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

Abstract

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.

• Authors: Soo Hwan Kim, Sungwon Na, Jin-Sub Choi, Se Hee Na, Seokyung Shin, Shin Ok Koh
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 110 Issue 5 Pg. 1349-54 (May 01 2010) ISSN: 1526-7598 [Electronic] United States
• PMID: 20418298 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Abdomen (surgery)
• Adolescent
• Adult
• Aged
• Analgesia, Patient-Controlled
• Anesthesia, General
• Diaphragm (diagnostic imaging, physiopathology)
• Digestive System Surgical Procedures
• Echocardiography
• Female
• Humans
• Liver (surgery)
• Lung Diseases (etiology)
• Male
• Middle Aged
• Pain Measurement
• Pain, Postoperative (diagnosis, 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