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Barbato F, Bombaci A, Colacicco G, Bruno G, Ippolito D, Pota V, Dongiovanni S, Sica G, Bocchini G, Valente T, Scaglione M, Mainenti PP, Guarino S. Chest Dynamic MRI as Early Biomarker of Respiratory Impairment in Amyotrophic Lateral Sclerosis Patients: A Pilot Study. J Clin Med 2024; 13:3103. [PMID: 38892814 PMCID: PMC11172785 DOI: 10.3390/jcm13113103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a neuromuscular progressive disorder characterized by limb and bulbar muscle wasting and weakness. A total of 30% of patients present a bulbar onset, while 70% have a spinal outbreak. Respiratory involvement represents one of the worst prognostic factors, and its early identification is fundamental for the early starting of non-invasive ventilation and for the stratification of patients. Due to the lack of biomarkers of early respiratory impairment, we aimed to evaluate the role of chest dynamic MRI in ALS patients. Methods: We enrolled 15 ALS patients and 11 healthy controls. We assessed the revised ALS functional rating scale, spirometry, and chest dynamic MRI. Data were analyzed by using the Mann-Whitney U test and Cox regression analysis. Results: We observed a statistically significant difference in both respiratory parameters and pulmonary measurements at MRI between ALS patients and healthy controls. Moreover, we found a close relationship between pulmonary measurements at MRI and respiratory parameters, which was statistically significant after multivariate analysis. A sub-group analysis including ALS patients without respiratory symptoms and with normal spirometry values revealed the superiority of chest dynamic MRI measurements in detecting signs of early respiratory impairment. Conclusions: Our data suggest the usefulness of chest dynamic MRI, a fast and economically affordable examination, in the evaluation of early respiratory impairment in ALS patients.
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Affiliation(s)
- Francesco Barbato
- Department of Emergency and Urgent Medicine, Stroke Unit, Santa Maria delle Grazie Hospital, 80078 Naples, Italy;
| | - Alessandro Bombaci
- PhD Program of Neuroscience, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy;
- Neurology Unit, IRCSS Policlinico San Donato, 20097 San Donato Milanese, Italy
- Department of Neurology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giovanni Colacicco
- NeuroMuscular Omnicentre (NEMO), Serena Onlus, 20162 Milan, Italy; (G.C.); (D.I.); (S.D.)
| | - Giorgia Bruno
- Division of Pediatric Neurology, Department of Neurosciences, “Santobono-Pausilipon” Children’s Hospital, 80121 Naples, Italy;
| | - Domenico Ippolito
- NeuroMuscular Omnicentre (NEMO), Serena Onlus, 20162 Milan, Italy; (G.C.); (D.I.); (S.D.)
| | - Vincenzo Pota
- Department of Women, Child, General and Specialistic Surgery, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Salvatore Dongiovanni
- NeuroMuscular Omnicentre (NEMO), Serena Onlus, 20162 Milan, Italy; (G.C.); (D.I.); (S.D.)
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.B.); (T.V.); (S.G.)
| | - Giorgio Bocchini
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.B.); (T.V.); (S.G.)
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.B.); (T.V.); (S.G.)
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), 80145 Naples, Italy;
| | - Salvatore Guarino
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (G.B.); (T.V.); (S.G.)
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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: 2] [Impact Index Per Article: 2.0] [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.
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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
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Oliver-Forniés P, Centeno-Pérez A, Martínez García M, Fajardo Pérez M, de la Quintana Gordon FB. Validation of Point-of-Care ultrasound in the diagnosis of a diaphragmatic hernia. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:404-408. [PMID: 37558049 DOI: 10.1016/j.redare.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/05/2022] [Indexed: 08/11/2023]
Abstract
Point-of-care ultrasound (POCUS) is a sensitive, specific tool for early diagnosis of diaphragm pathology in critically ill patients. We report the case of a patient with a history of iatrogenic diaphragmatic hernia who was admitted to the Resuscitation Unit after an emergency exploratory laparotomy. As the diagnosis of diaphragmatic hernia had already been confirmed, we determined the POCUS features that establish the diagnosis of diaphragmatic hernia: (1) normal bilateral diaphragmatic shortening fraction; (2) decreased diaphragmatic excursion; and (3) cephalic position of the diaphragmatic dome (4) greater in supine than in sitting position. We also outline a systematic ultrasound examination of the diaphragm and a POCUS-based differential classification of diaphragmatic dysfunction based on the functional integrity of the peripheral muscle and central diaphragmatic tendon in critically ill patients.
