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Bao X, Liu T, Feng H, Zhu Y, Wu Y, Wang X, Kang X. The Amplitude of Diaphragm Compound Muscle Action Potential Correlates With Diaphragmatic Excursion on Ultrasound and Pulmonary Function After Supraclavicular Brachial Plexus Block. Front Med (Lausanne) 2022; 8:744670. [PMID: 35386583 PMCID: PMC8977470 DOI: 10.3389/fmed.2021.744670] [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: 07/20/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022] Open
Abstract
Objective This prospective, double-blind, randomized study assessed (1) the associations between diaphragm compound muscle action potential (CMAP), hemidiaphragmatic excursion, and pulmonary function after supraclavicular brachial plexus block (SCBPB) and (2) diagnostic efficacy of pulmonary function for hemidiaphragmatic paralysis evidenced by diaphragm CMAP as an assessment of diaphragm strength was evaluated. Methods Eighty-six patients were scheduled for the removal of hardware after healing of a right upper limb fracture distal to the shoulder who were randomly assigned in a 1:1 ratio to two groups: Group A (diaphragmatic excursion), or Group B (pulmonary function). Phrenic nerve conduction studies (PNCSs), M-mode ultrasonography of the diaphragm, and pulmonary function tests (PFTs) were performed before and 30 min after SCBPB. PNCSs were used to determine the latency and amplitude of diaphragm CMAP. Ultrasonography of the diaphragm was performed with patients in a supine position using a low-frequency probe over the subcostal space at the midclavicular line. The diaphragmatic excursion was measured during quiet breathing and deep breathing. Pulmonary function, i.e., forced vital capacity (FVC), predicted value of FVC, and forced expiratory flow in the first second (FEV1), was measured with spirometry. Receiver Operating Characteristic (ROC) curve analysis was used to assess the diagnostic efficacy of pulmonary function for hemidiaphragmatic paralysis evidenced by diaphragm CMAP as an assessment of diaphragm strength. Results There were significant associations between the reduction in amplitude of diaphragm CMAP and reductions in diaphragmatic excursion during quiet breathing (r = 0.70, p < 0.01) and deep breathing (r = 0.63, p < 0.01) when expressed as a percentage of baseline values. There were significant associations between the reduction in amplitude of diaphragm CMAP and reductions in FVC (r = 0.67, p < 0.01), FVC% (r = 0.67, p < 0.01), and FEV1 (r = 0.62, p < 0.01), when expressed as percentage of baseline values. The area under the ROC curve for FVC was 0.86. A decrease of >8.4% in FVC compared to pre-block predicted hemidiaphragmatic paralysis (determined by diaphragm CMAP) with sensitivity and specificity of 79.2 and 100%, respectively. Conclusions The relative reduction in diaphragm CMAP amplitude after SCBPB was correlated with relative reductions in diaphragmatic excursion and pulmonary function. FVC has potential as a useful diagnostic indicator of hemidiaphragmatic paralysis, evidenced by diaphragm CMAP, after SCBPB. These data establish diaphragm CMAP as a direct and objective index of diaphragmatic paralysis after SCBPB.
