Diaphragm depth in normal subjects

Shahgholi, Leili; Baria, Michael R.; Sorenson, Eric J.; Harper, Caitlin J.; Watson, James C.; Strommen, Jeffrey A.; Boon, Andrea J.

doi:10.1002/mus.23953

Cited by 12 publications

(20 citation statements)

References 6 publications

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“… 21 , 22 , 24 , 31 , 45 – 48 Here, soft tissue layers are quite superficial affording better resolution, bracket the muscle for clearer identification, and the orientation of the diaphragm muscle is approximately parallel to the site of application of the transducer, thus avoiding anisotropy. 21 , 22 , 24 , 31 , 45 – 49 Although M-mode does have the advantage of capturing multiple breaths within one image allowing for easier comparison, 33 , 47 its limitations include wider variability in measuring muscle thickness, 47 the potential to overestimate diaphragm muscle thickness, 46 and an inability to discriminate between excursion resulting from extrinsic mechanical positive pressure and intrinsic diaphragm contractility. 21 , 24 , 33 Although reportedly technically more challenging, 23 B-mode provides a more detailed visualization of the diaphragm in 2 dimensions, and morphometry overcomes the limitations of displacement ambiguities by representing only active diaphragm contraction.…”

Section: Discussionmentioning

confidence: 99%

“…The approach at the zone of apposition requires visualizing beneath subcutaneous adipose tissue; thus, there is concern with respect to feasibility of this method with patients who are obese, 23 , 49 and in terms of how to control the degree of pressure applied to the transducer against the skin. 49 Considering this technical challenge, and that BMI has previously been found to be somewhat correlated with diaphragm muscle thickness measurements, 48 , 53 participants in the obese BMI range (≥30 kg/m 2 ) were excluded. Keeping this as a criterion for exclusion from study participation certainly limits generalizability, as patients who are obese certainly will be encountered in the ICU.…”

Section: Discussionmentioning

confidence: 99%

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Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility

Brown

Tseng

Mitchell

et al. 2018

Cardiopulm Phys Ther J

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Purpose:(1) Determine whether ultrasonography can detect differences in diaphragm contractility between body positions. (2) Perform reliability analysis of diaphragm thickness measurements in each test condition.Methods:We used a repeated-measures experimental design with 45 healthy adults where 3 B-mode ultrasound images were collected at peak-inspiration and end-expiration in supine, sitting, and standing. Mean diaphragm thickening fractions were calculated for each test position. Statistical significance was tested using 1-way repeated-measures analysis of variance with planned comparisons. For reliability analysis, the intraclass correlation coefficient (3, 3) was calculated.Results:Mean diaphragm thickening fraction increased from 60.2% (95% confidence interval [CI] 53.0%, 67.9%) in supine, to 96.5% (95% CI 83.2%, 109.9%) while seated and to 173.8% (95% CI 150.5%, 197.1%) while standing. Body position was a significant factor overall (P < .001), as were comparisons between each individual position (P < .001). Intraobserver reliability was excellent (>0.93) for all body positions tested.Conclusions:Ultrasound imaging detected positional differences in diaphragm contractility. The effect of gravitational loading on diaphragm length-tension, and body position-mediated changes in intra-abdominal pressure may explain the differences found. Future research should address methodological concerns and apply this method to patients participating in early mobilization programs in the intensive care unit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility

Brown

Tseng

Mitchell

et al. 2018

Cardiopulm Phys Ther J

View full text Add to dashboard Cite

show abstract

“…The test may be used in medical, surgical or intensive care settings as listed in table 1. Usually, it is performed for diagnostic reasons, but it may also serve as a guide for technical procedures, such as electrode insertion in electromyography in order to minimize the occurrence of pneumothorax [38,39,40,41,42,43]. In clinical practice, an elevated hemidiaphragm on the chest radiograph should prompt consideration of diaphragm function testing.…”

Section: Review Findingsmentioning

confidence: 99%

A Review of the Ultrasound Assessment of Diaphragmatic Function in Clinical Practice

et al. 2016

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Ultrasonography is the only non-invasive, non-ionizing imaging technique widely available to directly assess diaphragmatic function. Two different sonographic approaches permit the assessment of muscle thickening in the zone of apposition and excursion of the dome of the diaphragm. Thanks to the new hand-held ultrasound instruments, the morphology and function of the diaphragm can be assessed in different settings, such as outpatient clinic, pulmonary function test laboratory, hospital department and intensive care unit, and under different conditions. Despite the existence of different acoustic views and several codified approaches, a comprehensive sonographic examination has never been standardized for clinical use. In this review, we summarize the clinical indications, methods and perspectives of the technique in adults.

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“…Using this modality, Shahgholi et al, demonstrated that the location of diaphragm below the surface of the skin varied between 0.78 and 4.91 cm. The authors provided reference values to allow EDX consultants to predict the depth of the diaphragm based on the patient's body mass index …”

Section: Pneumothoraxmentioning

confidence: 99%

Safety and pain in electrodiagnostic studies

London

2016

Muscle and Nerve

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Discomfort is an unavoidable part of electrodiagnostic (EDX) studies. The most readily modifiable mediator of electromyography (EMG)-associated pain is muscle selection. Interventions that may reduce pain include vapocoolant spray, ibuprofen, and techniques such as slapping or stretching the skin. Needlestick injuries to health care workers carry the risk of transmitting bloodborne illnesses, but other infectious complications of EDX studies are very rare. EMG probably contributes to asymptomatic hemorrhage in approximately 1% of patients, but clinically significant bleeding has only been reported a few times. Therapeutic anticoagulation does not significantly increase this risk. With standard procedures, there have been no reports of patients developing cardiac arrhythmia from nerve conduction studies. No special precautions are necessary in patients with implantable cardiac devices or intravenous lines. There is a small risk of pneumothorax associated with EMG of the diaphragm and chest wall muscles. Several techniques have been suggested to improve the safety of diaphragm EMG. Muscle Nerve 55: 149-159, 2017.

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Diaphragm depth in normal subjects

Abstract: Diaphragm depth from the skin can vary by more than 4 cm. When image guidance is not available to enhance accuracy and safety of diaphragm EMG, it is possible to reliably predict the depth of the diaphragm based on BMI.

Cited by 12 publications

References 6 publications

Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility

Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility

A Review of the Ultrasound Assessment of Diaphragmatic Function in Clinical Practice

Safety and pain in electrodiagnostic studies

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