Diaphragmatic Motion Studied by M-Mode Ultrasonography

Boussuges, Alain; Gole, Yoann; Blanc, Philippe

doi:10.1378/chest.08-1541

Cited by 570 publications

(583 citation statements)

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“…However, a similar agreement was found by using the transthoracic lung ultrasound to detect lung recruitment [9] and to study the diaphragmatic motion [40]. This could be due to the high variability both in the anatomic localization of lobes and bronchopulmonary segments and in the visual assessment of the amount of consolidated/collapsed lung tissue in the CT images.…”

Section: Discussionsupporting

confidence: 60%

Visual anatomical lung CT scan assessment of lung recruitability

et al. 2012

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Purpose: The computation of lung recruitability in acute respiratory distress syndrome (ARDS) is advocated to set positive end-expiratory pressure (PEEP) for preventing lung collapse. The quantitative lung CT scan, obtained by manual image processing, is the reference method but it is time consuming. The aim of this study was to evaluate the accuracy of a visual anatomical analysis compared with a quantitative lung CT scan analysis in assessing lung recruitability. Methods: Fifty sets of two complete lung CT scans of ALI/ARDS patients computing lung recruitment were analyzed. Lung recruitability computed at an airway pressure of 5 and 45 cmH 2 O was defined as the percentage decrease in the collapsed/ consolidated lung parenchyma assessed by two expert radiologists using a visual anatomical analysis and as the decrease in not aerated lung regions using a quantitative analysis computed by dedicated software.Results: Lung recruitability was 11.3 % (interquartile range 7.39-16.41) and 15.5 % (interquartile range 8.18-21.43) with the visual anatomical and quantitative analysis, respectively. In the Bland-Altman analysis, the bias and agreement bands between the visual anatomical and quantitative analysis were -2.9 % (-11.8 to ?5.9 %). The ROC curve showed that the optimal cutoff values for the visual anatomical analysis in predicting high versus low lung recruitability was 8.9 % (area under the ROC curve 0.9248, 95 % CI 0.8550-0.9946). Considering this cutoff, the sensitivity, specificity, and diagnostic accuracy were 0.96, 0.76, and 0.86, respectively. Conclusions: Visual anatomical analysis can classify patients into those with high and low lung recruitability allowing more intensivists to get access to lung recruitability assessment.

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Section: Discussionsupporting

confidence: 60%

Visual anatomical lung CT scan assessment of lung recruitability

et al. 2012

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“…In M-mode representation diaphragm appears as a thick hyperechoic line approaching to the probe in inspiration and moving away from the probe in expiration. This visualization of diaphragm, although with different approaches, has been described by some authors [12][13][14][15][16][17][18][19]. The right hemidiaphragm can be studied in most cases by this approach; meanwhile the left dome could be often masked by artifacts generated by air in bowel and stomach [12].…”

Section: Introductionmentioning

confidence: 86%

“…This visualization of diaphragm, although with different approaches, has been described by some authors [12][13][14][15][16][17][18][19]. The right hemidiaphragm can be studied in most cases by this approach; meanwhile the left dome could be often masked by artifacts generated by air in bowel and stomach [12]. These studies performed a ''static'' measure of diaphragm motion obtained with the distance between endinspiratory and end-expiratory position of diaphragm during spontaneous and forced breath and analyzed diaphragm motion in different approaches, generating some differences in mean values due to a parallax error [19].…”

Section: Introductionmentioning

confidence: 90%

Ultrasound in obstructive lung diseases: the effect of airway obstruction on diaphragm kinetics. A short pictorial essay

Zanforlin¹,

Smargiassi

Inchingolo

et al. 2014

J Ultrasound

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The ultrasound study of the chest is showing a continuous development. This technique could be helpful in managing several chest diseases, but it is limited to the acoustic windows provided by intercostal spaces and by the inability to study healthy lung parenchyma and all intraparenchymal diseases such as chronic obstructive lung disease (COPD), because the interaction between ventilated lung and ultrasound generates only artifacts. Currently, there are few applications of ultrasound that are useful in COPD, with recent studies providing some innovation potentially useful in clinical practice. The similarity of the trend between the time/volume curve of spirometry and the M-mode representation of diaphragm during forced breath allowed to identify the M-mode Index of Obstruction (MIO), an index obtained from the ratio between forced diaphragmatic excursion in the first second (FEDE1, cm) and the maximal expiratory diaphragmatic excursion (EDEMax, cm). MIO has shown a linear correlation with the ratio between forced expiratory volume in the first second (FEV1) and vital capacity (VC), used in spirometry to identify airways obstruction. The value of MIO seems to be lower in patients affected by airways obstruction as showed by a recent study. The technique is easy to learn and fast to perform and the analysis could be provided with any ultrasound machine equipped with M-mode. In conclusion, these findings, if confirmed by other studies, could suggest a new add-on screening tool for obstructive lung diseases, in particular COPD, that could be performed during a routine abdominal ultrasound exam.Keywords Ultrasound Á Diaphragm Á Chronic obstructive pulmonary disease Á Airway obstruction Riassunto Lo studio ecografico del torace sta conoscendo un crescente sviluppo. Questa tecnica può essere di aiuto nella gestione di svariate patologie del torace, ma è limitata alle finestre acustiche fornite dagli spazi intercostali e dall'incapacità di studiare il parenchima polmonare sano e tutte le patologie intraparenchimali come la Broncopneumopatia Cronica Ostruttiva (BPCO), poiché l'interazione tra il polmone ventilato e gli ultrasuoni genera solo artefatti. Attualmente, ci sono poche applicazioni dell'ecografia fruibili nella BPCO, e alcuni studi recenti forniscono degli spunti innovativi potenzialmente utili nella pratica clinica. La somiglianza dell'andamento della curva spirometrica volume/tempo e della rappresentazione ecografica in M-mode della cinetica diaframmatica durante una manovra di espiro forzato ha consentito di identificare l'Indice di ostruzione in M-mode (MIO), un indice ottenuto dal rapporto tra l'escursione diaframmatica forzata nel primo secondo (FEDE1, cm) e l'escursione diaframmatica espiratoria massimale (EDEMax, cm), mostra una correlazione con il rapporto tra il volume espiratorio forzato nel primo secondo (FEV1) e la capacità vitale (VC), utilizzato nella spirometria per identificare l'ostruzione delle vie aeree. Il valore di MIO sembra essere inferiore nei pazienti affetti da ostruzione d...

