array:24 [ "pii" => "S2341192922001585" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.06.003" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1406" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2022;69:536-43" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935621003029" "issn" => "00349356" "doi" => "10.1016/j.redar.2021.06.009" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1406" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2022;69:536-43" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Confiabilidad interevaluador de la medición de la excursión diafragmática y fracción de engrosamiento diafragmático mediante ultrasonografía en voluntarios sanos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:3 [ 0 => "es" 1 => "es" 2 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "536" "paginaFinal" => "543" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Inter-rater reliability of the measurement of diaphragmatic excursion and fraction of diaphragmatic thickening by ultrasonography in healthy volunteers" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1808 "Ancho" => 2917 "Tamanyo" => 181604 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Grosor espiratorio (GE) en la ventana esplénica y hepática, en modo 2D y M medido por los 3 evaluadores. Los valores presentados son dados en centímetros. El número y ubicación de los asteriscos representan los datos atípicos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E.C. Wilches-Luna, F.E. Pabón-Muñoz, J.M. Arias-Campo, A.F. Caballero-Lozada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E.C." "apellidos" => "Wilches-Luna" ] 1 => array:2 [ "nombre" => "F.E." "apellidos" => "Pabón-Muñoz" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Arias-Campo" ] 3 => array:2 [ "nombre" => "A.F." "apellidos" => "Caballero-Lozada" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aceptable confiabilidad interevaluador de US diafragmática entre no médicos.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Concordancia sustancial en medición de la ED en las ventanas esplénica y hepática.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Concordancia leve en medición de la FED en la ventana hepática.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Medición de la FED en el modo 2D, en ventana esplénica tuvo concordancia regular.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192922001585" "doi" => "10.1016/j.redare.2021.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192922001585?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621003029?idApp=UINPBA00004N" "url" => "/00349356/0000006900000009/v1_202210300548/S0034935621003029/v1_202210300548/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192922001639" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.09.006" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1388" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2022;69:544-55" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Pre-clinical validation of a turbine-based ventilator for invasive ventilation—The ACUTE-19 ventilator" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "544" "paginaFinal" => "555" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1808 "Ancho" => 2926 "Tamanyo" => 587326 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ACUTE-19 ventilator prototype. A; Right: front view. Left: internal view showing the main components. B: touchscreen settings. See text for more details.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Alonso-Iñigo, G. Mazzinari, M. Casañ-Pallardó, J.I. Redondo-García, J. Viscasillas-Monteagudo, A. Gutierrez-Bautista, J. Ramirez-Faz, P. Alonso-Pérez, S. Díaz-Lobato, A.S. Neto, O. Diaz-Cambronero, P. Argente-Navarro, M. Gama de Abreu, P. Pelosi, M.J. Schultz" "autores" => array:16 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Alonso-Iñigo" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Mazzinari" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Casañ-Pallardó" ] 3 => array:2 [ "nombre" => "J.I." "apellidos" => "Redondo-García" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Viscasillas-Monteagudo" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Gutierrez-Bautista" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "Ramirez-Faz" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Alonso-Pérez" ] 8 => array:2 [ "nombre" => "S." "apellidos" => "Díaz-Lobato" ] 9 => array:2 [ "nombre" => "A.S." "apellidos" => "Neto" ] 10 => array:2 [ "nombre" => "O." "apellidos" => "Diaz-Cambronero" ] 11 => array:2 [ "nombre" => "P." "apellidos" => "Argente-Navarro" ] 12 => array:2 [ "nombre" => "M." "apellidos" => "Gama de Abreu" ] 13 => array:2 [ "nombre" => "P." "apellidos" => "Pelosi" ] 14 => array:2 [ "nombre" => "M.J." "apellidos" => "Schultz" ] 15 => array:1 [ "colaborador" => "for the open source smart breathing system ACUTE-19 investigators" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S003493562100267X" "doi" => "10.1016/j.redar.2021.09.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493562100267X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192922001639?idApp=UINPBA00004N" "url" => "/23411929/0000006900000009/v1_202211040623/S2341192922001639/v1_202211040623/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192922001603" "issn" => "23411929" "doi" => "10.1016/j.redare.2022.09.002" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1419" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2022;69:526-35" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Utility of the central venous-to-arterial CO<span class="elsevierStyleInf">2</span> difference to predict adverse outcomes after liver transplantation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "526" "paginaFinal" => "535" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la diferencia venoarterial de PCO2 como predictor de complicaciones en el postoperatorio inmediato del trasplante hepático" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1054 "Ancho" => 2925 "Tamanyo" => 205926 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Probability of survival at 30 days (a) and overall (b) by study group.