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

Zanforlin, Alessandro; Smargiassi, Andrea; Inchingolo, Riccardo; Valente, Salvatore; Ramazzina, Emilio

doi:10.1007/s40477-014-0122-5

Cited by 15 publications

(14 citation statements)

References 22 publications

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“…Indeed, a linear correlation between lung volumes and amplitude of diaphragm motion has already been proved [9]; furthermore, Zanforlin et al [22] have recently shown that the M-mode ultrasound forced expiratory profile presents similarities with the spirometric flow-volume curve. Consequently, ultrasound-derived indexes (i.e., forced diaphragmatic excursion in the first second or maximal expiratory diaphragm excursion, and the ratio of the 2) have a linear correlation with FEV1, FVC, and the FEV1/FVC ratio, both in healthy and obstructed subjects [23]. In addition, we were not able to test many variables potentially affecting the predictivity of diaphragm motion models.…”

Section: Discussionmentioning

confidence: 86%

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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Background: Assessing diaphragm mobility is important to detect malfunctions or impending exhaustion and to evaluate the effects of many chest and abdominal conditions on respiratory mechanics. Amongst several imaging methods, ultrasonography represents the only noninvasive, nonionizing imaging technique widely available for the direct assessment of diaphragm excursion. Objectives: the aim of this study is to prospectively assess the supine diaphragmatic motion amplitude, intra- and inter-observer agreement, and anthropometric correlates of diaphragm motion variability, measured through M-mode ultrasonography, in a sample of healthy volunteers. Methods: One-hundred healthy volunteers were considered eligible for the study. Instead of B-mode imaging, the M-mode technique was used to achieve a more accurate measurement of diaphragm motion. To assess intra-observer variability, 3 consecutive measurements (M-mode and B-mode) of the right dome motion were obtained at every session. To test for inter-rater reliability, the subjects were asked to provide 2 more diaphragm motion measurements every week, each performed by 2 experienced operators, and 42 subjects accepted. Results: Diaphragmatic motion was positively correlated with height and weight both at quiet (Spearman’s coefficient = 0.514, p < 0.001 and 0.314, p = 0.038) and deep breathing (Spearman’s coefficient = 0.342, p = 0.001 and 0.225, p = 0.024, respectively) and negatively correlated with age, but only during deep breathing (Spearman’s coefficient = –0.272, p = 0.006). Intra-observer agreement degree on all 3 measurements was excellent during both quiet and deep breathing, with a Cronbach’s alpha of 0.793 and 0.901, respectively, and an intra-class coefficient of 0.797 and 0.900, respectively. Similarly, the degree of inter-observer agreement achieved a Cronbach’s alpha of 0.638 and 0.776, and an inter-class coefficient of 0.632 and 0.778, respectively. Deep breathing was associated with sex only in linear multivariable models (B = –10.14; 95% confidence interval [CI] –17.86, –2.41; p = 0.011), while quiet breathing resulted to be affected by height only (B = 30.05; 95% CI 0.79–59.31; p = 0.044). Conclusions: Diaphragm excursion measurements using the M-mode technique were accurate and could be reproduced also when obtained in recumbent patients. After adjustments, the main predictors of diaphragmatic motion were sex and height, which should be considered to design a specifically tailored study and to develop normality reference equations.

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Section: Discussionmentioning

