Fourth, our study had a small sample size, so future studies should be conducted with larger samples. Lung ultrasound (LUS); aeration loss; atelectasis; diaphragmatic excursion; video-assisted thoracic surgery. Diaphragmatic excursion and extubation success. The probe was placed between the midclavicular and anterior axillary lines, in the subcostal area, and directed medially, cranially, and dorsally to achieve the best view of the right hemidiaphragm (Figure 1A). We conducted a prospective observational cross‐sectional study from July 2011 to October 2013. Good agreement was noted between the two devices, with ICCs of greater than 0.9 noted in all indices of measurement except for maximal excursion. Table 1 shows the anthropometric data for the groups. 9–11 In subjects with acute dyspnea admitted to the emergency department, a diaphragmatic ultrasound excursion < 2.3 cm was associated with a need for NIV. This site needs JavaScript to work properly. Perioperative LUS and diaphragmatic excursion assessment are also feasible for the continuous assessment of aeration loss in patients undergoing VATS. Results: Methods: These percentiles may be of great benefit to the pediatric radiologist and intensivist when assessing diaphragmatic excursion and will help in noninvasive bedside diagnosis of diaphragmatic weakness and paresis in children, without exposure to radiation during fluoroscopy or magnetic resonance imaging. We plotted percentile curves for right diaphragmatic excursion against body weight. Weight may have effects on pulmonary function tests including its impairment. Significant positive correlations were found between excursion of the right hemidiaphragm and body weight in all age groups (r = 0.52, 0.25, 0.27. and 0.20; P < .001, .013, .011, and .047 for groups 1–4, respectively). Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound: Ultrasonography Determination of Diaphragmatic Excursion Bassel Ericsoussi, MD Pulmonary … The authors found that, at 15-87% of inspiratory capacity, there was a linear relationship between diaphragmatic excursion … Ultrasound of the diaphragm is an evolving diagnostic modality with several techniques and measurements that can be used for structural and functional assessment of the diaphragm. 2019 Dec 2;7:54. doi: 10.1186/s40560-019-0409-x. We aimed at using an ultrasound image tracking algorithm (UITA) to trace diaphragm movement and reveal DE values in real time. The aims of this study were to determine reference values for diaphragmatic excursion and thickness, as evaluated by sonography in healthy infants and children, and identify correlations between them and anthropometric measurements, age, and sex. Departments of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt. Bland‐Altman plot for interobserver variability of right diaphragmatic excursion (bias, 0.08; 95% limits of agreement, −1.73 to 1.88; percent error, 0.15). The use of ultrasound to visualize the diaphragm is well established. 2020 Nov 9;20(1):281. doi: 10.1186/s12871-020-01196-3. This study aimed to test the feasibility of using LUS during the perioperative period of video-assisted thoracic surgery (VATS) and to continuously evaluate aeration changes through LUS examination and diaphragmatic excursion assessment. 8600 Rockville Pike Xie C, Sun K, You Y, Ming Y, Yu X, Yu L, Huang J, Yan M. BMC Anesthesiol. Bahgat E et al published Sonographic evaluation of diaphragmatic thickness and excursion as a predictor for successful extubation in mechanically ventilated preterm infants in the European Journal of Pediatrics. Table 5 shows correlations between right diaphragmatic excursion and body weight. Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound: Ultrasonography Determination of Diaphragmatic Excursion Bassel Ericsoussi, MD Pulmonary … Regarding nonexpandable lung, the increase in diaphragm excursion and velocity of contraction following fluid removal did not reach statistical significance. Performance of Lung Ultrasound in Detecting Peri-Operative Atelectasis after General Anesthesia. Examinations of numerous respiratory cycles were done and recorded on cine movies, and we counted the average of 3 cycles. ... Marchioni A, Castaniere I, Tonelli R, et al. If you do not receive an email within 10 minutes, your email address may not be registered, The results of these measurements are shown in Table 7 and Figures 3 and 4. Pleural pressure was measured at each aliquot of 250 mL of fluid removal. [14], Figure 1; p. 596). Clinical application of diaphragm muscle ultrasound (Figure modified according to: Tuinman et al. Monastesse A, Girard F, Massicotte N, Chartrand-Lefebvre C, Girard M. Anesth Analg. For intraobserver variability, the Bland‐Altman test showed low bias values (−0.10 for right diaphragmatic