Diaphragm Thickness Research Articles

Numerical and theoretical studies on the tensile strength and stiffness of plate-to-CFST column connections reinforced with internal T-shaped diaphragms

The internal T-shaped diaphragm for steel beam to square concrete-filled steel tubular (CFST) column connections is an improvement over conventional internal diaphragms in terms of construction, cost, and mechanical property. The performance of steel beam to square CFST column connections reinforced with internal T-shaped diaphragms is evaluated by conducting static tensile load in this study. Finite element models (FEM) were established and verified, including 24 plate-to-square CFST column connections with internal T-shaped diaphragms in the weak direction (PTC-WD connections), 20 plate-to-square CFST column connections with internal T-shaped diaphragms in the strong direction (PTC-SD connections), and 16 plate-to-square CFST column connections with conventional internal diaphragms (PTC-CID connections) for comparative study. The effects of tube thickness, diaphragm thickness, anchor plate size, beam flange width, concrete filling, and tube width on the tensile behavior of the connections were studied numerically. Additionally, the stress distribution of the tube, the beam flange, the divided diaphragm, the anchor plate, and the infilled concrete are analyzed. The results showed that the tensile strength and stiffness of PTC-WD connections were improved tremendously due to the anchoring effect, and its strength and stiffness were superior to those of PTC-SD connections and PTC-CID connections under the same conditions. Based on the assumed failure mechanism of each component, the theoretical models and formulas for the tensile strength and stiffness of the connections were provided. It was found that the theoretical strength and stiffness coincide well with those of FEM results and test results.

The effect of protein enriched nutrition on diaphragm function in mechanically ventilated patients

ObjectivesOur primary aim was to demonstrate the effect of high protein on diaphragm muscle thickness, our secondary aim was to evaluate the correlation of diaphragm thickness fraction with rectus femoris muscle thickness in high protein patients. Patients and methodsThis study included 49 mechanically ventilated patients who were randomly divided into a standard protein (1.2g/kg/d) group and high protein group (2.0g/kg/d). Thickness of rectus femoris, thickness of peak inspiratory diaphragm, thickness of end expiratory diaphragm were measured by ultrasonography. Thickness fraction of diaphragm was calculated. ResultsIn the high protein group, thickness of peak inspiratory diaphragm values were found to be statistically significantly higher on days 3rd, 5th, 7th, and 15th (P<0.05). Thicknesses of end-expiratory diaphragm values were found to be statistically significantly higher on the 3rd, 5th and 7th days (P<0.05). Thicknesses fraction of diaphragm values were found to be statistically significantly higher on days 3rd, 5th, 7th and 15th (P<0.05) in the high protein group. Thicknesses of rectus femoris values were higher in the high protein group compared with standard protein group on the 5th, 7th, and 15th days (P<0.005). In high protein group, statistically significant correlations were found between thickness of rectus femoris and thickness fraction of diaphragm at the 3rd day (rho=0.429, P=0.032). ConclusionThis study showed that diaphragmatic muscle thicknesses were higher in patients who received 2g/kg/d protein supplement, These findings have shown that muscle atrophy can be prevented with high protein support in the intensive care unit.

Experimental research on the launching system of auxiliary charge with filter cartridge structure

A launching system with a filter cartridge structure was proposed to improve the muzzle velocity of the projectile. The combustion chamber of the launching system is divided into two fixed chambers, one is located in the breech chamber, and the other is arranged in the barrel. The breech chamber charge was ignited first, and the charges in the auxiliary chambers were ignited by the high-temperature, high-pressure combustible gas trailing the projectile. In this way, the combustible gas in the auxiliary chambers could compensate for the pressure drop caused by the movement of the projectile. The proposed device features the advantage of launching a projectile with high muzzle velocity without exceeding the maximum pressure in the chamber. In order to obtain some internal ballistic characteristics of the launch system, some critical structure, such as the length of the filter cartridge auxiliary charge, the combustion degree of the propellant in the chamber, and the length of the barrel, are discussed. The experimental results show that with the increased auxiliary charge length, a pressure plateau or even a secondary peak pressure can be formed, which is less than the peak pressure. The projectile velocity increased by 23.57%, 14.64%, and 7.65% when the diaphragm thickness was 0 mm, 1 mm, and 2 mm, respectively. The muzzle velocity of the projectile can be increased by 13.42% by increasing the length of the barrel. Under the same charge condition, with the increase of barrel length, the energy utilization rate of propellant increases by 28.64%.

