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An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery

 Soo Hwan Kim  ;  Sungwon Na  ;  Jin-Sub Choi  ;  Se Hee Na  ;  Seokyung Shin  ;  Shin Ok Koh 
 ANESTHESIA AND ANALGESIA, Vol.110(5) : 1349-1354, 2010 
Journal Title
Issue Date
Abdomen/surgery* ; Adolescent ; Adult ; Aged ; Analgesia, Patient-Controlled ; Anesthesia, General ; Diaphragm/diagnostic imaging* ; Diaphragm/physiopathology* ; Digestive System Surgical Procedures ; Echocardiography* ; Female ; Humans ; Liver/surgery ; Lung Diseases/etiology* ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/diagnosis ; Pain, Postoperative/drug therapy ; Postoperative Complications/etiology* ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; ROC Curve ; Respiratory Function Tests ; Respiratory Paralysis/etiology ; Spirometry ; Vital Capacity/physiology ; Young Adult
BACKGROUND: Diaphragmatic dysfunction is a major factor in the etiology of postoperative pulmonary complications after upper abdominal surgery. M-mode ultrasonography is now an accepted qualitative method of assessing diaphragmatic motion in normal and pathological conditions. In this study, we evaluated whether diaphragmatic inspiratory amplitude (DIA) as measured by M-mode sonography can be a predictor of pulmonary dysfunction.

METHODS: A prospective, single-center, single-unit, observational study was performed in 35 ASA physical status I and II nonsmoking patients undergoing open liver lobectomy. Diaphragmatic movements were assessed by M-mode sonography after a pulmonary function test preoperatively and on postoperative days (PODs) 1, 2, and 7. We measured the DIA (cm) during quiet, deep, and sniff breathing.

RESULTS: After liver lobectomy, DIA during deep breathing and vital capacity (VC) showed significant reductions of 60% from their preoperative values on PODs 1 and 2 (P < 0.001). By POD 7, the variables recovered significantly, by 30% from the values on PODs 1 and 2 (P < 0.001). During deep breathing, DIA showed a significant correlation with VC (r = 0.839, P < 0.0001). The best cutoff values of DIA for detecting 30% and 50% decreases of VC from preoperative values, calculated by receiver operating characteristic analysis, were 3.61 and 2.41 cm, with sensitivity of 94% and 81% and specificity of 76% and 91%, respectively (P = 0.0001). Two patients showed postoperative diaphragmatic paralysis but did not complain of respiratory distress symptoms or need supplemental oxygen after being transferred to the general ward.

CONCLUSIONS: DIA using M-mode sonography showed a linear correlation with VC measured by spirometry throughout the postoperative period. We conclude that using the M-mode sonographic technique at the bedside can be a practical way to investigate postoperative diaphragmatic dysfunction, and may also be an effective bedside screening method for diaphragmatic paralysis.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koh, Shin Ok(고신옥)
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Na, Se Hee(라세희) ORCID logo https://orcid.org/0000-0003-4208-0769
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Choi, Jin Sub(최진섭)
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