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Ultrasound of the
Diaphragm and the
Respiratory Muscles
Ultrasound of the
Diaphragm and the
Respiratory Muscles
Edited by
Massimo Zambon
Anesthesiologist and Critical Care Specialist
Head of Department of Anesthesia and
Intensive Care of the Uboldo Hospital, Cernusco sul Naviglio, Milan, Italy
and by CRC Pres s 2 Park Squa re, Milton Park , Abingdon, Oxon, OX14 4RN
© 2022 Taylor & Franc is Group, LLC
CRC Press is an imprint of Taylor & Francis Group, LLC
is boo k contains in formation obtai ned from authent ic and highly re garded source s. While al l reasonable effor ts have been made to publish re liable data and i nformation, nei ther the author[s] nor the pub lisher can acc ept any legal res ponsibility o r liability fo r any error s or omissions that m ay be made. e publishe rs wish to make cl ear that any vi ews or opinions ex pressed in th is book by indiv idual editors , authors or contri butors are persona l to them and do not nece ssarily re flect the view s/opini ons of the publisher s. e infor mation or guida nce containe d in this book i s intended for use by med ical, scient ific or health-c are professiona ls and is provided s trictly as a s upplement to the medic al or other professi onal’s own judgement , their knowle dge of the patient’s med ical histor y, relevant manufa cturer’s inst ructions and t he appropriate best pr actice gu idelines. Be cause of the rapid ad vances in medica l science, any i nformation or adv ice on dosages , procedures or di agnoses shou ld be independent ly verified. e re ader is strong ly urged to consu lt the relevant nat ional drug for mulary and t he drug compa nies’ and devi ce or material ma nufacture rs’ printed i nstruct ions, and thei r websites, before ad minister ing or utili zing any of the dr ugs, devic es or materials me ntioned in thi s book.  is book does not in dicate whether a p articul ar treatment is ap propriate or suitabl e for a particu lar individu al. Ultimat ely it is the sol e responsibilit y of the medica l professional to ma ke his or her own profes sional judgement s, so as to advis e and treat patients a ppropriately. e authors a nd publishers have al so attempted to tr ace the copyr ight holders of al l material repro duced in this pu blication and ap ologize to copy right holders i f permission to pu blish in thi s form has not been obt ained. If any c opyright materia l has not been ack nowledged pleas e write and let u s know so we may recti fy in any fu ture reprint. Except a s permitted u nder U.S. Copyr ight Law, no part of t his book may be repr inted, reproduced , transmit ted, or utili zed in any form by any ele ctronic, mech anical, or ot her means, now k nown or hereaer i nvented, includi ng photocopying , microfilm ing, and recordi ng, or in any info rmation storage or re trieval s ystem, without w ritten perm ission from the pu blishers.
For permi ssion to photocopy or us e material elec tronical ly from this work , access ww w .copyr ight .c om or contact the Co pyright Cleara nce Center, Inc. (CCC), 222 Ros ewood Drive, Da nvers, MA 01923, 978-750-84 00. For works that a re not available on CC C please contact mpkbookspermissions @tandf .co .uk
Trademark notice: Product or cor porate names may be t rademarks or re gistered tra demarks and ar e used only for identi fication and explanation without intent to infringe.
Library of Congress CataloginginPublication Data
Names: Z ambon, Massi mo, editor. Title: Ult rasound of the d iaphragm an d the respirator y muscles / edite d by Massi mo Zambon. Descr iption: Boca Ra ton, FL : CRC Press, 202 2. | Includes biblio graphical references a nd index. | Sum mary: “Ultr asound is the mo st reliable, easil y available, fa st, non-invasive t echnique to stud y diaphragm func tion, and is an i rreplaceable to ol to diagnose , monitor and follow-up cri tical respir atory patients . is essenti al guide ana lyzes every a spect of ultr asound of the di aphragm whic h is vital to prov ide the most s uitable treat ment”-- Provided by publi sher. Identifie rs: LCCN 2021057518 (print) | LCCN 2021057519 (ebook) | ISBN 9780367652777 (hard back) | ISBN 9780367652760 (paperback) | ISBN 9781003128694 (ebo ok) Subject s: MESH: Diaphr agm--diag nostic imag ing | Respirator y Tract Disea ses--diag nostic imag ing | Respirat ion, Artific ial Classi fication: LCC QP145 (print) | LCC QP145 (ebook) | NL M WF 800 | DDC 611/.26--dc23/eng/20220106 LC record ava ilable at https ://lccn.lo c.gov/2021057518 LC ebook re cord available at ht tps://lccn.loc.gov/20 21057519
ISBN: 9780367652777 (hbk)
ISBN: 97803 67652760 (pbk) ISBN: 9781003128694 (ebk)
DOI: 10.1201/97 8100312869 4
Typeset in M inion by Deant a Global Publis hing Serv ices, Chenna i, India
Access the Supp ort Material: ww w .routledge .com /9780367652760
To our teachers, colleagues, trainees, who have been a
source of knowledge and inspiration. And to all the patients,
hoping knowledge will help to improve their care.
