Prevalence and time-course of diaphragmatic dysfunction following lung resection: A repeated ultrasonic assessment

Daniel, Matthieu; Lang, Elodie; Huynh, Thi Mum; Martin, Julien; Brebion, Myriam; Guessous, Karim; Zlotnik, Diane; Gouzien, Laura; Chaouch, Oussama; Delval, Paul; Ferraris, Anna Maria; Pimpec‐Barthes, Françoise Le; Cholley, Bernard

doi:10.1016/j.accpm.2022.101024

Cited by 7 publications

(11 citation statements)

References 34 publications

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“…1 A more recent report demonstrated a high incidence of diaphragm dysfunction (68%) on the operated side after lung surgery, and if still present on POD 3 were associated with an increase in respiratory infections, need for ICU admission and longer hospital stay. 6 A similar result was observed in the current study.…”

Section: Discussionsupporting

confidence: 91%

“…In adults, diaphragm dysfunction is usually defined when the diaphragmatic excursion is less than 10 mm. 1,6 A previous study showed that patients with diaphragmatic dysfunction had a higher percentage of pulmonary complications (odds ratio, 5.5) after thoracoscopy or thoracotomy. 1 A more recent report demonstrated a high incidence of diaphragm dysfunction (68%) on the operated side after lung surgery, and if still present on POD 3 were associated with an increase in respiratory infections, need for ICU admission and longer hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…In adults, diaphragm dysfunction is usually defined when the diaphragmatic excursion is less than 10 mm 1,6 . A previous study showed that patients with diaphragmatic dysfunction had a higher percentage of pulmonary complications (odds ratio, 5.5) after thoracoscopy or thoracotomy 1 .…”

Section: Discussionmentioning

confidence: 99%

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Changes in diaphragmatic ultrasonography findings and their association with postoperative complications in children undergoing pulmonary resection

Lee,

Kang,

Park

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Few studies have investigated the changes in diaphragmatic function and their association with postoperative pulmonary complications (PPCs) in paediatric patients after lung resection. OBJECTIVE This study aimed to evaluate diaphragmatic function using ultrasound after lung resection and its influence on PCCs in children. DESIGN Prospective observational study. SETTING A tertiary children's hospital. PATIENTS Children aged 6 years or less who were scheduled for video-assisted thoracoscopic lung resection. INTERVENTION Ultrasonographic measurements of diaphragmatic excursion (DE) and thickening fraction (TF) were performed for three epochs: before anaesthesia induction (T0), 1 h postoperatively (T1) and 24 h postoperatively (T2). The thickening fraction is calculated from the thickness of the diaphragm at end expiration and end inspiration at each time point. DET1/DET0, DET2/DET0, TFT1/TFT0 and TFT2/TFT0 (%) were calculated. The incidence of PCCs was also determined. MAIN OUTCOME MEASURES The primary outcomes were changes in diaphragmatic excursion and thickening fraction over time, from T0 to T2. The secondary outcomes were the association between ultrasound parameters of diaphragm function and the occurrence of early PPCs within 3 days. RESULTS Data from 74 children were analysed. On the operated side, both diaphragmatic excursion and thickening fraction decreased at T1 and recovered slightly at T2, and were significantly lower than the T0 values. Children with PPCs had significantly lower DET2/DET0 and TFT2/TFT0 scores on the operated side than those without PPCs. According to the receiver operating characteristic analysis, the DET2/DET0 (< 61.1%) on the operated side was associated with PPCs with an area under the curve of 0.764. CONCLUSIONS Peri-operative diaphragmatic function assessed by ultrasonography changed after lung resection in children. The diaphragmatic excursion and thickening fraction decreased postoperatively, and a prolonged decrease in diaphragmatic excursion was associated with pulmonary complications after lung surgery in children. CLINICAL TRIAL REGISTRY ClinicalTrials.gov, NCT04400370

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Changes in diaphragmatic ultrasonography findings and their association with postoperative complications in children undergoing pulmonary resection

Lee,

Kang,

Park

et al. 2023

European Journal of Anaesthesiology

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“…Therefore, P-IMT can be used to improve diaphragm function after surgery. [33][34][35][36] More studies are needed to clarify this point as well as the ideal characteristics of the program.…”

Section: Discussionmentioning

confidence: 99%

“…However, with the same percentage of subcutaneous emphysema and air leak in both groups, P-IMT did not increase these risks, contributing to the feasibility of P-IMT in postoperative PWLC. Therefore, P-IMT can be used to improve diaphragm function after surgery 33–36. More studies are needed to clarify this point as well as the ideal characteristics of the program.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Inspiratory Muscle Training in Patients With Lung Cancer After Surgery: A Systematic Review

Nguyen,

Latiers,

Aboubakar Nana

et al. 2023

Rehabilitation Oncology

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Objective: The standard of care treatment of potentially resectable lung cancer (LC) is surgery. However, postoperative pulmonary complications (PPCs) and impairments in physical capacity are common. Recently, the effect of inspiratory muscle training (IMT) in postoperative patients with LC (PWLC) was investigated in these outcomes in different studies. The purpose of this systematic review was to synthesize the effect of postoperative IMT (P-IMT) on PPCs and physical capacity in PWLC. Database: PubMed, EMBASE, Cochrane, and CINAHL were searched. Study Selection: Randomized controlled trials, including control/sham group, IMT as the intervention group, and key measures including PPCs, 6-minute walk test (6MWT), Vo 2peak, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), quality of life (QoL), physical activity level, hospital length of stay, spirometry. Data Synthesis: The quality of the studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. The outcome findings were compared and interpreted. Results: Five studies with 249 patients were analyzed. The PEDro scores of studies ranged from 6 to 8. There is no significant difference in PPCs between the groups. The effects of P-IMT on the 6MWT, Vo 2Peak, MIP, MEP, and QoL were ambiguous. No effect of P-IMT on spirometry was reported. Conclusion: No effect of P-IMT in PPCs was reported. The effect of P-IMT on physical capacity and respiratory muscle strength was not observed. The level of the effect of P-IMT on hospital length of stay and postoperative physical activity was low. No optimal setting of P-IMT for PWLC with surgery was found. More studies are needed.

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Exploring ultrasonographic diaphragmatic function in perioperative anesthesia setting: A comprehensive narrative review

Formenti,

Ruzza,

Pederzolli Giovanazzi

et al. 2024

Journal of Clinical Anesthesia

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Prevalence and time-course of diaphragmatic dysfunction following lung resection: A repeated ultrasonic assessment

Cited by 7 publications

References 34 publications

Changes in diaphragmatic ultrasonography findings and their association with postoperative complications in children undergoing pulmonary resection

Changes in diaphragmatic ultrasonography findings and their association with postoperative complications in children undergoing pulmonary resection

The Effect of Inspiratory Muscle Training in Patients With Lung Cancer After Surgery: A Systematic Review

Exploring ultrasonographic diaphragmatic function in perioperative anesthesia setting: A comprehensive narrative review

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