excursion, 0.04 for left diaphragmatic excursion, −0.03 for right diaphragmatic thickness, and 0.09 for left diaphragmatic thickness) and acceptable limits of agreement (95% confidence limits were −0.36 to 0.17 for right diaphragmatic excursion, −0.16 to 0.24 for left diaphragmatic excursion, −0.17 to 0.10 for right diaphragmatic thickness, and −0.03 to 0.2 for left diaphragmatic thickness). LUS was performed at four specific timepoints: before the induction of general anesthesia (timepoint A), 5 minutes after intubation (timepoint B), at the end of surgery (timepoint C), and 15 minutes after extubation (timepoint D). To evaluate intraobserver variability, the same sonographer examined 40 healthy participants twice (the participants returned especially for this study within 1–7 days). Santana et al. We used pacifiers to calm infants younger than 1 year, who were uncooperative during the examinations, and waited until they fell asleep. In conclusion, sonography proved to be a reproducible diagnostic tool for evaluation of diaphragmatic excursion and thickness in our study population. There were no statistically significant differences regarding sex concerning diaphragmatic excursion or thickness in each group. We acknowledge some limitations in our study. Those with obesity, failure to thrive, chronic illnesses, hepatomegaly or splenomegaly, cardio ‐respiratory diseases, or neurological diseases were excluded from the study. There were significant positive correlations between right and left diaphragmatic excursion and thickness and all anthropometric data. Acquired weakness in mechanical ventilation is a growing important cause of weaning failure. This results in thickening of the diaphragmatic muscle fibers, which can be measured at the ZOA, using ultrasound. Estimation of diaphragmatic excursion was conducted by measuring the vertical distance between the upper border of the liver (window on the right hemidiaphragm) or spleen (window on the left hemidiaphragm) at the end of expiration to the upper border of the liver or spleen at the end of inspiration: ie, the vertical distance between the bottom to the peak of the tracing line; the two points must be either below the tracing line or above it. Careers. It is responsible for three‐fourths of the increment in lung volume during quiet breathing.1 Diaphragmatic dysfunction is underdiagnosed because it has nonspecific clinical presentations, such as unexplained dyspnea or respiratory distress, paradoxical movement of the abdomen with respiration, recurrent pneumonia, lung collapse, and difficult weaning from mechanical ventilation.2 Therefore, determining baseline data for normal diaphragmatic excursion in infants and children will help physicians diagnose diaphragmatic dysfunction. and you may need to create a new Wiley Online Library account. Both lung ultrasound (LUS) and diaphragmatic excursion assessments are accurate and noninvasive for bedside imaging and examination. Boussuges et al11 assessed diaphragmatic excursion in healthy adult individuals during quiet breathing, deep breathing, and voluntary sniffing; they found differences in diaphragmatic excursion measurements according to the breathing pattern. Thickness is the perpendicular distance between the pleural and peritoneal reflections. The main objective of this study was to assess if ultrasound-based diaphragmatic excursion (DE) is helpful with RSBI as weaning predictors. Ultrasound recordings of diaphragmatic excursion and thickening were performed using an ultrasound machine (Vivid S5; GE Healthcare) with either high definition probe (12 MHz) for thickening of the apposition zone or a high penetration probe (4 MHz) for the excursion of the dome. Diaphragm excursion and velocity of diaphragm contraction were measured with M-mode ultrasonography of the affected hemidiaphragm. Diaphragmatic sonography overcomes the limitations of other imaging modalities.4 It is superior to measurement of transdiaphragmatic pressure because it is noninvasive and can determine unilateral diaphragmatic paralysis.10 It is also superior to fluoroscopic examination and magnetic resonance imaging because it is a simple bedside modality with no exposure to ionizing radiation.3 Moreover, it offers recordings that can be compared during follow‐up.1 M‐mode sonography is a well‐established tool for detection of diaphragmatic excursion and thickness in adults, and their normal values have been reported.11 Diaphragmatic thickness was assessed in previous studies in healthy preterm12 and full‐term infants.13 Despite its value in assessing diaphragmatic function, it is not routinely evaluated by radiologists and pediatric intensivists,14 and to our knowledge, no previous studies have evaluated reference values for diaphragmatic excursion and thickness in healthy infants and children. Xia J, Qian CY, Yang L, Li MJ, Liu XX, Yang T, Lu Q. J Intensive Care. 3 have also reported how to evaluate diaphragmatic excursion by using the subcostal view in B mode and transverse scanning. This method yields an unbiased estimate of a population percentile.16. Sonographic examinations were performed by 2 investigators (operator 1 [A.A.], a pediatric radiologist who routinely performs sonography of the diaphragm; and operator 2 [H.E. Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study. The major challenge of radiotherapy in the thorax is the motion associated with diaphragmatic excursion and cardiac contraction. Diaphragmatic excursion is the perpendicular distance between the upper border of the liver at the end of expiration and the end of inspiration. Mastery of this competency will allow for the most straightforward assessment of suspected diaphragm paralysis and dysfunction. Thickness is the perpendicular distance between the pleural and peritoneal reflections. Table 4 shows correlations between sonographic measurements of the diaphragm and anthropometric data (age, body weight, length, head circumference, chest circumference, and body surface area) in group 1. The Department of Internal Medicine, Faculty of Medicine, Al-Azhar University,Cairo, Egypt ABSTRACT Much has been written about extubation checklists including such measures as mean airway pressure minimums and oxygen thresholds as well as trials of pressure support at low rates. The average duration of the diaphragmatic sonographic examination was 5 minutes. doi: 10.1016/j.ijsu.2008.12.014. It occurs due to incomplete muscularisation of the diaphragm with a thin membranous sheet replacing normal diaphragmatic muscle. Diaphragmatic excursion and extubation success. Knowing when to extubate an ELBW is never an easy task. A data distribution evaluation was done with the Kolmogorov‐Smirnov test. The patients with supine position, DE is measured by ultrasonic probe in the right midline of the axillary and left axillary posterior line, respectively. Second, it might be difficult to evaluate breath‐by‐breath variability of liver and spleen displacement in infants and young children; however, we waited until we ensured quiet regular breathing, and we took an average of at least 3 respiratory cycles during our assessment. Among them were 4 (33.3%) lung resection patients and 8 (66.7%) mediastinal tumor resection patients. Bedside ultrasonography, which is already crucial in several aspects of critically illness, 81, 82 has recently been proposed as a simple, noninvasive method of quantification of diaphragm contractile activity. Diaphragmatic Excursion on Ultrasound is Associated with Respiratory Outcomes Following Repair of Congenital Diaphragmatic Hernia Ross JT, Liang NE, Phelps A, Vu L, Pacific Coast Surgical Association 2019 Annual Meeting, Tucson, AZ, 2/15/2019 The probe was placed between the anterior and midaxillary lines, in the subcostal or lower intercostal area, and directed medially, cranially, and dorsally to achieve the best view of the left hemidiaphragm (Figure 1B). During weaning from mechanical ventilation and spontaneous breathing trials, both diaphragmatic excursion and In this study, measurements of diaphragmatic excursion and thickness were done during quiet breathing. Accessibility Diaphragm Movement And Contractility Evaluation By Thoracic Ultrasound 1. It occurs due to incomplete muscularisation of the diaphragm with a thin membranous sheet replacing normal diaphragmatic muscle. Imperatori A, Rotolo N, Gatti M, Nardecchia E, De Monte L, Conti V, Dominioni L. Int J Surg. The idea of the “ultrasound stethoscope” is rapidly moving from the theoretical to reality, as had been described by Moore and Copel,17 referring to the great advances in the use of sonography by the physician, not just the radiologist, for diagnosis and management of different diseases. 24 for diaphragm examination was used. Does video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection? Unable to load your collection due to an error, Unable to load your delegates due to an error. Diaphragmatic excursion (DE) was calculated as the difference between axial slices through the lungs on inspiration and expiration, using the first slice at which the lung apex was evident as the cranial bound, and the first slice at which the diaphragm appeared as the caudal bound. Keywords: 85 Diaphragmatic eventration may be congenital or acquired in nature. Would you like email updates of new search results? Figure 2: Measurement of the diaphragmatic excursion (1.52cm) during quiet breathing, by M mode ultrasonography: the voltage pulse reports the beginning of both inspiration (arrow: larger voltage) and expiration (image produced using a Vivid E90 and a M5S transducer, GE Healthcare, Little Chalfont, United Kingdom). by All Things Neonatal | Jan 28, 2021 | Point of Care Ultrasound, ventilation. Methodology: Diaphragmatic excursion (DE) in cm was measured through ultrasound by marking liver and spleen displacement in patients who fulfilled the criteria of removal from ventilatory support. COVID-19 is an emerging, rapidly evolving situation. 