Explore the vast range of titles available.

Abstract Background: Reference values derived from existing diaphragm ultrasound protocols are inconsistent, and the association between sonographic measures of diaphragm function and volitional tests of respiratory muscle strength is still ambiguous. Objective: To propose a standardized and comprehensive protocol for diaphragm ultrasound in order to determine lower limits of normal (LLN) for both diaphragm excursion and thickness in healthy subjects and to explore the association between volitional tests of respiratory muscle strength and diaphragm ultrasound parameters. Methods: Seventy healthy adult subjects (25 men, 45 women; age 34 ± 13 years) underwent spirometric lung function testing, determination of maximal inspiratory and expiratory pressure along with ultrasound evaluation of diaphragm excursion and thickness during tidal breathing, deep breathing, and maximum voluntary sniff. Excursion data were collected for amplitude and velocity of diaphragm displacement. Diaphragm thickness was measured in the zone of apposition at total lung capacity (TLC) and functional residual capacity (FRC). All participants underwent invasive measurement of transdiaphragmatic pressure (Pdi) during different voluntary breathing maneuvers. Results: Ultrasound data were successfully obtained in all participants (procedure duration 12 ± 3 min). LLNs (defined as the 5th percentile) for diaphragm excursion were as follows: (a) during tidal breathing: 0.77 cm (males; M) and 0.74 cm (females; F) for amplitude, and 0.32 cm/s (M) and 0.5 cm/s (F) for velocity, (b) during maximum voluntary sniff: 1.4 cm (M) and 1.2 cm (F) for amplitude, and 4.9 (M) cm/s and 3.2 cm/s (F) for velocity, and (c) at TLC: 4.6 cm (M) and 4.4 cm (F) for amplitude. LLN for diaphragm thickness was 0.14 cm (M) and 0.12 cm (F) at FRC, and 0.39 cm (M) and 0.26 cm (F) at TLC. Values for males were consistently higher than for females, independent of age. LLN for diaphragmatic thickening ratio was approximately 1.8 with no significant difference between genders. LLN for invasively measured Pdi during different breathing maneuvers are presented. Voluntary Pdi showed only weak correlation with both diaphragm excursion velocity and amplitude during forced inspiration. Conclusions: Diaphragm ultrasound is an easy-to-perform and reproducible diagnostic tool for noninvasive assessment of diaphragm excursion and thickness. It supplements but does not replace respiratory muscle strength testing.

Diaphragm is crucial for respiration and plays a significant role in trunk stabilization, particularly during postural tasks. Several studies have focused primarily on trunk muscles in lumbar instability (LI) patients. However, the role of diaphragm remains underexplored. Therefore, this study aimed to compare diaphragm excursion, diaphragm thickness, and lung function represented by predicted percentage of forced vital capacity (%FVC predicted) during a load-lifting at tidal breathing between CLBP patients with (CLBP LI ) and without LI (CLBP NLI ). Ninety-six participants with CLBP, aged between 20 and 59 years, were divided into CLBP LI and age-matched CLBP NLI groups based on screening tools and clinical tests. Diaphragm excursion and diaphragm thickness were assessed using real-time ultrasound imaging during load-lifting with tidal breathing. Additionally, lung function was measured using a spirometer. CLBP LI group had significantly decreased total diaphragm excursion ( p -value = 0.003) and diaphragm thickness at inspiration ( p -value = 0.027) and expiration ( p -value = 0.34) compared to CLBP NLI group. There were no differences between the groups in excursions during inspiration and expiration, total thickness, thickness change, and %FVC predicted. Individuals with CLBP LI exhibited decreased diaphragm excursion and diaphragm thickness during inspiration and expiration. Addressing diaphragm training in rehabilitation programs may lead to more effective treatment outcomes for LI patients.