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Log-rank</span>: χ<span class="elsevierStyleSup">2</span> = 2.23; <span class="elsevierStyleItalic">P</span> = .5252 and χ<span class="elsevierStyleSup">2</span> = 5.72; <span class="elsevierStyleItalic">P</span> = .126, respectively.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Sáez de la Fuente, J. Sáez de la Fuente, C. Martín-Arriscado, J.Á. Sánchez-Izquierdo Riera, A. García de Lorenzo y Mateos, J.C. Montejo González" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Sáez de la Fuente" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sáez de la Fuente" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Martín-Arriscado" ] 3 => array:2 [ "nombre" => "J.Á." "apellidos" => "Sánchez-Izquierdo Riera" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "García de Lorenzo y Mateos" ] 5 => array:2 [ "nombre" => "J.C." "apellidos" => "Montejo González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935621003303" "doi" => "10.1016/j.redar.2021.11.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621003303?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192922001603?idApp=UINPBA00004N" "url" => "/23411929/0000006900000009/v1_202211040623/S2341192922001603/v1_202211040623/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Inter-rater reliability of the measurement of diaphragmatic excursion and fraction of diaphragmatic thickening by ultrasonography in healthy volunteers" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "536" "paginaFinal" => "543" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E.C. Wilches-Luna, F.E. Pabón-Muñoz, J.M. Arias-Campo, A.F. Caballero-Lozada" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E.C." "apellidos" => "Wilches-Luna" "email" => array:1 [ 0 => "esther.wilches@correounivalle.edu.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F.E." "apellidos" => "Pabón-Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Arias-Campo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A.F." "apellidos" => "Caballero-Lozada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Escuela de Rehabilitación Humana, Facultad de Salud, Universidad del Valle, Cali, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anestesiología y Reanimación, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Confiabilidad interevaluador de la medición de la excursión diafragmática y fracción de engrosamiento diafragmático mediante ultrasonografía en voluntarios sanos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1704 "Ancho" => 2927 "Tamanyo" => 201352 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">End-inspiratory thickness (IT) in the splenic and hepatic windows, in 2D and M mode, measured by the 3 raters. The values are given in centimetres. The number and location of asterisks represent outliers.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0025" class="elsevierStylePara elsevierViewall">Ultrasonography (US) is increasingly used in clinical practice as a rapid, cost-effective diagnostic method of evaluating diaphragm muscle function<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a>. Interest in US assessment of the diaphragm has grown steadily, and the results obtained contribute to diagnostic, prognostic and interventional decisions<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>. This has been accompanied by a growing body of literature on the standardization of US diaphragm measurement techniques. According to some studies on the intra- and inter-rater reliability of diaphragmatic excursion (DE)<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–11</span></a> and diaphragmatic thickness, measurements made in both the right and left hemithorax in quiet and forced breathing using 2-D and M-mode US are reliable, feasible, safe, and easy to perform<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–14</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It is essential to evaluate the reliability of all instruments and evaluation methods, i.e., the extent to which they reliably, accurately, and predictably record the same measurement over time<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>. The use of reliable US measurements is essential in clinical practice. Clinicians, regardless of their specialty, must be experienced in the technique, and studies are needed to evaluate the reliability of US measurements made by different specialists in order to reduce the risk of error. US is increasingly used by different healthcare practitioners to assess diaphragm function in critically ill patients.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>However, no studies have as yet evaluated the inter-rater reliability of US measurements of diaphragmatic excursion and thickening. The aim of this study has been to determine the inter-rater reliability of US measurement of DE and diaphragmatic thickening fraction (DTf) in 30 healthy volunteers. The measurements were taken by an expert anaesthesiologist, a third-year anaesthesiology resident, and a cardiopulmonary physiotherapist.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is a prospective, observational study performed between May and June 2019 using the Consensus-based Standards for the selection of health Measurement Instruments checklist<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>. The study was approved by our university’s Human Research Ethics Committee. It was classed as a minimal risk study according to Resolution 8430 of 1993, and adheres to the provisions of the Declaration of Helsinki. The participants signed an informed consent form before measurements were taken.