Replacement of fluoroscopy by ultrasonography in the evaluation of hemidiaphragm function, an exploratory prospective study.
Journal
The ultrasound journal
ISSN: 2524-8987
Titre abrégé: Ultrasound J
Pays: Italy
ID NLM: 101742146
Informations de publication
Date de publication:
08 Jan 2024
08 Jan 2024
Historique:
received:
11
10
2023
accepted:
18
12
2023
medline:
8
1
2024
pubmed:
8
1
2024
entrez:
8
1
2024
Statut:
epublish
Résumé
Dysfunction of the diaphragm may ultimately lead to respiratory insufficiency and compromise patient outcome. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been the gold standard to measure diaphragmatic excursion. Ultrasonography can visualize diaphragm excursion and holds many advantages such as no radiation exposure, increased portability and accessibility. However, correlation between fluoroscopy and ultrasonography has never been studied. We aimed to compare fluoroscopic and ultrasound measures of diaphragm excursion to determine if ultrasonography can replace fluoroscopy. We performed ultrasound and fluoroscopy simultaneously during sniff inspiration and at total inspiratory capacity in patients with chronic obstructive pulmonary disease, heart failure and in healthy volunteers. Cranio-caudal excursion was measured by fluoroscopy and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasonography. Forty-two participants were included. The Pearson correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76-1.04) in a regression analysis. Using the Bland-Altman method, the bias was - 0.39 cm (95% CI - 1.04-0.26), p = 0.24. The Pearson correlation between fluoroscopy and B-mode and area change ultrasonography was high; low for thickness and fraction. All correlations were lower during sniff inspiration compared with inspiratory capacity breathing. Ultrasonography has an acceptable correlation and bias compared to fluoroscopy and can thus be used as the primary tool to evaluate diaphragm excursion.
Identifiants
pubmed: 38189895
doi: 10.1186/s13089-023-00355-0
pii: 10.1186/s13089-023-00355-0
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1Informations de copyright
© 2023. The Author(s).
Références
Ferrari G, Skaarup SH, Panero F, Wrightson JM (2018) The diaphragm. ERS. Monogr 2018:129–147. https://doi.org/10.1183/2312508X.10006917
doi: 10.1183/2312508X.10006917
Boon AJ, Sekiguchi H, Harper CJ et al (2014) Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy. Neurology 83:1264–1270. https://doi.org/10.1212/WNL.0000000000000841
doi: 10.1212/WNL.0000000000000841
pubmed: 25165390
pmcid: 4180486
Pałac M, Rutka M, Wolny T et al (2022) Ultrasonography in assessment of respiratory muscles function: a systematic review. Respiration. https://doi.org/10.1159/000524785
doi: 10.1159/000524785
pubmed: 35760051
Carrillo-Esper R, Perez-Calatayud AA, Arch-Tirado E et al (2016) Standardization of sonographic diaphragm thickness evaluations in healthy volunteers. Respir Care 61:920–924. https://doi.org/10.4187/respcare.03999
doi: 10.4187/respcare.03999
Haaksma ME, Smit JM, Boussuges A et al (2022) EXpert consensus On Diaphragm UltraSonography in the critically ill (EXODUS): a Delphi consensus statement on the measurement of diaphragm ultrasound-derived parameters in a critical care setting. Crit Care 26:1–9. https://doi.org/10.1186/S13054-022-03975-5/TABLES/5
doi: 10.1186/S13054-022-03975-5/TABLES/5
Boussuges A, Rives S, Finance J, Brégeon F (2020) Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives. World J Clin Cases 8:2408–2424. https://doi.org/10.12998/wjcc.v8.i12.2408
doi: 10.12998/wjcc.v8.i12.2408
pubmed: 32607319
pmcid: 7322428
Houston JG, Angus RM, Cowan MD et al (1994) Ultrasound assessment of normal hemidiaphragmatic movement: relation to inspiratory volume. Thorax 49:500–503
doi: 10.1136/thx.49.5.500
pubmed: 8016774
pmcid: 474874
Gethin-Jones TL, Noble VE, Morse CR (2010) Quantification of diaphragm function using ultrasound: evaluation of a novel technique. Ultrasound Med Biol 36:1965–1969. https://doi.org/10.1016/j.ultrasmedbio.2010.08.003
doi: 10.1016/j.ultrasmedbio.2010.08.003
pubmed: 20870347
Skaarup SH, Løkke A, Laursen CB (2018) The Area method: a new method for ultrasound assessment of diaphragmatic movement. Crit Ultrasound J 10:15. https://doi.org/10.1186/s13089-018-0092-5
doi: 10.1186/s13089-018-0092-5
pmcid: 6019663
