Chest
Volume 135, Issue 2, February 2009, Pages 391-400
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Original Research
Ultrasonography
Diaphragmatic Motion Studied by M-Mode Ultrasonography: Methods, Reproducibility, and Normal Values

https://doi.org/10.1378/chest.08-1541Get rights and content

Background

Although diaphragmatic motion is readily studied by ultrasonography, the procedure remains poorly codified. The aim of this prospective study was to determine the reference values for diaphragmatic motion as recorded by M-mode ultrasonography.

Methods

Two hundred ten healthy adult subjects (150 men, 60 women) were investigated. Both sides of the posterior diaphragm were identified, and M-mode was used to display the movement of the anatomical structures. Examinations were performed during quiet breathing, voluntary sniffing, and deep breathing. Diaphragmatic excursions were measured from the M-mode sonographic images. In addition, the reproducibility (inter- and intra-observer) was assessed.

Results

Right and left diaphragmatic motions were successfully assessed during quiet breathing in all subjects. During voluntary sniffing, the measurement was always possible on the right side, and in 208 of 210 volunteers, on the left side. During deep breathing, an obscuration of the diaphragm by the descending lung was noted in subjects with marked diaphragmatic excursion. Consequently, right diaphragmatic excursion could be measured in 195 of 210 subjects, and left diaphragmatic excursion in only 45 subjects. Finally, normal values of both diaphragmatic excursions were determined. Since the excursions were larger in men than in women, the gender should be taken into account. The lower limit values were close to 0.9 cm for women and 1 cm for men during quiet breathing, 1.6 cm for women and 1.8 cm for men during voluntary sniffing, and 3.7 cm for women and 4.7 cm for men during deep breathing.

Conclusions

We demonstrated that M-mode ultrasonography is a reproducible method for assessing hemidiaphragmatic movement.

Section snippets

Materials and Methods

The local ethics committee approved the study protocol, and written informed consent was obtained from all healthy subjects. All volunteers were free of any signs of cardio-respiratory and neurologic diseases, and had normal pulmonary function tests. Pulmonary function was studied with a spirometer (Ilmeter 1304; Masterlab Jaeger; Wurzberg, Germany) according to the standards of the American Thoracic Society. The criteria for classification as normal consisted of a FVC > 80% of predicted, a FEV1

Results

Initially, 236 healthy subjects were screened. However, 26 subjects had lower spirometric parameters than normal and were excluded. In total, 210 subjects (150 men, 60 women, 50 ± 14 years) were investigated (Table 1). Their pulmonary function tests were normal [FVC = 3.6 ± 1 (100 ± 13% of predicted), FEV1 = 3.1 ± 0.9 L (95 ± 11% of predicted), FEV1/FVC = 87 ± 7%].

Right and left diaphragmatic motions were successfully accomplished during QB in the whole population. Mean excursions were measured

Discussion

In the present study, the ultrasonographic recording of the right hemidiaphragmatic movement was found to be straightforward. Indeed, the liver window was large and allowed a good visualization of the right diaphragmatic dome. Consequently, the diaphragmatic motion of the right hemidiaphragm could be obtained during QB and VS in the whole population. Although complete motion could be assessed in most cases during DB, the descending lung masked the ultrasonographic images and impeded the

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The authors have no conflicts of interest to disclose.

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