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Affiliation(s)
- P Oliver-Forniés
- Servicio de Anestesiología, Cuidados Críticos y Medicina del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain.
| | - A Centeno-Pérez
- Servicio de Anestesiología, Cuidados Críticos y Medicina del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain; MoMaRC - Morphological Madrid Research Center, Ultradissection Spain EchoTraining School, Madrid, Spain; Investigador del GIIS083, Instituto Aragonés de Investigación Sanitaria (IISAragón), Zaragoza, Spain
| | - M Martínez García
- Servicio de Anestesiología, Cuidados Críticos y Medicina del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - M Fajardo Pérez
- Servicio de Anestesiología, Cuidados Críticos y Medicina del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - F B de la Quintana Gordon
- Servicio de Anestesiología, Cuidados Críticos y Medicina del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain; MoMaRC - Morphological Madrid Research Center, Ultradissection Spain EchoTraining School, Madrid, Spain
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Mirea L, Cobilinschi C, Ungureanu R, Cotae AM, Darie R, Tincu R, Avram O, Constantinescu S, Minoiu C, Baetu A, Grintescu IM. A Trend towards Diaphragmatic Muscle Waste after Invasive Mechanical Ventilation in Multiple Trauma Patients-What to Expect? J Clin Med 2023; 12:jcm12093338. [PMID: 37176778 PMCID: PMC10179085 DOI: 10.3390/jcm12093338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Considering the prioritization of life-threatening injuries in trauma care, secondary dysfunctions such as ventilator-induced diaphragmatic dysfunction (VIDD) are often overlooked. VIDD is an entity induced by muscle inactivity during invasive mechanical ventilation, associated with a profound loss of diaphragm muscle mass. In order to assess the incidence of VIDD in polytrauma patients, we performed an observational, retrospective, longitudinal study that included 24 polytraumatized patients. All included patients were mechanically ventilated for at least 48 h and underwent two chest CT scans during their ICU stay. Diaphragmatic thickness was measured by two independent radiologists on coronal and axial images at the level of celiac plexus. The thickness of the diaphragm was significantly decreased on both the left and right sides (left side: -0.82 mm axial p = 0.034; -0.79 mm coronal p = 0.05; right side: -0.94 mm axial p = 0.016; -0.91 coronal p = 0.013). In addition, we obtained a positive correlation between the number of days of mechanical ventilation and the difference between the two measurements of the diaphragm thickness on both sides (r =0.5; p = 0.02). There was no statistically significant correlation between the body mass indexes on admission, the use of vitamin C or N-acetyl cysteine, and the differences in diaphragmatic thickness.
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Affiliation(s)
- Liliana Mirea
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Cobilinschi
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca Ungureanu
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana-Maria Cotae
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca Darie
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Radu Tincu
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Department of Clinical Toxicology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Oana Avram
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Department of Clinical Toxicology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sorin Constantinescu
- Department of Radiology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology, Victor Atanasiu National Aviation and Space Medicine Institute, 010825 Bucharest, Romania
| | - Costin Minoiu
- Department of Radiology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Alexandru Baetu
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Anesthesiology and Intensive Care, Grigore Alexandrescu Clinical Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Ioana Marina Grintescu
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Department of Anesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Kim T, Huh S, Chung JH, Kim YS, Yun RY, Park O, Lee SE. Clinical values of diaphragmatic movement in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2023; 23:33. [PMID: 36703157 PMCID: PMC9881315 DOI: 10.1186/s12890-022-02220-7] [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: 04/25/2022] [Accepted: 11/02/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The limitation of activity due to dyspnea in chronic obstructive pulmonary disease (COPD) patients is affected by diaphragmatic dysfunction and reduced lung function. This study aimed to analyze the association between diaphragm function variables and forced expiratory volume in the first second (FEV1) and to estimate the clinical significance of diaphragm function in the correlation between COPD severity and lung function. METHODS This prospective, single-center, cross-sectional observational study enrolled 60 COPD patients in a respiratory outpatient clinic. Data for baseline characteristics and the dyspnea scale were collected. Participants underwent a pulmonary function test (PFT), a 6-minute walk test (6MWT), and diaphragm function by ultrasonography. RESULTS The right excursion at forced breathing showed the most significant correlation with FEV1 (r = 0.370, p = 0.004). The cutoff value was 6.7 cm of the right diaphragmatic excursion at forced breathing to identify the FEV1 above 50% group. In the group with a right diaphragmatic excursion at forced breathing < 6.7 cm, modified Medical Research Council (mMRC), St. George's Respiratory Questionnaire and the total distance of 6MWT showed no difference between groups with FEV1 under and above 50% (p > 0.05). In the group with ≥ 6.7 cm, mMRC and the total distance of 6MWT showed a significant difference between FEV1 under and above 50% (p = 0.014, 456.7 ± 69.7 m vs. 513.9 ± 60.3 m, p = 0.018, respectively). CONCLUSION The right diaphragmatic forced excursion was closely related to FEV1, and analysis according to the right diaphragmatic forced excursion-based cut-off value showed a significant difference between both groups. When the diaphragm function was maintained, there was a lot of difference in the 6MWT's factors according to the FEV1 value. Our data suggest that diaphragmatic function should be performed when interpreting PFT.
