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Mamarabadi M, Mauney S, Li Y, Aboussouan LS. Evaluation and management of dyspnea as the dominant presenting feature in neuromuscular disorders. Muscle Nerve 2024. [PMID: 39267292 DOI: 10.1002/mus.28243] [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: 04/30/2024] [Revised: 08/18/2024] [Accepted: 08/21/2024] [Indexed: 09/17/2024]
Abstract
Dyspnea is a common symptom in neuromuscular disorders and, although multifactorial, it is usually due to respiratory muscle involvement, associated musculoskeletal changes such as scoliosis or, in certain neuromuscular conditions, cardiomyopathy. Clinical history can elicit symptoms such as orthopnea, trepopnea, sleep disruption, dysphagia, weak cough, and difficulty with secretion clearance. The examination is essential to assist with the diagnosis of an underlying neurologic disorder and determine whether dyspnea is from a cardiac or pulmonary origin. Specific attention should be given to possible muscle loss, use of accessory muscles of breathing, difficulty with neck flexion/extension, presence of thoraco-abdominal paradox, conversational dyspnea, cardiac examination, and should include a detailed neurological examination directed at the suspected differential diagnosis. Pulmonary function testing including sitting and supine spirometry, measures of inspiratory and expiratory muscle strength, cough peak flow, sniff nasal inspiratory pressure, pulse oximetry, transcutaneous CO2, and arterial blood gases will help determine the extent of the respiratory muscle involvement, assess for hypercapnic or hypoxemic respiratory failure, and qualify the patient for noninvasive ventilation when appropriate. Additional testing includes dynamic imaging with sniff fluoroscopy or diaphragm ultrasound, and diaphragm electromyography. Polysomnography is indicated for sleep related symptoms that are not otherwise explained. Noninvasive ventilation alleviates dyspnea and nocturnal symptoms, improves quality of life, and prolongs survival. Therapy targeted at neuromuscular disorders may help control the disease or favorably modify its course. For patients who have difficulty with secretion clearance, support of expiratory function with mechanical insufflation-exsufflation, oscillatory devices can reduce the aspiration risk.
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Affiliation(s)
- Mansoureh Mamarabadi
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Sarah Mauney
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Yuebing Li
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Loutfi S Aboussouan
- Respiratory and Neurological Institutes, Cleveland Clinic, Cleveland, Ohio, USA
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Kim Y, Yoo S, Kim SH, Kim H, Bae J, Park SK, Kim JT, Lim YJ. Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial. Reg Anesth Pain Med 2024; 49:558-564. [PMID: 37775273 DOI: 10.1136/rapm-2023-104520] [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: 03/17/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION This study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local anesthetic without intravenous dexamethasone when performing ultrasound-guided superior trunk block in patients undergoing arthroscopic shoulder surgery. METHODS Eighty-four adult patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to receive ultrasound-guided superior trunk block using 7 mL of 0.5% ropivacaine with 0.15 mg/kg of intravenous dexamethasone (treatment group), or 15 mL of 0.5% ropivacaine with intravenous normal saline (control group). The co-primary outcomes were (1) the duration of analgesia (time between block completion and onset of surgical pain with a Numeric Rating Scale pain score of 4 or higher), which was compared against a non-inferiority margin of 3 hours, and (2) the incidence of diaphragmatic paresis evaluated using M-mode ultrasonography in the post-anesthesia care unit. RESULTS The mean duration of analgesia was 12.4 (6.8) and 11.2 (4.6) hours in the treatment and control groups, respectively (mean difference: -1.2 hours; 95% CI -3.8 to 1.3]; p for non-inferiority<0.001), meeting the non-inferiority criteria. The incidence of diaphragmatic paresis was 45.2% and 85.4% in the treatment and control groups, respectively (relative risk: 0.53; 97.5% CI 0.35 to 0.80; p<0.001). CONCLUSIONS Superior trunk block using low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while providing non-inferior analgesic duration compared with the conventional volume of local anesthetic in patients undergoing arthroscopic shoulder surgery. TRIAL REGISTRATION NUMBER Clinical Research Information Service of Republic of Korea Registry (KCT0005998).
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Affiliation(s)
- Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hansol Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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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.
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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
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Hussen A, Sultan M, Kidane MT, Getachew M, Abicho TB, Yewedalsew SF, Hassen GW. Point-of-Care Ultrasound to Assess Diaphragmatic Paralysis in Resource-Limited Setting: A Case Series. Int Med Case Rep J 2024; 17:433-437. [PMID: 38737214 PMCID: PMC11088823 DOI: 10.2147/imcrj.s454708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/27/2024] [Indexed: 05/14/2024] Open
Abstract
Diaphragmatic dysfunction can arise from various factors, and Guillain-Barre syndrome, characterized by acute inflammatory polyradiculoneuropathy, is one such cause that may result in respiratory failure due to diaphragmatic paralysis. Prompt recognition and timely intervention, including airway protection and addressing the underlying pathology, are crucial for achieving optimal patient outcomes. Point-of-care ultrasound, specifically utilizing the M-mode function, can be employed for individuals displaying symptoms of diaphragmatic paralysis. This diagnostic approach is uncomplicated an effective tool for serial follow-up. In this context, we present a case series involving three patients with diaphragmatic paralysis in a limited-resource setting.
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Affiliation(s)
| | - Menbeu Sultan
- Saint Paul’s Hospital Millennium Medical College Department of Intensive Care Medicine, Addis Ababa, Ethiopia
| | - Muluneh Tufa Kidane
- Saint Paul’s Hospital Millennium Medical College Department of Intensive Care Medicine, Addis Ababa, Ethiopia
| | - Melaku Getachew
- Haramaya University, Department of Emergency Medicine, Harar, Ethiopia
| | - Temesgen Beyene Abicho
- Addis Ababa University, Black Lion Specialized Hospital, Department of Emergency Medicine, Harar, Ethiopia
| | | | - Getaw Worku Hassen
- New York Medical College, Metropolitan Hospital Center, New York, NY, USA
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Gillaspie EA. Imaging of the Diaphragm: A Primer. Thorac Surg Clin 2024; 34:119-125. [PMID: 38705659 DOI: 10.1016/j.thorsurg.2024.02.002] [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] [Indexed: 05/07/2024]
Abstract
The diaphragm is a critical musculotendinous structure that contributes to respiratory function. Disorders of the diaphragm are rare and diagnostically challenging. Herein, the author reviews the radiologic options for the assessment of the diaphragm.
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Affiliation(s)
- Erin A Gillaspie
- Division of Thoracic Surgery, Creighton University Medical Center, 7500 Mercy Boulevard, Omaha, NE 68124, USA.
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Tepe M, Inan I, Kafadar S. Bi-parametric MRI of the Diaphragm Using Dynamic and Static Images: The Initial Experience. Cureus 2024; 16:e61446. [PMID: 38953067 PMCID: PMC11215931 DOI: 10.7759/cureus.61446] [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] [Accepted: 05/31/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND With recent technological advances, magnetic resonance imaging (MRI) has offered new sequences that can evaluate the real-time motion of anatomic structures. This study aims to evaluate the interobserver agreement in the diagnosis of diaphragmatic dysfunctions using bi-parametric MRI, in which dynamic sequences for diaphragm movement and static sequences for soft tissue resolution are used together to provide a visualization of the diaphragm. METHODOLOGY Twenty-nine cases that underwent a bi-parametric magnetic resonance examination which includes coronal T2 single-shot turbo spin echo and the coronal SENSE single-shot balanced turbo field echo real-time sequences were retrospectively evaluated. The images of the patients were assessed by two independent observers. Cohen's kappa coefficient was calculated to evaluate the interobserver agreement. RESULTS The mean age of the patients was 44.86 ± 17.57, ranging from 18 to 80 years. The kappa value was calculated as 0.889, indicating a strong agreement between the interobservers. CONCLUSIONS Our experience suggests that bi-parametric MRI is a promising tool in the evaluation of diaphragmatic abnormalities.