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“…Sus limitaciones residen en la variabilidad inter e intraobservador y en la posibilidad de aplicar el estudio dinámico (excursión diafragmática) solo en pacientes sin VM 67,68,69,70 . Por otra parte, son varios los estudios que han demostrado buena precisión y reproducibilidad de los ultrasonidos en la valoración de la función diafragmática, tanto en voluntarios sanos como en pacientes críticos 52,69 .…”

Section: Ultrasonografíaunclassified

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 12 Los valores normales en pacientes no ventilados sanos son diferentes para hombres y mujeres, (18±3 mm y 16±3 mm respectivamente) 69 , siendo similares a valores basales encontrados en pacientes ventilados mecánicamente 71 . Se define DD como una excursión menor de 10 mm o una excursión negativa (o movimiento paradójico).…”

Section: Ultrasonografíaunclassified

Disfunción diafragmática: una realidad en el paciente ventilado mecánicamente

Dot

Samper

Masclans

2017

Archivos de Bronconeumología

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3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 1 ResumenLa afectación muscular del paciente crítico está presente en la mayoría de pacientes que ingresan en el Servicio de Medicina Intensiva (SMI). La alteración, en particular, del músculo diafragmático, inicialmente englobada en esta categoría, se ha diferenciado en los últimos años y se ha demostrado la existencia de una disfunción muscular propia de los pacientes sometidos a ventilación mecánica. En este subgrupo de pacientes, encontramos una disfunción muscular que aparece de manera precoz después del inicio de la ventilación mecánica y que se relaciona, principalmente, con el uso de modalidades control, la presencia de sepsis y/o de fracaso multiorgánico. Aunque se desconoce la etiología concreta que desencadena el proceso, el músculo presenta procesos de estrés oxidativo y alteración mitocondrial, que provocan un desequilibrio en la síntesis proteica, con el resultado de atrofia y alteración de la contractilidad y, como consecuencia, una menor funcionalidad. No fue, de hecho, hasta 2004 cuando Vassilakopoulos et al describieron el término "Disfunción diafragmática asociada a ventilación mecánica" que junto a la lesión por sobre distensión pulmonar y por barotrauma, representan un reto en el día a día de los pacientes ventilados.La disfunción diafragmática tiene influencia en el pronóstico, retardando la extubación, aumentando la estancia hospitalaria y afectando la calidad de vida de estos pacientes en los años siguientes al alta hospitalaria. La ecografía, como técnica no invasiva y accesible en la mayoría de Unidades, podría ser de utilidad en el diagnóstico precoz para iniciar, de forma avanzada, la rehabilitación e influir positivamente en el pronóstico de estos enfermos.Palabras clave: Diafragma, disfunción diafragmática, ventilación mecánica, ecografía. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 *Manuscrito (sin información de autores) AbstractThe critical patient muscle involvement is present in most patients admitted to the intensive care unit (ICU). Specifically the diaphragmatic muscle alteration, initially considered in this category, has been differentiated in recent years, and it has been demonstrated the existence of this muscular dysfunction during mechanical ventilation. In this subgroup of patients, we found that this muscle dysfunction appears at an early stage after the start of mechanical ventilation, which is mainly related to the use of modalities control, and also in presence of sepsis and/or multi-organ failure. Although the specific etiology that triggers the processes unknown, the muscle has processes oxidative stress and mitochond...

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Diaphragmatic Motion Studied by M-Mode Ultrasonography

Cited by 570 publications

References 20 publications

Visual anatomical lung CT scan assessment of lung recruitability

Visual anatomical lung CT scan assessment of lung recruitability

Ultrasound in obstructive lung diseases: the effect of airway obstruction on diaphragm kinetics. A short pictorial essay

Disfunción diafragmática: una realidad en el paciente ventilado mecánicamente

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