Evaluation of Diaphragmatic Thickness and Dysfunction by Ultrasonography in Mechanically Ventilated Children for Assessment of Extubation Success

This study aimed to evaluate diaphragm thickness (DT) and diaphragmatic thickening fraction (DTF) in mechanically ventilated children, and study the association of these measurements with extubation success. Consecutive children aged one month to 18 years, who required mechanical ventilation (MV) for more than 24 hours at our institution, were enrolled between April, 2019 to October, 2020. Ultrasonographic measure-ments of DT were documented, and DTF was calculated from baseline (within 24 hours of MV) until 14 days of MV, and up to three days post-extubation. Of the 54 children-enrolled, 40 underwent planned extubation trial, of which 9 (22.5%) had extubation failure. Pre-extubation and post-extubation DTF between children in extubation-success and extubation-failure groups were comparable (P=0.074). There was no significant difference in the diaphragm atrophy rate between the two groups (P=0.819). Binary logistic regression showed significantly decreased probability of successful extubation with total ventilation duration (P=0.012) and mean DTF% before extubation (P=0.033). Despite evidence of diaphragmatic atrophy in critically ill children receiving mechanical ventilation, there was no significant difference in DTF between extubation success and failure groups.

Assessment of excursion and thickness of diaphragm by ultrasound during acute exacerbation of chronic obstructive pulmonary disease and correlation with severity of airway obstruction

Background: Diaphragm dysfunction in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to increased morbidity and mortality. Early diagnosis of diaphragm dysfunction and aggressive management to improve the diaphragm function and may improve the outcome in AECOPD. Aims and Objectives: This study aimed to assess diaphragmatic excursion by ultrasound during AECOPD and correlation with the severity of airway obstruction. Materials and Methods: Sixty patients admitted with AECOPD were evaluated. Ultrasonography was done to assess the diaphragm excursion and thickness. Airway obstruction was classified as moderate, severe, and very severe by measuring forced expiratory volume in 1 s (FEV1). Comparison of excursion and thickness of the diaphragm in the study patients was done with normal values and analyzed using Student's t-test. Values of measured FEV1 were correlated with the normal values of excursion and thickness of the diaphragm and statistical analysis was done by ANOVA test. Results: Forty-six males and four females were included in the study. Thirty-four percent (17) had moderate COPD, 60% (30) had severe COPD, and 6% (3) had very severe COPD. The mean excursion and thickness of the diaphragm in the study patients were less when compared to the normal values. In moderate COPD, the mean excursion of the diaphragm was 29.94 mm, whereas in those with severe and very severe COPD, the mean excursions were 26.77 mm and 23.33 mm, respectively. Statistical analysis by ANOVA test was done to compare the diaphragm excursion and severity of COPD. The P = 0.039 was considered statistically significant. Patients with moderate COPD (34%) showed a mean diaphragm thickness of 2.82 mm, and those with severe (60%) and very severe (6%) COPD showed a diaphragm thickness of 2.23 mm and 2.00 mm, respectively. Statistical analysis by ANOVA test was done to compare the diaphragm thickness and severity of COPD. The P < 0.001 was considered statistically significant. Conclusions: Patients with AECOPD have reduced excursion and thickness of the diaphragm in comparison with normal subjects. Diaphragm dysfunction increases as the severity of airflow obstruction in COPD increases.