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Affiliation(s)
- Murat Tepe
- Radiology, Mediclinic City Hospital, Dubai, ARE
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Zieff G, Cornwall J, Blue MN, Smith-Ryan AE, Stoner L. Ultrasound-based measurement of central adiposity: Key considerations and guidelines. Obes Rev 2024; 25:e13716. [PMID: 38418428 DOI: 10.1111/obr.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 03/01/2024]
Abstract
Central adiposity, which is visceral and subcutaneous adiposity in the abdominal region, is a known risk factor for developing chronic cardiometabolic diseases. Central adiposity can be measured relatively inexpensively using ultrasound. Ultrasound has been shown to be precise and reliable, with measurement accuracy comparable to computed tomography and magnetic resonance. Despite the advantages conferred by ultrasound, widespread adoption has been hindered by lack of reliable standard operating procedures. To consolidate the literature and bring clarity to the use of ultrasound-derived measures of central adiposity, this review outlines (i) the [patho]physiological importance of central adiposity to cardiometabolic disease risk; (ii) an overview of the history and main technical aspects of ultrasound methodology; (iii) key measurement considerations, including transducer selection, subject preparation, image acquisition, image analysis, and operator training; and (iv) guidelines for standardized ultrasound protocols for measuring central adiposity.
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Affiliation(s)
- Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Malia N Blue
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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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: 0] [Impact Index Per Article: 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.
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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.
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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.
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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.
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Crowe CS, Pulos N, Spinner RJ, Bishop AT, Wigle DA, Shin AY. The diagnostic utility of inspiratory-expiratory radiography for the assessment of phrenic nerve palsy associated with brachial plexus injury. Acta Neurochir (Wien) 2023; 165:2589-2596. [PMID: 37198276 DOI: 10.1007/s00701-023-05622-6] [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: 03/20/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND The phrenic nerve is commonly injured with trauma to the brachial plexus. Hemi-diaphragmatic paralysis may be well-compensated in healthy individuals at rest but can be associated with persistent exercise intolerance in some patients. This study aims to determine the diagnostic value of inspiratory-expiratory chest radiography compared to intraoperative stimulation of the phrenic nerve for assessing phrenic nerve injury associated with brachial plexus injury. METHODS Over a 21-year period, the diagnostic utility of three-view inspiratory-expiratory chest radiography for identification of phrenic nerve injury was determined by comparison to intraoperative phrenic nerve stimulation. Multivariate regression analysis was used to identify independent predictors of phrenic nerve injury and having an incorrect radiographic diagnosis. RESULTS A total of 237 patients with inspiratory-expiratory chest radiography underwent intraoperative testing of phrenic nerve function. Phrenic nerve injury was present in approximately one-fourth of cases. Preoperative chest radiography had a sensitivity of 56%, specificity of 93%, positive predictive negative of 75%, and negative predictive value of 86% for identification of a phrenic nerve palsy. Only C5 avulsion was found to be a predictor of having an incorrect diagnosis of phrenic nerve injury on radiography. CONCLUSION While inspiratory-expiratory chest radiography has good specificity for detecting phrenic nerve injuries, a high number of false negatives suggest that it should not be relied upon for routine screening of dysfunction after traumatic brachial plexus injury. This is likely multifactorial and relates to variation in diaphragm shape and position, as well as limitations regarding static image interpretation of a dynamic process.
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Affiliation(s)
- Christopher S Crowe
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, 200 1st St., Southwest Rochester, MN, 55905, USA
| | - Nicholas Pulos
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, 200 1st St., Southwest Rochester, MN, 55905, USA
| | | | - Allen T Bishop
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, 200 1st St., Southwest Rochester, MN, 55905, USA
| | - Dennis A Wigle
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, USA
| | - Alexander Y Shin
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, 200 1st St., Southwest Rochester, MN, 55905, USA.
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Zhang Q, Yang D, Zhu Y, Liu Y, Ye X. An optimized optical-flow-based method for quantitative tracking of ultrasound-guided right diaphragm deformation. BMC Med Imaging 2023; 23:108. [PMID: 37592200 PMCID: PMC10436632 DOI: 10.1186/s12880-023-01066-7] [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: 01/31/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES To develop a quantitative analysis method for right diaphragm deformation. This method is based on optical flow and applied to diaphragm ultrasound imaging. METHODS This study enrolls six healthy subjects and eight patients under mechanical ventilation. Dynamic images with 3-5 breathing cycles were acquired from three directions of right diaphragm by a portable ultrasound system. Filtering and density clustering algorithms are used for denoising Digital Imaging and Communications in Medicine (DICOM) data. An optical flow based method is applied to track movements of the right diaphragm. An improved drift correction algorithm is used to optimize the results. The method can automatically analyze the respiratory cycle, inter-frame/cumulative vertical and horizontal displacements, and strain of the input right diaphragm ultrasound image. RESULTS The optical-flow-based diaphragm ultrasound image motion tracking algorithm can accurately track the right diaphragm during respiratory motion. There are significant differences in horizontal and vertical displacements in each section (p-values < 0.05 for all). Significant differences are found between healthy subjects and mechanical ventilation patients for both horizontal and vertical displacements in Section III (p-values < 0.05 for both). There is no significant difference in global strain in each section between healthy subjects and mechanical ventilation patients (p-values > 0.05 for all). CONCLUSIONS The developed method can quantitatively evaluate the inter-frame/cumulative displacement of the diaphragm in both horizontal and vertical directions, as well as the global strain in three different imaging planes. The above indicators can be used to evaluate diaphragmatic dynamics.
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Affiliation(s)
- Qi Zhang
- School of Information Science and Engineering, East China University of Science and Technology, Shanghai, 200237, PR China
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, PR China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, Shanghai, 200237, PR China
| | - Yu Zhu
- School of Information Science and Engineering, East China University of Science and Technology, Shanghai, 200237, PR China.
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, Shanghai, 200237, PR China.
| | - Yatong Liu
- School of Information Science and Engineering, East China University of Science and Technology, Shanghai, 200237, PR China
| | - Xiong Ye
- School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, PR China.
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Joseph KR, Wong TS, Singh J, Orde S, Oborska Y, Mayorchak Y. Single port thoracoscopic diaphragm plication: A novel treatment approach to bilateral phrenic nerve palsy and diaphragm paralysis. Int J Surg Case Rep 2023; 108:108387. [PMID: 37329609 PMCID: PMC10382738 DOI: 10.1016/j.ijscr.2023.108387] [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: 04/17/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The diaphragm is the primary muscle of respiration. Bilateral paralysis of the diaphragm due to phrenic nerve palsy causes severe dyspnoea and is life threatening. Diaphragmatic Plication has shown great promise in treating diaphragm paralysis and has evolved as operative treatment from an open thoracotomy to multiport and robotic video assisted thoracoscopic surgery. CASE PRESENTATION Here we present a case of idiopathic bilateral diaphragm paralysis resulting significant deterioration in lung function tests, supplemental oxygen, and ventilator dependence. The patient was treated with a 2-stage operative plication of each hemidiaphragm through a 2.5 cm single incision thoracoscopic technique, which resulted in normalization of lung function tests, elimination of oxygen dependence and negligible analgesia requirements. CASE DISCUSSION This is the first case reported in the literature of a single port VATS plication of the diaphragm for the treatment of bilateral phrenic nerve palsy. Surgery, specifically diaphragm plication, is indicated for patients with significant symptoms and persistent paralysis. Video-assisted thoracoscopic surgery (VATS) has evolved from open operations to smaller incisions, offering improved lung function, postoperative pain, hospital stay, morbidity, and mortality. CONCLUSION Single port diaphragmatic plication is a novel approach to the treatment of bilateral phrenic nerve palsy. We make the case for indication of the technique for treatment of diaphragmatic paralysis.
