Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.
Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound:  Ultrasonography Determination of Diaphragmatic Ex...
The Importance of the Diaphragm <ul><li>The most important of the respiratory muscles </li></ul><ul><li>Two components:  <...
Diaphragmatic Paralysis <ul><li>Unilateral vs. bilateral </li></ul><ul><li>Increase in load on the other respiratory acces...
 
Diagnosis of Diaphragmatic Paralysis <ul><li>Chest radiograph </li></ul><ul><ul><li>Elevated hemidiaphragm and atelectasis...
Diagnosis of Diaphragmatic Paralysis <ul><li>Pulmonary function tests  </li></ul><ul><ul><li>The decrease in VC from uprig...
Pleural Pressure: balloon at the lower third of the esophagus Gastric Pressure: balloon in the stomach Rib Cage movement A...
Diaphragmatic Movement Evaluation with Thoracic Ultrasound <ul><li>Thoracic ultrasound </li></ul><ul><ul><li>Lack of ioniz...
Equipment and Technique <ul><li>2.5 to 3.5 MHz transducer  (low frequency for deep tissue) </li></ul><ul><li>Probe positio...
 
 
 
Diaphragm Movements and M-mode Ultrasonographic Measurements  <ul><li>In inspiration the diaphragm descends, moving toward...
Diaphragm inspiratory time  Diaphragm expiratory time  Diaphragm inspiratory amplitude
Maneuver began at the end of normal expiration: Quiet Breathing (QB): Diaphragm excursion 1.5-2 cm Lower limit 0.9 cm for ...
Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vo...
Challenges <ul><li>During DB, the descending lung may obscure the diaphragm  </li></ul><ul><ul><li>The probe should be dis...
Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery <ul><li>After Cardiac Sur...
Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery CHEST February 2009 vol. ...
Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery <ul><li>Best E < 25 mm wa...
Diaphragmatic Paralysis: The Use of M Mode Ultrasound for Diagnosis in Adults <ul><li>Normal diaphragm </li></ul><ul><ul><...
Conclusion <ul><li>M mode ultrasonography is a relatively simple and accurate test for diagnosing paralysis of the diaphra...
References <ul><li>Alain Boussuges, MD, PhD, Yoann Gole, MSc and Philippe Blanc, MD. Diaphragmatic Motion Studied by M-Mod...
Nächste SlideShare
Wird geladen in …5
×

Diaphragm Movement And Contractility Evaluation By Thoracic Ultrasound

21.135 Aufrufe

Veröffentlicht am

Veröffentlicht in: Gesundheit & Medizin
  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • thank u
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • very nice presentation and very useful too
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • very helpful
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Diaphragm Movement And Contractility Evaluation By Thoracic Ultrasound

