Functional assessment of the diaphragm by speckle tracking ultrasound during inspiratory loading

Eline Oppersma, Nima Hatam, Jonne Doorduin, Johannes G. van der Hoeven, Gernot Marx, Andreas Goetzenich, Sebastian Fritsch, Leo M.A. Heunks*, Christian S. Bruells

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

50 Citations (Scopus)
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Assessment of diaphragmatic effort is challenging, especially in critically ill patients in the phase of weaning. Fractional thickening during inspiration assessed by ultrasound has been used to estimate diaphragm effort. It is unknown whether more sophisticated ultrasound techniques such as speckle tracking are superior in the quantification of inspiratory effort. This study evaluates the validity of speckle tracking ultrasound to quantify diaphragm contractility. Thirteen healthy volunteers underwent a randomized stepwise threshold loading protocol of 0-50% of the maximal inspiratory pressure. Electric activity of the diaphragm and transdiaphragmatic pressures were recorded. Speckle tracking ultrasound was used to assess strain and strain rate as measures of diaphragm tissue deformation and deformation velocity, respectively. Fractional thickening was assessed by measurement of diaphragm thickness at end-inspiration and endexpiration. Strain and strain rate increased with progressive loading of the diaphragm. Both strain and strain rate were highly correlated to transdiaphragmatic pressure (strain r2 = 0.72; strain rate r2 = 0.80) and diaphragm electric activity (strain r2 = 0.60; strain rate r2 = 0.66). We conclude that speckle tracking ultrasound is superior to conventional ultrasound techniques to estimate diaphragm contractility under inspiratory threshold loading. NEW & NOTEWORTHY Transdiaphragmatic pressure using esophageal and gastric balloons is the gold standard to assess diaphragm effort. However, this technique is invasive and requires expertise, and the interpretation may be complex. We report that speckle tracking ultrasound can be used to detect stepwise increases in diaphragmatic effort. Strain and strain rate were highly correlated with transdiaphragmatic pressure, and therefore, diaphragm electric activity and speckle tracking might serve as reliable tools to quantify diaphragm effort in the future.

Original languageEnglish
Pages (from-to)1063-1070
Number of pages8
JournalJournal of applied physiology
Issue number5
Publication statusPublished - 1 Nov 2017


  • Diaphragm
  • Mechanical ventilation
  • Speckle tracking ultrasound
  • Transdiaphragmatic pressure
  • 2023 OA procedure


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