Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility

Christopher Brown, Shih-Chiao Tseng, Katy Mitchell, Toni Roddey, Christopher Brown, Shih-Chiao Tseng, Katy Mitchell, Toni Roddey

Abstract

Purpose: (1) Determine whether ultrasonography can detect differences in diaphragm contractility between body positions. (2) Perform reliability analysis of diaphragm thickness measurements in each test condition.

Methods: We used a repeated-measures experimental design with 45 healthy adults where 3 B-mode ultrasound images were collected at peak-inspiration and end-expiration in supine, sitting, and standing. Mean diaphragm thickening fractions were calculated for each test position. Statistical significance was tested using 1-way repeated-measures analysis of variance with planned comparisons. For reliability analysis, the intraclass correlation coefficient (3, 3) was calculated.

Results: Mean diaphragm thickening fraction increased from 60.2% (95% confidence interval [CI] 53.0%, 67.9%) in supine, to 96.5% (95% CI 83.2%, 109.9%) while seated and to 173.8% (95% CI 150.5%, 197.1%) while standing. Body position was a significant factor overall (P < .001), as were comparisons between each individual position (P < .001). Intraobserver reliability was excellent (>0.93) for all body positions tested.

Conclusions: Ultrasound imaging detected positional differences in diaphragm contractility. The effect of gravitational loading on diaphragm length-tension, and body position-mediated changes in intra-abdominal pressure may explain the differences found. Future research should address methodological concerns and apply this method to patients participating in early mobilization programs in the intensive care unit.

Keywords: diaphragm; patient positioning; ultrasonography.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Processed ultrasound image of the diaphragm. These images were acquired from a 22-year-old woman while standing. At the moment of end-expiration (left panel), the muscle thickness measured 0.17 cm, and at peak-inspiration (right panel) measured 0.60 cm. Note the difference in diaphragm muscle thickness between the 2 conditions. The layers of tissue are as follows (from superficial to deep): (A) subcutaneous tissue layer, (B) anterolateral abdominal wall muscles (ie, external oblique, internal oblique, and transversus abdominis), (C) intercostal muscles (external intercostal, internal intercostal, and innermost intercostal), and (D) the diaphragm, bordered superficially by the pleural membrane, and deeply by the peritoneal membrane.
Fig. 2.
Fig. 2.
Mean diaphragm thickening fractions (including 95% confidence interval bars), by position. # Statistically significant difference, P < .001.

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