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Affiliation(s)
- Xiuxia Bao
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Liu
- Department of Anesthesiology, The First People' Hospital of Huzhou, Huzhou, China
| | - Haorong Feng
- Department of Anesthesiology, South Taihu Hospital of Huzhou, Huzhou, China
| | - Yeke Zhu
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yingying Wu
- Department of Anesthesiology, Huzhou Fourth Hospital, Huzhou, China
| | - Xianghe Wang
- Department of Anesthesiology, The 98th Clinical College of People's Liberation Army (PLM), Anhui Medical University, Huzhou, China
| | - Xianhui Kang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kato N, Terao T, Ishii T, Saito E, Hirokawa Y, Michishita S, Sasaki Y, Tani S, Murayama Y. Subclavian Artery Flow Dynamics Evaluated by Analytical Intraoperative Indocyanine Green Videoangiography During Surgical Treatment of Thoracic Outlet Syndrome: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:115-122. [PMID: 34989707 DOI: 10.1227/ons.0000000000000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indocyanine green (ICG) videoangiography is rarely used during the surgical treatment of thoracic outlet syndrome (TOS). OBJECTIVE To evaluate subclavian artery (SA) flow dynamics using the analytical ICG videoangiography during TOS surgeries. METHODS We examined patients with neurogenic TOS who received surgical treatment and whose SA blood flow at the interscalene space was evaluated using ICG videoangiography equipped with an analytical function (FLOW800). Anterior scalenectomy with or without middle scalenectomy and first rib resection were conducted for decompression of the brachial plexus. ICG videoangiography was performed before and after decompression of the brachial plexus. After acquisition of grayscale and color-coded maps, a region of interest was placed in the SA to obtain time-intensity diagrams. Maximum intensity (MI), rise time (RT), and blood flow index (BFi) were calculated from the diagram, in arbitrary intensity (AI) units. We compared values before and after decompression. Comparisons of the three parameters before and after decompression were assessed statistically using the paired t-tests and Wilcoxon signed-rank test. RESULTS We evaluated nine procedures in consecutively presenting patients. The observed mean values of MI, RT, and BFi before decompression were 174.1 ± 61.5 AI, 5.2 ± 1.1 s, and 35.2 ± 13.5 AI/s, respectively, and the observed mean values of MI, RT, and BFi after decompression were 299.3 ± 167.4 AI, 6.6 ± 0.8 s, and 44.6 ± 28.3 AI/s, respectively. These parameters showed higher values after decompression than before decompression, and the increase in MI and RT was statistically significant (P < .05). CONCLUSION ICG videoangiography allows semiquantitative evaluation of hemodynamic changes during TOS surgery. A marked decrease in the velocity of SA flow was observed after decompression.
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Affiliation(s)
- Naoki Kato
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan.,Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Tohru Terao
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan
| | - Takuya Ishii
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan.,Department of Neurosurgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Emiko Saito
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan
| | - Yusuke Hirokawa
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan
| | | | - Yuichi Sasaki
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan.,Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Satoshi Tani
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
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Marino S, Bettini P, Pini L, Guarneri B, Magri R, Bertolovic L, Tantucci C. Effects of Chronic and Acute Pulmonary Hyperinflation on Phrenic Nerve Conduction in Patients with COPD. COPD 2020; 17:378-383. [PMID: 32586145 DOI: 10.1080/15412555.2020.1779680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In patients with moderate-to-severe Chronic Obstructive Pulmonary Disorder (COPD), pulmonary hyperinflation can occur at rest and increase during episodes of exacerbation. Among other mechanical constraints, changes in position and configuration of the diaphragm are also induced by increased end-expiratory lung volume. Both descent and flattening of diaphragm might damage the phrenic nerves by stretching their fibers. The study aimed to investigate the phrenic nerve conduction in COPD patients in stable conditions and during COPD exacerbation. In a group of 11 COPD patients without relevant comorbidities in stable conditions and subsequently in another group of 10 COPD patients during in-hospital COPD exacerbation and recovery, measurements of functional respiratory parameters and assessment of phrenic nerves motor conduction by bilateral electric stimulation were performed concurrently. Significant increase in phrenic nerves latency (p < 0.05), but similar amplitude of motor compound muscle action potential (cMAP) was observed in stable COPD patients vs. matched controls (p < 0.05). However, in COPD patients with resting pulmonary hyperinflation as reliably detected by substantial Inspiratory Capacity reduction (<80% pred.), the mean bilateral latency was longer vs. COPD patients without pulmonary hyperinflation (p < 0.02). During COPD exacerbation, in contrast with mean latency, the mean amplitude of phrenic nerves cMAP improved at discharge when compared with in-hospital admission (p < 0.05). In stable COPD patients the velocity of phrenic nerve conduction was impaired mostly in the presence of pulmonary hyperinflation, while during COPD exacerbation where dynamic pulmonary hyperinflation abruptly occurs, the reversible decrease of cMAP amplitude does suggest a temporary, acute axonal damage of phrenic nerves, potentially contributing to diaphragmatic dysfunction in these circumstances.
