Unilateral diaphragmatic dysfunction in blunt chest trauma.
This study was undertaken to evaluate unilateral diaphragmatic dysfunction within ten days after blunt chest trauma. Thirty patients with unilateral chest injury, or predominantly one-sided injuries, were investigated in the supine position, under analgesia. Right and left hemidiaphragm displacement (DD) was measured, using digital subtraction radiography, during quiet and forced breathing. The diaphragmatic contribution to breathing was determined by rib cage and abdominal circumference measurement changes. In both breathing modes, DD of the injured side was lower than DD of the uninjured side (p less than 0.01, p less than 0.001). Six patients had complete diaphragmatic motionlessness. The inspired air volume due to diaphragmatic motion (Vab) was reduced when compared to normal subjects and Vab/VT ratio was always found to be less than 0.65. The degree of diaphragmatic dysfunction appeared related to injury location and is most severe in injuries of the lower chest which implies direct diaphragm muscle injury, although other mechanisms may be implicated. Diaphragmatic dysfunction can contribute to respiratory failure in these patients, and should be considered.
Gastinne
H
H
Department of Intensive Care Medicine, Dupuytren Academic Hospital, Limoges, France.
Venot
J
J
Dupuy
J P
JP
Gay
R
R
D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology*; D006801:Humans; D009068:Movement; D011859:Radiography; D012119:Respiration; D013147:Spirometry; D013382:Subtraction Technique; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*