Background The assessment of diaphragm function is crucial for effective clinical management and the prevention of complications associated with diaphragmatic dysfunction. However, current measurement methodologies rely on manual techniques that are susceptible to human error: How does the performance of an automatic diaphragm measurement system based on a segmentation neural network focusing on diaphragm thickness and excursion compare with existing methodologies? Methods The proposed system integrates segmentation and parameter measurement, leveraging a newly established ultrasound diaphragm dataset. This dataset comprises B-mode ultrasound images and videos for diaphragm thickness assessment, as well as M-mode images and videos for movement measurement. We introduce a novel deep learning-based segmentation network, the Multi-ratio Dilated U-Net (MDRU-Net), to enable accurate diaphragm measurements. The system additionally incorporates a comprehensive implementation plan for automated measurement. Results Automatic measurement results are compared against manual assessments conducted by clinicians, revealing an average error of 8.12% in diaphragm thickening fraction measurements and a mere 4.3% average relative error in diaphragm excursion measurements. The results indicate overall minor discrepancies and enhanced potential for clinical detection of diaphragmatic conditions. Additionally, we design a user-friendly automatic measurement system for assessing diaphragm parameters and an accompanying method for measuring ultrasound-derived diaphragm parameters. Conclusions In this paper, we constructed a diaphragm ultrasound dataset of thickness and excursion. Based on the U-Net architecture, we developed an automatic diaphragm segmentation algorithm and designed an automatic parameter measurement scheme. A comparative error analysis was conducted against manual measurements. Overall, the proposed diaphragm ultrasound segmentation algorithm demonstrated high segmentation performance and efficiency. The automatic measurement scheme based on this algorithm exhibited high accuracy, eliminating subjective influence and enhancing the automation of diaphragm ultrasound parameter assessment, thereby providing new possibilities for diaphragm evaluation.

Background With the increased ageing of society, more and more elderly people are admitted to the intensive care unit, How to accurately predict whether elderly patients can successfully wean from the ventilator is more complicated. Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were measured by bedside ultrasound to assess diaphragm function. The lung ultrasound score (LUS) and the rapid shallow breathing index (RBSI) were used as indices of diaphragm function to predict the outcome of weaning from mechanical ventilation. The aim of this study was to examine the clinical utility of these parameters in predicting extubation success. Methods This prospective study included 101 consecutive elderly patients undergoing a trial of extubation in the ICU of Haidian Hospital between June 2017 and July 2020. Patients were divided into the successful weaning group (n = 69) and the failed weaning group (n = 32). Baseline characteristics, including RSBI, were recorded. Measurements of DE, DTF and LUS were made using ultrasound within 24 h before extubation. Results Median DE was greater in patients with extubation success than in those with extubation failure (1.64 cm vs. 0.78 cm, p  = 0.001). Patients with extubation success had a greater DTF than those with extubation failure (49.48% vs. 27.85%, p  = 0.001). The areas under the receiver operating curves for the RSBI, LUS, DE and DFT were 0.680, 0.764, 0.831 and 0.881, respectively. The best cut-off values for predicting successful weaning were DTF ≥ 30%, DE ≥ 1.3 cm, LUS ≤ 11, and RSBI ≤ 102. The specificity of DTF (84%) in predicting weaning outcome was higher than that of RBSI (53%), that of LUS (55%), and that of DE (62%). The sensitivity of DTF (94%) was greater than that of RBSI (85%), that of LUS (71%), and that of DE (65%). The combination of RSBI, LUS, DE, and DTF showed the highest AUC (AUC = 0.919), with a sensitivity of 96% and a specificity of 89%. Conclusions DTF has higher sensitivity and specificity for the prediction of successful weaning in elderly patients than the other parameters examined. The combination of RSBI, LUS, DE and DFT performed well in predicting weaning outcome. This has potentially important clinical application and merits further evaluation.

NIV-NAVA mode for respiratory support in preterm infants is not well-studied. This study aimed to describe the diaphragmatic function, diaphragmatic excursion (DE), and thickness fraction (DTF), in preterm infants < 30 weeks’ gestation supported by NIV-NAVA compared to NIPPV using bedside ultrasonography. In this consecutive prospective study, DE, diaphragmatic thickness at end of expiration (DT exp ), end of inspiration (DT ins ), and DTF were assessed using bedside ultrasound. Lung aeration evaluation using lung ultrasound score (LUS) was performed for the two groups. Diaphragmatic measurements and LUS were compared for the 2 groups (NIV-NAVA group versus NIPPV group). Statistical analyses were conducted using the SPSS software version 22. Out of 70 infants evaluated, 40 were enrolled. Twenty infants were on NIV-NAVA and 20 infants on NIPPV with a mean [SD] study age of 25.7 [0.9] weeks and 25.1 [1.4] weeks respectively ( p  = 0.15). Baseline characteristics and respiratory parameters at the time of the scan showed no significant difference between groups. DE was significantly higher in NIV-NAVA with a mean SD of 4.7 (1.5) mm versus 3.5 (0.9) mm in NIPPV, p  = 0.007. Additionally, the mean (SD) of DTF for the NIV-NAVA group was 81.6 (30) % vs 78.2 (27) % for the NIPPV group [ p  = 0.71]. Both groups showed relatively high LUS but no significant difference between groups [12.8 (2.6) vs 12.6 (2.6), p  = 0.8].   Conclusion : Preterm infants managed with NIV-NAVA showed significantly higher DE compared to those managed on NIPPV. This study raises the hypothesis that NIV-NAVA could potentially improve diaphragmatic function due to its synchronization with patients’ own breathing. Longitudinal studies to assess diaphragmatic function over time are needed.   Trial registry : Clinicaltrials.gov (NCT05079412). Date of registration September 30, 2021. What is Known: • NIV-NAVA utilizes diaphragmatic electrical activity to provide synchronized breathing support. • Evidence for the effect of NIV-NAVA on diaphragmatic thickness fraction (DTF) and excursion (DE) is limited. What is New: • Ultrasonographic assessment of diaphragmatic function (DTF and DE) is feasible. • In preterm infants, DE was significantly higher in infants supported with NIV-NAVA compared to those supported with NIPPV.

