Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jul 10;14(14):1481.
doi: 10.3390/diagnostics14141481.

Ultrasonographic Assessment of the Diaphragm

Taiga Itagaki  1 , Yusuke Akimoto  2 , Takuya Takashima  3 , Jun Oto  3
Affiliations
Review

Ultrasonographic Assessment of the Diaphragm

Taiga Itagaki et al. Diagnostics (Basel). .

Abstract

Mechanical ventilation injures not only the lungs but also the diaphragm, resulting in dysfunction associated with poor outcomes. Diaphragm ultrasonography is a noninvasive, cost-effective, and reproducible diagnostic method used to monitor the condition and function of the diaphragm. With advances in ultrasound technology and the expansion of its clinical applications, diaphragm ultrasonography has become increasingly important as a tool to visualize and quantify diaphragmatic morphology and function across multiple medical specialties, including pulmonology, critical care, and rehabilitation medicine. This comprehensive review aims to provide an in-depth analysis of the role and limitations of ultrasonography in assessing the diaphragm, especially among critically ill patients. Furthermore, we discuss a recently published expert consensus and provide a perspective for the future.

Keywords: diagnostic ultrasonography; diaphragm; diaphragm-protective ventilation; inspiratory muscles.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Diaphragm ultrasonography with the intercostal approach. The double arrow indicates the thickness of the diaphragm. (A) A B-mode diaphragm ultrasonographic image obtained with a linear transducer along the right mid-axillary line. Separate images measuring the diaphragm thickness at end-expiration (top) and end-inspiration (bottom) were used to determine the thickening fraction of the diaphragm. (B) An M-mode ultrasonographic image (bottom) capturing temporal changes in one direction of the thickness of the diaphragm. The diaphragm thickness at end-expiration and end-inspiration were measured from this image to determine the thickening fraction of the diaphragm.
Figure 2
Figure 2
Diaphragm ultrasonography with the subcostal arch approach. An M-mode diaphragm ultrasonographic image was obtained using a cardiac transducer positioned subcostally on the right side and directed cranially through the liver. The lower image shows the diaphragm displacement passing through the M-mode beam over time. Vertical yellow line indicates diaphragm excursion.
See this image and copyright information in PMC

References

    1. Tremblay L.N., Slutsky A.S. Ventilator-induced lung injury: From the bench to the bedside. Intensive Care Med. 2006;32:24–33. doi: 10.1007/s00134-005-2817-8. - DOI - PubMed
    1. Goligher E.C., Brochard L.J., Reid W.D., Fan E., Saarela O., Slutsky A.S., Kavanagh B.P., Rubenfeld G.D., Ferguson N.D. Diaphragmatic myotrauma: A mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir. Med. 2019;7:90–98. doi: 10.1016/S2213-2600(18)30366-7. - DOI - PubMed
    1. Kim W.Y., Suh H.J., Hong S.B., Koh Y., Lim C.M. Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation. Crit. Care Med. 2011;39:2627–2630. doi: 10.1097/CCM.0b013e3182266408. - DOI - PubMed
    1. Sassoon C.S.H.H., Caiozzo V.J., Manka A., Sieck G.C. Altered diaphragm contractile properties with controlled mechanical ventilation. J. Appl. Physiol. 2002;92:2585–2595. doi: 10.1152/japplphysiol.01213.2001. - DOI - PubMed
    1. Shanely R.A., Zergeroglu M.A., Lennon S.L., Sugiura T., Yimlamai T., Enns D., Belcastro A., Powers S.K. Mechanical ventilation-induced diaphragmatic atrophy is associated with oxidative injury and increased proteolytic activity. Am. J. Respir. Crit. Care Med. 2002;166:1369–1374. doi: 10.1164/rccm.200202-088OC. - DOI - PubMed

LinkOut - more resources