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Rater training and pilot study</span><p id="par0040" class="elsevierStylePara elsevierViewall">The raters were an intensive care anaesthesiologist with more than 5 years of experience in measuring normal and abnormal diaphragms (rater 1, R1), a third-year anaesthesiology resident (rater 2, R2), and a cardiopulmonary physiotherapist with more than 5 years of experience in critical patient care (rater 3, R3). Before starting the study, the intensive care anaesthesiologist trained the resident and the physiotherapist in the technique for 4 weeks. The training included a 12-h theoretical section, which included a review of the literature on the anatomy of the diaphragm, the performance of diaphragm US and interpretation of results, and a practical demonstration of each technique by the expert, following by a supervised assessment in healthy volunteers. Training was considered complete when the anaesthesiology resident and the physiotherapist agreed on the measurements with the intensive care anaesthesiologist.</p><p id="par0045" class="elsevierStylePara elsevierViewall">After training, a pilot study was performed on 8 healthy volunteers; each practitioner (resident and physiotherapist) evaluated each volunteer and recorded the duration and performance of the study, the comments made, and the questions asked during the process. The characteristics of the volunteers in this pilot test were similar to those of the study sample.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inter-rater reliability</span><p id="par0050" class="elsevierStylePara elsevierViewall">Measurements were made in 30 healthy volunteers chosen by convenience sampling, who verbally stated that they had no history of lung disease, aged between 18 and 60 years, and with a Charlson comorbidity index score of 0 or 1. Volunteers with body mass index (BMI) of more than 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, aged over 30, and in whom difficulties were encountered in obtaining an adequate ultrasound window were excluded. Each volunteer was identified by a code to preserve their anonymity and guarantee the confidentiality of their data. A data collection form designed specifically for this study was used to record sociodemographic variables, DTf, DE and the duration of each measurement.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Measurements</span><p id="par0055" class="elsevierStylePara elsevierViewall">On the day of the evaluation, the volunteers were weighed (kg) and measured (height in cm) wearing light clothing and without shoes<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>, following the techniques standardized by the World Health Organization. Measurements were made using a calibrated Health o meter® professional scale (0.1<span class="elsevierStyleHsp" style=""></span>kg precision), with a capacity of 350 lbs/160<span class="elsevierStyleHsp" style=""></span>kg and a measuring bar or stadiometer (0.5<span class="elsevierStyleHsp" style=""></span>cm precision) ranging from 60 to 213<span class="elsevierStyleHsp" style=""></span>cm. The weight and height were used to calculate the BMI in kg/m<span class="elsevierStyleSup">2</span>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The evaluations were performed with an M-Turbo ultrasound machine, using a linear 6–15<span class="elsevierStyleHsp" style=""></span>MHz transducer and curved 3–5<span class="elsevierStyleHsp" style=""></span>MHz transducer (Sonosite). All 3 raters performed their measurements in each volunteer on the same day, and were asked to identify the characteristics of the structures to be evaluated in each window in order to determine the suitability of the window to perform the measurement<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,19–21</span></a>. The measurement area on the chest was cleaned between each measurement; in other words, there were no marks or gel remaining on the patient's skin to indicate the site of the US transducer, and measurements were made at an interval of 15<span class="elsevierStyleHsp" style=""></span>min. DE and DTf measurements were performed according to protocols published elsewhere<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,19–21</span></a>. The participant was placed in a semi-sitting position (head elevated at 45°), the area to be evaluated was unobstructed, and the individual was asked to raise their right arm. The conductive gel was applied to the transducer, which was moved over the area until an adequate acoustic window was obtained. Each rater separately observed several 3-min cycles of normal quiet breathing to establish a baseline. If this was not achieved within the first minute of observation, verbal commands were used to encourage the participant to relax and establish a normal breathing pattern.</p><p id="par0065" class="elsevierStylePara elsevierViewall">DE is the excursion amplitude from start of contraction to maximum inspiration<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>. The measurement was made in 2D mode using a curved, abdominal 3–5<span class="elsevierStyleHsp" style=""></span>MHz transducer, and then repeated in M mode to record diaphragmatic movement<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>. In the hepatic window, the transducer was placed transversely between the anterior axillary line and the midclavicular line, so that the ultrasound beam reached the dome of the hemidiaphragm. After this, inspiration and expiration movements were recorded in M mode. For the splenic window, the transducer was placed in the same way as in the right hemi-diaphragm to visualise the left diaphragmatic dome.