2013 Jul;17(1):159-62. doi: 10.1093/icvts/ivt097. For group comparisons of parametric data, we used an independent‐samples t test. Clinical features are highly variable according to underlying etiological factor: 1. unilateral paralysis: asymptomatic in most of the patients as the other lung compensates 1.1. may have dyspnea, headaches, fatigue, insomnia and overall breathing difficulty 2. bilateral diaphragmatic palsy can be a medical emergency; they present with severe dyspnea, even with mild exertion Ultrasonographic diaphragmatic excursion is inaccurate and not better than the MRC score for predicting weaning-failure in mechanically ventilated patients. There was a minimal increase in diaphragmatic excursion with pleural fluid drainage in subjects with nonexpandable lung. Privacy, Help The ultrasound evaluations were carried out before (preoperative) and after (i.e., 2 h and 24 h postoperatively) surgery. We evaluated 400 healthy infants and children (221 male and 179 female) in the 4 different age groups. Both B-mode and M-mode ultrasound techniques have been employed to assess diaphragm excursion (DE), which measures the distance that the diaphragm is able to move during the respiratory cycle. Data are presented as mean ± SD where applicable. PMID: 31278543 Diaphragmatic dysfunction (DD) has a high incidence in critically ill patients and is an under-recognized cause of respiratory failure and prolonged weaning from mechanical ventilation. Mini-Podium Presentation at the Annual Meeting of the Pacific Coast Surgical Association; 2019; Tucson, AZ. 12,13 Recently, diaphragmatic ultrasound assessment has been proposed as a useful tool in managing patients with a COPD exacerbation who were admitted to the emergency department and … The measurement will be repeated twice, and an average of the two will be taken. For interobserver variability, the Bland‐Altman test showed low bias values (0.08 for right diaphragmatic excursion, 0.14 for left diaphragmatic excursion, −0.07 for right diaphragmatic thickness, and −0.09 for left diaphragmatic thickness) and acceptable limits of agreement (95% confidence limits were −0.22 to 0.37 for right diaphragmatic excursion, −0.09 to 0.37 for left diaphragmatic excursion, −0.20 to 0.07 for right diaphragmatic thickness, and −0.28 to 0.1 for left diaphragmatic thickness). Diaphragmatic excursion was measured twice at each time point by a single well-trained expert (K.K.) The patients were followed up for 48 hours and classified according to the outcome as successful weaning and weaning failure. A diaphragmatic excursion >25 mm increased the likelihood of success of SBT (spontaneous breathing trial) in mechanically ventilated patients . This results in thickening of the diaphragmatic muscle fibers, which can be measured at the ZOA, using ultrasound. ... wherein Scheibe et al. ], a pediatric intensivist who was trained by the pediatric radiologist in repeated training sessions over 1 year on abdominal sonography and assessment of diaphragmatic excursion and thickness in infants and children and performed examinations on about 130 participants before this study). Diaphragm ultrasound has been shown to be a reliable tool in evaluating diaphragmatic excursion and thickness in critically ill subjects with AHRF who are undergoing invasive mechanical ventilation. The sonographic examinations were performed with the participants in the supine position during quiet breathing, excluding deep breathing, crying, participants with nasal obstruction, rhinorrhea, or cough, and participants with abdominal pain. We fixed the probe on the chest wall throughout the examination, used the 2‐dimensional mode to detect the best view, and then used M‐mode imaging. