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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5763_Библиотеки_им_академика_М_И_Перельмана.pdf
Preface
The diaphragm is the main respiratory muscle. Nevertheless, we can affirm that it has been
the least monitored aspect of respiration in medical history, due to the lack of available tools
and technologies to assess its function.
With the spreading use of ultrasound and the implementation of POCUS (Point of Care
Ultrasound), some clinicians started to understand that a new “window” of opportunity was
available to obtain information about the respiratory workload of our patients. Ultrasound
of the diaphragm is the last piece of a puzzle that allows clinicians to assess the respiratory
condition and to obtain valuable data of the patients with a quick, non-invasive, yet accurate
tool.
To our knowledge, this is the first book entirely dedicated to the subject. e book is
structured in four sections: a first part dedicated to the basics of anatomy, physiology, and
ultrasound; a second part describing the technique, featuring illustrations and videoclips;
and third and fourth parts dedicated to applications and new insights, respectively. Chapters
are written by leading experts in the field from different countries, including Italy, the
Netherlands, France, Brazil, Greece, and Canada. Given the relatively recent “discovery” of
diaphragm ultrasound, this choice has allowed us to approach the subject from different
points of view to provide a comprehensive perspective. My deep gratitude goes to every
author of each chapter; without their contribution the goal would have been impossible to
achieve.
Massimo Zambon
xi
Editor
Dr Massimo Zambon is a skilled anesthesiologist and critical care specialist, Head of
the Department of Anesthesia and Intensive Care of the Uboldo Hospital in Cernusco
sul Naviglio, Milan. Graduated in medicine at the University of Trieste before settling in
Italy, he gained professional experience working in some of the major European hospitals
both as researcher (research fellow at Erasme Hospital in Brussels, Belgium, 2005–06) and
clinician (anesthesiologist and critical care specialist at La Pitié-Salpétrière Hospital in
Paris, France, 2007–08). Subsequently, he became full-time staff physician at San Raffaele
Hospital in Milan, Italy (2009–15), where he was involved in training activities for internal
staff, residents, and students of the San Raffaele University. He has wide-ranging expertise
in intensive care medicine, mainly focusing on the application of ultrasound in critically
ill patients. In the last decade, he has started to perform ultrasound of the diaphragm on
critically ill patients, an innovative and non-invasive tool that facilitates assess to respiratory
muscle function. He has published more than 20 papers in critical care indexed journals,
mostly focused on ultrasound, and a number of abstracts and book chapters.
xiii
List of Contributors
Andre L. P. de Albuquerque
Pulmonary Division, University of São
Paulo
Research Institute, Hospital Sirio Libanes
São Paulo, Brazil
Elena Bignami
Department of Medicine and Surgery
University of Parma
Parma, Italy
Gianmaria Cammarota
Department of Medicine and Surgery
University of Perugia
Perugia, Italy
Leticia Z. Cardenas
Intensive Care Unit,
AC Camargo Cancer Center
São Paulo, Brazil
Cristian Deana
Department of Anesthesia and Intensive
Care
University Hospital of Udine
Udine, Italy
Abdallah Fayssoil
Hopital Raymond Poincaré
Université de Versailles SQY
Garches, France
Quentin Fossé
Service de Médecine Intensive et
Réanimation
Hôpital Pitié Salpétrière, APHP
Paris, France
Marco Gemma
NeuroAnesthesia and Intensive Care
Fondazione IRCCS Istituto Neurologico
C. Besta
Milan, Italy
Mark E. Haaksma
Department of Intensive Care Medicine
Amsterdam UMC, Location VUmc
Amsterdam, the Netherlands
Leo Heunks
Department of Intensive Care Medicine
Amsterdam UMC, Location VUmc
Amsterdam, the Netherlands
Heder J. de Vries
Department of Intensive Care Medicine
Amsterdam UMC, Location VUmc
Amsterdam, the Netherlands
Martin Dres
Service de Médecine Intensive et
Réanimation
Hôpital Pitie Salpetriere, APHP
Sorbonne University
Paris, France.
Annemijn H. Jonkman
Department of Intensive Care Medicine
Amsterdam UMC, Location VUmc
Amsterdam, the Netherlands
Daniele Orso
Department of Medicine
University of Udine
Udine, Italy
xv
List of Contributors
Pauliane V. Santana
Intensive Care Unit
AC Camargo Cancer Center
São Paulo, Brazil
Savvoula Savvidou
ICU Department
Papageorgiou General Hospital
essaloniki, Greece
Annia Schreiber
Interdepartmental Division of Critical
Care Medicine
University of Toronto
Toronto, Canada
and
Keenan Research Center and Li Ka Shing
Knowledge Institute
Unity Health Toronto (St Michael’s
Hospital)
Toronto, Canada
Zhonghua Shi
Department of Intensive Care Medicine
Amsterdam UMC, Location VUmc
Amsterdam, the Netherlands
Eleni Soilemezi
ICU Department
Papageorgiou General Hospital
essaloniki, Greece
Panagiota Sotiriou
ICU Department
Papageorgiou General Hospital
essaloniki, Greece
Matthew Tsagourias
ICU Department
Papageorgiou General Hospital
essaloniki, Greece
Pieter R. Tuinman
Department of Intensive Care Medicine
Amsterdam UMC, Location VUmc
Amsterdam, the Netherlands
Luigi Vetrugno
Department of Medicine
University of Udine
Udine, Italy
Myrte Wennen
Department of Intensive Care Medicine
Amsterdam UMC, Location VUmc
Amsterdam, the Netherlands
Massimo Zambon
Department of Anesthesia and Intensive
Care
Ospedale di Cernusco sul Naviglio – ASST
Melegnano e Martesana,
Milan, Italy
xvi
Introduction
Part I
1
Anatomy, Physiology, and
Dysfunction of the Diaphragm
Marco Gemma
Anatomy 3
Physiology 6
Dysfunction 8
References 10
In evolution, the diaphragm muscle is unique to mammals, and its physiological
importance cannot be argued (1).
Anatomy
e diaphragm is a dome-shaped 2–4 mm thick muscular sheet that separates the thoracic
and the abdominal cavities (2–5) (Figure 1.1).
Actually, the diaphragm is formed by two muscle bellies (domes or cupolae) connected
at the level of the xiphosternal joint by the central tendon. is flat non-contractile collagen
aponeurosis provides support to the heart, whereas the right and the le cupolae support
the corresponding lungs. e apex of the diaphragm ranges widely in height during the
breathing cycle (even between the fourth rib and the costal margin) depending on breathing
depth, body posture, and abdominal pressure. e right cupola, lying above the liver, reaches
a 2–3 cm higher level than the le one.
e diaphragm muscle fibres arise from the inner aspect of the thoracic cage (4–9).
Posteriorly, the diaphragm muscle fibres are organized in two paired crura, which
originate from the anterior aspects of L1–L3 and are joined by the median arcuate ligament.
Hypertrophy or lower displacement of this fibrous structure may cause the median arcuate
ligament syndrome (MALS, also known as celiac artery compression syndrome, celiac
axis syndrome, celiac trunk compression syndrome, or Dunbar syndrome).
More anteriorly, the diaphragm muscle fibres rise from the paired medial arcuate
ligaments, which join the vertebral tendinous origin of the respective diaphragmatic crus
to the transverse processes of L1 or L2, aer covering the anterior surface of the major
psoas muscle. Even more anteriorly, the muscle fibres take origin from the paired lateral
arcuate ligaments, which spread from the transverse processes of T12–L3 (variably) to
the mid portion of the twelh ribs covering the quadratus lumborum muscle. All these
DOI: 10.1201/9781003128694-2
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