Efeitos da COVID-19 na espessura diafragmática e desempenho físico de atletas

Abstract Introduction Studies suggest that diaphragm thickness (DT) is associated with inspiratory muscle strength and consequently, better ventilatory and mechanical efficiency. On the other hand, infectious diseases such as COVID-19 may impact the structure and function of the respiratory system. Objective Assess the association between DT and the physical performance (PP) of athletes and the effects of COVID-19 infection on these parameters. Methods This is a cross-sectional study of 63 athletes of both sexes from different sport modalities (women: 16.67 ± 5.03 years, 52.09 ± 14.01 kg, 155.90 ± 13.86 cm; men: 23.44 ± 9.65 years, 72.24 ± 14.18 kg, 174.84 ± 6.84 cm), submitted to DT assessment using ultrasound, followed by the PP(Yo-Yo) test) to determine maximum oxygen intake (VO2max). Pearson’s correlation was used to determine the association between VO2max and DT, and the Student’s t-test for differences between athletes with a positive and negative diagnosis for COVID-19. The significance level was set at 5%. Results There was no association between DT and PP (r = 0.30 and p = 0.22) or between athletes unaffected and affected by COVID-19 in relation to DT (57.00 ± 0.26 vs 52.00 ± 0.25%; p = 0.91) and PP (43.88 ± 2.29 vs 38.34 ± 13.61 ml/kg/min; p = 0.69). Conclusion DT was not associated with maximum oxygen intake in athletes. In addition, athletes infected by COVID-19 exhibited no differences in VO2max or DT when compared to nonaffected individuals.

Crashworthiness performance of gradient energy-absorbing structure for subway vehicles under quasi-static loading

&lt;abstract&gt;&lt;p&gt;To improve the uncertainty of the deformation sequence of the energy-absorbing structures at the end of the subway vehicles during crushing, this paper adopts the gradient design idea of honeycomb structure size, collapse initiator groove and diaphragm. To this end, this paper proposes a honeycomb-filled gradient energy-absorbing structure (HGES) as an energy absorber. The crashworthiness of HGES under axial crushing was investigated by means of finite element (FE) simulations and quasi-static loading tests. After performing parametric analyses on HGES, it was discovered that the wall thickness and the platform intensity of honeycomb had an evident impact, whereas the diaphragm thickness had a relatively little impact on the crashworthiness of HGES. The HGES is then given a multi-objective optimization to further enhance its crashworthiness. The wall thickness, the platform intensity of honeycomb and diaphragm thickness were utilized as the design parameters, while minimal peak crushing force (&lt;italic&gt;PCF&lt;/italic&gt;) and maximal specific energy absorption (&lt;italic&gt;SEA&lt;/italic&gt;) were set as optimization objectives. Finally, a methodology integrating entropy and the order preference by similarity to an ideal solution (TOPSIS) is employed to find the optimal HGES configuration. The &lt;italic&gt;SEA&lt;/italic&gt; and &lt;italic&gt;PCF&lt;/italic&gt; of optimized HGES are enhanced by 19.81 and 25.28%, respectively, when compared to the baseline.&lt;/p&gt;&lt;/abstract&gt;

Effects of intradialytic inspiratory muscle training at different intensities on diaphragm thickness and functional capacity: clinical trial protocol in patients undergoing haemodialysis

IntroductionPatients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) commonly present with a sedentary behaviour and reduced functional capacity, factors that can compromise their prognosis. Intradialytic inspiratory muscle training (IMT)...

Diaphragmatic Dynamics and Thickness Parameters Assessed by Ultrasonography Predict Extubation Success in Critically Ill Patients.

A frequent cause of weaning and extubation failure in critically ill mechanically ventilated patients is diaphragm muscle dysfunction. Ultrasound (US) evaluation of the diaphragm yields important data regarding its thickness (diaphragm thickening fraction [TFdi]) and its movement or excursion (diaphragmatic dynamics) that reveal the presence of diaphragmatic dysfunction. Cross-sectional study, which included patients older than 18 years with invasive mechanical ventilation with an expected duration of more than 48 h, in a tertiary referral center in Colombia. The excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi were evaluated by US. Prevalence and use of medications were evaluated, and the association with failure in ventilatory weaning and extubation was analyzed. Sixty-one patients were included. The median age and APACHE IV score were 62.42 years and 78.23, respectively. The prevalence of diaphragmatic dysfunction (assessed by excursion and TFdi) was 40.98%. The sensibility, specificity, positive predictive value, and negative predictive value for TFdi < 20% was 86%, 24%, 75%, and 40%, respectively, with an area under the receiver operating characteristic (ROC) curve of 0.6. The ultrasonographic analysis of excursion of the diaphragm, inspiratory and expiratory thickness, and TFdi (>20%) allow in its set and with normal values, predict success or failure for the extubation with an area under the ROC curve of 0.87. Diaphragmatic dynamics and thickness parameters together assessed by ultrasonography could predict the success of extubation in critically ill patients in Colombia, based on the finding of diaphragmatic dysfunction.