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. To evaluate the reproducibility of measuring diaphragmatic excursion and thickness using sonography, interobserver and intraobserver variability were assessed. FOIA Although lung-protective strategies are widely used in thoracic surgery, postoperative atelectasis can still occur. The 2‐dimensional mode was used to locate the best imaging view of right and left hemidiaphragms. using a 5–2 MHz convex transducer and an Edge II ultrasound … Clipboard, Search History, and several other advanced features are temporarily unavailable. First, applying a sonographic probe on the abdominal wall of a patient might change the breathing pattern of that patient; therefore, we should wait until ensuring quiet regular breathing before measuring liver and spleen displacement. A stepwise regression analysis was used to assess predictors of right diaphragmatic excursion. This vertical distance represents right/left diaphragmatic excursion (Figure 1C).6,15. During this type of major surgery, many factors may contribute to hemodynamic collapse, including myocardial infarction, pulmonary embolus, bleeding, and preload reduction owing to inferior vena cava clamping. Diaphragmatic excursion was measured twice at each time point by a single well-trained expert (K.K.) Epub 2008 Dec 13. C, M‐mode sonogram of the right diaphragm. These results indicate that sonographic measurement of diaphragmatic excursion and thickness is a reproducible technique. On the other hand, in an adult study, Boussuges et al11 found weak correlations between diaphragmatic excursion and body weight and height but no significant correlation with age. Table 3 shows the effect of sex on diaphragmatic movement and thickness in the groups. (A,B) Each hemithorax was divided into 6 quadrants by anterior and posterior axillary lines; (C) the diaphragm ultrasound investigation was performed with a low-frequency curvilinear transducer in bilateral costal margins between the anterior and posterior axillary lines. Percentile curves for right diaphragmatic excursion plotted against body weight were plotted. We discovered that changes in LUS scores were found to be associated with an increase of diaphragmatic excursions after assessment (Spearman's r=-0.54, P<0.001). We measured diaphragmatic excursion and thickness with participants in the supine position to avoid changes in diaphragmatic excursion with changes in position.27,28, Regarding reproducibility, the interobserver and intraobserver variability were assessed with Bland‐Altman plots and revealed low bias values and a high degree of agreement between sonographic measurements. Third, our measurements may not be applicable to all sick children, as some of them may not have normal quiet breathing patterns. They were divided into 4 equal groups according to age (group 1, 1 month–2 years; group 2, 2–6 years; group 3, 6–12 years; and group 4, 12–16 years). Diaphragmatic excursion assessment was performed only at the first (timepoint A) and last timepoints (timepoint D) for the use of paralytics during surgery. Please enable it to take advantage of the complete set of features! Between January 2019 and May 2019, data were prospectively collected from patients that were scheduled to undergo a VATS with one-lung ventilation (OLV). Thus, the aims of this study were to determine reference values for diaphragmatic excursion and thickness, as evaluated by sonography in healthy infants and children, and identify correlations between them and anthropometric measurements, age, and sex. M‐mode sonography is a noninvasive method for detection of diaphragmatic excursion and thickness. Both lung ultrasound (LUS) and diaphragmatic excursion assessments are accurate and noninvasive for bedside imaging and examination. Diaphragmatic excursion and its thickening fraction (TF) were measured as markers of diaphragmatic function. The measurement will be repeated twice, and an average of the two will be taken. by All Things Neonatal | Jan 28, 2021 | Point of Care Ultrasound, ventilation. 2008;6 Suppl 1:S78-81. B, B‐mode sonogram of the left hemidiaphragm. The participants were collected from the outpatient clinic in the morning, with at least 3 hours of fasting (to ensure an empty stomach, which would not affect diaphragmatic excursion or mask the left hemidiaphragmatic view). The participants were separated into 7 weight categories according to body weight: 10 kg and lower (n = 84), 10 to 20 kg (n = 116), 20 to 30 kg (n = 58), 30 to 40 kg (n = 46), 40 to 50 kg (n = 47), 50 to 60 kg (n = 29), and 60 to 65 kg (n = 20). The movements of the right and left hemidiaphragms were recorded on M‐mode sonography in real time. Ultrasound recordings of diaphragmatic excursion and thickening were performed using an ultrasound machine (Vivid S5; GE Healthcare) with either high definition probe (12 MHz) for thickening of the apposition zone or a high penetration probe (4 MHz) for the excursion of the dome. Over time this region stretches and on inspiration does not contract normally. Background: We considered P < .05 statistically significant. A linear 10-12 MHz ultrasound probe will be used to determine diaphragmatic excursion, by examining the zone of apposition. Although ultrasound diaphragmatic excursion and thickening fraction are correlated, excursion seems to be a more feasible and reproducible method in this