Assessment of the diaphragmatic mobility by chest ultrasound in patients with chest deformities before and after pulmonary rehabilitation program

Context
Chest wall malformations (CWMs) are a broad group of elevated-morbidity anomalies that were classified by Acastello into kyphoscoliosis, ankylosing spondylitis, and pectus excavatum. The diaphragm, as the major respiratory muscle, is affected by these CWMs, leading to respiratory insufficiency and failure. Ultrasound is the modality of choice used in assessing diaphragmatic mobility and monitoring its effects in the four mentioned diseases.


Aims
In this study, an assessment of the diaphragmatic mobility via chest ultrasound was performed in patients with chest deformities before and after a pulmonary rehabilitation program.


Settings and design
This was an observational comparative study.


Patients and methods
This study included 40 patients with acquired and developmental chest wall deformities, nonsmokers and individuals with no cardiopulmonary disorders. Chest wall deformity was diagnosed by chest radiograph posteroanterior and lateral views, whereas the severity of the deformity was detected by calculating Cobb’s angle in comparison with the severity of spirometry with respect to the forced vital capacity. Spirometry was performed in these patients before and after the pulmonary rehabilitation program, along with a chest ultrasound, to follow up their diaphragmatic excursion and compare the results.


Statistical analysis used
SPSS program (Statistical Package for Social Sciences), software, version 20, was used.


Results
A marked decrease in the right range of movement (ROM) of the diaphragmatic copula (P=0.001) as well as a marked decline in the left ROM of diaphragmatic copula in the patient group (P=0.029) were detected. Moreover, a marked improvement in the right as well as the left ROM, diaphragmatic thickness and maximal inspiratory pressure was detected after rehabilitation (P=0.001). Cobb’s angle higher than 43° has been statistically proposed as a cut-off value for predicting mortality, while maximal inspiratory pressure less than 55% has been statistically proposed as a cut-off value for predicting mortality after the operation.


Conclusions
CWMs restrict the chest wall skeletal structure as well as the spine, with its joints, and thus interfere with diaphragmatic mobility. Ultrasound represents a good, reliable, and real-time tool for assessing diaphragmatic mobility and monitoring response to rehabilitation programs.