B-Mode Ultrasound Assessment of Diaphragm Structure and Function in Patients With COPD

Baria, Michael R.; Shahgholi, Leili; Sorenson, Eric J.; Harper, Caitlin J.; Lim, Kaiser G.; Strommen, Jeffrey A.; Mottram, Carl D.; Boon, Andrea J.

doi:10.1378/chest.13-2306

Cited by 112 publications

(103 citation statements)

References 27 publications

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“…The authors showed that diaphragm thickness measured by ultrasound was significantly correlated with that directly measured by a ruler. 92 Since then, several studies have been performed to establish reference values of diaphragm thickness in supine healthy subjects, showing for the right hemidiaphragm mean values of 0.32 cm 93 or 0.33 cm, 94 independent of sex, age, or body constitution. More recently, Baldwin et al 95 described a mean diaphragm thickness value of 1.73 mm (range 1.11-2.98) when measured at end expiration in healthy volunteers.…”

Section: B-modementioning

confidence: 99%

“…Other authors reported how left hemidiaphragm measurements could not be consistently obtained, whereas right hemidiaphragm thickness measurements are highly reproducible, particularly after marking the location of the probe. 87 Some authors evaluated the variation of thickness at different lung volumes from RV to TLC in normal subjects, [90][91][92][93] suggesting the use of this maximal contractile capacity of the diaphragm. Another study measured diaphragm thickness in subjects with diaphragm paralysis to monitor recovery of the muscle over time.…”

Section: B-modementioning

confidence: 99%

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Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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The majority of patients admitted to the ICU require mechanical ventilation as a part of their process of care. However, mechanical ventilation itself or the underlying disease can lead to dysfunction of the diaphragm, a condition that may contribute to the failure of weaning from mechanical ventilation. However, extended time on the ventilator increases health-care costs and greatly increases patient morbidity and mortality. Nevertheless, symptoms and signs of muscle disease in a bedridden (or bed rest-only) ICU patient are often difficult to assess because of concomitant confounding factors. Conventional assessment of diaphragm function lacks specific, noninvasive, time-saving, and easily performed bedside tools or requires patient cooperation. Recently, the use of ultrasound has raised great interest as a simple, noninvasive method of quantification of diaphragm contractile activity. In this review, we discuss the physiology and the relevant pathophysiology of diaphragm function, and we summarize the recent findings concerning the evaluation of its (dys)function in critically ill patients, with a special focus on the role of ultrasounds. We describe how to assess diaphragm excursion and diaphragm thickening during breathing and the meaning of these measurements under spontaneous or mechanical ventilation as well as the reference values in health and disease. The spread of ultrasonographic assessment of diaphragm function may possibly result in timely identification of patients with diaphragm dysfunction and to a potential improvement in the assessment of recovery from diaphragm weakness.

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Section: B-modementioning

confidence: 99%

Section: B-modementioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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“…Baria et al had a similar study to ours with B-mode US where diaphragmatic thickness and thickening ratio were measured in COPD patients with coexisting neuromuscular respiratory weakness. No significant difference was found between COPD patients and healthy groups in terms of diaphragm thickness with the exception of a subgroup with severe air trapping so Baria et al concluded that normal values could be applied to COPD patients as reference values [4].…”

Section: Discussionmentioning

confidence: 99%

“…Studies dealing with inspiratory muscle weakness in COPD patients focus mostly on diaphragm since it is the principal generator of tidal volume [3]. US findings of diaphragm muscle in COPD patients is not concluded yet because of the varying results [3][4][5][6][7].These studies address the structure and the motion of the diaphragm [4]. The impairment of diaphragm is suggested to be an important factor which is associated with alterations in the principal pulmonary function parameters such as FEV1 [8].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound assessment of diaphragm thickness in COPD