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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.
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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
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14
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Rezk S, Azab N, El-Habashy M, El-Helbawy R, Habib R. Ultrasound assessment of the relation between the quantity of pleural effusion and diaphragmatic functions. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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15
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Boice EN, Hernandez Torres SI, Knowlton ZJ, Berard D, Gonzalez JM, Avital G, Snider EJ. Training Ultrasound Image Classification Deep-Learning Algorithms for Pneumothorax Detection Using a Synthetic Tissue Phantom Apparatus. J Imaging 2022; 8:jimaging8090249. [PMID: 36135414 PMCID: PMC9502699 DOI: 10.3390/jimaging8090249] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Ultrasound (US) imaging is a critical tool in emergency and military medicine because of its portability and immediate nature. However, proper image interpretation requires skill, limiting its utility in remote applications for conditions such as pneumothorax (PTX) which requires rapid intervention. Artificial intelligence has the potential to automate ultrasound image analysis for various pathophysiological conditions. Training models require large data sets and a means of troubleshooting in real-time for ultrasound integration deployment, and they also require large animal models or clinical testing. Here, we detail the development of a dynamic synthetic tissue phantom model for PTX and its use in training image classification algorithms. The model comprises a synthetic gelatin phantom cast in a custom 3D-printed rib mold and a lung mimicking phantom. When compared to PTX images acquired in swine, images from the phantom were similar in both PTX negative and positive mimicking scenarios. We then used a deep learning image classification algorithm, which we previously developed for shrapnel detection, to accurately predict the presence of PTX in swine images by only training on phantom image sets, highlighting the utility for a tissue phantom for AI applications.
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Affiliation(s)
- Emily N. Boice
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | | | - Zechariah J. Knowlton
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - David Berard
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Jose M. Gonzalez
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Guy Avital
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
- Trauma & Combat Medicine Branch, Surgeon General’s Headquarters, Israel Defense Forces, Ramat-Gan 52620, Israel
- Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 64239, Israel
| | - Eric J. Snider
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
- Correspondence: ; Tel.: +210-539-8721
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16
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The difference in the diaphragmatic physiological measures between inspiratory and expiratory phases in ALS. Neurol Sci 2022; 43:6821-6830. [DOI: 10.1007/s10072-022-06371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
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Abstract
When asked to assess patients in an intensive care unit (ICU) who have respiratory muscle weakness, oropharyngeal weakness and a vulnerable airway, our immediate thought may be of Guillain-Barré syndrome or myasthenia gravis, but there are many other possible causes. For example, previously unrecognised chronic neurological conditions may decompensate and require ICU admission. Clinicians can use various clinical clues to help recognise them and need to understand how patterns of weakness reflect differing causes of reduced consciousness on ICU. Additionally, patients admitted to ICU for any reason may develop weakness during their stay, the most likely cause being ICU-acquired weakness. Assessing patients in ICU is challenging, hampered by physical barriers (machines, tubes), medication barriers (sedatives) and cognitive barriers (delirium, difficulty communicating). Nonetheless, we need to reach a clinical diagnosis, organise appropriate tests and communicate clearly with both patients and ICU colleagues.
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18
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Fiott DL, Gauci J, Pace Bardon M, Balzan M. Type 2 respiratory failure secondary to left hemidiaphragmatic paralysis. Breathe (Sheff) 2022; 18:210165. [PMID: 36338253 PMCID: PMC9584595 DOI: 10.1183/20734735.0165-2021] [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: 11/29/2021] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
A 73-year-old man presented to the emergency department with worsening orthopnoea and exertional dyspnoea. He denied any other cardiorespiratory symptoms. The patient had a body mass index (BMI) of 23.3 kg·m−2 (height 163 cm, weight 62 kg). Lung function tests 3 months before admission showed a ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) of 88%. He had a past medical history of hypothyroidism, for which he was on levothyroxine 50 μg daily, and type 2 diabetes mellitus, for which he was on metformin 500 mg twice daily. Past surgical history included a gastrectomy 3 years prior to admission performed for gastric cancer, which was subsequently complicated by a subphrenic abscess, pancreatitis and residual pancreatic insufficiency. The patient was a lifelong non-smoker, worked in construction, reared birds as a hobby, and lived in an urban area. He was not on any other medication. This case describes an uncommon presentation of type 2 respiratory failure secondary to left hemidiaphragmatic paralysis. Emphasis is on the multitude of possible causes of hemidiaphragmatic paralysis and how to manage such a presentation.https://bit.ly/3Mcd2XI
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19
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Chow J, Hatem M. Quantitative analysis of diaphragm motion during fluoroscopic sniff test to assist in diagnosis of hemidiaphragm paralysis. Radiol Case Rep 2022; 17:1750-1754. [PMID: 35355529 PMCID: PMC8958460 DOI: 10.1016/j.radcr.2022.02.083] [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: 02/07/2022] [Accepted: 02/24/2022] [Indexed: 11/08/2022] Open
Abstract
The current imaging gold standard for detecting paradoxical diaphragm motion and diagnosing hemidiaphragm paralysis is to perform the fluoroscopic sniff test. The images are visually examined by an experienced radiologist, and if one hemidiaphragm ascends while the other descends, then it is described as paradoxical motion, which is highly suggestive of hemidiaphragm paralysis. However, diagnosis can be challenging because diaphragm motion during sniffing is fast, paradoxical motion can be subtle, and the analysis is based on a 2-dimensional projection of a 3-dimensional surface. This paper presents a case of chronic left hemidiaphragm elevation that was initially reported as mild paradoxical motion on fluoroscopy. After measuring the elevations of the diaphragms and modeling their temporal correlation using Gaussian process regression, the systematic trend of the hemidiaphragmatic motion along with its stochastic properties was determined. When analyzing the trajectories of the hemidiaphragms, no statistically significant paradoxical motion was detected. This could potentially change the prognosis if the patient was to consider diaphragm plication as treatment. The presented method provides a more objective analysis of hemidiaphragm motions and can potentially improve diagnostic accuracy.
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Affiliation(s)
- Jacky Chow
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, T2N 4N1, Canada
| | - Muhammed Hatem
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, T2N 4N1, Canada
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20
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Mohammed GS, Mazy AM, El-Ebahnasawy NS, Mohammed MN. Efficacy of superficial cervical plexus block versus cervical retrolaminar block both combined with auriculotemporal nerve block in parotid surgeries. Ann Med Surg (Lond) 2022; 75:103445. [PMID: 35386783 PMCID: PMC8977931 DOI: 10.1016/j.amsu.2022.103445] [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: 01/10/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Regional techniques in parotid surgeries include superficial cervical plexus block (SCPB) and auriculotemporal nerve (ATN) block, which can be used as an anesthetic technique for awake parotidectomy. This study aimed to evaluate the efficacy of cervical retrolaminar block (RLB) as an alternative to SCPB both, used in combination with auriculotemporal nerve (ATN) block, in parotid surgery. Material and methods A total of 40 patients undergoing parotid surgery were prospectively randomized into either the SCPB group (n = 20) or the cervical RLB group (n = 20) using 20 ml of 0.25% bupivacaine plus 5 mcg\mL epinephrine. Both were combined with ATN block using 5 ml of 0.25% bupivacaine plus 5 mcg\mL epinephrine. Results The time to first request for analgesia was longer in the RLB group than the SCPB group. Total intra operative fentanyl consumption and post-operative pethidine consumption in the first 24h were lower in group RLB. All patients (n = 20) in the SCPB group required rescue analgesia using pethidine, while only 40% of patients required pethidine in the RLB group. Visual analog scale was lower in the RLB group from 2 to 24-h post-operatively, but it was associated with hypotension and longer block technique time occurred with RLB than SCPB. There was no significant difference in side effects except for 20% Horner's syndrome in the SCPB group. Conclusion Cervical RLB is more effective analgesic technique than SCPB, as the cervical RLB showed longer time to first analgesic request, lower intraoperative anesthetic consumption, lower total post-operative pethidine consumption and lower VAS. A study on 40 patient undergoing elective parotid surgery of 2 groups; Cervical retrolaminar block or SCPB. Cervical retrolaminar block more effective than SCBP. Cervical retrolaminar block is alternative Technique to paravertebral block. No significant difference between the two study groups according to complications.
