Non-invasive quantification of diaphragm kinetics using m-mode sonography

Ayoub, Jean; Cohendy, R.; Dauzat, M.; Targhetta, R; Coussaye, Jean-Eminanuel De La; Bourgeois, Jean‐Marie; Ramonatxo, M; Préfaut, Christian; Pourcelot, L.

doi:10.1007/bf03013389

Cited by 94 publications

(65 citation statements)

References 20 publications

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“…[8][9][10][11] The first ultrasonographic study that we could find on diaphragmatic motion was published in 1975. 12 Of interest in that early study is that a posterior subcostal scan in the prone position was proposed as an alternative to the anterior approach.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic evaluation of diaphragmatic motion.

Gerscovich

Cronan

McGahan

et al. 2001

J of Ultrasound Medicine

277

207

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Objective. To evaluate the technical feasibility and utility of ultrasonography in the study of diaphragmatic motion at our institution. Methods. The study consisted of 2 parts. For part I, in 23 volunteers we performed 23 studies on 46 hemidiaphragms with excursions documented on M-mode ultrasonography. For part II, in 22 patients we performed 52 studies in 102 hemidiaphragms. In 50 studies both hemidiaphragms were studied, and in another 2 studies only 1 hemidiaphragm was studied. Patients' ages ranged from birth to 66 years (mean, 23 years). There were 16 male and 6 female patients. Indications for the study were (1) suggestion of paralysis of the diaphragm (n = 22); (2) if the diaphragm was already known to be paralyzed, for evaluation of response to phrenic nerve or pacer stimulation (n = 9); and (3) follow-up of previous findings (n = 21). Patients were examined in the supine position in the longitudinal semicoronal plane from a subcostal or low intercostal approach. Motion was documented with real-time ultrasonography and measured with M-mode ultrasonography. Results. Of the 102 clinical hemidiaphragms studied, findings included normal motion (n = 42), decreased motion (n = 22), no motion (n = 6), paradoxical motion (n = 10), positive pacer response (n = 13), negative pacer response (n = 2), positive phrenic stimulation (n = 6), and negative phrenic stimulation (n = 1). There were no failures of visualization. Conclusions. Ultrasonography proved feasible and useful in evaluating diaphragmatic motion. In our practice it has replaced fluoroscopy. Ultrasonography has advantages over traditional fluoroscopy, including portability, lack of ionizing radiation, visualization of structures of the thoracic bases and upper abdomen, and the ability to quantify diaphragmatic motion.

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Section: Discussionmentioning

confidence: 99%

Ultrasonographic evaluation of diaphragmatic motion.

Gerscovich

Cronan

McGahan

et al. 2001

J of Ultrasound Medicine

277

207

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“…Measurement protocols were those previously described by Ayoub et al 1 Ten cycles of quiet ventilation and three inspiratory capacities were recorded during pulmonary function test measurements. The Figure illustrates the diaphragmatic inspiratory slope at baseline (Figure, panel A), after SA and LP (Figure, panel B), and during NiPPV (Figure, panel C).…”

Section: Case Reportmentioning

confidence: 99%

Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia

Ferrandière¹,

Hazouard²,

Ayoub³

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: To document and explain the beneficial effects of non-invasive ventilation in correcting hypoxemia and hypoventilation in severe chronic obstructive pulmonary disease, during spinal anesthesia in the lithotomy position. Clinical features:A morbidly obese patient with severe chronic obstructive pulmonary disease underwent prostate surgery in the lithotomy position under spinal anesthesia. Hypoxemia was encountered during surgery, and a profound decrease of forced vital capacity associated with alveolar hypoventilation and ventilation/perfusion mismatching were observed. In the operating room, an M-mode sonographic study of the right diaphragm was performed, which confirmed that after spinal anesthesia and assuming the lithotomy position, there was a large decrease (-30%) in diaphragmatic excursion. Hypoxemia and alveolar hypoventilation were successfully treated with non-invasive positive pressure ventilation. Conclusions:Intraoperative application of non-invasive positive pressure ventilation improved diaphragmatic excursion and overall respiratory function, and reduced clinical discomfort in this patient. A N obese patient suffering from severe chronic obstructive pulmonary disease (COPD) utilizing his "hypoxic drive", underwent surgery in the lithotomy position (LP) under spinal anesthesia (SA). The respiratory consequences of both the anesthetic technique and patient positioning were studied. Impending hypoxemic respiratory failure, potentially requiring endotracheal intubation and controlled ventilation, was successfully treated with non-invasive positive-pressure ventilation (NiPPV). In accordance with the Institutional Review Board, all details of this procedure were discussed with the patient, and his written informed consent was obtained for the procedure and the publication of his personal health information. Objectif Case reportA 58-yr-old obese man (105 kg, body mass index 34 kg·m -2 ) with severe COPD was scheduled for transurethral resection of the prostate under SA. He was a heavy smoker with a 40-pack-yr history of cigarette usage and consequent severe respiratory disability. During four previous surgeries, supplemental oxygen administration had produced a hypoventilatory

