25!Gennaio!2020!

“Diaphragmatic+Sonography+vs+Structured+Light+Plethysmography+++after+NIV+an+
Mechanical+I=Exsufflator+treatments“
A. Longoni*/** , P. Pozzi **, A. Paddeu**
* S.R.R.F. - ** Cardio-Respiratory Rehabilitation Center “Paola Giancola Foundation”, S. Anthony Abate Hospital Cantù, ASST Lariana, Italy

angelo.longoni@asst-lariana.it

Case history
A 56 year-old male patient, former smoker and truck
driver that practised activity as bicyclist for 6 years
started suffering from right emiparesis in 2013; in 2014
the diagnosis of motoneuron disease (ALS) was set;
ALS went on and on 2016 the patient devoleped chest
wall muscles deficit and ipovalid cough. In 2017 he was
hospitalized to start non invasive mechanical ventilation
(NIMV) and assisted cough with a Cough Machine (CM)
in order to prevent respiratory insufficiency as well as
pneumonia.
The rehabilitative treatments
The patient has performed cycles of nighttime and
diurnal NIMV in S/T mode with oronasal mask, single
circuit with leak and esternal hot humidifier and three
daily treatments of diurnal cough machine with
Pressure I/E=+- 35cmH2O, (Time ins=2,5s, Time
exp=1,5s, Pause=1s) =1 cycle, for three/four repetitions
of five cycles. Once a day it performed motor exercises
with assisted minibike. Respiratory evaluation with
Ultrasound and Structured Light Plethysmography were
performed at the admission and at the discharge in
sitting position.
! +!
Investigations
The patient underwent a nighttime pulsoximetry. Pulmonary
function testings were not possible and we evaluated the patient
through the study of the diaphragm muscle excursion and chest
movements with a ultrasound (US) and the Pneumacare Thora
3-D System. The US machine, a portable one with a 1-5 MHz
Convex probe, was set in B and M-Mode modality and the
valutation was performed in an anterior subcostal approach on
semi-recumbent position. PneumaCare (called Structured Light
Plethysmography - SLP) consisted of a visible white light that
projected a grid pattern onto the patient’s chest. Two cameras
filmed the movement at high speed (30 frames per second) and
the software generated a 3D view of the chest wall movement
over the time and it calculated the volume of air moved. The
examination was performed in sitting or lying position in order to
measure the tidal volume in different settings.

SLP VS US

SLP: 7+4 = 11 VS US: 5+7 = 12

Conclusions
The difference in US diaphragmatic excursion was 0,4 cm to 1,5 cm with forced breath and 1,5 cm to 4 cm under Caugh Machine. The
Pneumacare
!!
values in forced breath were: upper left 61%, upper right 78%, lower left 90%, lower right 70% to upper left 22%, upper right 23%,
lower left 24%, lower right 30%. Our study suggests that the Ultrasonography and the Structured Light Plethysmography are a safe, reliable,
useful and complementary modality that provides clinicians with a non-invasive way, when the patient is no longer able to perform pulmonary
function testings, of observing active, real-time regional and selective respiratory function like the movement of the chest wall and the diaphragm
escursion.They can be used to set the NIMV and the Cough-assist machine at the bedside, in conscious or unconscious patient and they can help
clinicians and respiratory therapists in offering patients a tailored therapy.