Diaphragmatic movement studied with ultrasound during spontaneous breathing and mechanical ventilation with intermittent positive pressure ventilation (IPPV) and airway pressure release ventilation (APRV) in man.
Earlier knowledge about diaphragmatic movement during mechanical ventilation is based on radiological information. Since real-time bed-side monitoring is now possible the movement of the right hemidiaphragm was studied using ultrasound (US), both during spontaneous and mechanical ventilation. Nine healthy non-medicated volunteers lying supine were exposed to the following ventilation modes in random order: 1. breathing air at ambient pressure, or 2. at 7.6 mmHg of CPAP or 3. mechanical ventilation with airway pressure release ventilation (APRV), or 4. with IPPV, by mask. The movement of the diaphragm was recorded with a US sector transducer, imaging the ventral, dome and dorsal parts. The maximal movement was detected in the dome in four volunteers during spontaneous breathing with both ambient pressure and CPAP, but in the ventral part in seven and six volunteers, respectively, during APRV and IPPV. Diaphragmatic movement can be studied with US and the findings support the earlier study, with the diaphragm shifting towards the non-dependent regions of the lungs during mechanical ventilation. In this respect APRV is similar to IPPV.
Jousela
I
I
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Tahvanainen
J
J
Mäkeläinen
A
A
Ylä-Jarkko
A
A
Nikki
P
P
D000328:Adult; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000502:physiology*; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D009068:Movement; D012119:Respiration / Q000502:physiology*; D014463:Ultrasonography