Assessment of Diaphragm Function and Pleural Pressures During Thoracentesis

Garcia, Yunuen Aguilera; Palkar, Atul; Koenig, Seth; Narasimhan, Mangala; Mayo, Paul H.

doi:10.1016/j.chest.2019.07.019

Cited by 16 publications

(10 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, Boussuges et al reported that this ultrasound examination was highly reproducible when performed twice on volunteers ( n = 180) by the same observer at least 1 day apart 17 . As per Aguilera Garcia et al, the authors felt that two assessments pre‐drainage would cause undue discomfort to the participant 12 . Fifth, ideally, further investigations such as transdiaphragmatic pressure could provide further confirmation of the findings; however, these investigations are invasive and were not feasible in this cohort.…”

Section: Discussionmentioning

confidence: 76%

“…In the presence of an effusion, abnormal ipsilateral hemidiaphragm movement (assessed on ultrasonography) is associated with a tendency towards more breathlessness, as well as more significant improvements on post‐drainage breathlessness scores 29 . Ultrasound assessment has revealed that excursion, velocity of contraction and end‐inspiratory thickness of the ipsilateral hemidiaphragm tend to increase post‐drainage 12,13 . No published data exist on the effect of pleural effusion on the contralateral hemidiaphragm.…”

Section: Discussionmentioning

confidence: 99%

“…These have become the modality of choice to evaluate diaphragm function for many clinical groups 9–11 . The relatively few studies that utilized these techniques to assess how pleural effusion affects the diaphragm have studied only the ipsilateral hemidiaphragm 12–14 . In unilateral hemidiaphragm weakness secondary to phrenic nerve injury, compensatory activity of the contralateral hemidiaphragm has been observed 15 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ipsilateral and contralateral hemidiaphragm dynamics in symptomatic pleural effusion: The 2nd PLeural Effusion And Symptom Evaluation (PLEASE‐2) Study

et al. 2022

View full text Add to dashboard Cite

Background and objective: The pathophysiology of breathlessness in pleural effusion is unclear. In the PLEASE-1 study, abnormal ipsilateral hemidiaphragm shape and movement, assessed qualitatively, were independently associated with breathlessness relief after pleural drainage. Effects of pleural effusion on contralateral hemidiaphragm function are unknown. PLEASE-2, a prospective exploratory pilot study, assessed the effects of unilateral effusion and drainage on both hemidiaphragms using advanced quantitative bedside ultrasonography. Methods: Individuals with symptomatic unilateral pleural effusion undergoing therapeutic drainage were included. Measurements pre-and post-drainage included severity of breathlessness (visual analogue scale) and ultrasound measurements of diaphragm excursion and thickness, in addition to shape and movement. Diaphragm measurements were compared to published reference values. Results: Twenty participants were recruited (mean age 68.9 [SD 12.8] years, 12 females). During tidal breathing, contralateral hemidiaphragm excursion exceeded ipsilateral excursion and reference values (all p ≤ 0.001). Contralateral excursion was greatest in participants with abnormal ipsilateral hemidiaphragm movement and was inversely correlated with ipsilateral tidal excursion (r = À0.676, p = 0.001). Following drainage (mean volume 2121 [SD = 1206] ml), abnormal shape (n = 12) and paradoxical movement (n = 9) of the ipsilateral hemidiaphragm resolved in all participants, and tidal excursion of the contralateral hemidiaphragm normalized. Relief of breathlessness post-drainage correlated with improvement in ipsilateral hemidiaphragm excursion (r = 0.556, p = 0.031). Conclusion: This pilot study suggests, for the first time, that unilateral pleural effusion not only impairs ipsilateral hemidiaphragm function but also causes compensatory hyperactivity of the contralateral hemidiaphragm, which resolves post-drainage. These findings provide a basis for detailed studies of diaphragmatic function and ventilatory drive in patients with symptomatic pleural effusion.

show abstract

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ipsilateral and contralateral hemidiaphragm dynamics in symptomatic pleural effusion: The 2nd PLeural Effusion And Symptom Evaluation (PLEASE‐2) Study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…27,31,32 Both diaphragm excursion and thickening have been shown to correlate with invasive measurements of diaphragm function (transdiaphragmatic pressure 32 ). To date, there have been four studies [33][34][35][36] quantifying these measurements using a bedside thoracic ultrasound in patients with a pleural effusion. These studies have assessed the effect of pleural effusions on the diaphragm, and all have considered only the ipsilateral hemidiaphragm.…”

Section: Assessing Diaphragmatic Function In Patients With Pleural Ef...mentioning

confidence: 99%

Breathlessness with Pleural Effusion: What Do We Know?

