Technical report: Quantitative assessment of diaphragmatic movement — A reproducible method using ultrasound

Houston, J. Graeme; Morris, Andrew D.; Howie, Catherine A.; Reid, JL; McMillan, N.

doi:10.1016/s0009-9260(05)80688-9

Cited by 120 publications

(116 citation statements)

References 7 publications

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“…Our results concerning the amplitude of diaphragm movement (1.34 cm mean DIA before spirometry) are in agreement with those found by Whitelaw 16 (1.5 cm) using CT-scanning. Houston et al 17 studied diaphragmatic excursions by ultrasound. They demonstrated the reproducibility of this technique Before spirometry, we observed three successive phases of diaphragm displacement: diaphragm descent during inspiration (T t diaph, mean duration 1.27 sec), raising (T E diaph, mean duration 2.06 sec), and resting time (DRT, mean duration 0.47 sec).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1997

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Measurement TechniquesNon-invasive quantification of diaphragm kinetics using m-mode sonography Purpose: The standard conditions of spirometry (i.e., wearing a noseclip and breathing through a mouthpiece and a pneumotachograph) are likely to alter the ventilatory pattern. We used "time-motion" mode (M-mode) sonography to assess the changes in diaphragm kinetics induced by spirometry during quiet breathing.Methods: An M-mode sonographic study of the right diaphragm was performed before and during standard spirometry in eight pa~ents without respiratory disease (age 34 to 68 yr).Results: During spirometry, the diaphragm inspiratory amplitude (DIA) increased from 1.34 + 0.18 cm to 1.80 + 0, 18 cm (P = 0,007), whereas the diaphragmatic inspiratory time (T, diaph) increased from 1.27 -+_ 0.15 to 1.53 + 0.23 sec, (P = 0.015), without change in diaphragmatic total time interval (-I-tot diaph). Therefore, the diaphragm duty cycle (T, diaph /Ttot diaph) increased from 38% +--I% to 44% _ 496 (P = 0.023). The diaphragm inspiratory (DIV) and expiratory (DEV) motion velocity increased (P = 0.007).Conclusion: M-mode sonography enabled us to demonstrate that the wearing of a nose clip and breathing through a mouthpiece and a pneumotachograph induce measurable changes in diaphragm kinetics.Object-if : Les conditions de la spirom&ne standard (c.-,~-d. le port du pince-nez et la respiration ~ travers un embout buccal et un pneumotacographe) sont susceptibles d'altErer la morphologie de la ventilation. Nous avons utilisE le mode ~temps-amplitude,, (mode M) de la sonographie pour 6valuer les changements de la cinEtique diaphragmatique provoquEs par la spiromEtne pendant la respiration de repos.R~sultats : Pendant la spiromEtrie, I'amplitude inspiratoire diaphragmataque augmentait de 1,34 + 0, 18 ~ 1,80 +-0, 18 cm (P = 0,007), alors que le temps diaphragmatique inspiratoire (T, diaph) augmentmt de 1,27 _+ 0, I 5 ,~ 1,53 z 0,23 sec (P = 0,015), sans changement du temps diaphragmatique total (Trot diaph). Par consequent, le temps de I'activitE diaphragmatique (T, diaph/Ttot diaph) augmentait de 38 +_ I 96 ,~ 44 + 496 (P=0,023). La v41ocit4 de I'amplitude inspiratolre et expiratoire augmentait (P = 0,007).Conclusion : La sonographie en mode M nous a permis de dEmontrer que le port du pince-nez et la respiration h travers un embout buccal et un pneumotacographe provoquent des changements tangibles de la cin4tique diaphragmatique.From the

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Section: Discussionmentioning

confidence: 99%

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

et al. 1997

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“…[10][11][12][13] The Haldane effect refers to decreased carriage of CO 2 by oxyhemoglobin, and to increased CO 2 release in the presence of oxygen. 11 Hypoxic pulmonary vasoconstriction optimizes the distribution of ventilation/perfusion ratios, and minimizes the physiologic deadspace, improving the efficiency of CO 2 exchange at low FIO 2 . 10 When FIO 2 increases, on the other hand, hypoxic pulmonary vasoconstriction is less effective and the pulmonary vascular resistance decreases.…”

Section: A B Cmentioning

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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“…We now use it routinely in our EMG laboratory in the workup of patients with shortness of breath, not only to enhance the safety and accuracy of needle EMG of the diaphragm, 4 but also to evaluate for atrophy and lack of motion of the muscle, which are readily apparent on ultrasound in patients with phrenic neuropathy. [5][6][7][8] Sonographic assessment of diaphragm structure and function would be a useful clinical tool in patients with COPD presenting for evaluation of possible coexisting neuromuscular respiratory weakness, particularly because needle EMG is relatively contraindicated in this patient population due to the potential for lung hyperinfl ation and associated diffi culty involved in accurately localizing the muscle. However, to use ultrasound in this way, there is a need for normal values for diaphragm thickness and contraction in patients with COPD.…”

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confidence: 99%