title: Diaphragmatic excursion measurement in emergency patients with acute dyspnea: toward a new diagnostic tool?
abstract: BACKGROUND
  During acute dyspnea (AD), respiratory exhaustion is mainly due to diaphragm fatigue. The primary objective was to validate interobserver reproducibility of diaphragmatic excursion (DE) in emergency department (ED) patients admitted for AD. The secondary objectives were to assess the feasibility of DE measurement and intraobserver reproducibility. Finally, we examined whether the DE value was associated with a need for noninvasive ventilation (NIV).
  
  
  METHODS
  This was a monocentric, prospective, technical reproducibility study. Adult patients in spontaneous ventilation admitted for AD were included. Two operators carried out 2 consecutive diaphragm excursion measurements each on the right and left hemidiaphragms.
  
  
  RESULTS
  Twenty-four patients were analyzed. The feasibility was 96% on the right and 67% on the left. The interobserver concordance between the 2 measures was 0.80 (95% confidence interval [CI], 0.59-0.91) (average difference, -0.07±0.48 cm) on the right and 0.59 (95% CI, 0.19-0.82) (average difference, 0.30±0.91 cm) on the left. For right DE values inferior to 2.3 cm, the interobserver concordance between measures was 0.92 (95% CI, 0.78-0.97). The intraobserver concordance was 0.89 (95% CI, 0.81-0.94) (average difference, 0.02±0.35 cm) on the right and 0.90 (95% CI, 0.82-0.95) (average difference,-0.06±0.45 cm) on the left. When the DE was greater than 2 cm, no patient required NIV.
  
  
  CONCLUSIONS
  Diaphragmatic excursion measurement of the right diaphragm is feasible, with good interobserver and intraobserver reproducibility in ED patients admitted for AD. When the DE value is greater than 2 cm at admission, no subsequent NIV is required.
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, 30029 Nîmes, France. Electronic address: xavier.bobbia@gmail.com.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bobbia
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, 30029 Nîmes, France. Electronic address: aude.clement86@gmail.com.
authors.forename: Aude
authors.initials: A
authors.lastname: Clément
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, 30029 Nîmes, France. Electronic address: pierre.geraud.claret@gmail.com.
authors.forename: Pierre Géraud
authors.initials: PG
authors.lastname: Claret
authors.affiliation: Department of Biostatistics, Nîmes University Hospital, Nîmes, France. Electronic address: sophie.bastide@chu-nimes.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bastide
authors.affiliation: Department of Biostatistics, Nîmes University Hospital, Nîmes, France. Electronic address: sandrine.alonso@chu-nimes.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Alonso
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, 30029 Nîmes, France. Electronic address: patricia.wagner@chu-nimes.fr.
authors.forename: Patricia
authors.initials: P
authors.lastname: Wagner
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, 30029 Nîmes, France. Electronic address: tristan.tison@chu-nimes.fr.
authors.forename: Tristan
authors.initials: T
authors.lastname: Tison
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, 30029 Nîmes, France. Electronic address: laurent.muller@chu-nimes.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Muller
authors.affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, 30029 Nîmes, France. Electronic address: jean.emmanuel.delacoussaye@chu-nimes.fr.
authors.forename: Jean Emmanuel
authors.initials: JE
authors.lastname: de La Coussaye
mesh_terms: D000208:Acute Disease; D000368:Aged; D003964:Diaphragm / Q000503:physiopathology*; D004417:Dyspnea / Q000503:physiopathology*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D015656:Respiratory Mechanics / Q000502:physiology*