Poster n.

475
M-mode sonography of diaphragmatic motion in order to set the cough-assist
machine in the uncooperative patients
A. Longoni Respiratory Therapist, A. Paddeu MD, D. Mangiacasale MD, P. Pozzi MD, A.D. Marco MD, L. Cattaneo MD, M. Vago Respiratory Therapist
Asst Lariana -U.O. of Specialistic Cardio-Respiratory Rehabilitation 2, Paola Giancola Foundation, Cant, Italy
angelo.longoni@asst-lariana.it

Objective: M-mode sonograpny (US) of the diaphragmatic

motion may be an aid for the respiratory therapist to better Working phases
calibrate the cough-assist machine in uncooperative patients (Fig.1).

Methods: 10 uncooperative patients (Fig.13) in spontaneous

breathing and mechanically ventilated were studied. The US machine,
a portable one with a 1.3-4 MHz Sector Phased Array Transducer, was
set in B and M-Mode modality (Fig.2-3). US sonography were
performed in an anterior subcostal approach (Fig. 4) on semi- Fig. 1: Uncooperative pz. Fig. 2: Ecography B mode Fig. 3: M-Mode Fig. 4:Subcostal approch
recumbent position (Fig. 5), initially during normal breathing (Fig.
6),then with the cough assistant machine (Fig.7). The cough machine
pressures were: PI/E=+-10, 20, 25, 30, 35 ,40 cmH2O (Fig .
8,9,10,11,12 are of patient n. 5) while the Inspiratory Time (TI=3s.),
Expiratory Time (TE=2s.) and the Pause (P=1s.) were unchanged.

Results: The treatments were completed at patient bedside with

Fig. 5 :Position Fig. 6: Normal breath Fig. 7: Cough machine Fig.8: Pz n.5=+- 10 cm H2O
a considerable saving of time by two RT therapists. The best cough
machine value was achieved by considering the best ratio between
the diaphragm recruitment/excursion and the less pressure of work
(Fig. 10). A high pressure of the cough machine didnt always offer
effectiveness and comfort in the majority of patients (Fig. 11).

Conclusion: Our study suggests that the diaphragmatic

Fig.9: Pz n.5=+- 20 cm H2O Fig. 10: Pz n.5=+- 30 cm H2O Fig. 11: Pz n.5=+- 40 cm H2O Fig.12: Cough parameters
sonography is a safe, reliable, fast and useful modality to set the
cough-assist machine. It can be performed at the patient bedside
and it may help clinicians and therapists in offering uncooperative
patients a tailored therapy.

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Fig.13: Uncooperative respiratory patients