Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives

Table 1 Normal values in centimeters for the diaphragmatic excursions

Ref.	Position	Quiet breathing				Deep inspiration (TLC)
		Men		Women		Men		Women
		Right	Left	Right	Left	Right	Left	Right	Left
Boussuges et al[49], (n = 210)	Standing	1.8 ± 0.3	1.8 ± 0.4	1.6 ± 0.3	1.6 ± 0.4	7 ± 1.1, LLN = 4.7	7.5 ± 0.9, LLN = 5.6	5.7 ± 1, LLN = 3.6	6.4 ± 1, LLN = 4.3
Cardenas et al[13], (n = 64)	Semi recumbent	1.5 ± 0.4, LLN = 0.7		1.4 ± 0.3, LLN = 0.8		7.8 ± 0.8 LLN = 6.2		6.4 ± 1, LLN = 4.4
Gerscovich et al[10], (n = 23)	Supine	1.39	1.65	1.54	1.55	6.76	78	5.32	6.23
Testa et al[14], (n = 40)	Semi recumbent	18.7 ± 7.7		1.81 ± 0.77		7.79 ± 1.28		7.95 ± 1.4
Jung et al[15], (n = 16)	Semi, recumbent	2.3 ± 0.43	2.43 ± 0.5	2.67 ± 0.59	2.37 ± 0.66	7.16 ± 0.95	7.16 ± 0.56	6.5 ± 0.91	5.78 ± 0.76
Kantarci et al[4], (n = 164)	Supine					5.3 ± 1.1	5.4 ± 1.3	4.7 ± 1	4.8 ± 1
Scarlata et al[9], (n = 100)	Supine	2.03 ± 0.57		1.51 ± 0.37		6.93 ± 1.46		5.54 ± 1.33
Katipoglu et al[16], (n = 230) (median)	Supine					7.1 (6.5-8)	7.1 (6.8-8.5)	6 (5-7)	6.2 (5.2-7.2)

TLC: Total lung capacity; LLN: Lower limit of normality.

Table 2 Average values in millimeters for the right hemidiaphragm thickness

	Body position	Thickness at the end of expiration		Thickness at deep inspiration		Ratio
		Men	Women	Men	Women	Men	Women
Cardenas et al[13], (n = 64)	Semi-recumbent	1.9 ± 0.3, LLN = 1.25	1.79 ± 0.3, LLN = 1.23	5.6 ± 0.9 (TLC), LLN = 3.83	4.8 ± 1 (TLC), LLN = 2.91	TF = 204% ± 62%, LLN = 80%	TF = 170% ± 44%, LLN = 82%
Boon et al[43], (n = 150)	Supine	3.8 ± 1.5 (FRC), LLN = 1.7	2.7 ± 1 (FRC), LLN=1.5			TR = 1.7 ± 1.9, LLN = 1.2	TR = 1.7 ± 1.9, LLN = 1.3
Ueki et al[5], (n = 13)	Sitting	1.7 ± 0.2 (FRC), 1.6 ± 0.2 (RV)		4.4 ± 1.4 (max insp. Pressure)		Thickness pimax/FRC = 2.6 ± 0.7 (2-3.9)
Zhu et al[37], (n = 60)	Supine	1.6 ± 0.4 (FRC) (1.5-1.8)		3.1 ± 0.8 (TLC) (3-3.3)		TR = 1.99 ± 0.48 (1.81-2.04)
Baria et al[38], (n = 150)	Supine	3.2 ± 1.3 (1.3-7.3)				TR = 1.8 ± 0.5 (1.2-3.9)
Scarlata et al[31], (n = 66)	Recumbent	1.8 ± 0.4 (FRC)		2.6 ± 0.5 (TLC)		TR = 1.5 ± 0.24
Carrillo-Esper et al[34], (n = 109)	Supine	1.9 ± 0.4 (FRC)	1.4 ± 0.3 (FRC)			TR = 1.7 ± 1.9		TR = 1.7 ± 1.9
Gottesman et al[33], (n = 15)	Standing	2.8 ± 0.4 (FRC)				TF = 37% ± 9% (21-57)
Brown et al[40], (n = 45)	Supine, seated, standing	2.2 (2.1-2.4) (FRC), 2.4 (2.3-2.6) (FRC), 2.5 (2.3-2.8) (FRC)		3.5 (3.4-3.7) TLC, 4.6 (4.4-4.8) TLC, 6.5 (6.1-6.9) TLC		TF = 65% (61-69), TF = 97% (83-110), TF = 174% (151-197)
Kim et al[39], (n = 49)	Supine	2.1 ± 0.5 (FRC)		6.5 ± 1.4 (TLC)		4.4 ± 1.2 (TLC-FRC)

FRC: Functional residual capacity; RV: Residual volume; TLC: Total lung capacity; TR: Thickening ratio; TF: Thickening fraction; LLN: Lower limit of normality.

Table 3 Principal causes of diaphragmatic dysfunction

Surgery	Inflammatory lesion	Compression	Central neurological disease
Cardiac; Neck, cervical; Abdominal; Transplantation (Heart, lung liver)	Viral; Demyelinating neuropathy; (Guillain-Barré syndrome) ; Parsonnage-turner syndrome	Malignancy; Goiter; Arthrosis (cervical); Lymph node Abdominal HTP	Stroke; Medullary transection; Multiple sclerosis; Amyotrophic lateral sclerosis; Poliomyelitis
Medical procedure	Connective tissue diseases	Respiratory disease	Myopathy, muscular disease
Central vein cannulation; AF ablation; Nervous blockade	Systematic lupus erythematosus; (Shrinking lung syndrome); Dermatomyositis; Mixed connective-tissue disease	COPD; Asthma; Pleural effusion; Pneumothorax; Alveolar consolidation; Atelectasis	Duchenne muscular dystrophy; Myasthenia gravis; Myotonic dystrophy; Polymyositis; Dysthyroidism; Sarcopenia
Trauma	Others	Toxic	Critically ill patients
Chest; Brain; Spinal cord	Idiopathic; Electrolyte disorders; Amyloidosis; Pompe disease; Lyme disease	Botulism; Organophosphates; Glucocorticoids; Cordarone	Critical-illness polyneuropathy; Mechanical ventilation