M.Z.
Contents
Preface xi Editor xiii List of Contributors xv
Part I: Introduction
Chapter 1 Anatomy, Physiology, and Dysfunction of the
Diaphragm 3
Marco Gemma
Anatomy 3 Physiology 6 Dysfunction 8 References 10
Chapter 2 Ultrasound Basics 13
Massimo Zambon
Interactions of Sound and Tissues 14 Machine Setting 16 Resources 18
Part II: Diaphragm Ultrasound: Technique
Chapter 3 Diaphragmatic Excursion 21
Massimo Zambon
Technique 21 Reference Values, Reproducibility, Learning Curves 24 Usefulness 25 Excursion on Ventilated Patients 26 References 27
Chapter 4 Diaphragmatic Thickness and Thickening 29
Massimo Zambon
Usefulness 30 How to Measure ickness 30 How to Measure ickening 31 Reference Values 34 Meaning of Reduced/Increased 35 References 36
Part III: Applications of Diaphragm Ultrasound
Chapter 5 Diaphragm Ultrasound in Respiratory Disorders
and Diaphragm Paralysis 41
Pauliane Vieira Santana, Leticia Zumpano Cardenas, and Andre Luis Pereira de Albuquerque
Diaphragm Ultrasound in Respiratory Disorders and Diaphragm Paralysis 42 COPD 42
vii
Contents
Interstitial Lung Diseases (ILD) 47 Asthma Cystic Fibrosis and Non-cystic Fibrosis Bronchiectasis 50 Diaphragm Paralysis and DUS Findings 52 References 56
Chapter 6 Assessment of Diaphragm Dysfunction in
Mechanically Ventilated Patients 61
Quentin Fossé and Martin Dres
Introduction 61 Diaphragm Dysfunction 62 Conclusion 69 References 70
Chapter 7 Diaphragm Ultrasound during Weaning from
Mechanical Ventilation 77
Mark E. Haaksma, Heder J. de Vries, LeoHeunks, and Pieter R. Tuinman
Introduction 78 Ultrasound during Mechanical Ventilation 78 Patient–Ventilator Interactions 79 Diaphragm Ultrasound to Track Atrophy 81 Diaphragm Ultrasound to Titrate Ventilator Settings 82 A Comprehensive Ultrasound Approach during Weaning from Mechanical Ventilation: Ultrasound of Diaphragm, Heart, and Lungs 83 Ultrasound to Predict Extubation Success/Failure 84 Chapter Summary 85 References 85
Chapter 8 Diaphragmatic Ultrasound after Thoracic and
Abdominal Surgery 89
Luigi Vetrugno, Daniele Orso, ElenaBignami, and Gianmaria Cammarota
Introduction 89 Cardiac Surgery 90 oracic Surgery 91 Upper Abdominal Surgery 91 Conclusion 94 References 95
Chapter 9 Diaphragm Ultrasound in Patients with
Neuromuscular Disorders 99
Abdallah Fayssoil
Introduction 99 Diaphragm Ultrasound in Neuromuscular Disorders in a Neuromuscular Centre 101 Conclusion 105 References 105
viii
Chapter 10 Other Applications of Diaphragm Ultrasound:
Trauma, Malignancies, Ultrasound-Guided Pro ce dur es 111
Annia Schreiber, Cristian Deana, LuigiVetrugno, and Massimo Zambon
Trauma 111 References 114 Malignancies 115 References 116 Ultrasound-Guided Procedures 117 References 118
Part IV: New Perspectives
Chapter 11 Ultrasound Assessment of the Accessory
Respiratory Muscles 123
Myrte Wennen, Annemijn H. Jonkman, Zhonghua Shi, and Pieter R. Tuinman
Introduction 123 Ultrasound Techniques 124 Tips, Tricks, and Challenges 127 Potential Clinical Applications 129 Novel Techniques and Future Research Questions 131 Conclusion 132 References 132
Chapter 12 Tissue Doppler Imaging
of the Diaphragm 137
Eleni Soilemezi, Panagiota Sotiriou, Savvoula Savvidou, and Matthew Tsagourias
Introduction 137 Ultrasound Technique 137 Variables Identified 140 Use and Potential Applications 140 Limitations of the Technique 143 Future Directions 143 References 143
Chapter 13 Ultrasound of the Diaphragm in Paediatric Patients 145
Massimo Zambon
References 147
Index 149
Contents
ix