Assessing Diaphragm Function in Chest Wall and Neuromuscular Diseases

Minami, Taro; Manzoor, Kamran; McCool, F. Dennis

doi:10.1016/j.ccm.2018.01.013

Cited by 16 publications

(15 citation statements)

References 47 publications

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“…The criteria for the diagnosis of diaphragmatic paralysis by M-mode ultrasonography have been reported, previously [1][2]. The study of the diaphragmatic motion has demonstrated its relevance in various conditions such as after thoracic surgery [3] and in patients suffering from neuromuscular diseases [4][5].…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

Boussuges

Finance

Chaumet³

2021

ERJ Open Res

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BackgroundChest 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.MethodsHealthy 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.ResultsThe 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 gender. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three maneuvers 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.ConclusionThe normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction.

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Section: Introductionmentioning

confidence: 99%

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

Boussuges

Finance

Chaumet³

2021

ERJ Open Res

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“…Every US and spirometric assessment will be measured in the sitting and supine positions to assess the position in uence on diaphragmatic dysfunction (10,34,49). Moreover, every participant will be his own case-control comparison by assessing both diaphragm sides, the phrenic blocked side and the contralateral side, to assess the contralateral diaphragmatic motion.…”

Section: Discussionmentioning

confidence: 99%

“…Spirometry will be evaluated by using a certi cated portable spirometer with 90% sensitivity and 97% speci city (32,33). It will be performed in the supine and sitting positions to increase the sensitivity and speci city (34). Postoperative pain will be measured and collected by using a PCA pump record.…”

Section: Data Collection and Managementmentioning

confidence: 99%

Comparison of Diaphragmatic Paralysis, Respiratory Function and Postoperative Pain After Interscalene Brachial Plexus Block With a Reduction Dose of Levobupivacaine 0.25% 10 ml Versus 20 ml Undergoing Arthroscopic Shoulder Surgery: Study Protocol for the Randomized, Controlled and Double-blinded REDOLEV Study.

Oliver-Forniés¹,

Lahuerta²,

Gomez³

et al. 2020

Preprint

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Background: Arthroscopic shoulder surgery involves dynamic and severe postoperative pain. Interscalene brachial plexus block provides adequate analgesia, but the spread of local anaesthetics administered causes a phrenic nerve block that entrains a nonnegligible incidence of hemidiaphragmatic paralysis acute.The main objective of this trial is to compare the hemidiaphragmatic paralysis after interscalene brachial plexus block in arthroscopic shoulder surgery, between a standard volume (20 ml) and a low volume (10 ml) of 0.25% levobupivacaine.Methods: This is a comparative, prospective, single-center, double-blind, two-arm randomized controlled trial. Forty-eight patients will be included. The primary end-point is to determine the hemidiaphragmatic paralysis incidence diagnosed by the diaphragmatic thickness ratio in ultrasound. The secondary endpoints are as follows: (1) hemidiaphragmatic paralysis incidence diagnosed by forced vital capacity and (2) forced expiratory volume at 1 second decrease in spirometry; (3) hemidiaphragmatic paralysis incidence diagnosed by using diaphragmatic excursion decrease in ultrasound; (4) postoperative pain regarding 24-hour morphine intravenous total consumption and (5) time to first analgesic consumption of patient-controlled analgesia pump; and (6) postoperative harm between the two trial arms.Discussion: This trial would demonstrate that low-volume interscalene brachial plexus block decreases hemidiaphragmatic paralysis in arthroscopic shoulder surgery by using spirometry and ultrasound and would not provide inferior postoperative analgesia according to opioid requirements of postoperative patient-controlled analgesia in comparison to the standard volume used in current practice.Trial registration: EudraCT and Spanish Trial Register (REec) registration number: 2019-003855-12 (Registered on 07 January 2020). ClinicalTrials.gov identification number: NCT04385966 (Retrospectively registered on 08 May 2020). Ethics Committee approval: EC19/093 (18 Dic 2019).

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“…Diaphragm ultrasound is a new modality, which is non-invasive and gives the clinician the chance of direct examination of the diaphragm. 10 M-mode imaging was the most frequently used technique in diaphragmatic studies, but unfortunately this mode does not give specific anatomic information about the muscle itself, which needs B-mode imaging. 11,12 Previous studies have suggested a relationship between diaphragmatic thickness and function measured via pulmonary function tests, with excellent intra- and inter-variability results.…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic muscle thickness and diaphragmatic function are reduced in patients with systemic lupus erythematosus compared to those with primary Sjögren’s syndrome

Satış

Cındıl

Salman

et al. 2020

Lupus

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Introduction Systemic lupus erythematosus (SLE) is associated with an increased risk of pulmonary infections, as well as a rare condition known as shrinking lung syndrome (SLS). The diaphragm has an important role to play in lung physiology and might also play a role in these adverse events. Here, we aimed to investigate whether SLE patients have impairment in their diaphragmatic muscle thickness and function with respect to another connective-tissue disease: primary Sjögren’s syndrome (pSS). Method Patients diagnosed with SLE who were in remission or who had minimal disease activity and had at least one year of follow-up were included in this study. Patients with known lung pathology and smokers were excluded. Patients with pSS constituted the second experimental group. Ultrasonographic evaluation of the diaphragmatic muscle was conducted by an experienced independent sonographer at three time points, diaphragmatic thickness during deep and quiet inspiration and maximum expiration being measured. Diaphragmatic muscle function was evaluated with maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP). Results A total of 115 patients were studied ( n = 39 SLE; n = 76 pSS). The mean ± standard deviation ( SD) thickness of the diaphragmatic muscles during quiet inspiration was significantly reduced in patients with SLE compared to patients with pSS (2.32 mm vs. 2.81 mm; p < 0.05). Similarly, the thickness during deep inspiration and at maximum deep expiration were significantly lower in SLE patients (2.88 mm vs. 3.29 mm and 1.92 mm vs. 2.33 mm, respectively; p < 0.01). MIPs and MEPs, defined as the percentages of expected values, were significantly lower in patients with SLE compared to those with pSS (80% vs. 92% and 76% vs. 120%, respectively; p < 0.05). Diaphragmatic muscle thickness during deep inspiration demonstrated a moderate correlation with MIP ( r = 0.434; p = 0.001). Conclusion SLE patients had reduced diaphragmatic muscle thickness compared to those with pSS, which was associated with impaired functional tests. Further prospective studies are needed to investigate whether structural and functional impairments in diaphragmatic muscle play a role in an increased risk of pulmonary infections and SLS in patients with SLE.

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Assessing Diaphragm Function in Chest Wall and Neuromuscular Diseases

Cited by 16 publications

References 47 publications

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

Diaphragmatic muscle thickness and diaphragmatic function are reduced in patients with systemic lupus erythematosus compared to those with primary Sjögren’s syndrome

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