Does it make difference to measure diaphragm function with M mode (MM) or B mode (BM)?

  • Burhan Sami KalınEmail author
  • Gül Gürsel
Original Research


Diaphragm dysfunction occurs in mechanically ventilated subjects. Recent literature suggests that diaphragm thickening fraction (DTF) measured by ultrasound can be useful to predict weaning outcome. However, there is no standardized approach in the measurement of diaphragm thickness (DT) and limited data exists comparing different measurement techniques of diaphragm thickness (M mode-MM or B mode-BM). The goal of this study was to compare MM with BM in the measurements of DT and excursion in the ICU subjects. DT measurements were obtained from the right diaphragm during tidal and maximal inspiratory breathing. Three measurements of the DT were taken both in MM and BM and their mean values were calculated. DT was measured during inspiration and expiration and DTF was calculated. Excursion of diaphragm was also measured with MM and BM during tidal and maximal inspiratory breathing. Bias and agreement between the two measurement methods were evaluated with Bland and Altman test. Sixty-two subjects were enrolled in the study. While 25 (40%) subjects were receiving invasive mechanical ventilation, 14 (23%) subjects ventilated noninvasively. There were no significant difference between the measurement results of MM and BM. BM and MM tidal diaphragm measurements during the inspiratory (0.3 ± 0.08 and 0.31 ± 0.08 cm; P = 0.022), expiratory (0.24 ± 0.07 and 0.24 ± 0.07 cm; P = 0.315) phases and tidal DTF were (27 ± 16 and 31 ± 14%, P = 0.089) respectively. Results of our study suggests that except tidal inspiratory diaphragm thickness, all thickness and excursion measurements with MM and BM are very compatible with each other. Further studies are necessarry to confirm our results and to standardize the measurements of diaphragm.


Diaphragm ultrasound Point of care ultrasound (POCUS) Intensive care unit (ICU) Respiratory failure Mechanical ventilation 



This study was supported by the foundation of Gazi University Scientific Researche Projects (No: 01/2015-48).

Compliance with ethical standards

Conflict of interest

The authors alone are responsible for the content and writing of the manuscript. The authors report no conflicts of interest.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Division of Critical Care, Department of Internal MedicineGazi University School of MedicineAnkaraTurkey
  2. 2.Department of Pulmonary Critical Care MedicineGazi University School of MedicineAnkaraTurkey

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