Effects of COVID-19 on diaphragm thickness and physical performance of athletes

Resumo Introdução Estudos sugerem que a espessura diafrag-mática (ED) está associada à força muscular inspiratória e, consequentemente, à melhor eficiência ventilatória e mecânica. Por outro lado, doenças infecciosas como a COVID-19 podem impactar a estrutura e função do apa-relho respiratório. Objetivo Avaliar a associação entre a ED e o desempenho físico (DF) de atletas e os efeitos da infecção por COVID-19 sobre esses parâmetros. Métodos Trata-se de um estudo transversal envolvendo 63 atletas de diferentes modalidades esportivas, de ambos os sexos (feminino: 16,67 ± 5,03 anos, 52,09 ± 14,01 kg, 155,90 ± 13,86 cm; masculino 23,44 ± 9,65 anos, 72,24 ± 14,18 kg, 174,84 ± 6,84 cm), que foram submetidos à avaliação da ED por meio de ultrassom e, em seguida, ao teste de DF (Yo-Yo test) para determinar o consumo máximo de oxigênio (VO2max). Utilizou-se a correlação de Pearson para verificar a associação entre VO2max e ED, e o teste t de Student para diferenças entre atletas com diagnóstico positivo e negativo para COVID-19. O nível de significância foi ajustado em 5%. Resultados Não houve associação entre ED e DF (r = 0,30 e p = 0,22) e não houve diferença entre os atletas não infectados e infectados por COVID-19 em relação à ED (57,00 ± 0,26 vs 52,00 ± 0,25%; p = 0,91) e DF (43,88 ± 2,29 vs 38,34 ± 13,61 ml/kg/min; p = 0,69). Conclusão A ED não foi associada ao consumo máximo de oxigênio em atletas. Além disso, atletas infectados por COVID-19 não exibiram diferenças no VO2max e ED em relação aos não infectados.

Assessment Tools for Pulmonary Involvement in Patients with Ankylosing Spondylitis: Is Diaphragmatic Ultrasonography Correlated to Spirometry?

Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease that can lead to spinal ankylosis and consequently, restrictive pulmonary dysfunction. Thus, the present study aimed to assess the accuracy of diaphragm ultrasound compared to spirometry in the screening of restrictive pulmonary disorders in radiographic SpA patients. We conducted a cross-sectional study of 50 patients with radiographic SpA, over six months. Sociodemographic data, clinical characteristics of the disease, as well as biological, radiological, and therapeutic data, were collected. Spirometry and diaphragm ultrasound were performed. The mean age of the study participants (N= 50) was 42.7±11 years [range: 25-66] with male predominance (N= 41). Spirometry showed a restrictive disorder in 32% of cases. The mean chest expansion (CE) value was 3.9±1.81cm [range: 1-9] with a median of 4 cm. A pathological value (<5cm) was observed in 72% of cases. A significant positive correlation was found between the right inspiratory diaphragmatic thickness and forced vital capacity (FVC) (r= 0.36; p = 0.02) and the supine FVC (r=0.29; p = 0.04). The left inspiratory diaphragmatic thickness was correlated with the percentage of the FVC decrease (r= 0.35; p = 0.01) defined as the percentage of difference between FVC and supine FVC. The right expiratory diaphragmatic thickness was associated with the FVC (r=0.32; p = 0.02). A significant positive correlation was found between the CE and the presence of B lines (r=0.32; p = 0.02), but not between the CE and the FVC. The present study showed that diaphragm ultrasonography is correlated with spirometric findings in radiographic SpA patients. Further studies are required to assess its reliability, specificity, and sensitivity in this pathology.

