Does it make difference to measure diaphragm function with M mode (MM) or B mode (BM)?
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ORIGINAL RESEARCH
Does it make difference to measure diaphragm function with M mode (MM) or B mode (BM)? Burhan Sami Kalın1,2 · Gül Gürsel2 Received: 13 June 2019 / Accepted: 25 November 2019 © Springer Nature B.V. 2019
Abstract Diaphragm dysfunction occurs in mechanically ventilated subjects. Recent literature suggests that diaphragm thickening fraction (DTF) measured by ultrasound can be useful to predict weaning outcome. However, there is no standardized approach in the measurement of diaphragm thickness (DT) and limited data exists comparing different measurement techniques of diaphragm thickness (M mode-MM or B mode-BM). The goal of this study was to compare MM with BM in the measurements of DT and excursion in the ICU subjects. DT measurements were obtained from the right diaphragm during tidal and maximal inspiratory breathing. Three measurements of the DT were taken both in MM and BM and their mean values were calculated. DT was measured during inspiration and expiration and DTF was calculated. Excursion of diaphragm was also measured with MM and BM during tidal and maximal inspiratory breathing. Bias and agreement between the two measurement methods were evaluated with Bland and Altman test. Sixty-two subjects were enrolled in the study. While 25 (40%) subjects were receiving invasive mechanical ventilation, 14 (23%) subjects ventilated noninvasively. There were no significant difference between the measurement results of MM and BM. BM and MM tidal diaphragm measurements during the inspiratory (0.3 ± 0.08 and 0.31 ± 0.08 cm; P = 0.022), expiratory (0.24 ± 0.07 and 0.24 ± 0.07 cm; P = 0.315) phases and tidal DTF were (27 ± 16 and 31 ± 14%, P = 0.089) respectively. Results of our study suggests that except tidal inspiratory diaphragm thickness, all thickness and excursion measurements with MM and BM are very compatible with each other. Further studies are necessarry to confirm our results and to standardize the measurements of diaphragm. Keywords Diaphragm ultrasound · Point of care ultrasound (POCUS) · Intensive care unit (ICU) · Respiratory failure · Mechanical ventilation
1 Introduction Diaphragm is the main muscle of breathing and assessment of its thickness and excursion are important in detecting dysfunction and exhaustion [1]. Diaphragm dysfunction (DD) is associated with respiratory insufficiency and poor outcomes This study was presented at ISICEM 2018-38th International Symposium on Intensive Care and Emergency Medicine. * Burhan Sami Kalın [email protected] Gül Gürsel [email protected] 1
Division of Critical Care, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 06560 Ankara, Turkey
2
[2]. Clinical trials in the last decade have drawn attention to the relationship between DD and mechanical ventilation in intensive care unit (ICU) subjects. They have shown that most frequent cause of DD acquired in ICU is invasive mechanical ventilation [3]. DD is a very com
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