ORIGINAL ARTICLE

Sonographic assessment of changes in diaphragmatic kinetics induced by inspiratory resistive loading

  1. Eleni Soilemezi1,*,
  2. Matthew Tsagourias1,
  3. Michael A. Talias3,
  4. Elpidoforos S. Soteriades4,5,
  5. Vasilios Makrakis1,
  6. Epaminondas Zakynthinos2,
  7. Dimitrios Matamis1

Article first published online: 21 MAR 2013

DOI: 10.1111/resp.12011

Issue

Respirology

Respirology

Volume 18, Issue 3, pages 468–473, April 2013

Additional Information

How to Cite

Soilemezi, E., Tsagourias, M., Talias, M. A., Soteriades, E. S., Makrakis, V., Zakynthinos, E. and Matamis, D. (2013), Sonographic assessment of changes in diaphragmatic kinetics induced by inspiratory resistive loading. Respirology, 18: 468–473. doi: 10.1111/resp.12011

Author Information

  1. 1

    ICU Department, Papageorgiou Hospital, Thessaloniki

  2. 2

    ICU Department, University Hospital of Larissa, University of Thessaly, Thessaly, Greece

  3. 3

    Healthcare Management Program, Open University of Cyprus, Nicosia, Cyprus

  4. 4

    Department of Occupational and Environmental Medicine, Cyprus Institute of Biomedical Sciences, Nicosia, Cyprus

  5. 5

    Department of Environmental Health, Environmental and Occupational Medicine, and Epidemiology, Harvard School of Public Health, Boston, MA, USA

*Correspondence: Eleni Soilemezi, ICU Department, Papageorgiou General Hospital, N. Efkarpia, GR 56403, Thessaloniki, Greece. Email: elenisoil@hotmail.com

  1. Associate Editor: David Feller-Kopman

Publication History

  1. Issue published online: 21 MAR 2013
  2. Article first published online: 21 MAR 2013
  3. Accepted manuscript online: 5 NOV 2012 07:07AM EST
  4. Manuscript Accepted: 10 SEP 2012
  5. Manuscript Revised: 31 AUG 2012
  6. Manuscript Received: 1 JUL 2012

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Keywords:

  • airway resistance;
  • diaphragm;
  • respiratory mechanics;
  • respiratory muscle;
  • ultrasound

Abstract

Background and objective

Diaphragmatic breathing patterns under resistive loading remain poorly documented. To our knowledge, this is the first study assessing diaphragmatic motion under conditions of inspiratory resistive loading with the use of sonography.

Methods

We assessed diaphragmatic motion during inspiratory resistive loading in 40 healthy volunteers using M-mode sonography. In phase I of the study, sonography was performed during normal quiet breathing without respiratory loading. In phase II, sonography was performed after application of a nose clip and connection of the subjects to a pneumotachograph through a mouth piece. In phase III, the participants were assessed while subjected to inspiratory resistive loading of 50 cm H2O/L/s.

Results

Compared with baseline, the application of a mouth piece and nose clip induced a significant increase in diaphragmatic excursion (from 1.7 to 2.3 cm, P < 0.001) and a decrease in respiratory rate (from 13.4 to 12.2, P < 0.01). Inspiratory resistive loading induced a further decrease in respiratory rate (from 12.2 to 8.0, P < 0.01) and a decrease in diaphragmatic velocity contraction (from 1.2 to 0.8 cm/s, P < 0.01), and also an increase in tidal volume (from 795 to 904 mL, P < 0.01); diaphragmatic excursion, however, did not change significantly.

Conclusions

Inspiratory resistive loading induced significant changes in diaphragmatic contraction pattern, which mainly consisted of decreased velocity of diaphragmatic displacement with no change in diaphragmatic excursion. Tidal volume, increased significantly; the increase in tidal volume, along with the unchanged diaphragmatic excursion, provides sonographic evidence of increased recruitment of extradiaphragmatic muscles under inspiratory resistive loading.

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