by ultrasonography in 13 patients, two of whom suffered from hemidiaphragm paralysis. Patients with DD had more frequently muscle pain complaints and had a higher frequency of prior cardiothoracic or upper abdominal surgery than patients with normal diaphragm function. Pulmonary function testing revealed a significant decrease in lung volumes and DLCO and the dyspnea scores (mMRC and Borg10 scores) were significantly increased in patients with DD. Improvement in respiratory function was recorded in seven out of nine patients assessed 6 months after the first ultrasound examination.ConclusionAssessment of diaphragm function by ultrasonography after severe COVID-19 pneumonia revealed signs of dysfunction in 10% of our population. In some cases, ultrasound examination probably discovered an un-recognized pre-existing DD. COVID-19 nonetheless contributed to impairment of diaphragm function. Prolonged respiratory physiotherapy led to improvement in respiratory function in most patients.Clinical trial registration[www.cnil.fr], identifier [#PADS20-207].
Collapse
Affiliation(s)
- Alain Boussuges
- Faculté de Médecine, Center for Cardiovascular and Nutrition Research, C2VN, INSERM 1263, INRAE 1260, Aix-Marseille University, Marseille, France
- Explorations Fonctionnelles Respiratoires, Hôpital Nord, APHM, Marseille, France
- *Correspondence: Alain Boussuges, ,
| | - Paul Habert
- Département d’Imagerie, Hôpital Nord, APHM, LIIE, Aix-Marseille University, Marseille, France
| | | | - Rawah Rouibah
- Explorations Fonctionnelles Respiratoires, Hôpital Nord, APHM, Marseille, France
| | - Lea Delorme
- IRD, IHU-Méditerranée Infection, Marseille, France
| | - Amelie Menard
- Unité Post COVID, Service de Médecine Interne, Hôpital Nord, APHM, Marseille, France
| | - Matthieu Million
- Microbes Evolution Phylogeny and Infections (MEPHI), IHU-Méditerranée Infection, APHM, Aix-Marseille University, Marseille, France
| | - Axel Bartoli
- Département de Radiologie, CNRS, CRMBM, Hôpital Timone, APHM, Aix-Marseille University, Marseille, France
| | - Eric Guedj
- Department of Nuclear Medicine, CNRS, Centrale Marseille, Institut Fresnel, Hôpital Timone, CERIMED, APHM, Aix-Marseille University, Marseille, France
| | - Marion Gouitaa
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, APHM, Marseille, France
| | - Laurent Zieleskiewicz
- Faculté de Médecine, Center for Cardiovascular and Nutrition Research, C2VN, INSERM 1263, INRAE 1260, Aix-Marseille University, Marseille, France
- Service d’Anesthésie et Réanimation, Hôpital Nord, Marseille, France
| | - Julie Finance
- Explorations Fonctionnelles Respiratoires, Hôpital Nord, APHM, Marseille, France
| | - Benjamin Coiffard
- Département des Maladies Respiratoire et Transplantation Pulmonaire, Hôpital Nord, APHM, Aix-Marseille University, Marseille, France
| | - Stephane Delliaux
- Faculté de Médecine, Center for Cardiovascular and Nutrition Research, C2VN, INSERM 1263, INRAE 1260, Aix-Marseille University, Marseille, France
- Explorations Fonctionnelles Respiratoires, Hôpital Nord, APHM, Marseille, France
| | - Fabienne Brégeon
- Explorations Fonctionnelles Respiratoires, Hôpital Nord, APHM, Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), IHU-Méditerranée Infection, APHM, Aix-Marseille University, Marseille, France
| |
Collapse
|
|
42
|
Kabil AE, Sobh E, Elsaeed M, Hassanin HE, Yousef IH, Eltrawy HH, Ewis AM, Aboseif A, Albalsha AM, Elsawy S, Ali ARH. Diaphragmatic excursion by ultrasound: reference values for the normal population; a cross-sectional study in Egypt. Multidiscip Respir Med 2022; 17:842. [PMID: 35756096 PMCID: PMC9220962 DOI: 10.4081/mrm.2022.842] [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: 02/25/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Measurement of diaphragmatic motion by ultrasound is being utilized in different aspects of clinical practice. Defining reference values of the diaphragmatic excursion is important to identify those with diaphragmatic motion abnormalities. This study aimed to define the normal range of diaphragmatic motion (reference values) by Mmode ultrasound for the normal population. Methods Healthy volunteers were included in this study. Those with comorbidities, skeletal deformity, acute or chronic respiratory illness were excluded. Diaphragmatic ultrasound in the supine position was performed using a lowfrequency probe. The B-mode was applied for diaphragmatic identification, and the M-mode was employed for the recording of the amplitude of diaphragm contraction during quiet breathing, deep breathing and sniffing. Results The study included 757 healthy subjects [478 men (63.14%) and 279 women (36.86%)] with normal spirometry and negative history of previous or current respiratory illness. Their mean age and BMI were 45.17 ±14.84 years and 29.36±19.68 (kg/m2). The mean right hemidiaphragmatic excursion was 2.32±0.54, 5.54±1.26 and 2.90±0.63 for quiet breathing, deep breathing and sniffing, respectively, while the left hemidiaphragmatic excursion was 2.35±0.54, 5.30±1.21 and 2.97±0.56 cm for quiet breathing, deep breathing and sniffing, respectively. There was a statistically significant difference between right and left diaphragmatic excursion among all studied subjects. The ratio of right to left diaphragmatic excursion during quiet breathing was (1.009±0.19); maximum 181% and minimum 28%. Only 19 cases showed a right to left ratio of less than 50% (5 men and 14 women). The diaphragmatic excursion was higher in males than females. There was a significant difference in diaphragmatic excursion among age groups. Age, sex and BMI significantly affected the diaphragmatic motion. Conclusions Diaphragmatic excursion values presented in this study can be used as reference values to detect diaphragmatic dysfunction in clinical practice. Diaphragmatic motion is affected by several factors including age, sex and body mass index.
