J Korean Med Sci.  2011 Sep;26(9):1209-1213. 10.3346/jkms.2011.26.9.1209.

Influence of Diaphragmatic Mobility on Hypercapnia in Patients with Chronic Obstructive Pulmonary Disease

• Kang HW
• Kim TO
• Lee BR
• Yu JY
• Chi SY
• Ban HJ
• Oh IJ
• Kim KS
• Kwon YS
• Kim YI
• Kim YC
• Lim SC

• KMID: 1779396
• DOI: http://doi.org/10.3346/jkms.2011.26.9.1209

Abstract

A reduction in diaphragm mobility has been identified in patients with chronic obstructive pulmonary disease (COPD) and has been associated with a decline in pulmonary function parameters. However, little information exists regarding the potential role of diaphragm mobility on hypercapnia in COPD. A new method of assessing the mobility of the diaphragm, using ultrasound, has recently been validated. The purpose of the present study was to investigate the relationship between diaphragm mobility and pulmonary function parameters, as well as that between arterial blood gas values and diaphragm mobility, in COPD patients. Thirty seven COPD patients were recruited for pulmonary function test, arterial blood gas analysis and diaphragm mobility using ultrasound to measure the craniocaudal displacement of the left branch of the portal vein. There were significant negative correlations between diaphragmatic mobility and PaCO2 (r = -0.373, P = 0.030). Diaphragmatic mobility correlated with airway obstruction (FEV1, r = 0.415, P = 0.011) and with ventilatory capacity (FVC, r = 0.302, P = 0.029; MVV, r = 0.481, P = 0.003). Diaphragmatic mobility also correlated significantly with pulmonary hyperinflation. No relationship was observed between diaphragm mobility and PaO2 (r = -0.028, P = 0.873). These findings support a possibility that the reduction in diaphragm mobility relates to hypercapnia in COPD patients.

Keyword

Pulmonary Disease, Chronic Obstructive; Diaphragm mobility; Hypercapnia; Ultrasonography

MeSH Terms

Aged
Airway Resistance/physiology
Carbon Dioxide/blood/physiology
Diaphragm/physiopathology/*ultrasonography
Female
Humans
Hypercapnia/complications/*physiopathology
Male
Middle Aged
Portal Vein
Pulmonary Disease, Chronic Obstructive/complications/*physiopathology/ultrasonography
Pulmonary Gas Exchange
Respiratory Muscles/physiopathology

Figure

• 

  Fig. 1 B-mode ultrasonography measurement of craniocaudal displacement of the left intrahepatic portal vein branch. The line shows displacement of the left branch of the portal vein during maximal inspiratory and expiratory breathing in the sagittal plane. The P cursor marks the initial position of this vessel during maximal expiration, and another cursor (+) marks the position of the vessel during maximal inspiration. The craniocaudal displacement of this branch was recorded in millimeters.

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  Fig. 2 The relationship between diaphragmatic mobility and the PaCO2. There was a negative linear correlation between the two measurements (r = -0.373, P = 0.030). PaCO2, arterial carbon dioxide tension.

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