  1. 1. Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound: Ultrasonography Determination of Diaphragmatic Excursion Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow University of Illinois at Chicago
  2. 2. The Importance of the Diaphragm <ul><li>The most important of the respiratory muscles </li></ul><ul><li>Two components: </li></ul><ul><ul><li>Non-contractile central tendon </li></ul></ul><ul><ul><li>Contracting muscle fibers </li></ul></ul><ul><li>Innervated by phrenic nerve (C3-C5) </li></ul><ul><li>Contraction of the diaphragm </li></ul><ul><ul><li>Decreases intrapleural pressure </li></ul></ul><ul><ul><li>Generating positive intraabdominal pressure </li></ul></ul><ul><ul><li>contributes to ¾ of inspiratory volumes at the vital capacity </li></ul></ul>
  3. 3. Diaphragmatic Paralysis <ul><li>Unilateral vs. bilateral </li></ul><ul><li>Increase in load on the other respiratory accessory muscles </li></ul><ul><ul><li>Respiratory failure </li></ul></ul><ul><li>Clinical manifestations  </li></ul><ul><ul><li>DOE, Orthopnea </li></ul></ul><ul><ul><li>Rapid shallow breathing </li></ul></ul><ul><ul><li>Paradoxical abdominal wall retraction during inspiration </li></ul></ul><ul><ul><li>Hypoxemia (due to the atelectasis ) </li></ul></ul><ul><ul><li>Hypercapnia and hypoxemia </li></ul></ul><ul><ul><li>Severe cases (ventilatory failure, severe pulmonary hypertension, and secondary erythrocytosis ) </li></ul></ul>
  4. 5. Diagnosis of Diaphragmatic Paralysis <ul><li>Chest radiograph </li></ul><ul><ul><li>Elevated hemidiaphragm and atelectasis </li></ul></ul><ul><li>Fluoroscopy </li></ul><ul><ul><li>Requires patient transportation </li></ul></ul><ul><ul><li>Uses ionizing radiation </li></ul></ul><ul><ul><li>Sniff test: paradoxical elevation of the paralyzed hemidiaphragm with inspiration (>90%) </li></ul></ul>
  5. 6. Diagnosis of Diaphragmatic Paralysis <ul><li>Pulmonary function tests </li></ul><ul><ul><li>The decrease in VC from upright to supine position </li></ul></ul><ul><ul><ul><li>Up to 10% in normal population (VC 70-80% of predicted) </li></ul></ul></ul><ul><ul><ul><li>Up to 50% in bilateral diaphragmatic paralysis </li></ul></ul></ul><ul><li>Maximal inspiratory pressures (PI-max) </li></ul><ul><ul><li>Bilateral paralysis: < -60 cmH2O </li></ul></ul><ul><ul><li>Unilateral paralysis: WNL (due to preserved strength of the accessory muscles) </li></ul></ul><ul><li>Electromyography (EMG) and phrenic nerve stimulation </li></ul>
  6. 7. Pleural Pressure: balloon at the lower third of the esophagus Gastric Pressure: balloon in the stomach Rib Cage movement Abdominal wall movement
  7. 8. Diaphragmatic Movement Evaluation with Thoracic Ultrasound <ul><li>Thoracic ultrasound </li></ul><ul><ul><li>Lack of ionizing radiation </li></ul></ul><ul><ul><li>Bedside procedure </li></ul></ul><ul><ul><li>Should be the method of choice in the investigation of suspected hemidiaphragmatic movement abnormality. </li></ul></ul><ul><li>Proposed techniques </li></ul><ul><ul><li>Changes in diaphragm thickness during contraction </li></ul></ul><ul><ul><ul><li>Chronically paralyzed diaphragm is atrophic and does not thicken during inspiration (contraction). </li></ul></ul></ul>
  8. 9. Equipment and Technique <ul><li>2.5 to 3.5 MHz transducer (low frequency for deep tissue) </li></ul><ul><li>Probe position </li></ul><ul><ul><li>Right hemidiaphgragm </li></ul></ul><ul><ul><ul><li>Liver window: Right sub-costal between the midclavicular and anterior axillary lines </li></ul></ul></ul><ul><ul><li>Left hemidiaphgragm </li></ul></ul><ul><ul><ul><li>Spleen window: Left sub-costal between the midclavicular and anterior axillary lines </li></ul></ul></ul><ul><li>The probe directed medially, cranially, and dorsally </li></ul><ul><ul><li>the ultrasound beam reached the posterior third of the diaphragm. </li></ul></ul>
  9. 13. Diaphragm Movements and M-mode Ultrasonographic Measurements <ul><li>In inspiration the diaphragm descends, moving toward the ultrasound probe </li></ul><ul><ul><li>Upward inspiration slope on M-mode </li></ul></ul><ul><li>The diaphragm inspiratory excursion: The amplitude between the foot of the inspiration slope and the apex of this slope </li></ul><ul><ul><li>Always greater in men than in women </li></ul></ul><ul><ul><li>Always greater in the supine position than in the sitting or the standing positions </li></ul></ul><ul><ul><li>No significant correlation with age </li></ul></ul><ul><ul><li>Significant correlation with height and weight </li></ul></ul>
  10. 14. Diaphragm inspiratory time Diaphragm expiratory time Diaphragm inspiratory amplitude