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Affiliation(s)
- Ghada S. Mohammed
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Corresponding author. Department of Anesthesiology, Faculty of Medicine, Mansoura University, El Gomhouria St, Dakahlia, Governorate, 35516, Egypt.
| | - Alaa M. Mazy
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nahla S. El-Ebahnasawy
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed N. Mohammed
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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21
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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.
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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
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22
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Saisawart P, Sutthigran S, Soontornvipart K, Thanaboonnipat C, Darawiroj D, Choisunirachon N. The Feasibility of Ultrasonographic Diaphragmatic Excursion in Healthy Dogs: Effect of Positioning, Diaphragmatic Location, and Body Weight of Dogs. Front Vet Sci 2021; 8:763556. [PMID: 34859091 PMCID: PMC8631322 DOI: 10.3389/fvets.2021.763556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Diaphragmatic excursion (DE) has been utilized for detecting respiratory related problems in humans. However, several factors should be considered such as the ultrasound technique and factors intrinsic to patients. Nevertheless, knowledge of the effect of these factors on DE in dogs is still lacking. The aim of this study was to evaluate the proper ultrasound technique by varying postures and diaphragmatic locations for DE measurement and to explore intrinsic factors such as diaphragmatic sides, sex, and body weight of dogs on DE. The prospective, analytic, cross-sectional study included 44 healthy dogs; 12 beagles and 32 dogs of other breeds. The experiment was divided into (i) an exploration of the proper ultrasound technique by varying postures (supine, standing, and recumbent in each of the right and left lateral positions), diaphragmatic locations (middle crus and proximal to the last rib), and diaphragmatic sublocations (xiphoid, mid, and proximal rib) for detection of DE and (ii) the evaluation of canine intrinsic factors affecting DE. The results show that the mid-diaphragmatic sublocation in the middle crus area in almost all positions revealed the highest percentage DE detection. However, DEs were revealed to be more accessible in the supine position. There was no significant difference in DE between the right and the left diaphragms or between the sexes of beagle dogs. However, body weight was significantly correlated with the DE among dogs of various sizes. In conclusion, the posture of the dogs and the diaphragmatic location can affect DE evaluation. Neither sex nor diaphragmatic side had an influence, but body weight was revealed as a major factor in DE in dogs.
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Affiliation(s)
- Phasamon Saisawart
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Somchin Sutthigran
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Kumpanart Soontornvipart
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Chutimon Thanaboonnipat
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Damri Darawiroj
- Department of Anatomy, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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23
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Asan EU, Karasu D, Ozgunay SE, Yilmaz C, Uguz I, Asan S, Gamli M. Evaluation of Diaphragm Functions in Laparoscopic Bariatric Surgeries. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ezgi Unal Asan
- Anesthesiology and Reanimation, Bursa Gemlik State Hospital, Bursa, Turkey
| | - Derya Karasu
- Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Seyda Efsun Ozgunay
- Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Canan Yilmaz
- Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Ilken Uguz
- Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
| | - Selcuk Asan
- Anesthesiology and Reanimation, Uludag University, Bursa, Turkey
| | - Mehmet Gamli
- Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Turkey, Bursa, Turkey
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Cappellini I, Picciafuochi F, Bartolucci M, Matteini S, Virgili G, Adembri C. Evaluation of diaphragm thickening by diaphragm ultrasonography: a reproducibility and a repeatability study. J Ultrasound 2021; 24:411-416. [PMID: 32358646 PMCID: PMC8572279 DOI: 10.1007/s40477-020-00462-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/08/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We have focused on the two-dimensional (B-mode) and the time-motion (M-mode) analysis of the zone of apposition to determine the reliability of diaphragm ultrasonography in the clinical environment. METHODS Ten healthy volunteers were enrolled and studied by three operators with different skills in ultrasonography. For every volunteer, each operator acquired three images of the diaphragm for each side, both in B-mode and in M-mode. Then a fourth operator calculated the thickening fraction (TF), by means of the formula TF = (TEI - TEE)/TEE (TEI is the thickness at end inspiration and TEE the thickness at end expiration). Afterwards, intraclass correlation coefficients (ICCs) were computed on TF to establish reproducibility and repeatability both in the B- and M-modes. A Coefficient of Repeatability or repeatability (CR) ≤ 0.3 was considered acceptable. RESULTS Both B-mode (CRs 0.16-0.26) and M-mode (CRs 0.10-0.15) were sufficiently repeatable to assess TF, except for the less experienced operator (CRs B-Mode 0.20-0.32). Reproducibility was moderate to good between operators with CRs much narrower for the M-Mode (0.13-0.14). CONCLUSIONS The results of our study have shown that diaphragm ultrasound is repeatable and reproducible when carried out by a radiologist or an intensivist with a basic curriculum in ultrasonography. The method is more accurate when using the M-mode for less experienced operators, and in this case, repeatability and reproducibility are not sufficient to make clinical decisions. No TF value lower than 36% was obtained using both techniques. This suggests the existence of a cut-off value that could be used as an initial tool to discriminate healthy subjects from those affected by diaphragmatic dysfunction. CLINICAL TRIAL REGISTRATION EUDRACT 2015-004635-12.
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Affiliation(s)
- Iacopo Cappellini
- Department of Health Sciences, Section of Anesthesiology and Critical Care, University of Florence, Florence, Italy.
| | - Fabio Picciafuochi
- Radiology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Maurizio Bartolucci
- Radiology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simona Matteini
- Department of Health Sciences, Section of Anesthesiology and Critical Care, University of Florence, Florence, Italy
| | - Gianni Virgili
- Department of Health Sciences, Section of Anesthesiology and Critical Care, University of Florence, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Chiara Adembri
- Department of Health Sciences, Section of Anesthesiology and Critical Care, University of Florence, Florence, Italy
- Radiology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Gul F, Casey D, Mainigi S, Eiger G, Niroula A. A 65-Year-Old Woman With Dyspnea After Atrial Fibrillation Ablation. Chest 2021; 159:e29-e33. [PMID: 33422237 DOI: 10.1016/j.chest.2020.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/08/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022] Open
Abstract
CASE PRESENTATION A 65-year-old woman with a history of chronic persistent atrial fibrillation, tobacco use, and COPD was admitted to the hospital 2 months after catheter ablation for persistent atrial fibrillation and dyspnea. Her dyspnea was present at rest and worsened by exertion with limitation to ambulating less than two blocks. She also endorsed a 1-month history of cough with minimally productive whitish sputum with frequent nocturnal exacerbations and orthopnea. She denied any fevers, chest pain, or hemoptysis.