Background Unilateral diaphragmatic paralysis in patients with univentricular heart is a known complication after pediatric cardiac surgery. Because diaphragmatic excursion has a significant influence on perfusion of the pulmonary arteries and hemodynamics in these patients, unilateral loss of function leads to multiple complications. The current treatment of choice, diaphragmatic plication, does not lead to a full return of function. A unilateral diaphragmatic pacemaker has shown potential as a new treatment option. In this study, we investigated an accelerometer as a trigger for a unilateral diaphragm pacemaker (closed-loop system). Methods Seven pigs (mean weight 20.7 ± 2.25 kg) each were implanted with a customized accelerometer on the right diaphragmatic dome. Accelerometer recordings (mV) of the diaphragmatic excursion of the right diaphragm were compared with findings using established methods (fluoroscopy [mm]; ultrasound, M-mode [cm]). For detection of the amplitude of diaphragmatic excursions, the diaphragm was stimulated with increasing amperage by a cuff electrode implanted around the right phrenic nerve. Results Results with the different techniques for measuring diaphragmatic excursions showed correlations between accelerometer and fluoroscopy values (correlation coefficient 0.800, P  < 0.001), accelerometer and ultrasound values (0.883, P  < 0.001), and fluoroscopy and ultrasound values (0.816, P  < 0.001). Conclusion The accelerometer is a valid method for detecting diaphragmatic excursion and can be used as a trigger for a unilateral diaphragmatic pacemaker.

Introduction Dyspnea is a common symptom in survivors of severe COVID-19 pneumonia. While frequently employed in hospital settings, the use of point-of-care ultrasound in ambulatory clinics for dyspnea evaluation has rarely been explored. We aimed to determine how lung ultrasound score (LUS) and inspiratory diaphragm excursion (DE) correlate with patient-reported dyspnea during a 6-min walk test (6MWT) in survivors of COVID-19 acute respiratory distress syndrome (ARDS). We hypothesize higher LUS and lower DE will correlate with dyspnea severity. Study Design and Methods Single-center cross-sectional study of survivors of critically ill COVID-19 pneumonia (requiring high-flow nasal cannula, invasive, or non-invasive mechanical ventilation) seen in our Post-ICU clinic. All patients underwent standardized scanning protocols to compute LUS and DE. Pearson correlations were performed to detect an association between LUS and DE with dyspnea at rest and exertion during 6MWT. Results We enrolled 45 patients. Average age was 61.5 years (57.7% male), with average BMI of 32.3 Higher LUS correlated significantly with dyspnea, at rest ( r  =  + 0.41, p  =  < 0.01) and at exertion ( r  =  + 0.40, p  =  < 0.01). Higher LUS correlated significantly with lower oxygen saturation during 6MWT ( r  = -0.55, p  =  < 0.01) and lower 6MWT distance ( r  = -0.44, p  =  < 0.01). DE correlated significantly with 6MWT distance but did not correlate with dyspnea at rest or exertion. Conclusion Higher LUS correlated significantly with patient-reported dyspnea at rest and exertion. Higher LUS significantly correlated with more exertional oxygen desaturation during 6MWT and lower 6MWT distance. DE did not correlate with dyspnea.