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Affiliation(s)
- Simona Marino
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Paolo Bettini
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Laura Pini
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Bruno Guarneri
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Roberto Magri
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Lara Bertolovic
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Claudio Tantucci
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
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Bao X, Huang J, Feng H, Qian Y, Wang Y, Zhang Q, Hu H, Wang X. Effect of local anesthetic volume (20 mL vs 30 mL ropivacaine) on electromyography of the diaphragm and pulmonary function after ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial. Reg Anesth Pain Med 2019; 44:69-75. [PMID: 30640655 DOI: 10.1136/rapm-2018-000014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Diaphragmatic paralysis following supraclavicular brachial plexus block (SCBPB) is ascribed to phrenic nerve palsy. This study investigated the effect of 2 volumes of 0.375% ropivacaine on efficacy of block as a surgical anesthetic and as an analgesic and examined diaphragm compound muscle action potentials (CMAPs) and pulmonary function before and after SCBPB. METHODS Eighty patients scheduled for removal of hardware for internal fixation after healing of an upper limb fracture distal to the shoulder were randomized to receive ultrasound-guided SCBPC for surgical anesthesia with 20 mL (Group A) or 30 mL (Group B) 0.375% ropivacaine. The latency and amplitude of diaphragm CMAPs and forced vital capacity (FVC), FVC% predicted, and forced expiratory volume in 1 s (FEV1) were measured before and 30 min after SCBPB. RESULTS Block success as primary anesthetic in addition to analgesia was 81% in Group A and 91% in Group B. There were no obvious differences in the effectiveness of analgesia between the two groups. The mean time to onset of motor block was significantly longer in Group A (8.1±2.7 min) than in Group B (5.4 ± 2.8 min; p<0.05). The mean amplitude of the diaphragm CMAP was significantly lower in Group B than in Group A (p=0.03). The changes in FVC (Group A, - 8.1% vs Group B, -16.5%), FVC% (Group A, -8.0% vs Group B, -17.1%), and FEV1 (Group A, -9.5% vs Group B, -15.2%) from pre-SCBPB to post-SCBPB were significantly less in Group A than in Group B (all p=0.03). CONCLUSIONS The incidence rates of phrenic nerve palsy and diaphragm paralysis were reduced, and lung function was less impaired in patients who received 20 mL vs 30 mL of 0.375% ropivacaine without any differences in block success. Selecting a lower volume of anesthetic for nerve block may be especially beneficial in obese patients or patients with cardiopulmonary disease. TRIAL REGISTRATION NUMBER ChiCTR-IND-17012166.
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Affiliation(s)
- Xiuxia Bao
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China.,Department of Anesthesiology, The First Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Juanjuan Huang
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China
| | - Haorong Feng
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China
| | - Yuying Qian
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China
| | - Yajie Wang
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China
| | - Qunying Zhang
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China
| | - Huansheng Hu
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China
| | - Xianghe Wang
- Department of Anesthesiology, The 98th Clinical College of PLA, Anhui Medical University, Huzhou, China
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Caetano MR, Maranhão AA, Peixoto EM, Alamy AH, Casseta AP, Rodrigues Filho JC. Diaphragm quantitative electromyography in difficult-to-treat asthmatic patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:550-554. [PMID: 31508680 DOI: 10.1590/0004-282x20190085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/29/2019] [Indexed: 11/22/2022]
Abstract
Quantitative electromyography is an important tool to evaluate myopathies, and some difficult-to-treat asthmatic patients may have a subclinical corticosteroid myopathic process, using only inhaled corticosteroid, according to some studies. In this report, diaphragm quantitative electromyography was used to evaluate asthmatic difficult-to-treat patients, comparing them with a control group. Significant differences were obtained in amplitude, duration and size index of motor unit action potentials, with lower parameters in the asthmatic patients, which may indicate a myopathic process.
