Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé, Bruno-Pierre; Dres, Martin

doi:10.3390/jcm5120113

Cited by 144 publications

(141 citation statements)

References 183 publications

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“…Assessing its mobility is important to detect malfunctions or impending exhaustion and to evaluate the effects of many chest and abdominal conditions on respiratory mechanics [1]. Diaphragm dysfunction is associated with respiratory insufficiency and poorer outcomes [2].…”

Section: Introductionmentioning

confidence: 99%

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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Background: Assessing diaphragm mobility is important to detect malfunctions or impending exhaustion and to evaluate the effects of many chest and abdominal conditions on respiratory mechanics. Amongst several imaging methods, ultrasonography represents the only noninvasive, nonionizing imaging technique widely available for the direct assessment of diaphragm excursion. Objectives: the aim of this study is to prospectively assess the supine diaphragmatic motion amplitude, intra- and inter-observer agreement, and anthropometric correlates of diaphragm motion variability, measured through M-mode ultrasonography, in a sample of healthy volunteers. Methods: One-hundred healthy volunteers were considered eligible for the study. Instead of B-mode imaging, the M-mode technique was used to achieve a more accurate measurement of diaphragm motion. To assess intra-observer variability, 3 consecutive measurements (M-mode and B-mode) of the right dome motion were obtained at every session. To test for inter-rater reliability, the subjects were asked to provide 2 more diaphragm motion measurements every week, each performed by 2 experienced operators, and 42 subjects accepted. Results: Diaphragmatic motion was positively correlated with height and weight both at quiet (Spearman’s coefficient = 0.514, p < 0.001 and 0.314, p = 0.038) and deep breathing (Spearman’s coefficient = 0.342, p = 0.001 and 0.225, p = 0.024, respectively) and negatively correlated with age, but only during deep breathing (Spearman’s coefficient = –0.272, p = 0.006). Intra-observer agreement degree on all 3 measurements was excellent during both quiet and deep breathing, with a Cronbach’s alpha of 0.793 and 0.901, respectively, and an intra-class coefficient of 0.797 and 0.900, respectively. Similarly, the degree of inter-observer agreement achieved a Cronbach’s alpha of 0.638 and 0.776, and an inter-class coefficient of 0.632 and 0.778, respectively. Deep breathing was associated with sex only in linear multivariable models (B = –10.14; 95% confidence interval [CI] –17.86, –2.41; p = 0.011), while quiet breathing resulted to be affected by height only (B = 30.05; 95% CI 0.79–59.31; p = 0.044). Conclusions: Diaphragm excursion measurements using the M-mode technique were accurate and could be reproduced also when obtained in recumbent patients. After adjustments, the main predictors of diaphragmatic motion were sex and height, which should be considered to design a specifically tailored study and to develop normality reference equations.

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Section: Introductionmentioning

confidence: 99%

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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“…Patients who do not recover quickly using simple measures like BiPAP are at risk for prolonged hospital stay, long periods of mechanical ventilation, pulmonary infections, and increased mortality . van Onna et al reported that three out of 60 patients with PNP developed infections, bronchospasm, and neurologic complications.…”

Section: Discussionmentioning

confidence: 99%

“…4,55 Patients who do not recover quickly using simple measures like BiPAP are at risk for prolonged hospital stay, long periods of mechanical ventilation, pulmonary infections, and increased mortality. 31,32 van Onna et al 13 reported that three out of 60 patients with PNP developed infections, bronchospasm, and neurologic complications. Another study found no significant differences between patients who had PNP and matched controls in terms of postoperative arrhythmias, myocardial infarction, or mortality.…”

Section: Discussionmentioning

confidence: 99%

Management of phrenic nerve palsy following cardiac surgery

El-Masri

Saj

Wehbe³

et al. 2018

J Card Surg

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“…Bedside ultrasound assessment of the diaphragm in critically ill patients can also be used to detect diaphragm dysfunction (diaphragm activity is classified as: usual, reduced, or loss of function) [49]. Although it may help the clinician make therapeutic decisions, a possible role in ventilation and weaning from mechanical ventilation has yet to be fully determined [49][50][51][52].…”

Section: Diaphragm Ultrasound (Dus)mentioning

confidence: 99%

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

et al. 2020

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Although mechanical ventilation may be a patient's vital ally during acute illness, it can quickly transform into an enemy during chronic conditions. The weaning process is the fundamental phase that enables the resumption of physiological respiratory function; however, it is also associated with a number of life-threatening complications, and a large percentage of critically ill patients never achieve airway device removal or require the resumption of mechanical ventilation just a few days post-weaning. Indeed, the weaning process is, at present, more of an art than a science. As such, there is urgent need for novel contributions from the scientific literature to abate the growing rates of morbidity and mortality associated with weaning failure. The physician attempting to wean a patient must integrate clinical parameters and common-sense criteria. Numerous studies have striven to identify single predictive factors of weaning failure and sought to standardize the weaning process, but the results are characterized by remarkable heterogeneity. Despite the lack of benchmarks, it is clear that the analysis of respiratory function must include a detailed overview of the five situations described below rather than a single aspect. The purpose of this two-part review is to provide a comprehensive description of these situations to clarify the "arena" physicians are entering when weaning critically ill patients from mechanical ventilation. Publisher's NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Cited by 144 publications

References 183 publications

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Management of phrenic nerve palsy following cardiac surgery

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

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