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Affiliation(s)
- Taehwa Kim
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sungchul Huh
- grid.412591.a0000 0004 0442 9883Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan, Yangsan, South Korea
| | - Jae Heun Chung
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yun Seong Kim
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ra Yu Yun
- grid.412591.a0000 0004 0442 9883Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan, Yangsan, South Korea ,grid.262229.f0000 0001 0719 8572Pusan National University School of Medicine, Yangsan, South Korea
| | - Onyu Park
- grid.412591.a0000 0004 0442 9883College of Nursing, Pusan National University, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seung Eun Lee
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Finder JD. Respiratory Complications in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rives S, Schmid B, Chaumet G, Brégeon F, Boussuges A. Changes in Diaphragmatic Function Induced by an Increased Inspiratory Load Experienced by Military Divers: An Ultrasound Study. Front Physiol 2021; 12:756533. [PMID: 34916955 PMCID: PMC8670941 DOI: 10.3389/fphys.2021.756533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Inspiratory loading is experienced by military divers when they use rebreather device. Our objective was to assess the changes in diaphragm function induced by an increase in inspiratory load at values similar to those experienced by divers in real life. Methods: We recorded the excursion and the thickness of the right hemidiaphragm in 22 healthy male volunteers under inspiratory load conditions, using ultrasound in B- and M-mode. The measurements were performed at tidal volume and during breathing at 50% of inspiratory capacity. The breathing rate was regulated and similar in the various sessions with and without load. Results: The rebreather device used by French military divers leads to an increase in inspiratory load of close to 30 cmH2O. Consequently, the session under load was performed using a device set to this threshold. Significant increases in the excursion and the thickening fraction of the diaphragm were observed between the sessions at tidal volume and at high volume. With addition of the inspiratory load, the excursion of the right hemidiaphragm increased significantly from 2.3 to 3.4cm at tidal volume and from 3.9 to 4.7cm at high volume. The thickening fraction increased significantly from 30.4 to 76.6% at tidal volume and from 70 to 123% at high volume. The statistical analysis demonstrated that assessment of the changes of the thickening fraction during breathing at tidal volume was the most relevant marker to assess the impact of the inspiratory load on the diaphragm. Conclusion: Diaphragm ultrasound can be used to assess the changes in the diaphragm contraction pattern secondary to an increase in the respiratory load that can be generated by use a diving apparatus. The recording of the changes of the motion, and more importantly of the thickness of the diaphragm, during the breathing cycle is able to provide relevant information regarding the inspiratory load.