population. Among different methods to assess diaphragmatic function, diaphragm ultrasonography (DU) is noninvasive, rapid, and easy to perform at the bedside. As a result, LUS helped detect postoperative atelectasis in 12 patients (15.0%). The M-mode then is used to show movements and measure diaphragmatic excursion (Ex, cm), the inspiratory (Tinsp) and expiratory (Texp) times (s), and the speed of diaphragmatic contraction (slope, cm/s). The calculation of DE value requires recording the diaphragm movement, freezing the ultrasound image, recalling video and measuring target distance which is time consuming. Diaphragmatic eventration may be congenital or acquired in nature. This is of particular interest because the longitudinal approach has been reported to be preferable. 1 indicates measurements by an observer; and 2, repeated measurements by the same observer. Lung ultrasound scoring. The diaphragmatic inspiratory excursion and time to peak inspiratory amplitude of the diaphragm (TPIA dia) of each hemidiaphragm (right TPIA dia and left TPIA dia) were measured in M-mode using a 1- to 5-MHz ultrasound transducer during tidal breathing (Fig. eCollection 2019. From the ... elevated heart rate and increased respiratory excursion, may ini-tially help preserve the hemodynamics in spontaneously breath-ing patients. Background Successful weaning depends on several factors: muscle strength, cardiac, respiratory and metabolic. There are two proposed diaphragm sonographic predictors: the diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF). After ensuring quiet regular breathing by the participant, we froze the sonogram. The infants and children enrolled in this study were chosen from the outpatient clinic of Mansoura University Children's Hospital (coming with nonrespiratory and nonabdominal conditions). Diaphragmatic ultrasound excursion and thickness have been shown to be variously affected in subjects admitted to the emergency department with AHRF. Working off-campus? Significant positive correlations were found between right diaphragmatic excursion and body weight in all 4 groups. These findings are in agreement with the findings of Rehan and McCool,13 who studied healthy term infants and found significant correlations between diaphragmatic thickness and anthropometric measurements (weight, body length, and head circumference) and concluded that the diaphragmatic mass in healthy term infants is proportional to body size. (B) Use of a low-frequency (3.5-5 MHz) ultrasound transducer (convex or phased array probe) to identify the right hemidiaphragm (see above). A total of 400 healthy participants aged between 1 month and 16 years, divided into 4 equal groups (group 1, 1 month–2 years; group 2, 2–6 years; group 3, 6–12 years); and group 4, 12–16 years) were studied. Cohen et al., studying ten normal subjects, recorded simultaneously the diaphragmatic excursion (using ultrasound in M-mode) and the tidal volume at different inspiratory volumes. Lung Ultrasonography for the Assessment of Perioperative Atelectasis: A Pilot Feasibility Study. After cardiac surgery, the evolution of diaphragmatic function is characterized by a transient impairment followed by a quick recovery. Imaging of the diaphragm in the ZAP using B-mode, with measurement and interpretation of tdi, ∆tdi, and ∆tdi%, is the basic core competency in diaphragm ultrasound. 4 Ultrasound can be used to determine diaphragm excursion, 83, 84 which may help to identify patients with diaphragm dysfunction. ... Marchioni A, Castaniere I, Tonelli R, et al. Diaphragmatic Excursion Assessment by Ultrasound versus Volume Associated Weaning Parameters as A Prediction in Extubation in Critically Ill Patients Mohamed Ahmed Abdel Hamid Shaalan, Gamal Ali Badr ,Atef Abou Elfotouh Ibrahim , Amr Ahmed Mostafa . Correction to: Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study. We enrolled healthy infants and children with normal growth parameters. The investigators chose the probe offering the best image resolution. Many studies use ultrasound for diaphragmatic excursion (DE) evaluation. Bethesda, MD 20894, Copyright Bland‐Altman plot for intraobserver variability of right diaphragmatic excursion (bias, −0.10; 95% limits of agreement, −1.74 to 1.55; percent error, 0.13). This study aimed to test the feasibility of using LUS during the perioperative period of video-assisted thoracic surgery (VATS) and to continuously evaluate aeration changes through LUS examination and diaphragmatic excursion assessment. We used a portable Doppler ultrasound machine (Xario; Toshiba Medical Systems Co, Ltd, Tokyo, Japan) with a 10–5‐MHz linear transducer for infants and a 5–1‐MHz convex transducer for children and adolescents.
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