Introduction The optimal time to discontinue patients from mechanical ventilation is critical as premature discontinuation as well as delayed weaning can result in complications. The literature on diaphragm function assessment during the weaning process in the intriguing subpopulation of critically ill neuromuscular disease patients is lacking. Methods Patients with neuromuscular diseases, on mechanical ventilation for more than 7 days, and who were ready for weaning were studied. During multiple T-piece trials over days, diaphragm function using ultrasound and diaphragm electrical activity (Edi peaks using NAVA catheter) was measured every 30 min till a successful 2 h weaning. Results A total of 18 patients were screened for eligibility over 5-month period and eight patients fulfilled the inclusion criteria. Sixty-three data points in these 8 subjects were available for analysis. A successful breathing trial was predicted by Edi reduction (1.22 μV for every 30 min increase in weaning duration; 0.69 μV for every day of weaning) and increase in diaphragm excursion (2.81 mm for every 30 min increase in weaning duration; 2.18 mm for every day of weaning). Conclusion The Edi and diaphragm excursion changes can be used as additional objective tools in the decision-making of the weaning trials in neuromuscular disease.

Introduction Diaphragm excursion and contraction velocity measured using ultrasonography have been used to assess diaphragm function. We aimed to evaluate the performance of diaphragm ultrasonography during weaning from mechanical ventilation (MV). Methods Diaphragm ultrasonography was performed on 73 mechanically ventilated patients who were being considered for extubation on three separate occasions: (1) on assist control mode (A/C) during consistent patient triggered ventilation, (2) following 30 min during a spontaneous breathing trial (SBT), (3) 4–24 h following extubation. Right hemidiaphragm excursion and contraction velocity were measured on A/C, during SBT, and following extubation. These measurements were correlated with the outcome of extubation. Results Twenty patients failed extubation: 6 of whom required re-intubation and 14 of whom required non-invasive ventilatory support. During SBT, the mean diaphragm excursions were 1.7 ± 0.82 cm in the group who failed extubation compared to 2.1 ± 0.9 cm in the group who were successfully extubated ( p  = 0.06). To predict successful extubation, a decrease in diaphragm excursion of < 16.4% between A/C and SBT had a sensitivity of 84.9% and a specificity of 65%. The area under curve (AUC) for receiver operative characteristics for above cut-off was 0.75. Diaphragm contraction velocity performed poorly in predicting weaning outcome. Conclusions Diaphragm excursion measured during SBT is an imperfect predictor of the outcome of extubation. Maintenance of diaphragm excursion between A/C and SBT has good performance characteristics by AUC analysis. Diaphragm contraction velocity has poor ability to predict outcome of extubation.

A variaty pulmonary conditions known as interstitial lung diseases (ILDs) are presented by many symptoms, as well as decreased survival and quality of life. Even though those traits have been linked to parenchymal involvement, the idea has recently come under scrutiny due to the discovery that patients with ILD also have decreased peripheral muscle performance. The purpose of this study was to assess the viability of diaphragm ultrasound imaging in interstitial lung disease (ILD). This prospective cross-sectional study will include 50 subjects with ILD and a control group of 20 healthy volunteers who are similar to the patients for age, gender, body mass index, and smoking status. from those came to Chest department in Benha University Hospital, at the period of February 2023 to February 2024. All patients had written concent , Full history taking and clinical examination, HRCT chest, PFT, oxygen saturation by pulse oximetry, Serological analysis for CTD, Ultrasound imaging of the diaphragm. Results The study population consisted of 50 patients had ILD due to different causes and 20 healthy control persons. The mean age (±SD) of the studied group was 59.11(±7.23) years. 60.0% of them were females. There were no significant differences between cases and control according to their age and sex ( P ˃ 0.05). There were highly significant differences between cases and control regarding to their diaphragmatic measurements and mobility ( P = 0.000). Diaphragmatic inspiratory thickness was significantly lower among ILD patients (median (range) = 0.88 (0.35-1.60) mm) than control (median (range)= 2.0 (1.50-2.70) mm). Diaphragmatic expiratory thickness was significantly lower among ILD patients (mean±SD= 0.80 ± 0.30 mm) than control (mean±SD=1.91 ± 0.35 mm). Thickness fraction was significantly lower among ILD patients (median (range) = 4.25 (1.01-100.0) mm) than control (median (range)= 6.67 (4.10-21.0) mm). Thoracic excursion during deep breath was significantly lower among ILD patients (median (range) = 5.05 (1.96-7.00) cm) than control (median (range)= 8.00 (6.00-10.00) cm ). 80 % of ILD patients had reduced mobility while 100% of control had normal mobility. Conclusion One accurate and non-invasive method for evaluating diaphragmatic function is ultrasound. Patients with ILD have decreased diaphragmatic inspiratory thickness, expiratory thickness, thickness fraction, mobility, and excursion when compared to healthy controls.One accurate and non-invasive method for evaluating diaphragmatic function is ultrasound. Patients with ILD have decreased diaphragmatic inspiratory thickness, expiratory thickness, thickness fraction, mobility, and excursion when compared to healthy controls.