Çimşit¹,

Bekir²,

Karakurt³

et al. 2016

MMJ

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Objective: Thickness of the diaphragm was evaluated by B-mode ultrasonography (US) in chronic obstructive pulmonary disease (COPD) to determine the relationship between diaphragm thickness measurement, pulmonary function tests, and symptom scores.Patients and Methods: Fifty-three clinically stable patients with COPD were enrolled in this study for diaphragmatic thickness evaluation with B-mode US. The severity of COPD was determined by spirometric measurements in terms of %FEV1. Patients were also analyzed according to GOLD criteria. Correlation between diaphragm thickness and symptom scores like Medical Research Council (mMRC), COPD Assessment Test (CAT), composite scores and body mass index (BMI) were sought. Results:There was a moderate correlation between diaphragmatic muscle thickness and %FEV1 in mild COPD patients (r=0.62, p=0.017<0.05). No significant difference in diaphragmatic thicknesses of GOLD subgroups was found. There were no correlations between diaphragmatic muscle thickness, symptom scores, BMI, age, and gender. Conclusion:No correlation was found between diaphragmatic thickness in COPD patients and pulmonary function tests except for %FEV1 in mild COPD patients. There were no correlations between diaphragmatic muscle thickness and symptom scores. Further US studies should take place for functional evaluation of the diaphragm in COPD subgroups.Keywords: Diaphragm, Ultrasonography, Chronic obstructive pulmonary disease, Thickness. ÖZAmaç: Kronik obstruktive akciğer hastalığı (KOAH) olan hastaların, diyafram kalınlıklarını ultrasonografi ile ölçerek solunum fonksiyon testleri ve semptom skorları ile ilişkisinin araştırılmasıdır. Gereç ve Yöntem:KOAH nedeniyle takip edilmekte olan, son iki aydır klinik olarak stabil seyirli 53 hasta çalışmamıza dahil edildi. Bronkodilatör sonrası FEV1 değerlerinde %12 artış, çalışmada uygulanan testlerden herhangi birine uyumsuzluk, oksijen bağımlılığı, abdominal ya da torasik cerrahi geçirme hikayeleri çalışmadan dışlanma kriterleri olarak belirlendi. KOAH düzeyi spirometri ölçümlerine ve GOLD kriterlerine göre sınıflandırıldı.Hayat kalitesi değerlendirmesi için mMRC ve CAT semptom skorları testleri ile kompozit KOAH skor ölçümü hesaplanması için alevlenme sayıları sorularak kaydedildi. Bulgular: KOAH düzeyi hafif olan hastalarda FEV1 % ile diyafram kalınlığı arasında anlamlı ilişki bulundu (r=0.62, p=0,017<0,05). Diyafram kalınlığı ile GOLD alt grupları, semptom skorları, BMI , yaş ve cinsiyet gibi parametreler arasında anlamlı ilişki bulunamadı.Sonuç: KOAH hastalarında ultrasonografi ile ölçülen diyafram kalınlığı ile solunum fonksiyon testleri arasında hafif KOAH'lı hasta grubu haricinde anlamlı ilişki gösterilememiştir. Diyafram kalınlığı ile semptom skorları arasında anlamlı ilişki bulunamadı. Ultrasonografi ile planlanacak yeni çalışmalarda, KOAH alt gruplarında diyafram fonksiyonunu yansıtacak diyafram kalınlık oranları irdelenmelidir.

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“…A thickness <0.2 cm measured at the end of expiration has been proposed as a cut-off to define diaphragm atrophy. These values apply when assessing the neuromuscular status of the diaphragm in patients with chronic obstructive pulmonary disease (COPD) (29). Excursion is best measured in the M-mode, and the normal range of motion from the resting expiratory position to full inspiration is 1.9-9 cm in adults with higher values reported in deep breathing or sniffing.…”

Section: Diaphragmatic Pathologymentioning

confidence: 99%

Transthoracic Ultrasonography for Clinicians

Vorster¹,

Allwood²,

Koegelenberg³

2015

Eurasian J Pulmonol

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Transthoracic ultrasonography (US) has become an essential tool for respiratory, emergency, and critical care physicians. It can be performed with basic equipment and by personnel with minimum training as a modality for the evaluation of a wide range of thoracic pathologies. Its advantages include immediate application at the point of care, low cost, and lack of radiation. The main indications for transthoracic US are the qualitative and quantitative assessment of pleural effusions, pleural thickening, diaphragmatic pathology, as well as chest wall and pleural tumors. Transthoracic US is also useful in visualizing pulmonary pathologies that abut the pleura, such as pneumonic consolidation and interstitial syndromes, including pulmonary edema. Transthoracic US is more sensitive than the traditional chest radiograph in the detection of pneumothoraces, and it is useful in diagnosing skeletal abnormalities such as rib fractures. It is the ideal tool to guide transthoracic procedures, including thoracocentesis and pleural biopsy. Moreover, transthoracic US-guided procedures can be performed by a single clinician with no sedation and minimal monitoring. Transthoracic US-guided fine needle aspiration and/or cutting needle biopsy of extrathoracic lymph nodes and lesions arising from the chest wall, pleura, peripheral lung, and mediastinum are safe to perform and have a high yield in the of hands of experienced clinicians. Transthoracic US can also potentially guide the aspiration and biopsy of diffuse pulmonary infiltrates, consolidations, and lung abscesses. Moreover, transthoracic US may be used in the detection of pulmonary embolism.

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B-Mode Ultrasound Assessment of Diaphragm Structure and Function in Patients With COPD

Cited by 112 publications

References 27 publications

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasound assessment of diaphragm thickness in COPD

Transthoracic Ultrasonography for Clinicians

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