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Affiliation(s)
- Marcelo R Caetano
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurocirurgia, Rio de Janeiro RJ, Brasil
| | - Analucia A Maranhão
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Tórax, Rio de Janeiro RJ, Brasil
| | - Eduardo M Peixoto
- Universidade Federal do Estado do Rio de Janeiro, Faculdade de Enfermagem, Rio de Janeiro RJ, Brasil
| | - Alexandre H Alamy
- Neuroclass, Departamento de Neurofisiologia, Rio de Janeiro RJ, Brasil
| | - Ana Paula Casseta
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Cardiologia, Rio de Janeiro RJ, Brasil
| | - Julio C Rodrigues Filho
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Tórax, Rio de Janeiro RJ, Brasil
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Abstract
Respiratory failure is common during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Phrenic nerve conduction (PNC), transcranial magnetic stimulation (TMS), and cervical magnetic stimulation (CMS) are of great value in identifying the feature and site of AE-COPD.PNC, TMS, and CMS were performed in 20 AE-COPD patients with respiratory failure, and re-examined after weaning. Latencies and amplitudes of the diaphragmatic compound muscle action potential (dCMAP), motor evoked potential of the diaphragm (dMEP) evoked by TMS and CMS, and central motor conduction time (CMCT) were measured. Blood gas analysis and serum electrolyte levels were also evaluated. The results were compared with those from 20 healthy subjects.AE-COPD patients showed prolonged CMCT and latencies of dCMAP and dMEP, decreased amplitudes of dCMAP and dMEP evoked by CMS, while CMCT and the latency of dMEP evoked by TMS were shortened after weaning. Significant correlation was identified between arterial blood gas analysis, serum electrolyte levels, disease duration, the duration of mechanical ventilation and the electrophysiological findings in AE-COPD patients prior to weaning.The central and peripheral respiratory pathway is involved in AE-COPD. Central respiratory pathway function is improved after weaning in AE-COPD patients with respiratory failure.
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Affiliation(s)
- Yu Wang
- Department of Neurology, Third Central Hospital of Tianjin
- Tianjin Institute of Hepatobiliary Disease
- Tianjin Key Laboratory of Artificial Cell
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Na Liu
- Department of Neurology, Third Central Hospital of Tianjin
- Tianjin Institute of Hepatobiliary Disease
- Tianjin Key Laboratory of Artificial Cell
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Zhecheng Zhang
- Department of Neurology, Third Central Hospital of Tianjin
- Tianjin Institute of Hepatobiliary Disease
- Tianjin Key Laboratory of Artificial Cell
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
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7
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Maranhão AA, Rodrigues MMJ, Carvalho SRDS, Caetano MR, Compagnoni IM, Carnio TK, Ribeiro D. Is phrenic nerve conduction affected in patients with difficult-to-treat asthma? ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:177-182. [PMID: 29809230 DOI: 10.1590/0004-282x20180010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
Objective The aim of this study was to obtain data on phrenic neuroconduction and electromyography of the diaphragm muscle in difficult-to-treat asthmatic patients and compare the results to those obtained in controls. Methods The study consisted of 20 difficult-to-treat asthmatic patients compared with 27 controls. Spirometry, maximal inspiratory and expiratory pressure, chest X-ray, phrenic neuroconduction and diaphragm electromyography data were obtained. Results The phrenic compound motor action potential area was reduced, compared with controls, and all the patients had normal diaphragm electromyography. Conclusion It is possible that a reduced phrenic compound motor action potential area, without electromyography abnormalities, could be related to diaphragm muscle fiber abnormalities due to overload activity.
