Dyspnea and exercise intolerance and reduced mobility in patients with COAD |
Three studies presented similar techniques for the diaphragm mobilization analysis (3,6,8). Scholars used the ultrasound scanner (Logiq 500, Pro series; GE Medical Systems Milwaukee WI, SA) in B mode and the abdominal motion ratio was employed for the whole body plethysmograph (Collins GS II, Collins, Braintree, MA, USA). A 3,5 MHz convex transducer was positioned on the right subcostal region and on the left portal vein branch. To measure the muscle displacement of the craniocaudal sensor, the scholars placed the patients in dorsal decubitus, and it was measured during expiration and forced inspiration (3). In another study, the method was similar with the patients in dorsal decubitus; diaphragm mobilization was measured according to the displacement of the portal vein intrahepatic branches, using a LOGIQ 500 brand ultrasound system (Pro Series; GE Medical Systems Milwaukee, WI) in B-mode with a 3.5 MHz convex transducer and the field of view of the vein left door demarcated with a cursor at the end of expiration and forced inspiration (6). Another study with the same ultrasound system in B-mode, with a frequency of 3.5 MH and the convex transducer positioned on the right subcostal at an angle of incidence perpendicular to the craniocaudal axis facing the inferior vena cava was conducted. The authors used a whole-body plethysmograph (Collins GS II, Collins, Braintree, MA, USA). The radiologist who identified the left branch of the portal vein from the cursor demarcating movement during expiration and forced inspiration was blinded to patient data (8). |
Pulmonary hyperinflation diaphragm COPD Dyspnea |
A diaphragmatic mobilization technique yielded the simultaneous observation of the transdiaphragmatic pressure with a difference in pressure between the gastric and esophageal pressures, a change in the diaphragm volume, as measured by lateral fluoroscopy, a duration of inspiration and EMG calculated with 6 pairs of juxtaposed bipolar electrodes, armed in a catheter placed in the lower esophagus. The EMG signals were assessed by the RMS of the signals. The electrically active center of the diaphragm was located in the fourth pair of the electrodes. The subjects were sitting upright, and the measurements were taken at the time of breathing in CRF and during EPAP-induced hyperinflation. The measurements were repeated with an inspiratory threshold (7.5 cm H2O) plus the resistive load (6.5 cm H2O / 1s). The image exposed on the lower chest set a clockwise rotation of 94 °. After the gastric, esophageal and buccal flow pressure were measured, the signals were stored and computerized, and the mouth volume was altered (PowerLab, version 6, ADI Instruments). The authors used lateral fluoroscopic images of the diaphragm and adjacent chest wall, which were stored and analyzed on videotapes (19). |
Diaphragmatic plaralysis complication of cardiac surgery |
Researchers have verified diaphragmatic mobility through the fluoroscopic "sniff" at the thoracic level with expiratory and inspiratory examinations. For the technique, patients were asked to breathe quickly through the nose for possible detection of both right and left sides of the diaphragm. A radiology expert not involved in the study interpreted the data. Pulmonary functions, as well as its values, were measured by spirometry and plethysmography (SensorMedics 6200, Autobox DL; SensorMedics Corp., Yorba Linda, California) (21). |
Hyperinflation and resistance and Dyspnea. |
In another study, radiographs were taken of patients in the supine position on a fluoroscopy table. A ruler was used as a parameter for the longitudinal analysis under the trunk region of the subject in the caudal trunk direction for possible subsequent correction of the amplitude provided by the X-ray divergence. The same film was used in all other examinations during an expiratory and inspiratory maneuver, and the method reported by Saltiel et al. (12) was used by the researchers to verify the mobility of the diaphragm in the expiratory and inspiratory phases, i.e., from the highest point of the hemidome, a straight line was drawn, and a pachymer was used (Messen; Sensor Technology Co., Guangdong, China) (22). |
Severe airflow obstruction and hyperinflation |
Scholars measured the ventilation and muscle activity of the PARA in awake, sitting, and breathing patients (pneumo tachycardus chart and pressure transducer to measure inspiratory airflow). In the expiratory limb, the final CO2 (ETCO2) was continuously verified. CO2-stimulated ventilation was performed by reinhalation of 5.8% CO2 in O2. For the EMG measurement, the electrode pairs of each PARA muscle were preamplified, amplified, rectified, filtered and adjusted with a continuous mean. All signals were monitored in real time on the computer and collected concomitantly for further analysis. The quality and durability of the EMG signal were confirmed by checking the EMG amplitude at the beginning and end of the experiment during maximum inspiration. Pulmonary function tests included spirometry and pulmonary volume and subdivisions by body plethysmography (25). |
Dyspnea and air trapping in the lungs that leads to hyperinflation and resistance |
A study verified diaphragmatic mobility using the anteroposterior chest radiograph method, using a radiopaque ruler on the longitudinal and craniocaudal throne near the thoracoabdominal transition for possible correction of the rays enlargement and / or divergence. The Wright Respirometer, a British ventilometer, was used as a strategy to ensure maximum volume during diaphragm excursion evaluation. Slow, vital capacity was measured in relation to the near residual volume during expiration, and the inspiratory capacity to total lung capacity was measured. A radiologist performed the exam at both times, for both expiration and inspiration (29). |
Idiopathic pulmonary fibrosis |
In a survey conducted in 2019, patients underwent clinical examinations, which included measurements of their height, weight, and abdomen and chest circumference. To verify mobilization of the diaphragm, the researchers used a LUS convex ultrasound probe. All patients were evaluated in the supine position with a minimum saturation of S 2> 94%. A subcostal straight ascendant between axillary and middle clavicular area was used. The diaphragm was examined with B-mode ultrasound, and the diaphragm excursions were measured with M-mode ultrasound. The patients underwent 3 measurements in the inspiratory phase, at rest, and deep inspiration (45). |
COPD e Body Composition (BMI) |
Researchers used a 4 MHz convex probe to measure diaphragm kinetics and thickness. In TD, the measurements were taken from the nearest point where the visibility of the two layers of the diaphragmatic muscle was clearly identified in the right intercostal position. The researchers used the Mylab 50 Gold Cardiovascular ultrasound (Esaote Spa, Rome, Italy) to perform ultrasound measurements using 3.5 to 5 and 7.5 to 12 MHz probes. The position of the patients for the procedure was with the bed inclined 45°. With a 10 MHz probe, the examination was performed with the patient lying in a semirecumbent 45° position. The TD measurements were performed at the end of normal expiration, according to the CRF, after maximal inspiration corresponding to CPT and at the end of maximum expiration according to VR. Thus, the TDFRC, TDTLC and TDRV were evaluated. The operator was the same and proceeded blindly, and the differences between TDTLC and TDFRC were assessed by bioelectrical impedance analysis (47). |
Obesity |
Diaphragm mobility was performed by chest X-ray in the posteroanterior view of the patient in the standing position. Two radiographic exposures of the same film were taken during complete inspiration and expiration. Scholars used the scanned radiographic image, the area being measured in square centimeters from both the right and left sides, and the axis measured in centimeters. UTHSCSA software, Image Tool for Windows, version 1.28 was used, and the same radiologist performed the analyzes (50). |