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The DTf measurement was performed using a high frequency 7–10<span class="elsevierStyleHsp" style=""></span>MHz linear transducer. The diaphragmatic movements in inspiration and expiration were recorded in 2D mode and M mode at a depth of 2–4<span class="elsevierStyleHsp" style=""></span>cm, depending on body build. For the hepatic window, the linear transducer was placed longitudinally between the anterior axillary line and the midaxillary line, between the eighth and tenth intercostal spaces. For the splenic window, the volunteer continued in the same position and the linear transducer was placed in the same way as in the right hemi-diaphragm, and DTf was recorded in 2D mode at end-inspiration (IT) and end-expiration (ET), and these parameters were entered into the following formula to calculate the DTf:<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0075" class="elsevierStylePara elsevierViewall">The evaluation forms were filled out individually by each rater without the knowledge of the other raters. To check the quality of the data collected, at the end of each measurement day the main researcher reviewed the measurement form in order to identify potential recording errors and avoid information bias.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Once the data in the collection forms had been checked, it was uploaded to a digital database. IBM SPSS® 25 software was used for statistical analysis. The sociodemographic variables of the study volunteers were analysed according to the measurement scale of each variable. Measures of central tendency, mean and median plus their standard deviation were used, and absolute frequencies and percentages were used according to the type and distribution of each variable.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The Kappa index was used to assess rater agreement with the suitability of the ultrasound window, the intraclass correlation index (ICC) was used to assess the inter-rater reliability of continuous quantitative variables, and 95% confidence intervals (CI) were determined. Significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05. The Landis and Koch classification was used to interpret the ICC and Kappa index values<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> (0: poor; 0.01−0.20: slight; 0.21−0.40: fair; 0.41−0.60: moderate; 0.61−0.80: good; 0.81–1.00: almost perfect). The normality of the data was tested using the Kolmogorov test.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">We recruited 30 healthy volunteers, 20 of them women (66.7%). The average age was 27.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.7 years, the average height was 1.7<span class="elsevierStyleHsp" style=""></span>m, and the average weight was 67.8<span class="elsevierStyleHsp" style=""></span>kg. The hepatic window was considered suitable by R1 in 90% of cases, by R2 in 97% of cases, and by R3 in 80% of cases. The splenic window was considered adequate by R1 in 80% of cases, by R2 in 70% of cases, and by R3 in 63% of cases. Raters disagreed on the suitability of the ultrasound window (hepatic and splenic) to measure diaphragmatic mobility, although this difference was not significant (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Diaphragmatic excursion (cm)</span><p id="par0095" class="elsevierStylePara elsevierViewall">DE values in the hepatic and splenic window reported by the 3 evaluators ranged from 0.5 to 2.9<span class="elsevierStyleHsp" style=""></span>cm, approximately. Regarding the measurement of the DE, inter-rater agreement was good in both windows, because the ICC was greater than 0.6; this was statistically significant (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Diaphragmatic thickening (cm)</span><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding inspiratory thickness (IT), the greatest variability was observed in R1, who recorded higher scores, but with few outliers. In all windows and in both modes, R2 recorded the lowest scores and R3 recorded the highest number of outliers. Scores ranged from 0.1 to 0.4<span class="elsevierStyleHsp" style=""></span>cm, and no major differences were identified between each of the modes and windows (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Scores for the measurement of expiratory thickness (ET) tended to be more homogeneous, with very few outliers. Scores ranged from 0.05 to 0.3<span class="elsevierStyleHsp" style=""></span>cm approximately, with an outlier of approximately 0.9<span class="elsevierStyleHsp" style=""></span>cm recorded by R2 in M mode in the hepatic window (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Few outlier scores were recorded in the measurement of DTf, and the inter-rater scores varied very little. In the hepatic window, we observed moderate agreement with measurements of IT in 2D mode (ICC 0.55) and good agreement in M mode (ICC 0.74), both being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Moderate agreement was observed for measurements of ET in 2D mode (ICC 0.49) and good agreement in M mode (ICC 0.72), both being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0115" class="elsevierStylePara elsevierViewall">The DTf measurement in the hepatic window showed slight agreement in both 2D and M mode (ICC 0.06 and 0.15, respectively), neither being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">In the splenic window, we observed good agreement with measurements of IT in 2D mode (ICC 0.63) and good agreement in M mode (ICC 0.74), both being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Moderate agreement was observed for measurements