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Affiliation(s)
- Analúcia Abreu Maranhão
- Faculdade de Medicina, Universidade Federal do Estado Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | - Marcelo Ribeiro Caetano
- Departamento de Neurocirurgia, Faculdade de Medicina, Universidade Federal do Estado Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Tatiane Katia Carnio
- Faculty of Medicine, Rio de Janeiro State Federal University, Rio de Janeiro, Brazil
| | - Débora Ribeiro
- Faculty of Medicine, Rio de Janeiro State Federal University, Rio de Janeiro, Brazil
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Maranhão AA, Carvalho SRDS, Caetano MR, Alamy AH, Peixoto EM, Filgueiras PDEP. Phrenic nerve conduction studies: normative data and technical aspects. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:869-874. [PMID: 29236890 DOI: 10.1590/0004-282x20170153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the present study was to define normative data of phrenic nerve conduction parameters of a healthy population. METHODS Phrenic nerve conduction studies were performed in 27 healthy volunteers. RESULTS The normative limits for expiratory phrenic nerve compound muscle action potential were: amplitude (0.47 mv - 0.83 mv), latency (5.74 ms - 7.10 ms), area (6.20 ms/mv - 7.20 ms/mv) and duration (18.30 ms - 20.96 ms). Inspiratory normative limits were: amplitude (0.67 mv - 1.11 mv), latency (5.90 ms - 6.34 ms), area (5.62 ms/mv - 6.72 ms/mv) and duration (13.77 ms - 15.37 ms). CONCLUSION The best point of phrenic nerve stimulus in the neck varies among individuals between the medial and lateral border of the clavicular head of the sternocleidomastoid muscle and stimulation of both sites, then choosing the best phrenic nerve response, seems to be the appropriate procedure.
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Affiliation(s)
- Analucia Abreu Maranhão
- Universidade Federal do Estado do Rio de Janeiro, Faculdade de Medicina, Departamento de Pneumologia, Rio de Janeiro RJ, Brasil
| | - Sonia Regina da Silva Carvalho
- Universidade Federal do Estado do Rio de Janeiro, Faculdade de Medicina, Departamento de Pneumologia, Rio de Janeiro RJ, Brasil
| | - Marcelo Ribeiro Caetano
- Universidade Federal do Estado do Rio de Janeiro, Faculdade de Medicina, Departamento de Neurocirurgia, Rio de Janeiro RJ, Brasil
| | | | - Eduardo Mesquita Peixoto
- Universidade Federal do Estado do Rio de Janeiro, Faculdade de Enfermagem, Rio de Janeiro RJ, Brasil
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10
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Podnar S, Doorduin J. Safety of needle electromyography of the diaphragm: Anterior lung margins in quietly breathing healthy subjects. Muscle Nerve 2015; 54:54-7. [PMID: 26599417 DOI: 10.1002/mus.24992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/30/2015] [Accepted: 11/23/2015] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Controversy persists as to whether the lung interposes on the needle electrode insertion path during diaphragm electromyography (EMG). METHODS Using high-resolution ultrasonography, we measured the distances between the medial recess of the intercostal spaces (ICSs) around the mid-clavicular line (MCL) and the lung margin. We performed measurements bilaterally during quiet breathing in the seated and supine positions. RESULTS We studied 10 young healthy men and found that, in the first ICS with the medial recess clearly (i.e., several cm) lateral to MCL (usually the eighth ICS), the distance between the recommended insertion site and the lung margin varied from 7.5 to 17 cm. The distance was slightly larger on the right side and in the supine position. CONCLUSIONS This study confirms that properly conducted "trans-intercostal" needle EMG of the diaphragm is generally safe in healthy subjects. Muscle Nerve 54: 54-57, 2016.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center, Zaloška cesta 7, SI - 1525, Ljubljana, Slovenia
| | - Jonne Doorduin
- Departments of Clinical Neurophysiology and Critical Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Podnar S. Idiopathic phrenic neuropathies: A case series and review of the literature. Muscle Nerve 2015; 52:986-92. [DOI: 10.1002/mus.24673] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology; Division of Neurology; University Medical Centre Ljubljana; SI-1525 Ljubljana Slovenia
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12
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El-tantawi GAY, Imam MH, Morsi TS. Phrenic Nerve Conduction Abnormalities Correlate with Diaphragmatic Descent in Chronic Obstructive Pulmonary Disease. COPD 2015; 12:516-24. [DOI: 10.3109/15412555.2014.993465] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Baria MR, Shahgholi L, Sorenson EJ, Harper CJ, Lim KG, Strommen JA, Mottram CD, Boon AJ. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest 2015; 146:680-685. [PMID: 24700122 DOI: 10.1378/chest.13-2306] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Electromyographic evaluation of diaphragmatic neuromuscular disease in patients with COPD is technically difficult and potentially high risk. Defining standard values for diaphragm thickness and thickening ratio using B-mode ultrasound may provide a simpler, safer means of evaluating these patients. METHODS Fifty patients with a diagnosis of COPD and FEV₁ < 70% underwent B-mode ultrasound. Three images were captured both at end expiration (Tmin) and at maximal inspiration (Tmax). The thickening ratio was calculated as (Tmax/Tmin), and each set of values was averaged. Findings were compared with a database of 150 healthy control subjects. RESULTS There was no significant difference in diaphragm thickness or thickening ratio between sides within groups (control subjects or patients with COPD) or between groups, with the exception of the subgroup with severe air trapping (residual volume > 200%), in which the only difference was that the thickening ratio was higher on the left (P = .0045). CONCLUSIONS In patients with COPD presenting for evaluation of coexisting neuromuscular respiratory weakness, the same values established for healthy control subjects serve as the baseline for comparison. This knowledge expands the role of ultrasound in evaluating neuromuscular disease in patients with COPD.
