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Improving ultrasonic measurement of diaphragmatic excursion after cardiac surgery using the anatomical M-mode: a randomized crossover study

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Abstract

Purpose

Motion-mode (MM) echography allows precise measurement of diaphragmatic excursion when the ultrasound beam is parallel to the diaphragmatic displacement. However, proper alignment is difficult to obtain in patients after cardiac surgery; thus, measurements might be inaccurate. A new imaging modality named the anatomical motion-mode (AMM) allows free placement of the cursor through the numerical image reconstruction and perfect alignment with the diaphragmatic motion. Our goal was to compare MM and AMM measurements of diaphragmatic excursion in cardiac surgical patients.

Methods

Cardiac surgical patients were studied after extubation. The excursions of the right and left hemidiaphragms were measured by two operators, an expert and a trainee, using MM and AMM successively, according to a blinded, randomized, crossover sequence. Values were averaged over three consecutive respiratory cycles. The angle between the MM and AMM cursors was quantified for each measurement.

Results

Fifty patients were studied. The mean (±SD) angle between the MM and AMM cursors was 37° ± 16°. The diaphragmatic excursion as measured by experts was 1.8 ± 0.7 cm using MM and 1.5 ± 0.5 cm using AMM (p < 0.001). Overall, the diaphragmatic excursion as estimated by MM was larger than the value obtained with AMM in 75 % of the measurements. Bland-Altman analysis showed tighter limits of agreement between experts and trainees with AMM [bias: 0.0 cm; 95 % confidence interval (CI): 0.8 cm] than with MM (bias: 0.0 cm; 95 % CI: 1.4 cm).

Conclusion

MM overestimates diaphragmatic excursion in comparison to AMM in cardiac surgical patients. Using MM may lead to a lack of recognition of diaphragmatic dysfunction.

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Conflicts of interest

The authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, AP-HP, Paris, France

    Daniela Pasero, Adrien Koeltz, Rui Placido, Mariana Fontes Lima, Olivia Haun, Mario Rienzo, David Marrache, Romain Pirracchio, Denis Safran & Bernard Cholley

  2. Anaesthesia and Critical Care Medicine Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy

    Daniela Pasero

  3. Service de Biostatistiques et Informatique Médicale, INSERM U1153, Université Paris Diderot, Sorbonne Paris-Cité, Paris, France

    Romain Pirracchio

  4. Université Paris Descartes, Sorbonne Paris-Cité, Paris, France

    Denis Safran & Bernard Cholley

Authors
  1. Daniela Pasero
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  2. Adrien Koeltz
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  3. Rui Placido
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  4. Mariana Fontes Lima
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  5. Olivia Haun
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  6. Mario Rienzo
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  7. David Marrache
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  8. Romain Pirracchio
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  9. Denis Safran
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  10. Bernard Cholley
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Corresponding authors

Correspondence to Daniela Pasero or Bernard Cholley.

Additional information

Take-home message:

Anatomical M-mode might be preferable compared to regular M-mode to measure diaphragmatic excursion after cardiac surgery. By avoiding frequent overestimation in measurements, this technique is more likely to identify diaphragmatic dysfunction in patients.

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Pasero, D., Koeltz, A., Placido, R. et al. Improving ultrasonic measurement of diaphragmatic excursion after cardiac surgery using the anatomical M-mode: a randomized crossover study. Intensive Care Med 41, 650–656 (2015). https://doi.org/10.1007/s00134-014-3625-9

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  • DOI: https://doi.org/10.1007/s00134-014-3625-9

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