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Affiliation(s)
- Fahad Gul
- Department of Internal Medicine, Albert Einstein Medical Center Ringgold standard institution, Philadelphia, PA.
| | - Daniel Casey
- Philadelphia College of Osteopathic Medicine Ringgold standard institution, Philadelphia, PA
| | - Sumeet Mainigi
- Department of Cardiology, Albert Einstein Medical Center Ringgold standard institution, Philadelphia, PA
| | - Glenn Eiger
- Department of Internal Medicine, Albert Einstein Medical Center Ringgold standard institution, Philadelphia, PA
| | - Abesh Niroula
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University Ringgold standard institution, Atlanta, GA
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Torres Jimenez AR, Ruiz Vela N, Cespedes Cruz AI, Velazquez Cruz A, Bernardino Gonzalez AK. Shrinking lung syndrome in pediatric systemic lupus erythematosus. Lupus 2021; 30:1175-1179. [PMID: 33888011 DOI: 10.1177/09612033211010331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe clinical, radiological and treatment characteristics in pediatric patients with SLS. MATERIAL AND METHODS This is a descriptive and retrospective study in patients under 16 years old with the diagnosis of SLE complicated by SLS at the General Hospital. National Medical Center La Raza. Clinical, radiological and treatment variables were analyzed. Results are shown in frequencies and percentages. RESULTS Data from 11 patients, 9 females and 2 males were collected. Mean age at diagnosis of SLS was 12.2 years. Age at diagnosis of SLE was 11.1 years. SLEDAI 17.3. Renal desease 72%, hematological 91%, lymphopenia 63%, mucocutaneous 72%, neurological 9%, arthritis 54%, serositis 91%, fever 81%, secondary antiphospholipid syndrome, low C3 72%, low C4 81%, positive ANA 91%, positive anti-DNA 91%. Regarding clinical manifestations of SLE: cough 81%, dyspnea 91%, hipoxemia 81%, pleuritic pain 71%, average oxygen saturation 83%. Chest X-rays findings: right hemidiaphragm affection 18%, left 63%, bilateral 18%. Elevated hemidiaphragm 91%, atelectasis 18%, pleural effusion 91%, over one third of the cardiac silhouette under the diphragm 36%, bulging diaphragm 45%, 5th. anterior rib that crosses over the diaphragm 91%. M-mode ultrasound: diaphragmatic hypomotility 100%, pleural effusion 63%. Pulmonary function tests: restrictive pattern in 45% of the cases. Treatment was with supplementary oxygen 100%, intubation 18%, antibiotics 100%, steroids 100%, intravenous immunoglobulin 54%, plasmapheresis 18%, cyclophosphamide 54% and rituximab 18%. The clinical course was favorable in 81%. CONCLUSIONS SLS should be suspected in patients with SLE and active disease who present hipoxemia, pleuritic pain, cough, dyspnea, pleural effusion and signs of restriction on chest X-rays. Therefore, a diaphragmatic M-mode ultrasound should be performed in order to establish the diagnosis.
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Affiliation(s)
| | - Nayma Ruiz Vela
- Department of Pediatric Rheumatology, National Medical Center La Raza, IMSS, México City, México
| | | | - Alejandra Velazquez Cruz
- Department of Pediatric Rheumatology, National Medical Center La Raza, IMSS, México City, México
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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: 34] [Impact Index Per Article: 11.3] [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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Laghi FA, Saad M, Shaikh H. Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction. BMC Pulm Med 2021; 21:85. [PMID: 33722215 PMCID: PMC7958108 DOI: 10.1186/s12890-021-01441-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/19/2021] [Indexed: 12/25/2022] Open
Abstract
Diaphragm muscle dysfunction is increasingly recognized as an important element of several diseases including neuromuscular disease, chronic obstructive pulmonary disease and diaphragm dysfunction in critically ill patients. Functional evaluation of the diaphragm is challenging. Use of volitional maneuvers to test the diaphragm can be limited by patient effort. Non-volitional tests such as those using neuromuscular stimulation are technically complex, since the muscle itself is relatively inaccessible. As such, there is a growing interest in using imaging techniques to characterize diaphragm muscle dysfunction. Selecting the appropriate imaging technique for a given clinical scenario is a critical step in the evaluation of patients suspected of having diaphragm dysfunction. In this review, we aim to present a detailed analysis of evidence for the use of ultrasound and non-ultrasound imaging techniques in the assessment of diaphragm dysfunction. We highlight the utility of the qualitative information gathered by ultrasound imaging as a means to assess integrity, excursion, thickness, and thickening of the diaphragm. In contrast, quantitative ultrasound analysis of the diaphragm is marred by inherent limitations of this technique, and we provide a detailed examination of these limitations. We evaluate non-ultrasound imaging modalities that apply static techniques (chest radiograph, computerized tomography and magnetic resonance imaging), used to assess muscle position, shape and dimension. We also evaluate non-ultrasound imaging modalities that apply dynamic imaging (fluoroscopy and dynamic magnetic resonance imaging) to assess diaphragm motion. Finally, we critically review the application of each of these techniques in the clinical setting when diaphragm dysfunction is suspected.
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Affiliation(s)
- Franco A Laghi
- Department of Internal Medicine, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA
| | - Marina Saad
- Department of Biomedical and Clinical Sciences (DIBIC), Division of Pulmonary Diseases, University of Milan, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, V. G.B. Grassi, 74, 20157, Milan, Italy
| | - Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital (111N), 5th Avenue and Roosevelt Road, Hines, IL, 60141, USA. .,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL, 60153, USA.
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Azour L, Mendelson DS, Rogers L, Salvatore MM. Diaphragmatic excursion: Quantitative measure to assess adequacy of expiratory phase CT chest images. Eur J Radiol 2021; 136:109527. [PMID: 33460955 DOI: 10.1016/j.ejrad.2021.109527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/03/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate diaphragmatic excursion as a quantitative metric for change in lung volume between inspiratory and expiratory chest computed tomography (CT) images. METHODS A 12-month retrospective review identified 226 chest CT exams with inspiratory and expiratory phase imaging, 63 in individuals referred with diagnosis of asthma by ICD9/10 code. Exams acquired in the supine position at 1.25 mm slice thickness in each phase were included (n = 30, mean age = 62, M = 15, F = 15). Diaphragmatic excursion was calculated as the difference between axial slices through the lungs on inspiration and expiration, using the lung apex as the cranial bound, and the hemidiaphragm caudally. Inspiratory and expiratory lung and tracheal volumes were calculated through volumetric segmentation. Tracheal morphology was assessed at 1 cm above the level of the aortic arch, and 1 cm above the carina. RESULTS Inspiratory and expiratory lung volumes were higher in men (mean I = 5 + 1.6 L, E = 3.1 + 1.2 L) than women (mean I = 3.6 + 0.8 L, E = 2.4 + 0.7 L), p = .005 and p = .047, respectively. Average inspiratory and expiratory tracheal volumes were higher in men (I = 61 + 17 mL, E = 43 + 14) than women (I = 44 + 14, E = 30 + 8), p = .006 and p = .005. Average change in lung and tracheal volume between inspiratory and expiratory scans did not significantly differ between men and women. Average diaphragmatic excursion was 2.5 cm between inspiratory and expiratory scans (2.7 cm in men, 2.3 cm in women; p = .5). There was a strong positive correlation between diaphragmatic excursion and change in lung (r = .84) and tracheal volume (r = .79). A moderate correlation was also found between change in tracheal volume and change in lung volume (r = 0.67). Change in tracheal morphology between inspiratory and expiratory imaging was associated with change in tracheal volume at both 1 cm above the aortic arch (p = .04) and 1 cm above the carina (p = .008); there was no association with diaphragmatic excursion or lung volume. CONCLUSIONS Diaphragmatic excursion is a quantitative measure of expiratory effort as validated by both lung and tracheal volumes in asthma patients, and may be more accurate than qualitative assessment based on tracheal morphology.