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Affiliation(s)
- Michael R Baria
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN
| | - Leili Shahgholi
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN
| | - Eric J Sorenson
- Division of Clinical Neurophysiology, Mayo Clinic and Foundation, Rochester, MN
| | - Caitlin J Harper
- Department of Neurology, Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN
| | - Kaiser G Lim
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN; Division of Allergic Diseases, Mayo Clinic and Foundation, Rochester, MN
| | - Jeffrey A Strommen
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN; Division of Clinical Neurophysiology, Mayo Clinic and Foundation, Rochester, MN
| | - Carl D Mottram
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN; Division of Clinical Neurophysiology, Mayo Clinic and Foundation, Rochester, MN.
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Smargiassi A, Inchingolo R, Tagliaboschi L, Di Marco Berardino A, Valente S, Corbo GM. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration 2014; 87:364-71. [PMID: 24732295 DOI: 10.1159/000358564] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 01/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skeletal muscle weakness with loss of fat-free mass (FFM) is one of the main systemic effects of chronic obstructive pulmonary disease (COPD). The diaphragm is also involved, leading to disadvantageous conditions and poor contractile capacities. OBJECTIVES We measured the thickness of the diaphragm (TD) by ultrasonography to evaluate the relationships between echographic measurements, parameters of respiratory function and body composition data. METHODS Thirty-two patients (23 males) underwent (1) pulmonary function tests, (2) echographic assessment of TD in the zone of apposition at various lung volumes, i.e. TD at residual volume (TDRV), TD at functional residual capacity (TDFRC) and TD at total lung capacity (TDTLC), and (3) bioelectrical body impedance analysis. The BMI and the BODE (BMI-Obstruction-Dyspnea-Exercise) index values were reported. RESULTS TDRV, TDFRC and TDTLC measured 3.3, 3.6 and 6 mm, respectively, with good intraobserver reproducibility (0.97, 0.97 and 0.96, respectively). All the TDs were found to be related to FFM, with the relationship being greater for TDFRC (r(2) = 0.39 and p = 0.0002). With regard to lung volumes, inspiratory capacity (IC) was found to be closely related to TDTLC (r(2) = 0.42 and p = 0.0001). The difference between TDTLC and TDRV, as a thickening value (TDTLCRV), was closely related to FVC (r(2) = 0.34 and p = 0.0004) and to air-trapping indices (RV/TLC, FRC/TLC and IC/TLC): the degree of lung hyperinflation was greater and the TDTLCRV was less. Finally, we found a progressive reduction of both thicknesses and thickenings as the severity of IC/TLC increased, with a significant p value for the trend in both analyses (p = 0.02). CONCLUSIONS Ultrasonographic assessment of the diaphragm could be a useful tool for studying disease progression in COPD patients, in terms of lung hyperinflation and the loss of FFM. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Andrea Smargiassi
- Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Rome, Italy
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Phrenic Nerve Injury During Cardiac Surgery: Mechanisms, Management and Prevention. Heart Lung Circ 2013; 22:895-902. [DOI: 10.1016/j.hlc.2013.06.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 11/17/2022]
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