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“…22,[27][28][29] Therefore, the measurement corresponds to the anteroposterior movement of the muscle. 24,25,28 The correlation between this measurement and the craniocaudal mobility changes as a function of the angle formed by the ultrasound beam obtained by the operator and the movement direction. 10,27 In the B-mode, the craniocaudal movement is observed on longitudinal sections, and, ideally, the transducer should be positioned at an angle of incidence perpendicular to the direction of movement.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29] To overcome these limitations, the transducer can be placed in the subcostal position and aimed in a cephalic direction underneath the inferior costal margin. 24,25 However, the craniocaudal excursion of the muscle is taken in a direction oblique to the angle of incidence of the ultrasound beam, and this impairs the precision of the mobility measurement. Moreover, the left hemidiaphragm often cannot be shown because of gas in the intervening stomach or bowel.…”

Section: Discussionmentioning

confidence: 99%

“…7,10,[21][22][23][24][25][26] Ultrasonography has several advantages over fluoroscopy in the evaluation of diaphragmatic kinetics, including lack of ionizing radiation, equipment portability, and direct quantitative evaluation. 9,21,[27][28][29][30] Nevertheless, the accuracy of ultrasonography in the evaluation of diaphragmatic displacement may be limited, partially because of difficulties in obtaining an adequate angle of visualization of the diaphragmatic dome.…”

mentioning

confidence: 99%

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Left Hemidiaphragmatic Mobility

Toledo

Kodaira

Massarollo

et al. 2006

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the correlation between the radiographic and ultrasonographic measurements of craniocaudal displacement of the left hemidiaphragm. Methods. Forty-nine patients with clinical indications for interventional procedures prospectively underwent radiographic evaluation of left hemidiaphragmatic mobility and B-mode ultrasonographic measurement of craniocaudal displacement of the hilum and the inferior pole of the spleen. Ultrasonography was performed with a 3.5-MHz convex transducer in a left intercostal position under a longitudinal orientation. Statistical analyses were performed with linear regression, a paired Student t test, and Bland-Altman analyses. Results. The correlation between the craniocaudal splenic hilum displacement and radiographic measurements was found to be linear: hemidiaphragmatic mobility = 17.795 + 0.429 × splenic hilum displacement (SE for the regression coefficient = 0 .12; P = .0012), although the values obtained with both methods were statistically different (P < .05). The same results could be observed with the use of the inferior pole of the spleen: hemidiaphragmatic mobility = 9.5596 + 0.5455 × inferior polo displacement (SE for the regression coefficient = 0 .11; P < .0001). The mean difference between the values obtained by ultrasonography and by radiography was statistically significant (16.7 ± 16.1 mm; P < .05 [hilum]; 18.9 ± 14.2 mm; P < .05 [inferior pole]). Conclusions. These results allow us to conclude that ultrasonography can be used as an alternative method for left hemidiaphragm mobility evaluation compared with radiography.

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Non-invasive quantification of diaphragm kinetics using m-mode sonography

Cited by 94 publications

References 20 publications

Ultrasonographic evaluation of diaphragmatic motion.

Ultrasonographic evaluation of diaphragmatic motion.

Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia

Left Hemidiaphragmatic Mobility

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