Ultrassom diafragmático após manobra de estabilização costal manual em recém-nascidos prematuros: ensaio clínico

Abstract Introduction The manual rib cage stabilization maneu-ver (MRCSM) is a physical therapy intervention that promotes stabilization of the zone of apposition of the diaphragm, facilitating the contraction of this muscle and the work of breathing. Objective To evaluate by diaphragm ultrasound the diaphragmatic excursion in premature newborns before and after MRCSM. Methods Before-after clinical trial assessing by diaphragm ultra-sound the effectiveness of MRCSM in the amplitude of diaphragmatic excursions. Results The study sample consisted of 48 premature newborns born at a mean gestational age of 33.0 ± 2.8 weeks with a mean birth weight of 1,904.1 ± 708.9 grams. The newborns were classified in three groups: without respiratory distress syndrome (RDS; n = 26), with RDS (n = 15) and with apnea (n = 7) as a cause of admission to the neonatal intensive care unit (NICU). The measurements of diaphragmatic excursion and thickening were similar in newborns without or with RDS or apnea and there was a significant increase in the amplitude of diaphragmatic excursions after MRCSM (p &lt; 0.001; effect size &gt; 0.68) and less diaphragmatic thickening at exhalation in all of them. The diaphragm thickening fraction was 0.50 (0.33 - 0.72), and the diaphragm thickening rate was 0.04 (0.03 - 0.07). These measurements showed no significant variation with the presence or absence of RDS or apnea (p &gt; 0.05). No significant variations in heart rate (p = 0.30), respiratory rate (p = 0.79), and peripheral oxygen saturation, consid-ering newborns in ambient air (p = 0.17) compared with baseline. Conclusion The MRCSM was effective, safe, and increased the amplitude of diaphragmatic excursion and thickness in premature newborns at one week of age, regardless of the presence or absence of RDS or apnea as a cause of admission to the NICU.

Ultrasound assessment of the relation between the quantity of pleural effusion and diaphragmatic functions

Background Diaphragm is a necessary respiratory muscle. In cases with pleural effusion, abnormal diaphragmatic functions may be observed. Thoracic ultrasound is a simple, accurate, and noninvasive method to investigate the relation between the quantity of pleural effusion and diaphragmatic functions. Aim The work was done to clarify the relation between the quantity of pleural effusion and diaphragmatic functions using ultrasound. Patients and methods A prospective case–control study, where patients were divided into two groups: GI (cases), 20 patients with pleural effusion for ultrasound evaluation of the relation between the quantity of pleural effusion and diaphragmatic functions, and GII, (controls) 20 healthy volunteers without pleural effusion for ultrasound assessment of diaphragmatic functions. Between 2019 and 2020, clinical assessment, routine investigations, and demographic and radiological data were reviewed for the two groups. Results Thoracic ultrasound for GI at different quantities of pleural effusions revealed significant differences in diaphragmatic functions such as thickness at the end of inspiration, diaphragm thickening fraction, excursion at deep breathing, and excursion at quiet breathing. The statistical comparison of sonographic findings between GI and GII showed significant differences in the thickness at the end of expiration, thickness at the end of inspiration, diaphragmatic thickening fraction, excursion at quiet breathing, and excursion at deep breathing. These changes are proportionate to the quantity of pleural effusion. Conclusion There is an adverse effect of pleural effusion at different quantities on diaphragmatic functions as observed by thoracic ultrasound.

An extrinsic Fabry–Pérot interference fiber sensorfor ultrasonic detection of partial discharge

An ultrasonic sensor based on extrinsic Fabry–Pérot interference (EFPI) has been designed and demonstrated to detect the ultrasonic wave signal. The sensitivity and natural frequency of fiber Fabry–Pérot (F-P) sensor with different structure parameter have been simulated by COMSOL. The simulation results illustrate that the sensitivity is up to 1.737 nm/kPa and the natural frequency is 2.1 MHz, when the silica diaphragm thickness is 2 μm, the radius is 90 μm, and the cavity length is 18 μm. The most suitable parameters have been selected and the F-P sensor has been fabricated. When the ultrasonic signals with the frequencies of 40 kHz and 1.2 MHz are respectively applied to the sensor, the frequencies detected by the EFPI ultrasonic sensor are 39 kHz and 1.21 MHz based on a partial discharge detection experiment for the designed demodulation system. The experimental results show that the sensor can accurately detect ultrasonic signals. As an excellent platform for ultrasonic signal sensing, this EFPI ultrasonic sensing system has great potential applications in partial discharge detection field.