Muruganandan

Mishra

Singh

2023

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements in breathlessness. Impaired hemidiaphragm function and a compensatory increase in respiratory drive to maintain ventilation appear to be an important mechanism of breathlessness associated with pleural effusion. Thoracocentesis reduces diaphragm distortion and improves its movement; these changes appear to reduce respiratory drive and associated breathlessness by improving the neuromechanical efficiency of the diaphragm.

show abstract

“…Initially, DE was used to detect the respiratory problems that induced dyspnea (1). In the last few years, studies have shown that DE can be utilized in several aspects of detection and clinical assistance, i.e., the detection of phrenic-nerve-injury-induced diaphragmatic paralysis (3)(4)(5), the evaluation of chronic obstructive pulmonary disease (6)(7)(8), or chronic pulmonary disease patients (9), the assessment of respiratory function in post-thoracentesis (10), or chronic kidney disease patients with hemodialysis (11), the guided technique for ventilator use and weaning in critically ill patients (12)(13)(14), and as an intervention in the diaphragmatic pacing protocol for the appropriate stimulation of diaphragmatic muscle (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of Ultrasonographic Diaphragmatic Excursion in Healthy Dogs: Effect of Positioning, Diaphragmatic Location, and Body Weight of Dogs

et al. 2021

View full text Add to dashboard Cite

Diaphragmatic excursion (DE) has been utilized for detecting respiratory related problems in humans. However, several factors should be considered such as the ultrasound technique and factors intrinsic to patients. Nevertheless, knowledge of the effect of these factors on DE in dogs is still lacking. The aim of this study was to evaluate the proper ultrasound technique by varying postures and diaphragmatic locations for DE measurement and to explore intrinsic factors such as diaphragmatic sides, sex, and body weight of dogs on DE. The prospective, analytic, cross-sectional study included 44 healthy dogs; 12 beagles and 32 dogs of other breeds. The experiment was divided into (i) an exploration of the proper ultrasound technique by varying postures (supine, standing, and recumbent in each of the right and left lateral positions), diaphragmatic locations (middle crus and proximal to the last rib), and diaphragmatic sublocations (xiphoid, mid, and proximal rib) for detection of DE and (ii) the evaluation of canine intrinsic factors affecting DE. The results show that the mid-diaphragmatic sublocation in the middle crus area in almost all positions revealed the highest percentage DE detection. However, DEs were revealed to be more accessible in the supine position. There was no significant difference in DE between the right and the left diaphragms or between the sexes of beagle dogs. However, body weight was significantly correlated with the DE among dogs of various sizes. In conclusion, the posture of the dogs and the diaphragmatic location can affect DE evaluation. Neither sex nor diaphragmatic side had an influence, but body weight was revealed as a major factor in DE in dogs.

show abstract

Assessment of Diaphragm Function and Pleural Pressures During Thoracentesis

Cited by 16 publications

References 17 publications

Ipsilateral and contralateral hemidiaphragm dynamics in symptomatic pleural effusion: The 2nd PLeural Effusion And Symptom Evaluation (PLEASE‐2) Study

Ipsilateral and contralateral hemidiaphragm dynamics in symptomatic pleural effusion: The 2nd PLeural Effusion And Symptom Evaluation (PLEASE‐2) Study

Breathlessness with Pleural Effusion: What Do We Know?

The Feasibility of Ultrasonographic Diaphragmatic Excursion in Healthy Dogs: Effect of Positioning, Diaphragmatic Location, and Body Weight of Dogs

Contact Info

Product

Resources

About