Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses

Cardenas, Letícia Zumpano; Albuquerque, André Luís Pereira de; Carvalho, Carlos Roberto Ribeiro; Caruso, Pedro

doi:10.36416/1806-3756/e20200064

Cited by 46 publications

(33 citation statements)

References 94 publications

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“…Our sample size was only 100 patients, but this is higher than most of the studies already published on DUS [20]. This limited the power to assess the prognostic value of DUS in respiratory diseases.…”

Section: Limitationsmentioning

confidence: 95%

“…Due to the study outcome and the setting, we chose two easy-to-collect measurements. In particular, we did not evaluate the thickening fraction [20]. This has been described in ICU studies as an informative diaphragm assessment, defined as the ratio between diaphragm the thickness measured at the end-inspiration minus the thickness at endexpiration, and the thickness at end-expiration [21].…”

Section: Limitationsmentioning

confidence: 99%

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Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Pivetta

Cara

Paglietta

et al. 2021

JCM

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Background: Lung Ultrasound Evaluation (LUS) is usefully applied in the Emergency Department (ED) to patients with suspected or confirmed COVID-19. Diaphragmatic Ultrasound (DUS) may provide additional insight into ventilatory function. This proof-of-concept study aimed to evaluate the feasibility of LUS and DUS in a third level ED during the COVID-19 pandemic. Methods: Adult patients presenting with COVID-19 symptoms were eligible. After the physical examination, both LUS and DUS (i.e., diaphragmatic motion and thickness) were performed. All patients were followed after 30 days to determine their need for ventilation, admission, and/or a new ED evaluation after discharge. The diagnostic accuracies of diaphragm measurements in assessing the risk of the 30-day outcome were calculated as well as the measurements’ usefulness. Bland–Altman plots were used for comparing bedside and off-line diaphragm measurements. Results: 118 patients were enrolled. Median thickness and motion were 1.7 mm (iqr 0.4) and 1.8 cm (iqr 0.7), respectively, with a mean difference of 0.009 mm (95% CI −0.037–0.056 mm) and −0.051 cm (95% CI −0.108–0.006 cm), respectively. The 30-day outcome was associated with an increase in thickness (OR 5.84, 95% CI 0.96–35.4), and a lower motion (OR 0.49, 95% CI 0.2–1.21). Conclusion: DUS seemed to be feasible and reliable in the ED in a population of patients presenting with symptoms related to COVID-19 infection.

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Section: Limitationsmentioning

confidence: 95%

Section: Limitationsmentioning

confidence: 99%

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Pivetta

Cara

Paglietta

et al. 2021

JCM

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“…Percentage of type-I [slow-twitch fibers] in the adult human diaphragm is approximately 55%; while percentages of type-IIa and type-IIb [fast-twitch fibers] are 21% and 24% respectively. In general, fast-twitch muscle fibers are less resistant to fatigue than slow-twitch fibers [4,5] .…”

Section: Introductionmentioning

confidence: 99%

“…From a functional perspective, the diaphragm is responsible for maintaining continuous, rhythmic and interrupted breathing. This is why the majority of its fibers are type I, slow-twitch fibers that are highly fatigue resistant [5] .…”

Section: Introductionmentioning

confidence: 99%

Inspiratory Muscle Training Prevents Diaphragmatic Atrophy in Mechanically Ventilated COVID-19 Patients

Naggar

Obaya

Ismail

et al. 2021

International Journal of Medical Arts

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Background: Unloading the diaphragm by mechanical ventilation results in diaphragmatic dysfunction and atrophy, a condition recognized in critical care settings as ventilator-induced diaphragmatic dysfunction (VIDD). This condition contributes to prolonged mechanical ventilation, extubation failure and higher risk of mortality. The aim of The Study:The current study aimed to investigate the effectiveness of inspiratory muscle training in preventing or reversing diaphragmatic atrophy in mechanically ventilated COVID-19 patients.Materials and Methods: 55 intubated, mechanically ventilated patients with hypoxic respiratory failure due to COVID-19 were randomly assigned into study (n = 32) and control (n = 23) groups. The former received inspiratory muscle training with the routine physiotherapy programme and the latter received routine physiotherapy only. Diaphragmatic thickness was measured and compared in both groups using ultrasonography.Results: In the study group, diaphragmatic thickness at end of inspiration and expiration significantly increased by 14% and 8% respectively (p < 0.001). The increase in thickness fraction for this group (7.5%) was statistically insignificant (p > 0.05). In the control group, there was a significant decrease in all three parameters (p < 0.001). Conclusion:Inspiratory muscle training by adjusting the ventilator's trigger sensitivity is a safe, effective and feasible method that can successfully prevent diaphragmatic atrophy in mechanically ventilated, COVID-19 patients.

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“…In DE evaluation, there are several factors that need to be considered. In humans, US techniques including diaphragmatic location and the angle of the US beam have been reported to influence DE ( 19 , 33 , 35 , 36 ). Moreover, DE differs between diaphragmatic sides, and varies according to the patient's sex, age, and body weight (BW) ( 37 – 39 ).…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of Ultrasonographic Diaphragmatic Excursion in Healthy Dogs: Effect of Positioning, Diaphragmatic Location, and Body Weight of Dogs

et al. 2021

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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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Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses

Cited by 46 publications

References 94 publications

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Inspiratory Muscle Training Prevents Diaphragmatic Atrophy in Mechanically Ventilated COVID-19 Patients

The Feasibility of Ultrasonographic Diaphragmatic Excursion in Healthy Dogs: Effect of Positioning, Diaphragmatic Location, and Body Weight of Dogs

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