  11. 15. Maneuver began at the end of normal expiration: Quiet Breathing (QB): Diaphragm excursion 1.5-2 cm Lower limit 0.9 cm for women and 1 cm for men Voluntary Sniffing (VS) Diaphragm excursion 2.5-3 cm Lower limit 1.6 cm in women and 1.8 cm in men “normal caudal movement of the diaphragm during inspiration” Deep Breathing (DB) Diaphragm excursion 6-7 cm Lower limit 3.7 cm for women and 4.7 cm for men
  12. 16. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400
  13. 17. Challenges <ul><li>During DB, the descending lung may obscure the diaphragm </li></ul><ul><ul><li>The probe should be displaced caudally with an angle adjustment to maintain a perpendicular approach of the hemidiaphragmatic motion. </li></ul></ul><ul><li>Patients with respiratory disease and dyspnea </li></ul><ul><ul><li>Increased respiratory effort can result in greater chest wall movement and cause the ribs and lung to obscure the images </li></ul></ul><ul><li>Visualization of the left hemidiaphragm is recognized as more difficult due to the smaller window of the spleen as compared with the liver window </li></ul>
  14. 18. Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery <ul><li>After Cardiac Surgery </li></ul><ul><ul><li>Surgery-related phrenic nerve injury </li></ul></ul><ul><ul><li>Severe diaphragmatic dysfunction can prolong mechanical ventilation </li></ul></ul><ul><ul><li>(US) probe is positioned on right midaxillary line </li></ul></ul><ul><ul><li>visualization of the entire length of the diaphragm is frequently permitted by presence of some amount of pleural effusion and/or atelectasis </li></ul></ul><ul><ul><li>Diaphragmatic excursion measured from the end of normal expiration ( C ) to end of maximal inspiratory effort (D) </li></ul></ul>
  15. 19. Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery CHEST February 2009 vol. 135 no. 2 401-407 Diaphragm contribution to respiratory pressure severe diaphragmatic dysfunction
  16. 20. Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery <ul><li>Best E < 25 mm was associated with severe diaphragmatic dysfunction </li></ul><ul><li>None of the patients with uncomplicated postoperative course have Best E < 25 mm, either before or after surgery </li></ul><ul><li>Excellent negative likelihood ratio of Best E < 25 mm </li></ul>CHEST February 2009 vol. 135 no. 2 401-407
  17. 21. Diaphragmatic Paralysis: The Use of M Mode Ultrasound for Diagnosis in Adults <ul><li>Normal diaphragm </li></ul><ul><ul><li>Sniff test: sharp upstroke (normal caudal movement of the diaphragm during inspiration) </li></ul></ul><ul><li>Diaphragmatic paralysis </li></ul><ul><ul><li>No active caudal movement of the diaphragm with inspiration </li></ul></ul><ul><ul><li>Sniff test: Abnormal paradoxical movement (cranial movement on inspiration) </li></ul></ul>Spinal Cord. 2006 Aug;44(8):505-8. Epub 2005 Dec 6.
  18. 22. Conclusion <ul><li>M mode ultrasonography is a relatively simple and accurate test for diagnosing paralysis of the diaphragm </li></ul><ul><li>Diaphragmatic function assessment with ultrasound is important in patients with prolonged ventilation </li></ul><ul><li>Ultrasonography should be considered to exclude severe diaphragmatic dysfunction following cardiac surgery in daily practice with the advantages of being fully noninvasive and widely available in ICU </li></ul>
  19. 23. References <ul><li>Alain Boussuges, MD, PhD, Yoann Gole, MSc and Philippe Blanc, MD. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400 </li></ul><ul><li>Nicolas Lerolle, MD*, Emmanuel Guérot, MD, Saoussen Dimassi, MD, Rachid Zegdi, MD, PhD, Christophe Faisy, MD, PhD, Jean-Yves Fagon, MD, PhD and Jean-Luc Diehl, MD. Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After Cardiac Surgery. CHEST February 2009 vol. 135 no. 2 401-407 </li></ul><ul><li>Ueki J, De Bruin PF, Pride NB (1995) In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax. 50:1157–1161 </li></ul><ul><li>Gottesman E, Mc Cool FD (1997) Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 155:1570–1574. </li></ul><ul><li>Scott S, Fuld JP, Carter R, et al. (2006) Diaphragm ultrasonography as an alternative to whole-body plethysmography in pulmonary function testing. J Ultrasound Med 25:225–232 </li></ul><ul><li>Ayoub J, Cohendy R, Prioux J, et al. (2001) Diaphragm movement before and after cholecystectomy: a sonographic study. Anesth Analg 92:755–761 </li></ul><ul><li>Lloyd T, Tang YM, Benson MD, et al. (2006) Diaphragmatic paralysis: the use of M-mode ultrasound for diagnosis in adults. Spinal Cord 44:505–508 </li></ul>

×