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Affiliation(s)
- Lea Azour
- Department of Radiology, Icahn School of Medicine at Mount Sinai, United States; Department of Radiology, NYU Langone Health, United States.
| | - David S Mendelson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, United States
| | - Linda Rogers
- Department of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Mary M Salvatore
- Department of Radiology, Icahn School of Medicine at Mount Sinai, United States; Department of Radiology, Columbia University Medical Center, United States
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Santana PV, Cardenas LZ, Albuquerque ALPD, Carvalho CRRD, Caruso P. Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses. J Bras Pneumol 2020; 46:e20200064. [PMID: 33237154 PMCID: PMC7909996 DOI: 10.36416/1806-3756/e20200064] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/30/2020] [Indexed: 12/12/2022] Open
Abstract
The diaphragm is the main muscle of respiration, acting continuously and uninterruptedly to sustain the task of breathing. Diaphragmatic dysfunction can occur secondary to numerous pathological conditions and is usually underdiagnosed in clinical practice because of its nonspecific presentation. Although several techniques have been used in evaluating diaphragmatic function, the diagnosis of diaphragmatic dysfunction is still problematic. Diaphragmatic ultrasound has gained importance because of its many advantages, including the fact that it is noninvasive, does not expose patients to radiation, is widely available, provides immediate results, is highly accurate, and is repeatable at the bedside. Various authors have described ultrasound techniques to assess diaphragmatic excursion and diaphragm thickening in the zone of apposition. Recent studies have proposed standardization of the methods. This article reviews the usefulness of ultrasound for the evaluation of diaphragmatic function, addressing the details of the technique, the main findings, and the clinical applications.
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Affiliation(s)
- Pauliane Vieira Santana
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Unidade de Terapia Intensiva, A.C. Camargo Cancer Center, São Paulo (SP) Brasil
| | - Leticia Zumpano Cardenas
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Unidade de Terapia Intensiva, A.C. Camargo Cancer Center, São Paulo (SP) Brasil
| | - André Luis Pereira de Albuquerque
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Carlos Roberto Ribeiro de Carvalho
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Pedro Caruso
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Unidade de Terapia Intensiva, A.C. Camargo Cancer Center, São Paulo (SP) Brasil
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Meineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P, Denault A, Desjardins G, Fayad A, Funk D, Hegazy AF, Kim H, Kruger M, Kruisselbrink R, Perlas A, Prabhakar C, Syed S, Sidhu S, Tanzola R, Van Rensburg A, Talab H, Vegas A, Bainbridge D. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Can J Anaesth 2020; 68:376-386. [DOI: 10.1007/s12630-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
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Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block. Eur J Anaesthesiol 2020; 37:1105-1114. [DOI: 10.1097/eja.0000000000001367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Patel DC, Berry MF, Bhandari P, Backhus LM, Raees S, Trope W, Nash A, Lui NS, Liou DZ, Shrager JB. Paradoxical Motion on Sniff Test Predicts Greater Improvement Following Diaphragm Plication. Ann Thorac Surg 2020; 111:1820-1826. [PMID: 33031777 DOI: 10.1016/j.athoracsur.2020.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/25/2020] [Accepted: 07/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diaphragm plication (DP) improves pulmonary function and quality of life for those with diaphragm paralysis or dysfunction. It is unknown whether differing degrees of diaphragm dysfunction as measured by sniff testing affect results after plication. METHODS Patients who underwent minimally invasive DP from 2008 to 2019 were dichotomized based on sniff test results: paradoxical motion (PM) versus no paradoxical motion (NPM); the latter included normal, decreased, and no motion. Preoperative and postoperative pulmonary function testing (PFT) after DP was compared between groups. The impact of the diaphragm height index, a measure of diaphragm elevation, was also assessed. RESULTS A total of 26 patients underwent preoperative sniff testing, DP, and postoperative PFT. Including all patients, DP resulted in a 17.8% ± 5.5% improvement in forced expiratory volume in 1 second (P < .001), a 14.4% ± 5.3% improvement in forced vital capacity (P < .001), and a 4.7% ± 4.6% improvement in the diffusing capacity of carbon monoxide (P = .539). There were greater improvements in the PM group (n = 16) compared with the NPM group (n = 10) for forced expiratory volume in 1 second (27.2% ± 6.0% versus 3.9% ± 6.2%; P = .017) and forced vital capacity (28.1% ± 5.3% versus -0.5% ± 3.3%; P = .001). There was no difference in the change in the diffusing capacity of carbon monoxide between groups. There were no differences between patients with PM and NPM in the postoperative course or complications. No value for diaphragm height index predicted improvement in PFT after DP. CONCLUSIONS Patients with PM on sniff test have dramatically greater objective improvements in pulmonary function after plication compared with those without PM. Most patients without PM do not demonstrate improvement in standard PFT. Improvements in dyspnea require additional study.
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Affiliation(s)
- Deven C Patel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Health System, Palo Alto, California
| | - Shehzaib Raees
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Winston Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Abraham Nash
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Health System, Palo Alto, California.
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Boussuges A, Rives S, Finance J, Brégeon F. Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives. World J Clin Cases 2020; 8:2408-2424. [PMID: 32607319 PMCID: PMC7322428 DOI: 10.12998/wjcc.v8.i12.2408] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
This article reports the various methods used to assess diaphragmatic function by ultrasonography. The excursions of the two hemidiaphragms can be measured using two-dimensional or M-mode ultrasonography, during respiratory maneuvers such as quiet breathing, voluntary sniffing and deep inspiration. On the zone of apposition to the rib cage for both hemidiaphragms, it is possible to measure the thickness on expiration and during deep breathing to assess the percentage of thickening during inspiration. These two approaches make it possible to assess the quality of the diaphragmatic function and the diagnosis of diaphragmatic paralysis or dysfunction. These methods are particularly useful in circumstances where there is a high risk of phrenic nerve injury or in diseases affecting the contractility or the motion of the diaphragm such as neuro-muscular diseases. Recent methods such as speckle tracking imaging and ultrasound shear wave elastography should provide more detailed information for better assessment of diaphragmatic function.
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Affiliation(s)
- Alain Boussuges
- Institut de Recherche Biomédicale des Armées, ERRSO, Toulon 83800, France
- Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM (1260), INRAE (1263), Toulon 83800, France
| | - Sarah Rives
- Institut de Recherche Biomédicale des Armées, ERRSO, Toulon 83800, France
| | - Julie Finance
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille 13015, France
| | - Fabienne Brégeon
- Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille 13015, France
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35
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Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery. Eur J Anaesthesiol 2020; 37:44-51. [DOI: 10.1097/eja.0000000000001055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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36
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37
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Sivashanmugam T, Maurya I, Kumar N, Karmakar MK. Ipsilateral hemidiaphragmatic paresis after a supraclavicular and costoclavicular brachial plexus block. Eur J Anaesthesiol 2019; 36:787-795. [DOI: 10.1097/eja.0000000000001069] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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38
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Diaphragmatic dysfunction. Pulmonology 2019; 25:223-235. [DOI: 10.1016/j.pulmoe.2018.10.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/16/2018] [Accepted: 10/28/2018] [Indexed: 12/13/2022] Open
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Abdelwahed WM, Abd Elghafar MS, Amr YM, Alsherif SEDI, Eltomey MA. Prospective study: Diaphragmatic thickness as a predictor index for weaning from mechanical ventilation. J Crit Care 2019; 52:10-15. [PMID: 30904733 DOI: 10.1016/j.jcrc.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/08/2019] [Accepted: 03/13/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Wafaa M Abdelwahed
- Faculty of Medicine, Tanta University, Department of Anesthesia and Surgical Intensive Care, Tanta University Hospital, Tanta, Egypt.
| | - Mohamed S Abd Elghafar
- Faculty of Medicine, Tanta University, Department of Anesthesia and Surgical Intensive Care, Tanta University Hospital, Tanta, Egypt
| | - Yasser M Amr
- Faculty of Medicine, Tanta University, Department of Anesthesia and Surgical Intensive Care, Tanta University Hospital, Tanta, Egypt
| | - Salah El-Din I Alsherif
- Faculty of Medicine, Tanta University, Department of Anesthesia and Surgical Intensive Care, Tanta University Hospital, Tanta, Egypt
| | - Mohamed A Eltomey
- Faculty of Medicine, Tanta University, Department of Diagnostic Radiology, Tanta University Hospital, Tanta, Egypt
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Abstract
Pathologic processes that involve the central nervous system, phrenic nerve, neuromuscular junction, and skeletal muscle can impair diaphragm function. When these processes are of sufficient severity to cause diaphragm dysfunction, respiratory failure may be a consequence. This article reviews basic diaphragm anatomy and physiology and then discusses diagnostic and therapeutic approaches to disorders that result in unilateral or bilateral diaphragm dysfunction. This discussion provides a context in which disorders of the diaphragm and their implications on respiratory function can be better appreciated.
