Ultrasound Assessment of Diaphragmatic Motion in Subjects With ARDS During Transpulmonary Pressure-Guided PEEP Titration

Roy J. Cho, Alex Adams, Sum Ambur, Scott Lunos, Robert S Shapiro, Matthew E. Prekker

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


BACKGROUND: We aimed to investigate the effects of incremental PEEP titration in patients with ARDS on regional diaphragmatic motion with bedside ultrasound. METHODS: Dorsal diaphrag-matic excursion (DDE) and ventral diaphragmatic excursion (VDE) were measured using anatomic M-mode ultrasonography of the right hemidiaphragm as PEEP was randomized to-6,-3, +3, and +6 cm H 2O from baseline to achieve a positive transpulmonary pressure. Inter-operator variability of DDE was assessed in 10 separate subjects. RESULTS: A total of 14 subjects ventilated for ARDS were enrolled. Subjects had a mean age of 54 ± 12 y, mean P aO2/F IO2 = 137 ± 54 mm Hg, and mean sequential organ failure assessment (SOFA) score = 14 ± 1). Transpulmonary pressure, DDE, and DDE/VDE ratio increased with incremental PEEP titration (-1.15 cm H 2O vs 3.63 cm H 2O, P < .001; 4.9 mm vs 8.2 mm, P < .001; and 62% vs 93%, P < .001, respectively). When trans-pulmonary pressure became positive, a visual increase in DDE and DDE/VDE ratio 0.60 to 0.93 was observed (from 0.48 cm to 0.82 cm, R 2 = 0.87, P = .02; and R 2 = 0.93, P = .006, respectively). There was high agreement in DDE measurements between 2 ultrasonographers (intra-class correlation 0.987, P < .001). CONCLUSIONS: DDE was affected by incremental PEEP titration toward a positive transpulmonary pressure. The ultrasound assessment using anatomic M-mode allowed for specific measurement of regional diaphragmatic excursion. This pattern of motion in the dependent regions of the diaphragm during PEEP titration in subjects with ARDS achieving a positive trans-pulmonary pressure may reflect a potential target for future studies in the bedside assessment for lung recruitment.

Original languageEnglish (US)
Pages (from-to)314-319
Number of pages6
JournalRespiratory care
Issue number3
StatePublished - Mar 1 2020

Bibliographical note

Publisher Copyright:
© 2020 Daedalus Enterprises.


  • ARDS
  • critical care ultrasound
  • PEEP
  • Critical care ultrasound
  • Motion
  • Humans
  • Middle Aged
  • Male
  • Positive-Pressure Respiration
  • Respiratory Distress Syndrome/diagnostic imaging
  • Diaphragm/diagnostic imaging
  • Ultrasonography
  • Adult
  • Female
  • Aged
  • Respiratory Mechanics

PubMed: MeSH publication types

  • Journal Article


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