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Affiliation(s)
- Sarah Rives
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Bruno Schmid
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | | | - Fabienne Brégeon
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
| | - Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France.,Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
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Lang J, Liu Y, Zhang Y, Huang Y, Yi J. Peri-operative diaphragm ultrasound as a new method of recognizing post-operative residual curarization. BMC Anesthesiol 2021; 21:287. [PMID: 34794389 PMCID: PMC8603586 DOI: 10.1186/s12871-021-01506-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022] Open
Abstract
Background This study sought to evaluate the diagnostic accuracy of peri-operative diaphragm ultrasound in assessing post-operative residual curarization (PORC). Methods Patients undergoing non-thoracic and non-abdominal surgery under general anaesthesia were enrolled from July 2019 to October 2019 at Peking Union Medical College Hospital. A train-of-four ratio (TOFr) lower than 0.9 was considered as the gold standard for PORC. Diaphragm ultrasound parameters included diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) during quiet breathing (QB) and deep breathing (DB). The diaphragm excursion fraction (DEF) was calculated as the DE-QB divided by the DE-DB. The diaphragm excursion difference (DED) was defined as DE-DB minus DE-QB. Receiver operating characteristic curve analysis was used to determine the cut-off values of ultrasound parameters for the prediction of PORC. Results In total, 75 patients were included, with a PORC incidence of 54.6%. The DE-DB and DED were positively correlated with the TOFr, while the DEF was negatively correlated with the TOFr. The DE-DB cut-off value for predicting PORC was 3.88 cm, with a sensitivity of 85.4% (95% confidence interval [CI]: 70.1–93.9%), specificity of 64.7% (95% CI: 46.4–79.7%), positive likelihood ratio of 2.42 (95% CI 1.5–3.9), and negative likelihood ratio of 0.23 (95% CI: 0.1–0.5). The DED cut-off value was 1.5 cm, with a specificity of 94.2% (95% CI: 80.3–99.3%), sensitivity of 63.4% (95% CI: 46.9–77.9%), positive likelihood ratio of 10.78 (95% CI: 2.8–42.2), and negative likelihood ratio of 0.39 (95% CI: 0.3–0.6). Conclusions Peri-operative diaphragm ultrasound may be an additional method aiding the recognition of PORC, with DED having high specificity.
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Affiliation(s)
- Jiaxin Lang
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No 1, Shuaifuyan, Dongcheng district, Beijing, 100730, China
| | - Yuchao Liu
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No 1, Shuaifuyan, Dongcheng district, Beijing, 100730, China
| | - Yuelun Zhang
- Medical Research Center, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No 1, Shuaifuyan, Dongcheng district, Beijing, 100730, China
| | - Jie Yi
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No 1, Shuaifuyan, Dongcheng district, Beijing, 100730, China.
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Oliver-Fornies P, Ortega Lahuerta JP, Gomez Gomez R, Gonzalo Pellicer I, Oliden Gutierrez L, Viñuales Cabeza J, Gallego Ligorit L, Orellana Melgar CE. Diaphragmatic paralysis, respiratory function, and postoperative pain after interscalene brachial plexus block with a reduced dose of 10 ml levobupivacaine 0.25% versus a 20 ml dose in patients undergoing arthroscopic shoulder surgery: study protocol for the randomized controlled double-blind REDOLEV study. Trials 2021; 22:287. [PMID: 33874993 PMCID: PMC8053891 DOI: 10.1186/s13063-021-05216-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Arthroscopic shoulder surgery causes severe postoperative pain. An interscalene brachial plexus block provides adequate analgesia, but unintended spread of the local anesthetic administered may result in a phrenic nerve block, usually associated with a nonnegligible incidence of acute hemidiaphragmatic paralysis. The main purpose of this trial will be to analyze the incidence of hemidiaphragmatic paralysis ensuing after interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery administered a standard volume (20 ml) vs. a low volume (10 ml) of levobupivacaine 0.25%. Methods This will be a prospective double-blind randomized controlled single-center two-arm comparative trial. Forty-eight patients will be included. The primary goal will be to ultrasonographically determine the incidence of hemidiaphragmatic paralysis by calculating the diaphragmatic thickness ratio in each group. The secondary goals will be to compare the two arms in terms of (1) decrease in forced vital capacity and (2) in forced expiratory volume at 1 s by spirometry; (3) decrease in diaphragmatic excursion by ultrasound; (4) 24-h total intravenous morphine consumption; (5) time to first opioid request of a patient-controlled analgesia pump; and (6) postoperative complications. Discussion This trial will demonstrate that a low-volume interscalene brachial plexus block decreases hemidiaphragmatic paralysis following arthroscopic shoulder surgery according to spirometry and ultrasound measurements and does not provide inferior postoperative analgesia to the standard volume, as measured by opioid requirements. Trial registration EudraCT and Spanish Trial Register (REec) registration number: 2019-003855-12 (registered on 7 January 2020). ClinicalTrials.gov identification number: NCT04385966 (retrospectively registered on 8 May 2020). Ethics Committee approval: EC19/093 (18 December 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05216-6.
