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Ultrasound-detected postoperative diaphragmatic dysfunction and its association with pulmonary complications. A

Jose D Jimenez-Santana1, Danila Azzolina2, Gaetano Scaramuzzo3

  • 1Departament de Medicina, Facultat de Medicina i Odontologia, Universitat de València, Av. Blasco Ibáñez 15, 46010 Valencia, Spain; Department of Anaesthesiology, Hospital Universitari i Politécnic la Fe, 46026 Valencia, Spain.

Journal of Clinical Anesthesia
|October 2, 2025
PubMed

Insights

Postoperative diaphragmatic dysfunction (PDD), identified via ultrasound, significantly increases the risk of pulmonary complications, including pneumonia. This highlights PDD

Area of Science:

  • Critical Care Medicine
  • Pulmonary Medicine
  • Surgical Outcomes

Background:

  • Postoperative diaphragmatic dysfunction (PDD) is a frequent complication after major surgery, linked to adverse clinical outcomes.
  • Ultrasound assessment is the current standard for evaluating PDD.
  • Understanding the link between PDD and postoperative pulmonary complications (PPCs) is crucial for patient management.

Purpose of the Study:

  • To systematically assess the association between ultrasound-diagnosed PDD and PPCs.
  • To investigate the specific relationship between PDD and pneumonia as a component of PPCs.

Main Methods:

  • A systematic review and meta-analysis of clinical studies evaluating PDD using ultrasound (diaphragmatic excursion or thickening fraction).
  • Searches were conducted in PubMed, Scopus, and Embase databases with a specific inclusion period.
  • Studies involving adult patients undergoing cardiac, thoracic, or abdominal surgery were included, adhering to PRISMA guidelines.

Main Results:

  • The review included 19 studies, with six qualifying for meta-analysis.
  • PDD demonstrated a significant association with increased odds of PPCs (OR 2.99) and pneumonia (OR 5.41).
  • Low heterogeneity and no significant publication bias were observed.

Conclusions:

  • Ultrasound-assessed PDD is a significant predictor of PPCs, including pneumonia.
  • These findings underscore the clinical utility of bedside ultrasound in identifying patients at risk for PDD and subsequent pulmonary complications.
  • Early detection and management of PDD can potentially mitigate adverse surgical outcomes.
Abstract

Keywords:
Diaphragmatic excursionDiaphragmatic thickening fractionPostoperative diaphragmatic dysfunctionPostoperative pulmonary complicationsUltrasound

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