Boussuges A, Gole Y, Blanc P (2009) Diaphragmatic motion studied by M-mode ultrasonography. Chest 135:391–400. https://doi.org/10.1378/chest.08-1541
doi: 10.1378/chest.08-1541
pubmed: 19017880
Gerscovich EO, Cronan M, McGahan JP et al (2001) Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 20:597–604
doi: 10.7863/jum.2001.20.6.597
pubmed: 11400933
Cammarota G, Boniolo E, Santangelo E et al (2021) Diaphragmatic kinetics assessment by tissue doppler imaging and extubation outcome. Respir Care 66:983–993. https://doi.org/10.4187/RESPCARE.08702
doi: 10.4187/RESPCARE.08702
Corradi F, Vetrugno L, Orso D et al (2021) Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: a single-center pilot study. Respir Physiol Neurobiol. https://doi.org/10.1016/J.RESP.2020.103585
doi: 10.1016/J.RESP.2020.103585
pubmed: 33197604
Orde SR, Boon AJ, Firth DG et al (2015) Diaphragm assessment by two dimensional speckle tracking imaging in normal subjects. BMC Anesthesiol 16:43. https://doi.org/10.1186/s12871-016-0201-6
doi: 10.1186/s12871-016-0201-6
Vetrugno L, Orso D, Corradi F et al (2022) Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study. Respir Res. https://doi.org/10.1186/S12931-022-02138-Y
doi: 10.1186/S12931-022-02138-Y
pmcid: 9392990
Mahmoodpoor A, Fouladi S, Ramouz A et al (2022) Diaphragm ultrasound to predict weaning outcome: systematic review and meta-analysis. Anaesthesiol Intensive Ther 54:164–174. https://doi.org/10.5114/AIT.2022.117273
doi: 10.5114/AIT.2022.117273
pubmed: 35792111
pmcid: 10156496
Spadaro S, Grasso S, Mauri T et al (2016) Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care. https://doi.org/10.1186/S13054-016-1479-Y
doi: 10.1186/S13054-016-1479-Y
pubmed: 27885969
pmcid: 5078922
Skaarup SH, Lonni S, Quadri F et al (2019) Ultrasound evaluation of hemidiaphragm function following thoracentesis: a study on mechanisms of dyspnea related to pleural effusion. J Bronchol Interv Pulmonol. https://doi.org/10.1097/LBR.0000000000000627
doi: 10.1097/LBR.0000000000000627
Muruganandan S, Azzopardi M, Thomas R et al (2020) The PLeural Effusion and Symptom Evaluation (PLEASE) study of breathlessness in patients with a symptomatic pleural effusion. Eur Respir J 55:1900980. https://doi.org/10.1183/13993003.00980-2019
doi: 10.1183/13993003.00980-2019
pubmed: 32079642
Marchioni A, Castaniere I, Tonelli R et al (2018) Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation. Crit Care 22:109. https://doi.org/10.1186/s13054-018-2033-x
doi: 10.1186/s13054-018-2033-x
pubmed: 29703214
pmcid: 5921560
Kocyigit H, Gunalp M, Genc S et al (2021) Diaphragm dysfunction detected with ultrasound to predict noninvasive mechanical ventilation failure: a prospective cohort study. Am J Emerg Med 45:202–207. https://doi.org/10.1016/J.AJEM.2020.08.014
doi: 10.1016/J.AJEM.2020.08.014
pubmed: 33046306
Harper CJ, Shahgholi L, Cieslak K et al (2013) Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound. J Orthop Sport Phys Ther 43:927–931. https://doi.org/10.2519/jospt.2013.4931
doi: 10.2519/jospt.2013.4931
Epelman MM, Navarro OM, Daneman A, Miller SF (2005) M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients. Pediatr Radiol 35:661–667. https://doi.org/10.1007/s00247-005-1433-7
doi: 10.1007/s00247-005-1433-7
pubmed: 15776227
Testa A, Soldati G, Giannuzzi R et al (2011) Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol 37:44–52. https://doi.org/10.1016/j.ultrasmedbio.2010.10.004
doi: 10.1016/j.ultrasmedbio.2010.10.004
pubmed: 21144957
Bland JM, Altman DG (2012) Agreed statistics: measurement method comparison. Anesthesiology 116:182–185. https://doi.org/10.1097/ALN.0b013e31823d7784
doi: 10.1097/ALN.0b013e31823d7784
pubmed: 22129533
Hanneman SK, Katz JB, Hannemanauth SK (2008) Design, analysis and interpretation of method-comparison studies. AACN Adv Crit Care 19:223–234. https://doi.org/10.1097/01.AACN.0000318125.41512.a3
doi: 10.1097/01.AACN.0000318125.41512.a3
pubmed: 18560291
pmcid: 2944826
Banka RA, Skaarup SH, Mercer RM, Laursen CB (2020) Thoracic ultrasound: a key tool beyond procedure guidance. ERS Monogr. https://doi.org/10.1183/2312508X.10023219
doi: 10.1183/2312508X.10023219
Garofalo E, Bruni A, Pelaia C et al (2019) Comparisons of two diaphragm ultrasound-teaching programs: a multicenter randomized controlled educational study. Ultrasound J 11:21. https://doi.org/10.1186/s13089-019-0137-4
doi: 10.1186/s13089-019-0137-4
pubmed: 31578700
pmcid: 6775177