Ultrasound of the Diaphragm and the Respiratory Muscles

Description

Ultrasound is the most reliable, easily available, fast, non-invasive technique to study diaphragm function, and is an irreplaceable tool to diagnose, monitor and follow-up critical respiratory patients. This essential guide analyses every aspect of ultrasound of the diaphragm, a reliable assessment of whose function is vital to provide the most suitable treatment. It provides insight to diagnose diaphragmatic dysfunction or paralysis following surgery or neuromuscular diseases, to follow the muscular activity and the time-course of atrophy during mechanical ventilation, and to monitor the weaning phase. It is ideal for professionals and trainees practicing ultrasound in a clinical setting. Key Features Sets the standard for training and competency of this emerging, yet scientifically approved non-invasive technique of ultrasound with all the essential information on how to perform ultrasound and interpret the images obtained. Features clear and didactic images demonstrating echo findings in various situations along with videos of diaphragmatic ultrasound offering a unique "window" on mechanically ventilated patients, allowing to take important clinical decisions on ventilatory modes and assistance by pulmonologists, critical care specialists, thoracic surgeons, emergency medicine specialists as well as trainees. Includes a chapter on pediatric ultrasound along with ultrasound of other respiratory muscles (i.e., intercostal and abdominal) which is emerging as a useful complementary tool. Cover Half Title Title Page Copyright Page Dedication Table of Contents Preface Editor List of Contributors Part I Introduction Chapter 1 Anatomy, Physiology, and Dysfunction of the Diaphragm Anatomy Physiology Dysfunction References Chapter 2 Ultrasound Basics Interactions of Sound and Tissues Machine Setting Frequency (or the right probe) Depth Focus Gain/TGC Resources Part II Diaphragm Ultrasound: Technique Chapter 3 Diaphragmatic Excursion Technique Reference Values, Reproducibility, Learning Curves Usefulness Excursion on Ventilated Patients References Chapter 4 Diaphragmatic Thickness and Thickening Usefulness How to Measure Thickness How to Measure Thickening Reference Values Meaning of Reduced/Increased Reproducibility Learning Curve References Part III Applications of Diaphragm Ultrasound Chapter 5 Diaphragm Ultrasound in Respiratory Disorders and Diaphragm Paralysis Diaphragm Ultrasound in Respiratory Disorders and Diaphragm Paralysis COPD Rationale for Diaphragmatic Dysfunction in COPD Diaphragmatic Mobility in COPD Reduced Diaphragmatic Mobility in COPD – Clinical Relevance Diaphragmatic Thickness in COPD Altered Diaphragmatic Thickness in COPD – Clinical Relevance Diaphragmatic Function Assessed by DUS and Interventions Diaphragm Function and Acute Exacerbations of COPD (AECOPD) – Thickness Diaphragm Function and AECOPD – Excursion Interstitial Lung Diseases (ILD) Rationale for Diaphragmatic Dysfunction in ILD DUS in ILD – Diaphragmatic Mobility and Thickness Asthma Cystic Fibrosis and Non-cystic Fibrosis Bronchiectasis Asthma Cystic Fibrosis (CF) Non-cystic Fibrosis Bronchiectasis Diaphragm Paralysis and DUS Findings References Chapter 6 Assessment of Diaphragm Dysfunction in Mechanically Ventilated Patients Introduction Diaphragm Dysfunction An Underestimated Disease in the ICU A Disease with Common Risk Factors A Disease Associated with Clinical Outcomes When Evaluating the Diaphragm Function? How Is the Diaphragm Function Defined? Which Methods to Assess the Diaphragm Function? Diaphragm Pressure-Generating Capacity Inspiratory Pressure Recorded at the Mouth Transdiaphragmatic Pressure Ultrasound Assessment Electrical Activity of the Diaphragm Conclusion References Chapter 7 Diaphragm Ultrasound during Weaning from Mechanical Ventilation Introduction Ultrasound during Mechanical Ventilation Inspiratory Pressure Positive End Expiratory Pressure Modes of Ventilation Summary of Ultrasound in Mechanical Ventilation Patient–Ventilator Interactions Ineffective Triggering or Wasted Effort Auto-triggering Trigger Delay Double Trigger Reverse Triggering Diaphragm Ultrasound to Track Atrophy Diaphragm Ultrasound to Titrate Ventilator Settings Diaphragm Ultrasound and Diaphragm Effort In Clinical Practice A Comprehensive Ultrasound Approach during Weaning from Mechanical Ventilation: Ultrasound of Diaphragm, Heart, and Lungs ABCD-Approach In Clinical Practice Ultrasound to Predict Extubation Success/Failure Thickening Fraction Excursion In Clinical Practice Chapter Summary References Chapter 8 Diaphragmatic Ultrasound after Thoracic and Abdominal Surgery Introduction Cardiac Surgery Thoracic Surgery Upper Abdominal Surgery A Concept in Development Shoulder Surgery (Diaphragmatic Paralysis after Interscalene Block) Conclusion References Chapter 9 Diaphragm Ultrasound in Patients with Neuromuscular Disorders Introduction Pathophysiology of Respiration Function in Neuromuscular Disorders Diaphragm Ultrasound Diaphragm Ultrasound in Neuromuscular Disorders in a Neuromuscular Centre Conclusion References Chapter 10 Other Applications of Diaphragm Ultrasound: Trauma, Malignancies, Ultrasound-Guided Procedures Trauma References Malignancies References Ultrasound-Guided Procedures Guidance for Needle EMG Assessment of Phrenic Nerve Pacing Assessment of Paralysis after Interscalene Brachial Plexus Block References Part IV New Perspectives Chapter 11 Ultrasound Assessment of the Accessory Respiratory Muscles Introduction Ultrasound Techniques Parasternal Intercostal Muscle Ultrasonography Expiratory Abdominal Muscle Ultrasonography Tips, Tricks, and Challenges Tips and Tricks Reliability and Accuracy Potential Clinical Applications Changes in Thickness Recruitment of Accessory Respiratory Muscles Novel Techniques and Future Research Questions Strain Imaging Shear Wave Elastography Echogenicity Conclusion References Chapter 12 Tissue Doppler Imaging of the Diaphragm Introduction Ultrasound Technique Variables Identified Use and Potential Applications Limitations of the Technique Future Directions References Chapter 13 Ultrasound of the Diaphragm in Paediatric Patients References Index