Reduced Diaphragm Excursion During Reflexive Citric Acid Cough Test in Subjects With Subacute Stroke

Choi, Yong Chan; Park, Geun-Young; Yoo, Yeun Jie; Sohn, Donggyun; Jang, Yong Suk; Im, Sun

doi:10.4187/respcare.05488

Cited by 13 publications

(15 citation statements)

References 32 publications

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“…The diaphragmatic paralysis and elevated right hemidiaphragm also contributed to the development of right basal pneumonia by causing persistent atelectasis of the right lung base. The decreased ability to cough and decreased mucociliary transport secondary to the impairment of contraction of the right hemidiaphragm led to the accumulation of mucus in the right lung base, which served as a nidus leading to the subsequent development of right basal pneumonia [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Hemidiaphragmatic Paralysis Post Stroke Leading to Hypercapneic Respiratory Failure

Arumairaj¹,

Agarwal²,

Borkar³

et al. 2021

Cureus

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Unilateral diaphragmatic paralysis is a rare complication after stroke. We report a case of right-sided hemidiaphragmatic paralysis after stroke in a 51-year-old man who presented with shortness of breath and orthopnea. Chest X-ray (CXR) revealed an elevated right-sided hemidiaphragm. The weakened diaphragmatic contraction from paralyzed right hemidiaphragm resulted in persistent atelectasis of the right lung base and inadequate alveolar ventilation leading to the development of right basal pneumonia with hypercapneic respiratory failure. However, the patient had a remarkable improvement with the appropriate institution of non-invasive ventilation and medical management with intravenous antibiotics.

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Section: Discussionmentioning

confidence: 99%

Hemidiaphragmatic Paralysis Post Stroke Leading to Hypercapneic Respiratory Failure

Arumairaj¹,

Agarwal²,

Borkar³

et al. 2021

Cureus

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“…The evaluation of the diaphragmatic function after an ischaemic stroke could have potential clinical consequences. Development of respiratory failure, atelectasis and respiratory infections has been described, as well as a reduction in the cough reflex in these patients 39 . In addition, the early diagnosis of this dysfunction could reinforce rehabilitation treatment for the purpose of improving recovery of respiratory function in these patients.…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke.

Catalá-Ripoll

Monsalve-Naharro

Hernández-Fernández

2019

Preprint

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Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one hemibody. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods : Patients with supratentorial ischaemic stroke were selected in the first 48 hours of admission for 6 months. Ultrasonography of the diaphragm was performed on each hemithorax to obtain the thickening fraction applying the formula [(inspiratory thickness - expiratory thickness)/expiratory thickness]. Forced breathing was then requested to them and the examination was performed again. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The statistical relationship with the vascular territory involved, the NIHSS scale, the hemiparesis degree and the success of reperfusion techniques were examined. Results : An incidence of diaphragmatic dysfunction of 51.7% was observed on the contralateral side and of 1.7% on the ipsilateral side. A reduction of up to 11.7% was seen in the incidence of dysfunction on the contralateral side upon breathing forcedly. All patients with NIHSS above 6 had diaphragmatic dysfunction on the contralateral side (p < 0.001). They also had lower degrees of muscle strength (p < 0.001). Conclusions : There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke. An estimation of the diaphragmatic function can be obtained using the thickening fraction.

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“…The clinical impact of diaphragmatic dysfunction in stroke is still to be elucidated. However, the appearance of respiratory symptoms has been described as a form of presentation of diaphragmatic dysfunction [37]. The TF reduction can be related to a reduction in pulmonary volumes that predispose to respiratory infection [38], as well as a reduction in the inspiratory flow during coughing that limits effective cough [39].…”

Section: Ultrasonography Is a Technique With Advantages Derivedmentioning

confidence: 99%

“…The evaluation of the diaphragmatic function after an ischaemic stroke could have potential clinical consequences. Development of respiratory failure, atelectasis and respiratory infections has been described, as well as a reduction in the cough reflex in these patients [37]. In addition, the early diagnosis of this dysfunction could reinforce rehabilitation treatment for the purpose of improving recovery of respiratory function in these patients.…”

Section: Ultrasonography Is a Technique With Advantages Derivedmentioning

confidence: 99%

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

2020

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Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods: A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. Results: An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cutoff point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). Conclusions: There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.

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Reduced Diaphragm Excursion During Reflexive Citric Acid Cough Test in Subjects With Subacute Stroke

Abstract: Stroke subjects at risk of silent aspiration showed reduced CPF and more limited diaphragm excursion during the citric acid-induced reflexive cough test. (ClinicalTrials.gov registration NCT02080988.).

Cited by 13 publications

References 32 publications

Hemidiaphragmatic Paralysis Post Stroke Leading to Hypercapneic Respiratory Failure

Hemidiaphragmatic Paralysis Post Stroke Leading to Hypercapneic Respiratory Failure

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke.

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

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