Collapse
Affiliation(s)
- Ahmed E Kabil
- Chest Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Eman Sobh
- Chest Diseases Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.,College of Medical Rehabilitation Sciences, Taibah University, Medina, Saudi Arabia
| | - Mahmoud Elsaeed
- Chest Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ibrahim H Yousef
- Chest Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Heba H Eltrawy
- Chest Diseases Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ahmed M Ewis
- Chest Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Aboseif
- Chest Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - AbdAllah M Albalsha
- Chest Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sawsan Elsawy
- Chest Diseases Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Abdul Rahman H Ali
- College of Medical Rehabilitation Sciences, Taibah University, Medina, Saudi Arabia.,Mahatma Gandhi University, Meghalaya, India
| |
Collapse
|
|
43
|
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.
Collapse
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
| |
Collapse
|
|
44
|
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.
Collapse
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
| |
Collapse
|
|
45
|
Boussuges A, Rives S, Finance J, Chaumet G, Vallée N, Risso JJ, Brégeon F. Ultrasound Assessment of Diaphragm Thickness and Thickening: Reference Values and Limits of Normality When in a Seated Position. Front Med (Lausanne) 2021; 8:742703. [PMID: 34778304 PMCID: PMC8579005 DOI: 10.3389/fmed.2021.742703] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Diagnosing diaphragm dysfunction in the absence of complete paralysis remains difficult. The aim of the present study was to assess the normal values of the thickness and the inspiratory thickening of both hemidiaphragms as measured by ultrasonography in healthy volunteers while in a seated position. Methods: Healthy volunteers with a normal pulmonary function test were recruited. The diaphragmatic thickness was measured on both sides at the zone of apposition of the diaphragm to the rib cage during quiet breathing at end-expiration, end-inspiration, and after maximal inspiration. The thickening ratio, the thickening fraction, and the thickness at end-inspiration divided by the thickness at deep breathing were determined. The mean values and the lower and upper limits of normal were determined for men and women. Results: 200 healthy volunteers (100 men and 100 women) were included in the study. The statistical analysis revealed that women had a thinner hemidiaphragm than men on both sides and at the various breathing times studied. The lower limit of normality of the diaphragm thickness measured at end-expiration was estimated to be 1.3 mm in men and 1.1 mm in women, on both sides. The thickening fraction did not differ significantly between men and women. In men, it ranged from 60 to 260% on the left side and from 57 to 200% on the right side. In women, it ranged from 58 to 264% on the left side and from 60 to 229% on the right side. The lower limits of normality of the thickening fraction were determined to be 40 and 39% in men and 39 and 48% in women for the right and left hemidiaphragms, respectively. The upper limit for normal of the mean of both sides of the ratio thickness at end-inspiration divided by the thickness at deep breathing was determined to be 0.78 in women and 0.79 in men. Conclusion: The normal values of thickness and the indexes of diaphragmatic function should help clinicians with detecting diaphragm atrophy and dysfunction.
Collapse
Affiliation(s)
- Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRAE, Marseille, France.,Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Sarah Rives
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRAE, Marseille, France
| | - Julie Finance
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | | | - Nicolas Vallée
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | - Jean-Jacques Risso
- 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, MEPHI, IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
|
46
|
van Doorn JLM, Pennati F, Hansen HHG, van Engelen BGM, Aliverti A, Doorduin J. Respiratory muscle imaging by ultrasound and MRI in neuromuscular disorders. Eur Respir J 2021; 58:13993003.00137-2021. [PMID: 33863737 DOI: 10.1183/13993003.00137-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 11/05/2022]
Abstract
Respiratory muscle weakness is common in neuromuscular disorders and leads to significant respiratory difficulties. Therefore, reliable and easy assessment of respiratory muscle structure and function in neuromuscular disorders is crucial. In the last decade, ultrasound and MRI emerged as promising imaging techniques to assess respiratory muscle structure and function. Respiratory muscle imaging directly measures the respiratory muscles and, in contrast to pulmonary function testing, is independent of patient effort. This makes respiratory muscle imaging suitable to use as tool in clinical respiratory management and as outcome parameter in upcoming drug trials for neuromuscular disorders, particularly in children. In this narrative review, we discuss the latest studies and technological developments in imaging of the respiratory muscles by US and MR, and its clinical application and limitations. We aim to increase understanding of respiratory muscle imaging and facilitate its use as outcome measure in daily practice and clinical trials.
Collapse
Affiliation(s)
- Jeroen L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Hendrik H G Hansen
- Department of Medical Imaging, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|