Characteristics of the paralysed diaphragm studied by M-mode ultrasonography

Boussuges, Alain; Bregeon, Fabienne; Blanc, Philippe; Gil, Jean-Marie; Poirette, Laurent

doi:10.1111/cpf.12549

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Characteristics of the paralysed diaphragm studied by M-mode ultrasonography

Author(s): Alain Boussuges ¹ ^, ² , Fabienne Brégeon ³ , Philippe Blanc ⁴ , Jean-Marie Gil ⁵ , Laurent Poirette ⁶

Publication date (Electronic): October 16 2018

Journal: Clinical Physiology and Functional Imaging

Publisher: Wiley

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Abstract

M-mode ultrasonography might be useful for detecting hemidiaphragm paralysis. The objective of the present study was to describe the motion recorded by M-mode ultrasonography of both diaphragmatic leaves in patients with a pre-established diagnosis of hemidiaphragm paralysis.

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Most cited references 23

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Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values.

Alain Boussuges, Yoann Gole, Philippe Blanc (2009)

Although diaphragmatic motion is readily studied by ultrasonography, the procedure remains poorly codified. The aim of this prospective study was to determine the reference values for diaphragmatic motion as recorded by M-mode ultrasonography. Two hundred ten healthy adult subjects (150 men, 60 women) were investigated. Both sides of the posterior diaphragm were identified, and M-mode was used to display the movement of the anatomical structures. Examinations were performed during quiet breathing, voluntary sniffing, and deep breathing. Diaphragmatic excursions were measured from the M-mode sonographic images. In addition, the reproducibility (inter- and intra-observer) was assessed. Right and left diaphragmatic motions were successfully assessed during quiet breathing in all subjects. During voluntary sniffing, the measurement was always possible on the right side, and in 208 of 210 volunteers, on the left side. During deep breathing, an obscuration of the diaphragm by the descending lung was noted in subjects with marked diaphragmatic excursion. Consequently, right diaphragmatic excursion could be measured in 195 of 210 subjects, and left diaphragmatic excursion in only 45 subjects. Finally, normal values of both diaphragmatic excursions were determined. Since the excursions were larger in men than in women, the gender should be taken into account. The lower limit values were close to 0.9 cm for women and 1 cm for men during quiet breathing, 1.6 cm for women and 1.8 cm for men during voluntary sniffing, and 3.7 cm for women and 4.7 cm for men during deep breathing. We demonstrated that M-mode ultrasonography is a reproducible method for assessing hemidiaphragmatic movement.

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Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation.

Won Kim, Hee Suh, Sang-Bum Hong … (2011)

To determine the prevalence of diaphragmatic dysfunction diagnosed by M-mode ultrasonography (vertical excursion <10 mm or paradoxic movements) in medical intensive care unit patients and to assess the influence of diaphragmatic dysfunction on weaning outcome. Prospective, observational study. Twenty-eight-bed medical intensive care unit in a university-affiliated hospital. Eighty-eight consecutive patients in the medical intensive care unit who required mechanical ventilation over 48 hrs and met the criteria for a spontaneous breathing trial were assessed. Patients with a history of diaphragmatic or neuromuscular disease or evidence of pneumothorax or pneumomediastinum were excluded. During spontaneous breathing trial, each hemidiaphragm was evaluated by M-mode ultrasonography using the liver and spleen as windows with the patient supine. Rapid shallow breathing index was simultaneously calculated at the bedside. The prevalence of ultrasonographic diaphragmatic dysfunction among the eligible 82 patients was 29% (n = 24). Patients with diaphragmatic dysfunction had longer weaning time (401 [range, 226-612] hrs vs. 90 [range, 24-309] hrs, p < .01) and total ventilation time (576 [range, 374-850] hrs vs. 203 [range, 109-408] hrs, p < .01) than patients without diaphragmatic dysfunction. Patients with diaphragmatic dysfunction also had higher rates of primary (20 of 24 vs. 34 of 58, p < .01) and secondary (ten of 20 vs. ten of 46, p = .01) weaning failures than patients without diaphragmatic dysfunction. The area under the receiver operating characteristics curve of ultrasonographic criteria in predicting weaning failure was similar to that of rapid shallow breathing index. Using M-mode ultrasonography, diaphragmatic dysfunction was found in a substantial number of medical intensive care unit patients without histories of diaphragmatic disease. Patients with such diaphragmatic dysfunction showed frequent early and delayed weaning failures. Ultrasonography of the diaphragm may be useful in identifying patients at high risk of difficulty weaning.

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Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity.

Ewan C Goligher, Pasini Laghi, Michael Detsky … (2015)

Ultrasound measurements of diaphragm thickness (T di) and thickening (TFdi) may be useful to monitor diaphragm activity and detect diaphragm atrophy in mechanically ventilated patients. We aimed to establish the reproducibility of measurements in ventilated patients and determine whether passive inflation by the ventilator might cause thickening apart from inspiratory effort.

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Author and article information

Journal

Title: Clinical Physiology and Functional Imaging

Abbreviated Title: Clin Physiol Funct Imaging

Publisher: Wiley

ISSN: 14750961

Publication date (Electronic): October 16 2018

Affiliations

[1 ]Institut de Recherche Biomédicale des Armées (IRBA); Brétigny sur Orge France

[2 ]Center for Cardiovascular and Nutrition Research (C2VN); Aix Marseille Université; INSERM; INRA; Marseille France

[3 ]Service d'Explorations Fonctionnelles Respiratoires; CHU Nord; Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ; IRD, APHM; MEPHI; IHU-Méditerranée Infection; Marseille France

[4 ]Sainte Clotilde Rehabilitation Center; Reunion Island France

[5 ]Service de Cardiologie; HIA Laveran; Marseille France

[6 ]Leon Berard Hospital; Unité de Réhabilitation; Hyères France