Predictive Machine Learning Algorithms in Anticipating Problems with Airway Management

Machine learning is artificial intelligence (AI) which can predict the output variable with the fed input features. This allows computers to learn from experience without being programmed. The outcome variable in machine learning algorithm may be continuous variable or categorical variable. Supervised machine learning is commonly applied artificial intelligence (AI) in medical field. Decision tree, gradient boost machine (GBM) learning, extreme GBM (XGBM), Support vector machine, K nearest neighbour and multi-layer perceptron are few machine learning algorithms which are being utilised to address the classification and regression problems. Though the incidence of difficult intubation (DI) is rare, occurrence of such event in an unanticipated situation can result in development of arrhythmias due to desaturation and cardiac arrest if not intervened on time. It is preferred to choose the physical parameters that can predict the difficult airway more accurately in clinical scenario and train the algorithm rather than including all the non-specific parameters. Body mass index (BMI) [&gt;30 kg.m-2: anticipated difficult mask ventilation (DMV), direct laryngoscopy (DL) and DI], inter-insicor distance (IID) (&lt;2 cm: anticipated DL), modified Mallampati (MMP) (Grade 1 and 2: Ease of intubation; Grade 3 and 4: anticipated DI), temporomandibular distance (TMD) (&lt;6.5 cm - anticipated DI), restriction of neck extension (if present: anticipated DL and DI), receded mandible (if present: anticipated DL and DI), and poor submandibular space compliance (if present: anticipated DL and DI) parameters which are used to predict DA by clinical assessment, can be used to feed to train the machine learning algorithm. Despite using these sophisticated tools, extubation may fail and patients require reintubation in ICU. It is very challenging to assess the lung compliance in spontaneously breathing patients as compliance will be overestimated due to generation of negative pressure. Cause for which patient has been placed on mechanical ventilation is resolved/resolving, BMI (&gt;30 kg.m-2), intact sensorium (absence of delirium), absence of consolidation, absence of copious secretions, oxygenation status (PaO2/FiO2: &gt;250), ventilation status (paCO2: 30-45 mmHg), measure of work of breathing (respiratory rate, rapid shallow breathing index), heart rate and blood pressure during spontaneous breathing trial (SBT) and diaphragmatic thickness fraction can be used as input features to predict the success of extubation in critically ill patients. With widespread utility of applications in medical fraternity, applications for prediction of difficult airway (or for weaning success) can be programmed which can be accessed by the clinicians to predict DA, thereby all the preparations for managing DA may be done to prevent adverse consequences of unanticipated difficult airway.

Sonographic assessment of thickness of normal diaphragm by B mode ultrasound

Background: The thickness of diaphragm and diaphragmatic thickness fraction can be assessed by ultrasonography which can be used in early detection of the neuromuscular conditions and follow-up. Objectives: To measure the thickness of diaphragm during inspiration and expiration; and diaphragmatic thickness fraction by B mode ultrasound in healthy patients. Methods: An analytical cross-sectional study was conducted in 260 patients. Data were collected from 2020 July 10 to 2021 July 9 in Department of Radiology, BPKIHS after ethical clearance. Patients who were referred for sonographic evaluation and without neurological complains were included. Purposive sampling was done. Inferential statistical analysis was done applying SPSS v.11.5. Results: Mean diaphragmatic thickness on deep inspiration was found to be 2.80 ± 0.57 mm (95% CI 2.73-2.87 mm) and 2.71 ± 0.53 mm (95% CI 2.64-2.77 mm) on right and left side respectively. Mean diaphragmatic thickness on end expiration was found to be 2.01 ± 0.41 mm (95% CI 1.96-2.06 mm) and 1.97 ± 0.40 mm (95% CI 1.92-2.01 mm) respectively on right and left side. Mean diaphragmatic thickness fraction was observed 40 ± 7.79% (22-67%) and 38 ± 7.98% (22- 60%) on right and left side respectively. The mean difference between right and left side on inspiration was found to be statistically significant. A weak positive correlation of diaphragmatic thickness with BMI on both sides and on both during inspiration and expiration was seen. There was no statistically significant correlation of diaphragmatic thickness fraction with age and BMI. Conclusion: Sonographic diaphragm thickness measurement and diaphragm thickness fraction can provide both anatomical and physiological evaluation quickly.

