An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery

Anesth Analg. 2010 May 1;110(5):1349-54. doi: 10.1213/ANE.0b013e3181d5e4d8.


Background: Diaphragmatic dysfunction is a major factor in the etiology of postoperative pulmonary complications after upper abdominal surgery. M-mode ultrasonography is now an accepted qualitative method of assessing diaphragmatic motion in normal and pathological conditions. In this study, we evaluated whether diaphragmatic inspiratory amplitude (DIA) as measured by M-mode sonography can be a predictor of pulmonary dysfunction.

Methods: A prospective, single-center, single-unit, observational study was performed in 35 ASA physical status I and II nonsmoking patients undergoing open liver lobectomy. Diaphragmatic movements were assessed by M-mode sonography after a pulmonary function test preoperatively and on postoperative days (PODs) 1, 2, and 7. We measured the DIA (cm) during quiet, deep, and sniff breathing.

Results: After liver lobectomy, DIA during deep breathing and vital capacity (VC) showed significant reductions of 60% from their preoperative values on PODs 1 and 2 (P < 0.001). By POD 7, the variables recovered significantly, by 30% from the values on PODs 1 and 2 (P < 0.001). During deep breathing, DIA showed a significant correlation with VC (r = 0.839, P < 0.0001). The best cutoff values of DIA for detecting 30% and 50% decreases of VC from preoperative values, calculated by receiver operating characteristic analysis, were 3.61 and 2.41 cm, with sensitivity of 94% and 81% and specificity of 76% and 91%, respectively (P = 0.0001). Two patients showed postoperative diaphragmatic paralysis but did not complain of respiratory distress symptoms or need supplemental oxygen after being transferred to the general ward.

Conclusions: DIA using M-mode sonography showed a linear correlation with VC measured by spirometry throughout the postoperative period. We conclude that using the M-mode sonographic technique at the bedside can be a practical way to investigate postoperative diaphragmatic dysfunction, and may also be an effective bedside screening method for diaphragmatic paralysis.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery*
  • Adolescent
  • Adult
  • Aged
  • Analgesia, Patient-Controlled
  • Anesthesia, General
  • Diaphragm / diagnostic imaging*
  • Diaphragm / physiopathology*
  • Digestive System Surgical Procedures
  • Echocardiography*
  • Female
  • Humans
  • Liver / surgery
  • Lung Diseases / etiology*
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy
  • Postoperative Complications / etiology*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Respiratory Function Tests
  • Respiratory Paralysis / etiology
  • Spirometry
  • Vital Capacity / physiology
  • Young Adult