The Evaluation of Referance Values for Diaphragmatic Excursion in Turkish Population

Öz

Background: The diaphragm is the largest respiratory muscle that contributes to the respiratory work. The aim of this study was to measure the diaphragm excursion, which shows diaphragm function in healthy volunteers, and to determine the reference values in the Turkish population.

Material-Methods: This cross-sectional descriptive study was carried out at a university hospital between 01.01-01.04.2019. Two hundred and thirthy (230) healthy subjects had no history of pulmonar or neuromusculary disease were included in the study. Age, sex and diaphragmatic excursion measurements of subjects were recorded. Measurements were obtained by lung silhouette, anterior and Right Hemidiaphmgm and Left Hemidiaphragm Ultrasonographic Method with M  Mode. p<0.05 was considered statistically significant.

Results: 230 healthy subjects were included in the study. The male/female ratio was 1.04. No statistically significant difference was found between male and female in terms of age and body mass index. It is concluded that there were statistically significant higher LungSilR, Ant Ax. B Mode R, Ant Ax. B Mode L, Ant. Ax. M Mode R, Ant. Ax. M Mode L of male than female sex. There were a significantly strong positive association between LungSilR and LungSilL, Ant Ax. B Mode R and Ant Ax. B Mode L,  Ant. Ax. M Mode R and Ant. Ax. M Mode L.There were a significantly strong positive association between LungSilR and Ant Ax. B Mode R, LungSilL and Ant Ax. B Mode L; significantly weak association between LungSilR and Ant Ax. M Mode R, Ant Ax. B Mode R and Ant. Ax. M Mode R, LungSilL and Ant Ax. M Mode L, Ant Ax. B Mode L and Ant. Ax. M Mode L.

Conclusion: It was concluded that diaphragmatic excursion in theTurkish population was 55.9 - 62 mm in female sex and 67.1 - 71 mm in male sex, since it was found that there was no obstacle in the creation of reference values due to changes in measurement methods and direction, and correlation was found in all methods and right-left measurements for diaphragmatic excursion results.

Anahtar Kelimeler

• diaphragm ultrasonography,excursion,healthy subjects,referans values,Turkish population

Kaynakça

1. 1. Yamaguti WPS, Paulin E, Shibao S, Kodaira S, Chammas MC, Carvalho CRF. Ultrasound evaluation of diaphragmatic mobility in different postures in healthy subjects. J Bras Pneumol 2007;33: 407–413.
2. 2. Scillia P, Cappello M, De Troyer A. Determinants of diaphragm motion in unilateral diaphragmatic paralysis. J Appl Physiol 2004;96: 96–100.
3. 3. Hart N, Nickol AH, Cramer D,Ward SP, Lofaso F, Pride NB, Moxham J, Polkey MI. Effect of severe isolated unilateral and bilateral diaphragm weakness on exercise performance. Am J Respir Crit Care Med 2002;165:1265–1270.
4. 4. Ueki J, De Bruin PF, Pride NB. In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax. 1995;50(11):1157–1161.
5. 5. Cohn D, Benditt JO, Eveloff S, McCool FD. Diaphragm thickening during inspiration. J Appl Physiol. 1997;83(1):291–296.
6. 6. Toledo NS, Kodaira SK, Massarollo PC, Pereira OI, Mies S. Right hemidiaphragmatic mobility: assessment with US measurement of cran¬iocaudal displacement of left branches of portal vein. Radiology. 2003;228(2):389–394.
7. 7. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest. 2009;135(2):391–400.
8. 8. Houston JG, Morris AD, Howie CA, Reid JL, McMillan N. Technical report: quantitative assessment of diaphragmatic movement – a repro¬ducible method using ultrasound. Clin Radiol. 1992;46(6):405–407.

9. 9. Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N. Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol 2011;37:44–52.
10. 10. Lerolle N, Guerot E, Dimassi S, Zegdi R, Faisy C, Fagon JY, Diehl JL. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 2009;135:401–407.
11. 11. Lloyd T, Tang YM, Benson MD, King S. Diaphragmatic paralysis: The use of M-mode ultrasound for diagnosis in adults. Spinal Cord 2006;44:505–508.
12. 12. Akiyama N, Ishikawa S, Takeuchi T. Ultrasonographic evaluation of the influence of different postures on diaphragmatic motion in mechanically ventilated patients. Eur J Ultrasound 2000;11:205–211.
13. 13. Kantarci F, Mihmanli I, Demirel MK, Harmanci K, Akman C, Aydogan F, Mihmanli A, Uysal O. Normal diaphragmatic motion and the effects of body composition: Determination with M-mode sonography. J Ultrasound Med 2004;23:255–260.
14. 14. Boon AJ, Harper CJ, Ghahfarokhi LS, Strommen JA, Watson JC, Sorenson EJ. Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve. 2013;47(6):884-9.
15. 15. Cimsit C, Bekir M, Karakurt S, Eryüksel E. Ultrasound assessment of diaphragm thickness in COPD. Marmara Medical Journal 2016; 29: 8-13.
16. 16. Smargiassi A, Inchingolo R, Tagliaboschi L et al. Ultrasonographic assessment of the diaphragm in COPD patients: relationships with pulmonary function and the influence of body composition-a pilot study. Respiration 2014; 87: 364-71.
17. 17. Haber K, Asher M, Freimanis AK. Echographic evaluation of diaphragmatic motion in intra-abdominal diseases. Radiology 1975;114: 141–144. 18. Topeli A , Laghi F , Tobin MJ . The voluntary drive to breathe is not decreased in hypercapnic patients with severe COPD . Eur Respir J . 2001 ; 18 ( 1 ): 53 - 60. 19. Baria MR, Shahgholi L, Sorenson EJ, Harper CJ, Lim K, Strommen JA, Mottram CD, Boon AJ. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest 2014; 146: 680-685.
18. 20. Goligher EC, Laghi F, Detsky M.E. Measuring diaphragm thicknesswith ultrasound in mechanically ventilatedpatients: feasibility, reproducibility and validity. Intensive Care Med. 2015 Apr;41(4):642-9. doi: 10.1007/s00134-015-3687-3. Epub 2015 Feb 19.
19. 21. Scott S, Fuld JP, Carter R, McEntegart M, MacFarlane NG. Diaphragm ultrasonography as an alternative to whole-body plethysmography in pulmonary function testing. J Ultrasound Med 2006;25:225–232.