Diaphragmatic impairment as a predictor of invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease patients

ABSTRACT Objective Study the impact of ultrasound-assessed diaphragmatic impairment (DI) on predicting need for invasive mechanical ventilation (IMV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients treated by non-invasive ventilation (NIV). Design A prospective observational study. Setting Critical Care Units of Alexandria Main University Hospital. Patients 75 adult AECOPD patients of both sexes according to sample size calculation. Methods Ultrasound was used to measure diaphragmatic thickness (DT), diaphragmatic thickness fraction (DTF) was calculated, and DI was diagnosed when fraction was less than 20%. Patients were treated by NIV. Switching to IMV was done after NIV failure. Primary outcome was value of DI to predict need for IMV after NIV failure. Secondary outcome was impact of DI on fate of patients. Results According to fate of NIV, patients were categorized into successful and failed NIV groups. DTF in both groups were ≥33–38% and ≤16–18%. DTF with a cut-off value of <26–29% on both sides was able to predict NIV failure with 96.67% sensitivity and 80–82.22% specificity. Days of MV and ICU stay were significantly lower in the successful NIV group, p < 0.001. 28-day mortality was significantly less encountered in successful NIV group, p = 0.018. Conclusion DTF was a good indicator of DI that could predict need for IMV after NIV failure in AECOPD patients with good sensitivity and moderate specificity. MV Days, ICU stay, and 28-day mortality were significantly higher in patients with DI who needed IMV.

Surgical Treatment of Catamenial Chest Pain: Excision of diaphragmatic endometriosis during robot-assisted laparoscopic surgery.

10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment. This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis. The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube. The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery. Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.

Chest Ultrasonographic Assessment of Diaphragmatic Excursion and Thickness as a New Weaning Parameter in Mechanically Ventilated Chronic Obstructive Pulmonary Disease Patients

Chest Ultrasonographic Assessment of Diaphragmatic Excursion and Thickness as a New Weaning Parameter in Mechanically Ventilated Chronic Obstructive Pulmonary Disease Patients

Ultrasonographic evaluation of diaphragm function in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis.

Some studies have reported using ultrasonic evaluations to assess diaphragm function in patients with chronic obstructive pulmonary disease (COPD). However, they have limitations and thus cannot provide strong evidence to support ultrasound evaluations for diaphragm function and dysfunction severity assessments in this patient population. Additionally, quantitative studies on the relationship between ultrasound evaluations and diaphragm function do not exist. Therefore, we performed a systematic review and meta-analysis to explore the usefulness of ultrasonography for evaluating diaphragm function in patients with COPD. The Cochrane Library, PubMed, Embase, Web of Science, Chinese Biomedical Literature Database, Wanfang Data, China National Knowledge Network, and Chinese Scientific Journal Database (i.e., VIP) databases were searched for literature about ultrasonic evaluations of diaphragm function in patients with COPD for systematic review. We extracted patient demographic, diaphragm mobility, diaphragm thickness, diaphragm thickening score, and other related parameter data using RevMan 5.3 software for the meta-analysis. We included 13 articles in the systematic review, 8 of which (494 participants) were included in the meta-analysis. The degree of diaphragm offset in patients with COPD was significantly lower than that in healthy controls (weighted mean difference [WMD] = -1.34; 95% confidence interval [CI]: -2.15, 0.53; P < .05). The diaphragm deviation was lower in the severe COPD group than in the mild-to-moderate COPD group (WMD = 0.50; 95% CI: -0.01, 1.01; P = .06), but the difference was not significant. Ultrasonography effectively evaluates diaphragm function in patients with COPD. The diaphragm offset can be used as an auxiliary diagnostic index for COPD, which is also related to disease severity.