of ET in both 2 D (ICC 0.54) and M mode (ICC 0.59), both being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). In the splenic window, fair agreement was found for DTf in 2D mode (ICC 0.23) and slight agreement was found in M mode (ICC 0.10), both being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The aim of this study was to determine the inter-rater reliability of US DE and DTf measurements in healthy volunteers. We observed variations in the measurements made by 3 practitioners with different degrees of experience and training: an expert anaesthesiologist (R1), a third-year anaesthesiology resident (R2), and a cardiopulmonary physiotherapist (R3). We believe that this study mimics the situation found in intensive care units (ICU), where different practitioners evaluate the patient at different times, and confirms the applicability of our findings.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The use of US to evaluate the diaphragm in the ICU has been spearheaded by intensivists, although recent studies have shown that the technique is also used by physiotherapists<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,24</span></a>. US is a non-invasive technique that allows clinicians to rapidly evaluate diaphragmatic function at the patient's bedside without exposing them to ionizing radiation. Hayward et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> suggest that performing inter-rate reliability analyses in healthy volunteers is the first step to introducing a new evaluation method in a particular profession. For this reason, we included a specialist physical therapist in our study in order to identify their level of accuracy in measuring DE and DTf after training. Previous literature reviews<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26,27</span></a> suggest that practice increases diagnostic accuracy. However, the authors observed a lack of specific training standards for physical therapists, considering the specific competencies and skills of the profession. We were unable to find studies reporting the reliability of measurements taken by other healthcare practitioners.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Analysing the results of the choice of an appropriate ultrasound window to measure diaphragmatic mobility, the 3 raters disagreed on the suitability of the hepatic and splenic windows. This could be due to individual differences in transducer positioning during the measurement process. However, although the raters disagreed on the choice of window, good agreement with statistical significance was observed in the measurement of diaphragmatic excursion in both windows. Similarly, Scarlata et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>, who evaluated the degree of inter-rater agreement on the amplitude of diaphragmatic movement in 100 healthy volunteers, observed moderate agreement for the measurements recorded during both quiet and deep breathing. These results could be related to the training received by the raters. According to the recent review by Lewińska et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>, there is scant information on the extent of US training required by non-physician healthcare practitioners, but studies suggest they can be successfully trained to perform chest US<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>. There is an unmet need for specific US training courses and examination protocols for physiotherapists<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>. Practical experience together with a high degree of successful examinations would improve accuracy and enable physiotherapists to use US in daily practice<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our study, the DE values in centimetres in the hepatic and splenic window ranged from 0.5 to 2.9<span class="elsevierStyleHsp" style=""></span>cm in all raters. This is similar to the range reported by Boussuges et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>, who also measured DE during quiet breathing in healthy volunteers using M mode US. These authors evaluated inter- and intra-observer reliability, and reported good reliability and normal DE values of between 1.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3 and 2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.6<span class="elsevierStyleHsp" style=""></span>cm in men and 1.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3 and 2.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.5 in women.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In our study, we found good agreement in the measurements of IT and ET in the hepatic window in M mode, with statistical significance, and in the splenic window, good agreement was obtained in measurements of IT in both M and 2D mode. We believe that these results show that accurate measurements can be taken by professionals with different levels of academic training who receive training in US techniques. US would therefore extend the therapeutic arsenal available to these practitioners and broaden the scope of their clinical practice.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In our study, good agreement was observed in the hepatic window, possibly because the excellent acoustic window provided by the liver greatly facilitates visualisation of the right hemidiaphragm at each attempt, in contrast to the left hemidiaphragm, where the smaller acoustic window of the spleen can make visualisation difficult<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Bearing in mind that the volunteers received similar instructions during the examination, and that measurements were taken using the same ultrasound machine, we assume that the variations observed in the DTf results are due to variations in body morphology and rib angles, and differences in breathing measurements, even though all volunteers received the same breathing instructions in order to avoid these variations.