Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives

Boussuges, Alain; Rives, Sarah; Finance, Julie; Brégeon, Fabienne

doi:10.12998/wjcc.v8.i12.2408

Cited by 92 publications

(126 citation statements)

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“…In patients suffering from hemidiaphragm paralysis, on the paralyzed side, the hemidiaphragm did not thicken significantly or it even became thinner [30]. A threshold of 20% is accepted by most authors for the diagnosis of hemidiaphragm paralysis [12]. In patients with hemidiaphragm excursions lower than the LLN, the control of the diaphragmatic motion in the supine position and the measurement of the inspiratory diaphragm thickening provides information in support of a diagnosis of diaphragmatic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…The normal values of diaphragmatic excursions studied by M-mode ultrasonography (US) [9][10][11] have most often been based on studies of subjects in the supine position (for a review see [12]). It has been reported that for the same volume inspired, excursions are larger in the supine position than with standing or sitting positions [13].…”

Section: Introductionmentioning

confidence: 99%

“…Two studies have used a semi-recumbent position in a small sample of healthy volunteers (64 volunteers for Cardenas et al, 40 for Testa et al) [7][8][9][10][11][12][13][14]. For a number of reasons, the populations studied did not appear to be sufficient to determine robust reference values.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Boussuges

Finance

Chaumet³

2021

ERJ Open Res

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“…9 This alludes to the fact that extubation failure is multi-factorial and can be secondary to any one or a combination of factors, such as high airway resistance, poor respiratory system compliance, respiratory muscle dysfunction, cardiac failure, excessive metabolic demands, excessive secretions, poor cough reflex or depressed conscious level. 41,50,51 Two recent studies involving ventilated adults reported that an integrated cardiac, lung, and diaphragm ultrasound accurately predicted extubation failure, with the most predictive factors being left ventricular diastolic dysfunction and loss of lung aeration. 65,66 Both studies did not assess DT or DTF, but reported that DE was poorly predictive of extubation failure.…”

Section: Future Directionsmentioning

confidence: 99%

“…In contrast to the prior study, DE was significantly associated with weaning success, with a cutoff value of >6.2 mm. In addition, there are early data proposing thresholds for DE for the identification of DD in adults, with cutoffs of 14 and 12 mm for the right and left hemidiaphragm, respectively 41,42 …”

Section: Weaning Of Mechanical Ventilationmentioning

confidence: 99%

A narrative review of diaphragmatic ultrasound in pediatric critical care

Weber

Lim

Glau

et al. 2021

Pediatric Pulmonology

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The use of point of care ultrasound (POCUS) at the bedside has increased dramatically within emergency medicine and in critical care. Applications of POCUS have spread to include diaphragmatic assessments in both adults and children. Diaphragm POCUS can be used to assess for diaphragm dysfunction (DD) and atrophy or to guide ventilator titration and weaning. Quantitative, semi-quantitative and qualitative measurements of diaphragm thickness, diaphragm excursion, and diaphragm thickening fraction provide objective data related to DD and atrophy. The potential for quick, noninvasive, and repeatable bedside diaphragm assessments has led to a growing amount of literature on diaphragm POCUS. To date, there are no reviews of the current state of diaphragm POCUS in pediatric critical care. The aims of this narrative review are to summarize the current literature regarding techniques, reference values, applications, and future innovations of diaphragm POCUS in critically ill children. A summary of current practice and future directions will be discussed.

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