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Affiliation(s)
- P Oliver-Fornies
- Morphological Madrid Research Center Investigator, Department of Anesthesiology, Critical Care and Pain Management, Lozano Blesa University Clinical Hospital, Aragon Institute for Health Research, Avda. San Juan Bosco, 15 50009, Zaragoza, Spain.
| | - J P Ortega Lahuerta
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Management, Miguel Servet University Hospital, Zaragoza, Spain
| | - R Gomez Gomez
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Management, Miguel Servet University Hospital, Zaragoza, Spain
| | - I Gonzalo Pellicer
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Management, Miguel Servet University Hospital, Zaragoza, Spain
| | - L Oliden Gutierrez
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Management, Miguel Servet University Hospital, Zaragoza, Spain
| | - J Viñuales Cabeza
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Management, Miguel Servet University Hospital, Zaragoza, Spain
| | - L Gallego Ligorit
- Department of Anesthesiology, Critical Care and Pain Management, Miguel Servet University Hospital, Aragon Institute for Health Research, Zaragoza, Spain
| | - C E Orellana Melgar
- Department of Pneumology, Miguel Servet University Hospital, Zaragoza, Spain
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10
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Boussuges A, Finance J, Chaumet G, Brégeon F. Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality. ERJ Open Res 2021; 7:00714-2020. [PMID: 33778044 PMCID: PMC7983192 DOI: 10.1183/23120541.00714-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022] Open
Abstract
Chest ultrasonography has proven to be useful in the diagnosis of diaphragm dysfunction. The aim of the present study was to determine the normal values of the motion of both hemidiaphragms recorded by M-mode ultrasonography. Healthy volunteers were studied while in a seated position. Diaphragmatic excursions and diaphragm profiles were measured during quiet breathing, voluntary sniffing and deep breathing. Diaphragmatic excursions were assessed by M-mode ultrasonography, using an approach perpendicular to the posterior part of the diaphragm. Anatomical M-mode was used for the recording of the complete excursion during deep breathing. The study included 270 men and 140 women. The diaphragmatic motions during quiet breathing and voluntary sniffing were successfully recorded in all of the participants. The use of anatomical M-mode was particularly suitable for measurement of the entire diaphragmatic excursion during deep breathing. The statistical analysis showed that the diaphragmatic excursions were larger in men compared to women, supporting the determination of normal values based on sex. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three manoeuvres that were investigated. The lower limits of normal diaphragmatic excursions during deep breathing should be used to detect diaphragmatic hypokinesia, i.e. 3.3 and 3.2 cm in women and 4.1 and 4.2 cm in men for the right and the left sides, respectively. The normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction. These normal values of diaphragmatic motion, and the lower and upper limits of normal excursion, can be used by physicians to detect diaphragm hypokinesia and hyperkinesia, and thus diagnose diaphragmatic dysfunctionhttps://bit.ly/35R9OFk
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Affiliation(s)
- Alain Boussuges
- Institut de Recherche Biomédicale des Armées (IRBA), ERRSO, Toulon and 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
| | | | - 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
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11
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McCool FD, Tzelepis GE. Tissue Doppler Imaging of the Diaphragm: A New Kid on the Block? Am J Respir Crit Care Med 2020; 202:921-922. [PMID: 32749867 PMCID: PMC7528794 DOI: 10.1164/rccm.202007-2771ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- F Dennis McCool
- Alpert Medical School of Brown University, Providence, Rhode Island and
| | - George E Tzelepis
- National and Kapodistrian University of Athens Medical School, Athens, Greece
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12
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Satış H, Cindil E, Salman RB, Yapar D, Temel E, Demir NB, Babaoğlu H, Gündoğdu O, Ataş N, Şendur H, Avanoğlu Güler A, Karadeniz H, Tufan A, Öztürk MA, Haznedaroğlu Ş, Göker B. Diaphragmatic muscle thickness and diaphragmatic function are reduced in patients with systemic lupus erythematosus compared to those with primary Sjögren's syndrome. Lupus 2020; 29:715-720. [PMID: 32338144 DOI: 10.1177/0961203320919848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is associated with an increased risk of pulmonary infections, as well as a rare condition known as shrinking lung syndrome (SLS). The diaphragm has an important role to play in lung physiology and might also play a role in these adverse events. Here, we aimed to investigate whether SLE patients have impairment in