Assessment of Diaphragm functions

Sharma , Vishnu M and *, Anupama N (2011) Assessment of Diaphragm functions. Pulmon, 13 (3). pp. 102-107.

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Diaphragm is the chief muscle of respiration. In normal quiet breathing diaphragm contributes to 75% of inspiratory effort. Diaphragm is mainly affected in various neuromuscular diseases, most of which are degenerative and progressive diseases. Weakness of the diaphragm is one of the main causes for respiratory morbidity and recurrent lower respiratory tract infections in patients with neurological diseases. Indications of testing diaphragm function are unexplained dyspnea, unexplained orthopnea, nocturnal hypercapnia in the absence of sleep disordered breathing, ineffective cough, inability to clear airway secretions without any obvious cause, recurrent lower respiratory tract infection without any obvious cause especially in a patient with neuromuscular disease. Decreased chest movement, paradoxical movement of chest and abdomen during respiration, tidal percussion, Litten’s sign and Hoover’s sign are the useful clinical tests for assessing diaphragm movement. In unilateral paralysis of diaphragm elevation of the hemi dome can be seen in chest X-ray. In bilateral diaphragm paralysis both domes may be elevated mimicking expiratory film. In unilateral paralysis vital capacity is reduced by 20-25% in upright posture. A fall in vital capacity between upright and supine position is a sensitive indicator of diaphragm weakness. Arterial blood gas analysis may show hypoxia and hypercapnia. Movement of diaphragm during respiration can be assessed by fluoroscopy. Thoracic ultrasound can be used to assess the diaphragm movement. Maximal inspiratory and expiratory pressures, maximal trans-diaphragmatic pressure and phrenic nerve stimulation are more specific tests for assessing diaphragm function.

Item Type: Article
Uncontrolled Keywords: Diaphragm, Assessment, Function, Trans-diaphragmatic pressure, Thoracic ultrasounds
Subjects: Medicine > KMC Mangalore > Physiology
Depositing User: KMCMLR User
Date Deposited: 30 Oct 2012 07:20
Last Modified: 30 Oct 2012 07:20

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