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Affiliation(s)
- F Dennis McCool
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA.
| | - Kamran Manzoor
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA
| | - Taro Minami
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA
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41
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Minami T, Manzoor K, McCool FD. Assessing Diaphragm Function in Chest Wall and Neuromuscular Diseases. Clin Chest Med 2019; 39:335-344. [PMID: 29779593 DOI: 10.1016/j.ccm.2018.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Diaphragm dysfunction is defined as the partial or complete loss of diaphragm muscle contractility. However, because the diaphragm is one of only a few skeletal muscles that is not amenable to direct examination, the tools available for the clinician to assess diaphragm function have been limited. Traditionally, measures of lung volume, inspiratory muscle strength, and radiographic techniques such as fluoroscopy have provided the major method to assess diaphragm function. Measurement of transdiaphragmatic pressure provides the most direct means of evaluating the diaphragm, but this technique is not readily available to clinicians. Diaprhragm ultrasonography is new method that allows for direct examination of the diaphragm.
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Affiliation(s)
- Taro Minami
- The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA
| | - Kamran Manzoor
- The Warren Alpert Medical School of Brown University, 111 Brewster Street, Pawtucket, RI 02860, USA
| | - F Dennis McCool
- The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA.
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Aliste J, Bravo D, Layera S, Fernández D, Jara Á, Maccioni C, Infante C, Finlayson RJ, Tran DQ. Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery. Reg Anesth Pain Med 2019; 44:rapm-2018-100055. [PMID: 30635497 DOI: 10.1136/rapm-2018-100055] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND This randomized trial compared ultrasound-guided interscalene block (ISB) and costoclavicular brachial plexus block (CCB) for arthroscopic shoulder surgery. We hypothesized that CCB would provide equivalent analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis. METHODS All 44 patients received an ultrasound-guided block of the intermediate cervical plexus. Subsequently, they were randomized to ISB or CCB. The local anesthetic agent (20 mL of levobupivacaine 0.5% and epinephrine 5 µg/mL) and pharmacological block adjunct (4 mg of intravenous dexamethasone) were identical for all study participants. After the block performance, a blinded investigator assessed ISBs and CCBs every 5 min until 30 min using a composite scale that encompassed the sensory function of the supraclavicular nerves, the sensorimotor function of the axillary nerve and the motor function of the suprascapular nerve. A complete block was defined as one displaying a minimal score of six points (out of a maximum of eight points) at 30 min. Onset time was defined as the time required to reach the six-point minimal composite score. The blinded investigator also assessed the presence of hemidiaphragmatic paralysis at 30 min with ultrasonography.Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12, and 24 hours. Patient satisfaction at 24 hours, consumption of intraoperative and postoperative narcotics, and opioid-related side effects (eg, nausea/vomiting, pruritus) were also tabulated. RESULTS Both groups displayed equivalent postoperative pain scores at 0.5, 1, 2, 3, 6, 12, and 24 hours. ISB resulted in a higher incidence of hemidiaphragmatic paralysis (100% vs 0%; P < 0.001) as well as a shorter onset time (14.0 (5.0) vs 21.6 (6.4) minutes; p<0.001). However, no intergroup differences were found in terms of proportion of patients with minimal composite scores of 6 points at 30 min, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours. CONCLUSION Compared to ISB, CCB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate if CCB can provide surgical anesthesia for arthroscopic shoulder surgery. CLINICAL TRIALS REGISTRATION NCT03411343.
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Affiliation(s)
- Julián Aliste
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Daniela Bravo
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Sebastián Layera
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Diego Fernández
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Álvaro Jara
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Cristóbal Maccioni
- Department of Orthopedic Surgery, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Carlos Infante
- Department of Orthopedic Surgery, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | | | - De Q Tran
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
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Fayssoil A, Stojkovic T, Ogna A, Laforet P, Prigent H, Lofaso F, Orlikowski D, Bassez G, Eymard B, Behin A. Assessment of diaphragm motion using ultrasonography in a patient with facio-scapulo-humeral dystrophy: A case report. Medicine (Baltimore) 2019; 98:e13887. [PMID: 30681553 PMCID: PMC6358327 DOI: 10.1097/md.0000000000013887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Diaphragm is the main inspiratory respiratory muscle and little is known about diaphragm ultrasound in facio-scapula-humeral muscular dystrophy, a neuromuscular disease characterized by an asymmetric skeletal muscle involvement. PATIENT CONCERNS Diaphragm function evaluation DIAGNOSIS:: Diaphragm muscle weakness attested by the drop of vital capacity (VC) value from sitting position (74%) to supine position (46%). INTERVENTIONS A diaphragm ultrasound was performed in supine position, from the anterior subcostal window OUTCOMES:: We found an opposite side to side hemi diaphragm displacement, either during sniff maneuver or during deep inspiration maneuver, showing a cranial abnormal reduced motion of the right hemi diaphragm whereas the left hemi diaphragm moved caudally. LESSONS Diaphragm weakness may be present with an asymmetric pattern and an opposite motion during inspiration or sniff manoeuver in facio-scapula-humeral muscular dystrophy. A future study with a systematic evaluation of a greater number of FSHD1 patients will be necessary to characterize this population.