their diaphragmatic muscle thickness and function with respect to another connective-tissue disease: primary Sjögren's syndrome (pSS). METHOD Patients diagnosed with SLE who were in remission or who had minimal disease activity and had at least one year of follow-up were included in this study. Patients with known lung pathology and smokers were excluded. Patients with pSS constituted the second experimental group. Ultrasonographic evaluation of the diaphragmatic muscle was conducted by an experienced independent sonographer at three time points, diaphragmatic thickness during deep and quiet inspiration and maximum expiration being measured. Diaphragmatic muscle function was evaluated with maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP). RESULTS A total of 115 patients were studied (n = 39 SLE; n = 76 pSS). The mean ± standard deviation (SD) thickness of the diaphragmatic muscles during quiet inspiration was significantly reduced in patients with SLE compared to patients with pSS (2.32 mm vs. 2.81 mm; p < 0.05). Similarly, the thickness during deep inspiration and at maximum deep expiration were significantly lower in SLE patients (2.88 mm vs. 3.29 mm and 1.92 mm vs. 2.33 mm, respectively; p < 0.01). MIPs and MEPs, defined as the percentages of expected values, were significantly lower in patients with SLE compared to those with pSS (80% vs. 92% and 76% vs. 120%, respectively; p < 0.05). Diaphragmatic muscle thickness during deep inspiration demonstrated a moderate correlation with MIP (r = 0.434; p = 0.001). CONCLUSION SLE patients had reduced diaphragmatic muscle thickness compared to those with pSS, which was associated with impaired functional tests. Further prospective studies are needed to investigate whether structural and functional impairments in diaphragmatic muscle play a role in an increased risk of pulmonary infections and SLS in patients with SLE.
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Affiliation(s)
- Hasan Satış
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
| | - Emetullah Cindil
- Faculty of Medicine, Radiology Department, Gazi University, Ankara, Turkey
| | - Reyhan B Salman
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
| | - Dilek Yapar
- Faculty of Medicine, Public Health and Biostatistics, Gazi University, Ankara Turkey
| | - Esra Temel
- Faculty of Medicine, Radiology Department, Gazi University, Ankara, Turkey
| | - Nur B Demir
- Faculty of Medicine, Radiology Department, Gazi University, Ankara, Turkey
| | - Hakan Babaoğlu
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
| | - Onur Gündoğdu
- Faculty of Medicine, Radiology Department, Gazi University, Ankara, Turkey
| | - Nuh Ataş
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
| | - Halit Şendur
- Faculty of Medicine, Radiology Department, Gazi University, Ankara, Turkey
| | | | - Hazan Karadeniz
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
| | - Abdurrahman Tufan
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
| | - Mehmet A Öztürk
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
| | | | - Berna Göker
- Faculty of Medicine, Rheumatology Department, Gazi University, Ankara, Turkey
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Chada A, Leu RM, Perez IA, Esther CR, Kasi AS. Positional impairment of gas exchange during diaphragm pacing alleviated by increasing amplitude settings in congenital central hypoventilation syndrome. J Clin Sleep Med 2020; 16:459-462. [PMID: 31992416 DOI: 10.5664/jcsm.8232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
None Diaphragm pacing (DP) by phrenic nerve stimulation is a modality of chronic ventilatory support in individuals with congenital central hypoventilation syndrome (CCHS). We report a 9-year-old girl with CCHS who uses DP without tracheostomy during sleep. Her parents report hypoxemia and hypercapnia related to positional changes of the body during sleep requiring frequent adjustment of pacer settings. Overnight polysomnography was performed to titrate DP settings that showed adequate gas exchange in the supine position, but intermittent hypoxemia and hypercapnia were noted in the left decubitus position without obstructive sleep apnea occurring. Subsequently, the DP amplitude settings were increased during polysomnography, thereby identifying and treating positional hypoxemia and hypercapnia in various body positions. Our case emphasizes the importance of polysomnography in children with CCHS using DP to monitor for sleep-disordered breathing and titration of DP settings to achieve optimal oxygenation and ventilation with different body positions during sleep.
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Affiliation(s)
- Aditya Chada
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Atlanta, Georgia
| | - Roberta M Leu
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Atlanta, Georgia
| | - Iris A Perez
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Charles R Esther
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ajay S Kasi
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Atlanta, Georgia
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