title: Diaphragmatic regional displacement assessed by ultrasound and correlated to subphrenic organ movement in the critically ill patients--an observational study.
abstract: BACKGROUND
  The objectives of the study are to identify the most reliably imaged regions of the diaphragm, to evaluate the correlation of movement between different parts of each hemidiaphragm, and to assess the agreement between liver or spleen displacement and movement of the ipsilateral hemidiaphragm.
  
  
  METHODS
  Images of the diaphragm, liver, and spleen were obtained using 2-dimensional ultrasound. Acceptable agreement between regions of the diaphragm, liver, and spleen was defined as an absence of fixed or proportional bias using Deming regression analysis and limits of agreement of 2 SDs of the difference less than 30% of the mean value.
  
  
  RESULTS
  We included 90 critically ill patients. The medial (87%) and middle (73%) regions of the right hemidiaphragm, liver (87.7%), and spleen (81%) and medial (71%) and middle regions (51%) of the left hemidiaphragm were most frequently imaged. In nonintubated patients, acceptable agreement was present for comparisons of the left middle and medial, right middle and medial, and left middle regions and spleen displacement. In intubated patients and in all patients when combined, acceptable agreement was only present for comparisons of the left middle and medial and right middle and medial regions of the diaphragm. Acceptable agreement was not present for intubated and all patients for diaphragmatic and solid organ movement.
  
  
  CONCLUSIONS
  The diaphragm medial part is visualized in the majority of studied patients. The medial and middle thirds may be used interchangeably to assess hemidiaphragm movement. Acceptable agreement does not exist for diaphragm and solid organ movement, other than for the left middle region and the spleen.
authors.affiliation: Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria, Australia. Electronic address: kevee@bigpond.com.
authors.forename: Kavi
authors.initials: K
authors.lastname: Haji
authors.affiliation: Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. Electronic address: Alistair.Royse@heartweb.com.
authors.forename: Alistair
authors.initials: A
authors.lastname: Royse
authors.affiliation: Frankston Hospital, Frankston, Victoria, Australia. Electronic address: dtharmaraj@gmail.com.
authors.forename: Dhaksha
authors.initials: D
authors.lastname: Tharmaraj
authors.affiliation: Emergency Department, Frankston Hospital, Frankston, Victoria, Australia. Electronic address: darsim@bigpond.com.
authors.forename: Darsim
authors.initials: D
authors.lastname: Haji
authors.affiliation: Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria, Australia. Electronic address: JBotha@phcn.vic.gov.au.
authors.forename: John
authors.initials: J
authors.lastname: Botha
authors.affiliation: Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia; Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. Electronic address: Colin.Royse@heartweb.com.
authors.forename: Colin
authors.initials: C
authors.lastname: Royse
mesh_terms: D000368:Aged; D016638:Critical Illness; D003964:Diaphragm / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009068:Movement; D011446:Prospective Studies; D012119:Respiration; D012120:Respiration Disorders / Q000000981:diagnostic imaging*; D012121:Respiration, Artificial; D013154:Spleen / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Diaphragm movement; Liver displacement; Solid organ; Spleen displacement; Ultrasound