Diaphragm sniff ultrasound: Normal values, relationship with sniff nasal pressure and accuracy for predicting respiratory involvement in patients with neuromuscular disorders

• Published in: PloS one Vol. 14; no. 4; p. e0214288
• Main Authors: Fayssoil, Abdallah, Nguyen, Lee S., Ogna, Adam, Stojkovic, Tanya, Meng, Paris, Mompoint, Dominique, Carlier, Robert, Prigent, Helene, Clair, Bernard, Behin, Anthony, Laforet, Pascal, Bassez, Guillaume, Crenn, Pascal, Orlikowski, David, Annane, Djillali, Eymard, Bruno, Lofaso, Frederic
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.04.2019; Public Library of Science (PLoS)
• Subjects: Adult; Analysis; Biology and Life Sciences; Case-Control Studies; Clinical trials; Diagnostic systems; Diaphragm; Diaphragm - diagnostic imaging; Diaphragm - physiopathology; Disorders; Doppler effect; Female; Human health and pathology; Humans; Life Sciences; Lung volume measurement; Male; Medical research; Medical tests; Medicine and Health Sciences; Middle Aged; Movement; Muscle function; Neuromuscular diseases; Neuromuscular Diseases - diagnostic imaging; Neuromuscular Diseases - physiopathology; Nose - physiopathology; Physical Sciences; Pressure; Pulmonology and respiratory tract; Research and Analysis Methods; Respiration; Respiratory function; Respiratory insufficiency; ROC Curve; Tidal Volume; Time Factors; Ultrasonic imaging; Ultrasonography, Doppler; Ultrasound; Ultrasound imaging; Velocity; Ventilation; Venture capital; Vital Capacity; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0214288

In patients with neuromuscular disorders, assessment of respiratory function relies on forced vital capacity (FVC) measurements. Providing complementary respiratory outcomes may be useful for clinical trials. Diaphragm sniff ultrasound (US) is a noninvasive technique that can assess diaphragm function that may be affected in patients with neuromuscular disorders. We aimed to provide normal values of sniff diaphragm ultrasound, to assess the relationship between sniff diaphragm US, vital capacity (VC) and sniff nasal pressure. Additionally, we aimed to evaluate the diagnostic accuracy of sniff diaphragm US for predicting restrictive pulmonary insufficiency. We included patients with neuromuscular disorders that had been tested with a sniff diaphragm US and functional respiratory tests. Healthy subjects were also included to obtain normal diaphragm sniff ultrasound. We performed diaphragm tissue Doppler imaging (TDI) and time movement (TM) diaphragm echography combined with sniff maneuver. A total of 89 patients with neuromuscular diseases and 27 healthy subjects were included in our study. In patients, the median age was 32 years [25; 50] and the median FVC was 34% of predicted [18; 55]. Sniff diaphragm motion using TM ultrasound was significantly associated with sniff nasal pressure, both for the right hemidiaphragm (r = 0.6 p <0.0001) and the left hemidiaphragm (r = 0.63 p = 0.0008). Right sniff peak TDI velocity was also significantly associated with FVC (r = 0.72, p<0.0001) and with sniff nasal pressure (r = 0.66 p<0.0001). Sniff diaphragm ultrasound using either TM mode or TDI displayed significant accuracy for predicting FVC<60% with an area under curve (AUC) reaching 0.93 (p<0.0001) for the right sniff diaphragm ultrasound in TM mode and 0.86 (p<0.001) for right peak diaphragm TDI velocity. Sniff diaphragm TM and TDI measures were significantly associated with sniff nasal pressure. Sniff diaphragm TM and TDI had a high level of accuracy to reveal respiratory involvement in patients with neuromuscular disorders. This technique is useful to assess and follow up diaphragm function in patients with neuromuscular disorders. It may be used as a respiratory outcome for clinical trials.