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Diaphragm motion and lung function prediction in patients operated for lung cancer--a pilot study on 27 patients.

Subotic DR, Stevic R, Gajic M, Vesovic R - J Cardiothorac Surg (2013)

Bottom Line: A significant positive correlation was found for the entire group only between the patients' height and the differences ppo FEV1 - actual FEV1: the prediction was more unprecise in taller patients.With the cut-off value of 550 ml for differences between ppo FEV1 and actual FEV1, a significant inverse correlation was found only if the preoperative ipsilateral diaphragm amplitude was presented as a percentage of the preoperative apex-base distance in inspiration.Diaphragm movements influence the accuracy of the postoperative lung function prediction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinic for Thoracic Surgery, Clinical Center of Serbia, University of Belgrade School of Medicine, 26/20, Visegradska Street, 11000 Belgrade, Serbia. profsubotic@gmail.com.

ABSTRACT

Background: The influence of the diaphragm motion to the accuracy of postoperative lung function prediction after the lung resction is still debatable.

Methods: Prospective study that included 27 patients who underwent a lung resection for cancer. Diaphragm movements were assessed radiographically and by ultrasonography before the operation and postoperatively, with the lung fully expanded. The relationship between the diaphragm movements and differences between ppo FEV1 and measured postoperative FEV1, was analysed by expressing diaphragm movements as preoperative diaphragm amplitudes, preoperative-postoperative amplitude differences or in relation to fixed intrathoracic distances.

Results: The mean difference between preoperative and postoperative diaphragm amplitudes of the diseased side was 2.42 ± 1.25 cm and 2.11 ± 2.04 cm when measured radiographically and by ultra sound respectively (p > 0.05). A significant positive correlation was found for the entire group only between the patients' height and the differences ppo FEV1 - actual FEV1: the prediction was more unprecise in taller patients. With the cut-off value of 550 ml for differences between ppo FEV1 and actual FEV1, a significant inverse correlation was found only if the preoperative ipsilateral diaphragm amplitude was presented as a percentage of the preoperative apex-base distance in inspiration. For right-sided tumours, the greater the difference between preoperative and postoperative ipsilateral diaphragm amplitudes, the greater discrepancy between predicted and actual postoperative FEV1. For left-sided tumours, inverse correlation existed if the preoperative diaphragm amplitude was presented as a percentage of the preoperative distance apex-base.

Conclusion: Diaphragm movements influence the accuracy of the postoperative lung function prediction.

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Related in: MedlinePlus

Ultra-sonographic measurement of diaphragm movements. Craniocaudal ultrasound image of the right diaphragm during inspiration (top) and expiration (bottom). Hemidiaphragm movements are measured as shown (arrows).
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Figure 2: Ultra-sonographic measurement of diaphragm movements. Craniocaudal ultrasound image of the right diaphragm during inspiration (top) and expiration (bottom). Hemidiaphragm movements are measured as shown (arrows).

Mentions: With the patient in the supine, 45° semirecumbent position, a 3.75-MHz convex transducer was placed subcostally between the mid-clavicular and mid-axillary line symmetrically to obtain a sagital plane of the hemidiaphragm during all phases of respiration. After identifying the dome of the right and left hemidiaphragm, two-dimensional (2D) scans were performed, by using a real-time gray scale technology in the sagital plane, that included the maximal renal bipolar length. The position of the diaphragm was measured relative to the renal pelvis from the 2D images obtained. Craniocaudal excursion was measured from the renal pelvis to a point on the diaphragm lying at the same depth from the transducer on the ultrasonographic scan (Figure 2). The distance between these points was measured on maximal inspiration and at the end of a forced expiration. For each maneuver, at least three satisfactory readings were taken before selecting a value to be used for analysis.


Diaphragm motion and lung function prediction in patients operated for lung cancer--a pilot study on 27 patients.

Subotic DR, Stevic R, Gajic M, Vesovic R - J Cardiothorac Surg (2013)

Ultra-sonographic measurement of diaphragm movements. Craniocaudal ultrasound image of the right diaphragm during inspiration (top) and expiration (bottom). Hemidiaphragm movements are measured as shown (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3842649&req=5

Figure 2: Ultra-sonographic measurement of diaphragm movements. Craniocaudal ultrasound image of the right diaphragm during inspiration (top) and expiration (bottom). Hemidiaphragm movements are measured as shown (arrows).
Mentions: With the patient in the supine, 45° semirecumbent position, a 3.75-MHz convex transducer was placed subcostally between the mid-clavicular and mid-axillary line symmetrically to obtain a sagital plane of the hemidiaphragm during all phases of respiration. After identifying the dome of the right and left hemidiaphragm, two-dimensional (2D) scans were performed, by using a real-time gray scale technology in the sagital plane, that included the maximal renal bipolar length. The position of the diaphragm was measured relative to the renal pelvis from the 2D images obtained. Craniocaudal excursion was measured from the renal pelvis to a point on the diaphragm lying at the same depth from the transducer on the ultrasonographic scan (Figure 2). The distance between these points was measured on maximal inspiration and at the end of a forced expiration. For each maneuver, at least three satisfactory readings were taken before selecting a value to be used for analysis.

Bottom Line: A significant positive correlation was found for the entire group only between the patients' height and the differences ppo FEV1 - actual FEV1: the prediction was more unprecise in taller patients.With the cut-off value of 550 ml for differences between ppo FEV1 and actual FEV1, a significant inverse correlation was found only if the preoperative ipsilateral diaphragm amplitude was presented as a percentage of the preoperative apex-base distance in inspiration.Diaphragm movements influence the accuracy of the postoperative lung function prediction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinic for Thoracic Surgery, Clinical Center of Serbia, University of Belgrade School of Medicine, 26/20, Visegradska Street, 11000 Belgrade, Serbia. profsubotic@gmail.com.

ABSTRACT

Background: The influence of the diaphragm motion to the accuracy of postoperative lung function prediction after the lung resction is still debatable.

Methods: Prospective study that included 27 patients who underwent a lung resection for cancer. Diaphragm movements were assessed radiographically and by ultrasonography before the operation and postoperatively, with the lung fully expanded. The relationship between the diaphragm movements and differences between ppo FEV1 and measured postoperative FEV1, was analysed by expressing diaphragm movements as preoperative diaphragm amplitudes, preoperative-postoperative amplitude differences or in relation to fixed intrathoracic distances.

Results: The mean difference between preoperative and postoperative diaphragm amplitudes of the diseased side was 2.42 ± 1.25 cm and 2.11 ± 2.04 cm when measured radiographically and by ultra sound respectively (p > 0.05). A significant positive correlation was found for the entire group only between the patients' height and the differences ppo FEV1 - actual FEV1: the prediction was more unprecise in taller patients. With the cut-off value of 550 ml for differences between ppo FEV1 and actual FEV1, a significant inverse correlation was found only if the preoperative ipsilateral diaphragm amplitude was presented as a percentage of the preoperative apex-base distance in inspiration. For right-sided tumours, the greater the difference between preoperative and postoperative ipsilateral diaphragm amplitudes, the greater discrepancy between predicted and actual postoperative FEV1. For left-sided tumours, inverse correlation existed if the preoperative diaphragm amplitude was presented as a percentage of the preoperative distance apex-base.

Conclusion: Diaphragm movements influence the accuracy of the postoperative lung function prediction.

Show MeSH
Related in: MedlinePlus