Diaphragm: Pathophysiology and Ultrasound Imaging in Neuromuscular Disorders

Fayssoil, Abdallah; Béhin, Anthony; Ogna, Adam; Mompoint, D.; Amthor, Helge; Clair, Bernard; Laforêt, Pascal; Mansart, Arnaud; Prigent, Hélène; David, Olivier; Stojkovic, Tanya; Vinit, Stéphane; Carlier, Robert; Eymard, B.; Lofaso, Frédéric; Annane, Djillali

doi:10.3233/jnd-170276

Cited by 80 publications

(77 citation statements)

References 64 publications

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“…Diaphragm being the major respiratory drive muscle, VIDD has an adverse impact on weaning off and is associated with prolonged mechanical ventilation and hospital stay 4 . Conventional measures of diaphragmatic function such as phrenic nerve conduction study, transdiaphragmatic pressure measurement, pulmonary function testing, fluoroscopy, and diaphragmatic electrical activity, have limitations such as the need for special equipment, invasiveness, and exposure to ionizing radiations 5 . Ultrasound is a noninvasive bedside alternative for the assessment of diaphragmatic bulk and function 5 …”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Mistri

Dhochak

Jana

et al. 2020

Pediatric Pulmonology

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Rationale The extent of diaphragmatic atrophy and dysfunction in critically ill children from developing countries is not established. Objectives To estimate changes in ultrasound measurements of diaphragmatic thickness over the first week of mechanical ventilation. To assess magnitude and risk factors of diaphragmatic atrophy. Methods In an observational cohort study, children aged 1–18 years, requiring mechanical ventilation were included. Ultrasound measurements of diaphragmatic thickness at end‐expiration (DTe) and end‐inspiration (DTi), and diaphragmatic thickening fraction (DTF) were performed daily during the first week of admission, and pre‐ and post‐extubation. Diaphragmatic atrophy (%) and atrophy rate (rate of decline in DTe, % per day) were calculated. Measurements and Main Results Of 55 children (74.6% boys) enrolled, 20 (36.4%) died. Of 35 children with planned extubation, 5 (14.3%) required reintubation. Baseline median (interquartile range [IQR]) DTe, DTi, and DTF were 1.27 mm (1, 1.6), 1.76 mm (1.35, 2.10), and 33.75% (26.90, 44.60), respectively. There was a significant reduction in DTe over the first week of mechanical ventilation (p < .001), median (IQR) diaphragmatic atrophy and atrophy rate of 9.91% (5.26, 17.35) and 2.01% (1.08, 3.04) per day, respectively. Diaphragmatic atrophy rate was lower in pressure targeted ventilation (n = 44; 1.79% [1.03, 2.87]) than volume targeted ventilation (n = 11; 3.10% [1.31, 5.49]), p = .038. There was no difference in diaphragmatic parameters (atrophy rate, and peri‐extubation DTe and DTF) in extubation success versus failure. Conclusions The diaphragm undergoes progressive atrophy during the first week of mechanical ventilation in critically ill children. Future studies should evaluate ventilation strategies to reduce the diaphragmatic atrophy.

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Section: Introductionmentioning

confidence: 99%

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Mistri

Dhochak

Jana

et al. 2020

Pediatric Pulmonology

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“…This was due to the increase of the rib cage contribution to generate more volume to counterbalance the disadvantages of positioning and diaphragmatic weakness in subjects with DMD. 4,10,49 Our results during quiet spontaneous breathing indicate that subjects with DMD presented lower chest wall tidal volume at the expense of a higher f, resulting in a higher RSBI compared with controls, as a strategy to reduce the elastic work within the breath and the perception of dyspnea. 10,50 Our results agree with those reported by Misuri et al, 50 who evaluated subjects with neuromuscular disease using a pneumotachograph, including subjects with DMD, and observed that the subjects' ventilatory pattern showed a normal _ V E , a consistent decrease in T i and T e , and an increase in f and RSBI.…”

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confidence: 75%

Effects of Positioning on Cough Peak Flow and Muscular Electromyographic Activation in Duchenne Muscular Dystrophy

et al. 2020

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BACKGROUND: Advanced stages of Duchenne muscular dystrophy (DMD) result in muscle weakness and the inability to generate an effective cough. Several factors influence the effectiveness of cough in patients with DMD. The aim of this study was to assess whether differences in positioning affect cough peak flow (CPF) and muscular electromyographic activation in subjects with DMD compared with paired healthy subjects. METHODS: Optoelectronic plethysmography and surface electromyography were used to assess chest wall volumes, chest wall inspiratory capacity, CPF, breathing pattern, and electromyographic activity of sternocleidomastoid, scalene, rectus abdominis, and external oblique muscles during inspiratory and expiratory cough phases in the supine position, supine position with headrest raised at 45 , and sitting with back support at 80 in 12 subjects with DMD and 12 healthy subjects. RESULTS: Subjects with DMD had lower CPF (P < .01) in comparison to control subjects in all positions; the DMD group also exhibited lower CPF (P 5 .045) in the supine position versus 80. Moreover, the relative volume contributions of the rib cage and abdominal compartments to tidal volume modified significantly with posture. The electromyographic activity during inspiratory and expiratory cough phases was lower in subjects with DMD compared to healthy subjects for all evaluated muscles (P < .05), but no significant differences were observed with posture change. CONCLUSIONS: In subjects with DMD, posture influenced CPF and the relative contribution of the rib cage and abdominal compartments to tidal volume. However, muscular electromyographic activation was not influenced by posture in subjects with DMD and healthy subjects.

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“…In the current study, one LOPD subject with inspiratory muscle weakness and absent C-C excursion required the use of BiPAP to image tidal breathing. Therefore, while ultrasonography can yield lower tissue resolution and an insufficient window in some patients, it may be preferred in clinical settings or to monitor moderate to severe diaphragmatic involvement 25,26 . Additionally, sniff nasal inspiratory pressure (SNIP) reflects pressure associated with a maximal effort sniff.…”

Section: Discussionmentioning

confidence: 99%

Dynamic respiratory muscle function in late-onset Pompe disease

Smith

Allen

Mays

et al. 2019

Sci Rep

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Maximal inspiratory pressure (PIMAX) reflects inspiratory weakness in late-onset Pompe disease (LOPD). However, static pressure tests may not reveal specific respiratory muscle adaptations to disruptions in breathing. We hypothesized that dynamic respiratory muscle functional tests reflect distinct ventilatory compensations in LOPD. We evaluated LOPD (n = 7) and healthy controls (CON, n = 7) during pulmonary function tests, inspiratory endurance testing, dynamic kinematic MRI of the thorax, and ventilatory adjustments to single-breath inspiratory loads (inspiratory load compensation, ILC). We observed significantly lower static and dynamic respiratory function in LOPD. PIMAX, spirometry, endurance time, and maximal diaphragm descent were significantly correlated. During single-breath inspiratory loads, inspiratory time and airflow acceleration increased to preserve volume, and in LOPD, the response magnitudes correlated to maximal chest wall kinematics. The results indicate that changes in diaphragmatic motor function and strength among LOPD subjects could be detected through dynamic respiratory testing. We concluded that neuromuscular function significantly influenced breathing endurance, timing and loading compensations.

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Diaphragm: Pathophysiology and Ultrasound Imaging in Neuromuscular Disorders

Cited by 80 publications

References 64 publications

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Effects of Positioning on Cough Peak Flow and Muscular Electromyographic Activation in Duchenne Muscular Dystrophy

Dynamic respiratory muscle function in late-onset Pompe disease

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