Kavi Haji1, Alistair Royse2, Dhaksha Tharmaraj3, Darsim Haji4, John Botha5, Colin Royse6. 1. Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria, Australia. Electronic address: kevee@bigpond.com. 2. Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. Electronic address: Alistair.Royse@heartweb.com. 3. Frankston Hospital, Frankston, Victoria, Australia. Electronic address: dtharmaraj@gmail.com. 4. Emergency Department, Frankston Hospital, Frankston, Victoria, Australia. Electronic address: darsim@bigpond.com. 5. Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria, Australia. Electronic address: JBotha@phcn.vic.gov.au. 6. Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia; Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. Electronic address: Colin.Royse@heartweb.com.
Abstract
INTRODUCTION: The objectives of the study are to identify the most reliably imaged regions of the diaphragm, to evaluate the correlation of movement between different parts of each hemidiaphragm, and to assess the agreement between liver or spleen displacement and movement of the ipsilateral hemidiaphragm. METHODS: Images of the diaphragm, liver, and spleen were obtained using 2-dimensional ultrasound. Acceptable agreement between regions of the diaphragm, liver, and spleen was defined as an absence of fixed or proportional bias using Deming regression analysis and limits of agreement of 2 SDs of the difference less than 30% of the mean value. RESULTS: We included 90 critically ill patients. The medial (87%) and middle (73%) regions of the right hemidiaphragm, liver (87.7%), and spleen (81%) and medial (71%) and middle regions (51%) of the left hemidiaphragm were most frequently imaged. In nonintubated patients, acceptable agreement was present for comparisons of the left middle and medial, right middle and medial, and left middle regions and spleen displacement. In intubated patients and in all patients when combined, acceptable agreement was only present for comparisons of the left middle and medial and right middle and medial regions of the diaphragm. Acceptable agreement was not present for intubated and all patients for diaphragmatic and solid organ movement. CONCLUSION: The diaphragm medial part is visualized in the majority of studied patients. The medial and middle thirds may be used interchangeably to assess hemidiaphragm movement. Acceptable agreement does not exist for diaphragm and solid organ movement, other than for the left middle region and the spleen.
INTRODUCTION: The objectives of the study are to identify the most reliably imaged regions of the diaphragm, to evaluate the correlation of movement between different parts of each hemidiaphragm, and to assess the agreement between liver or spleen displacement and movement of the ipsilateral hemidiaphragm. METHODS: Images of the diaphragm, liver, and spleen were obtained using 2-dimensional ultrasound. Acceptable agreement between regions of the diaphragm, liver, and spleen was defined as an absence of fixed or proportional bias using Deming regression analysis and limits of agreement of 2 SDs of the difference less than 30% of the mean value. RESULTS: We included 90 critically ill patients. The medial (87%) and middle (73%) regions of the right hemidiaphragm, liver (87.7%), and spleen (81%) and medial (71%) and middle regions (51%) of the left hemidiaphragm were most frequently imaged. In nonintubated patients, acceptable agreement was present for comparisons of the left middle and medial, right middle and medial, and left middle regions and spleen displacement. In intubated patients and in all patients when combined, acceptable agreement was only present for comparisons of the left middle and medial and right middle and medial regions of the diaphragm. Acceptable agreement was not present for intubated and all patients for diaphragmatic and solid organ movement. CONCLUSION: The diaphragm medial part is visualized in the majority of studied patients. The medial and middle thirds may be used interchangeably to assess hemidiaphragm movement. Acceptable agreement does not exist for diaphragm and solid organ movement, other than for the left middle region and the spleen.
Authors: Pieter R Tuinman; Annemijn H Jonkman; Martin Dres; Zhong-Hua Shi; Ewan C Goligher; Alberto Goffi; Chris de Korte; Alexandre Demoule; Leo Heunks Journal: Intensive Care Med Date: 2020-01-14 Impact factor: 17.440