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Affiliation(s)
- Abdallah Fayssoil
- Myology Institute, Pitié Salpetriere Hospital, APHP, Paris
- Raymond Poincaré Hospital, APHP, Garches, France
| | | | - Adam Ogna
- Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Laforet
- Myology Institute, Pitié Salpetriere Hospital, APHP, Paris
- Raymond Poincaré Hospital, APHP, Garches, France
| | | | | | | | | | - Bruno Eymard
- Myology Institute, Pitié Salpetriere Hospital, APHP, Paris
| | - Anthony Behin
- Myology Institute, Pitié Salpetriere Hospital, APHP, Paris
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44
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Theerawit P, Eksombatchai D, Sutherasan Y, Suwatanapongched T, Kiatboonsri C, Kiatboonsri S. Diaphragmatic parameters by ultrasonography for predicting weaning outcomes. BMC Pulm Med 2018; 18:175. [PMID: 30470204 PMCID: PMC6251135 DOI: 10.1186/s12890-018-0739-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 11/12/2018] [Indexed: 01/21/2023] Open
Abstract
Background Diaphragmatic dysfunction remains the main cause of weaning difficulty or failure. Ultrasonographic measurement of diaphragmatic function can be used to predict the outcomes of weaning from mechanical ventilation. Our primary objective was to investigate the performance of various sonographic parameters of diaphragmatic function for predicting the success of weaning from mechanical ventilation. Methods We prospectively enrolled 68 adult patients requiring mechanical ventilation who were admitted to the intensive care unit from June 2013 to November 2013. The diaphragmatic inspiratory excursion, time to peak inspiratory amplitude of the diaphragm (TPIAdia), diaphragmatic thickness (DT), DT difference (DTD), and diaphragm thickening fraction (TFdi) were determined by bedside ultrasonography performed at the end of a spontaneous breathing trial. A receiver operating characteristic curve was used for analysis. Results In total, 62 patients were analyzed. The mean TPIAdia was significantly higher in the weaning success group (right, 1.27 ± 0.38 s; left, 1.14 ± 0.37 s) than in the weaning failure group (right, 0.97 ± 0.43 s; left, 0.85 ± 0.39 s) (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of a TPIAdia of > 0.8 s in predicting weaning success were 92, 46, 89, and 56%, respectively. The diaphragmatic inspiratory excursion, DTD, and TFdi were associated with reintubation within 48 h. The P values were 0.047, 0.021, and 0.028, and the areas under the receiver operating characteristic curve were 0.716, 0.805, and 0.784, respectively. Conclusion Among diaphragmatic parameters, TPIAdia exhibits good performance in predicting the success of weaning from mechanical ventilation. This study demonstrated a trend toward successful use of TPIAdia rather than diaphragmatic inspiratory excursion as a predictor of weaning from mechanical ventilation. Electronic supplementary material The online version of this article (10.1186/s12890-018-0739-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pongdhep Theerawit
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dararat Eksombatchai
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270 Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Yuda Sutherasan
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270 Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Thitiporn Suwatanapongched
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Charn Kiatboonsri
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270 Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Sumalee Kiatboonsri
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270 Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
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45
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Boussuges A, Brégeon F, Blanc P, Gil JM, Poirette L. Characteristics of the paralysed diaphragm studied by M-mode ultrasonography. Clin Physiol Funct Imaging 2018; 39:143-149. [PMID: 30325572 DOI: 10.1111/cpf.12549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/17/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND M-mode ultrasonography might be useful for detecting hemidiaphragm paralysis. The objective of the present study was to describe the motion recorded by M-mode ultrasonography of both diaphragmatic leaves in patients with a pre-established diagnosis of hemidiaphragm paralysis. METHODS A study was conducted in 26 patients (18 men, 8 women) with unilateral diaphragmatic paralysis. They were referred to two different rehabilitation centres after thoracic surgery in 23 cases and cardiac interventional procedures in three cases. The pulmonary function tests and the study of the diaphragmatic motion using M-mode ultrasonography were recorded. RESULTS The pulmonary function tests showed a restrictive pattern. The M-mode ultrasonography reported either the absence of motion or a weak paradoxical (cranial) displacement (less than 0·5 cm) of the paralysed hemidiaphragm during quiet breathing. A paradoxical motion was recorded in all patients during voluntary sniffing, reaching around -1 cm. During deep breathing, a paradoxical motion at the beginning of the inspiration was observed. Thereafter, a re-establishment of the motion in the craniocaudal direction was recorded. The excursions measured on the healthy side, during quiet breathing and voluntary sniffing, were increased in patients suffering from contralateral hemidiaphragm paralysis, when compared with 170 healthy volunteers. CONCLUSIONS To detect diaphragmatic dysfunction in patients at risk, it would be useful to study diaphragmatic motion by M-mode ultrasonography during quiet breathing, voluntary sniffing and deep breathing.
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Affiliation(s)
- Alain Boussuges
- Institut de Recherche Biomédicale des Armées (IRBA), Brétigny sur Orge, France.,Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRA, 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
| | - Philippe Blanc
- Sainte Clotilde Rehabilitation Center, Reunion Island, France
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46
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A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery. Reg Anesth Pain Med 2018; 43:590-595. [DOI: 10.1097/aap.0000000000000767] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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El-Masri N, Saj F, Wehbe T, Nasrallah G, Ejbeh S. Management of phrenic nerve palsy following cardiac surgery. J Card Surg 2018; 33:534-538. [PMID: 30014534 DOI: 10.1111/jocs.13772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Phrenic nerve palsy (PNP) is a potential complication of cardiac surgery. It may prolong ventilation and hospitalization and result in significant morbidity and mortality. The diagnosis and management of PNP following cardiac surgery is reviewed.
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Affiliation(s)
- Noura El-Masri
- The Lebanese University School of Medicine, Al-Hadath, Lebanon
| | - Fatima Saj
- The Lebanese University School of Medicine, Al-Hadath, Lebanon
| | - Tarek Wehbe
- The Lebanese Canadian and The Notre Dame University Hospitals, Department of Hematology, Jounieh, Lebanon
| | - Georges Nasrallah
- The Notre Dame University Hospital, Chief of Cardiothoracic Anesthesia, Jounieh, Lebanon
| | - Sarkis Ejbeh
- The Notre Dame University Hospital, Chief of Cardiothoracic Surgery, Jounieh, Lebanon
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48
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Oftadeh M, Jellish WS. In Reply: Diaphragmatic Dysfunction Following Cardiac Surgery: Is There a Role for Pulmonary Ultrasound? J Cardiothorac Vasc Anesth 2018; 32:e7-e8. [PMID: 29937246 DOI: 10.1053/j.jvca.2018.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Mina Oftadeh
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
| | - W Scott Jellish
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
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49
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Marty P, Ferré F, Basset B, Marquis C, Bataille B, Chaubard M, Merouani M, Rontes O, Delbos A. Diaphragmatic paralysis in obese patients in arthroscopic shoulder surgery: consequences and causes. J Anesth 2018; 32:333-340. [PMID: 29511891 DOI: 10.1007/s00540-018-2477-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/28/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Ambulatory process in arthroscopic shoulder surgery has boomed over past decades. Some anesthetic techniques such as interscalene block (ISB) and its surrogates are associated with diaphragmatic paralysis and might compromise outpatient procedure. HYPOTHESIS This study aims to assess consequences of diaphragmatic paralysis in obese patients. METHODS This prospective observational study screened patients with body mass index (BMI) ≥ 30 kg/m2 undergoing acromioplasty or supraspinatus tendon repair. Surgery was performed using brachial plexus block, and the method of brachial plexus block was left at the discretion of attending anesthesiologists. Post-operative hemidiaphragmatic paralysis was evaluated using M-mode ultrasonography and its consequences on patient ventilation were assessed: occurrence of hypoxic episode defined as oxygen saturation less than 90% (by pulse oximeter) in room air, dyspnea and failure of ambulatory procedure. Causes of diaphragmatic paralysis were also analyzed. RESULTS Ninety-one patients were screened, 82 patients were included in this study and 37 patients (45%) presented diaphragmatic paralysis. Compared to patients without diaphragmatic paralysis, diaphragmatic paralysis was associated with dyspnea [10 (27%) versus 1 (2%); p = 0.0019], occurrence of patients presenting at least one hypoxic episode [6 (16%) versus 1 (2%); p = 0.02] and failure of ambulatory process [10 (27%) versus 1 (2%); p = 0.009]. The combination of axillary and suprascapular nerve blocks, but also low volume ISB, was found to be protective against diaphragmatic paralysis when compared to high volume ISB [Odds ratios 0.0019 (0.001-0.026) and 0.0482 (0.008-0.27), respectively; p < 0.001]. CONCLUSION In patients with BMI ≥ 30 kg/m2 undergoing arthroscopic shoulder surgery, diaphragmatic paralysis is associated with dyspnea, occurrence of hypoxic episodes and failure of ambulatory procedure. High volume ISB and also, to a lesser extent, low volume ISB were found to be responsible for diaphragmatic paralysis. TRIAL REGISTRY NUMBER Registration n° 2014-202.
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Affiliation(s)
- Philippe Marty
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France.
| | - Fabrice Ferré
- Département Anesthésie-Réanimation, Hôpital Pierre-Paul Riquet, CHU Purpan, 31059, Toulouse, France
| | - Bertrand Basset
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Constance Marquis
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Benoit Bataille
- Department of Intensive Care, Centre hospitalier Hôtel-Dieu, Narbonne, France
| | - Martine Chaubard
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Mehdi Merouani
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Olivier Rontes
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Alain Delbos
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
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50
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Harlaar L, Ciet P, van der Ploeg A, Brusse E, van der Beek N, Wielopolski P, de Bruijne M, Tiddens H, van Doorn P. Imaging of respiratory muscles in neuromuscular disease: A review. Neuromuscul Disord 2018; 28:246-256. [DOI: 10.1016/j.nmd.2017.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/01/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
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