confidence: 86%

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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“…This will also represent the ideal opportunity to explore a wide range of emergent ultrasound measures to assess the short-term effects of PR on the structure and motion of the diaphragm and peripheral muscles (biceps and quadriceps). Ultrasonographic assessment of the rectus femoris muscle (thickness and cross sectional area) has been found to be correlated with muscle strength [70], and some measures of diaphragmatic kinetics have been proposed as promising to study disease progression (e.g., MIO) [73, 74] and prognosis of PR outcomes (e.g. change in the diaphragmatic length of zone of apposition at functional residual capacity ΔLzapp%) [109].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the following secondary outcomes will be assessed: symptoms of dyspnoea (modified Medical Research Council Questionnaire [mMRC]) [51], fatigue (Checklist of individual strength [CIS-20]) [52] and Functional assessment of chronic illness therapy – fatigue [FACIT-F]) [53, 54], cough and sputum (Leicester cough questionnaire [LCQ] [55] and Cough and sputum assessment questionnaire [CASA-Q]) [56], impact of the disease (COPD Assessment Test [CAT]) [57, 58], emotional status (The Hospital Anxiety and Depression Scale [HADS]) [59, 60], Family Adaptation and Cohesion Scales [FACES-IV]) [61, 62], peripheral (biceps and quadriceps with the hand held dynamometer, 1 [1-RM] or 10 [10-RM] repetition-maximum) [63, 64] and inspiratory and expiratory muscle strength (respiratory pressure meter) [65], exercise capacity (six-minute walk test [6MWT] and one-minute sit to stand test [1-min STS]) [66, 67], balance (brief-balance evaluation systems test [Brief-BESTest]) [68] and physical activity (accelerometer) [14]. Peripheral muscle (rectus femoris and biceps brachialli) and diaphragm thickness, cross sectional area [69, 70] and echointensity [71], excursion and M-Mode Index of Obstruction (MIO) [72–74], will be measured with ultrasound images – ImageJ and Matlab software. Global rating of change scale [75] for fatigue, cough, sputum, peripheral and respiratory muscle strength and balance will also be collected.…”

Section: Methodsmentioning

confidence: 99%

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis

et al. 2019

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Background Pulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. Methods A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. Discussion This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. Trial registration The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666 ). Electronic supplementary material The online version of this article (10.1186/s12889-019-7045-1) contai...

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“…In analogy to the time/volume curve of spirometry, the calculated M-mode Index of Obstruction (MIO) from the ratio between forced diaphragmatic excursion in the first second and the maximal expiratory diaphragmatic excursion correlates linearly with airway obstruction [58]. In the general clinical setting, the detection of abnormalities in respiratory motion can contribute to the early detection of COPD as an ancillary finding in abdominal ultrasound [59].…”

Section: Obstructive Lung Diseasesmentioning

confidence: 99%

Ultrasonography of the Lung

Radziņa

Biederer

2019

Fortschr Röntgenstr

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ABSTR AC T Background High diagnostic accuracy, increasing clinical experience and technical improvements are good reasons to consider lung ultrasound (US) for the assessment of pleural and pulmonary diseases. In the emergency room and in intensive care, it is well acknowledged, but application in other settings is rare. The aim of this review is to update potential users in general radiology about the diagnostic scope of lung US and to encourage more frequent use of this generally underestimated lung imaging modality.Method Literature review was done independently by the two authors in MEDLINE (via PubMed) covering a time span from 2002 until 2017 using free text and Medical Subject Headings/MeSH. Article selection for the bibliography was based on consensus according to relevance and evidence. Results and ConclusionThe technical prerequisites include a standard ultrasound unit with a suitable transducer. Pleural effusion and pneumothorax, atelectasis, interstitial edema, pneumonia, exacerbated chronic obstructive pulmonary disease/asthma and pulmonary embolism can be distinguished by particular ultrasound signs, artifacts and their combinations. A highly standardized selection of access points and terminology for the description of imaging findings contributes to high diagnostic accuracy even in challenging patients and settings. Besides the assessment of acute respiratory failure in the emergency room, lung US may be used for monitoring interstitial fluid accumulation in volume therapy and for the diagnosis of pneumonia or the assessment of pleural effusion and pleurisy in a routine outpatient setting. Last but not least, the increasing concerns about medical radiation exposure warrant a more extensive use of this sometimes underestimated modality as a cost-, time-and radiation-saving alternative or valuable adjunct to the standard imaging modalities. Key Points:▪ Lung US is a safe, quick and readily available method with options for dynamic imaging of respiratory function. ▪ Proper selection of technical parameters customized to the clinical question and standardized terminology for the precise description and interpretation of the imaging signs regarding patient history determine its diagnostic accuracy. ▪ In dyspnea lung US differentiates pneumothorax, lung edema, pneumonia, pulmonary embolism, atelectasis and pleural effusion. ▪ In intensive care, lung US allows monitoring of lung ventilation and fluid administration. ▪ It saves radiation exposure in serial follow-up, in pregnancy and pediatric radiology. Citation Format ▪ Radzina M, Biederer J, Ultrasonography of the Lung. Fortschr Röntgenstr 2019; 191: 909-923

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

Cited by 15 publications

References 22 publications

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis

Ultrasonography of the Lung

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