</p><p id="par0160" class="elsevierStylePara elsevierViewall">This study has some limitations, specifically, the size of the sample. Although this was adequate for evaluating inter-rater reliability in healthy individuals, a larger sample size that included older volunteers would make it possible to generalize our findings across age groups. The strengths of our study include the expert training received by the raters, the use of a measurement protocol, and the rigorous methodology applied. This, moreover, is the first study in our setting to evaluate the reliability of US measurements in a non-medical health practitioner.</p><p id="par0165" class="elsevierStylePara elsevierViewall">US is increasingly used by physiotherapists to evaluate diaphragmatic function and monitor results in fields such as intensive care and pulmonary rehabilitation. For US measurements to be reliable, physiotherapists must receive training and gain experience in the technique.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">Diaphragmatic US is a reproducible method with acceptable reliability for measurement at IT and ET, but poor reliability for measurement of DTf performed by health practitioners with different levels of academic training and experience.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Author contributions</span><p id="par0175" class="elsevierStylePara elsevierViewall">E.C. Wilches-Luna: conceptualisation and design, data acquisition analysis and interpretation, writing, critical review of the intellectual content, and approval of the final manuscript.</p><p id="par0180" class="elsevierStylePara elsevierViewall">F.E. Pabón-Muñoz: data acquisition analysis and interpretation, writing and editing, critical review of the intellectual content and approval of the final manuscript.</p><p id="par0185" class="elsevierStylePara elsevierViewall">J. Marcela Arias-Campo: data acquisition analysis and interpretation, writing and editing, critical review of the intellectual content and approval of the final manuscript.</p><p id="par0190" class="elsevierStylePara elsevierViewall">A.F. Caballero-Lozada: study design, data acquisition analysis and interpretation, writing, critical review of the intellectual content, and approval of the final manuscript.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interests</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1796052" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1796053" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Participants and methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1572062" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1796054" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Participantes y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1572063" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Participants and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Rater training and pilot study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Inter-rater reliability" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Measurements" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Diaphragmatic excursion (cm)" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Diaphragmatic thickening (cm)" ] ] ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Author contributions" ] 11 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-04-15" "fechaAceptado" => "2021-06-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1572062" "palabras" => array:6 [ 0 => "Ultrasonography" 1 => "Diaphragm" 2 => "Diaphragmatic excursion" 3 => "Diaphragmatic thickening fraction" 4 => "Reliability" 5 => "Healthy volunteers" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1572063" "palabras" => array:6 [ 0 => "Ultrasonografía" 1 => "Diafragma" 2 => "Excursión diafragmática" 3 => "Fracción de engrosamiento diafragmático" 4 => "Confiabilidad" 5 => "Voluntarios sanos" ] ] ] ] "tieneResumen" => true "highlights" => array:2 [ "titulo" => "Highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acceptable inter-rater reliability of diaphragmatic US among non-physicians.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Substantial agreement in DE measurement in splenic and hepatic windows.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Slight agreement in measuring DTf in the hepatic window.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fair concordance in measurement of DTf in 2D mode in the splenic window.</p></li></ul></p></span>" ] "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Background and objective</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">To determine the inter-rater reliability in the ultrasonographic (US) measurement of the diaphragmatic excursion (DE) and the diaphragm thickness fraction (DTF) performed by non-medical health professionals in healthy people.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Participants and methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Prospective observational study in a third level hospital in Cali, Colombia. Measurements were made to 30 healthy volunteers chosen by convenience sampling, without a history of lung diseases, with ages between 18–60 years. A pilot test was previously carried out with 8 healthy volunteers. US measurements of DE, and DTF were based on previously published protocols. Each assessor independently observed several cycles of normal quiet breathing for 3<span class="elsevierStyleHsp" style=""></span>min to establish a baseline. The Intraclass Correlation Index (ICC) was used to evaluate the inter-rater reliability in the measurements of DE and DTF, with 95% confidence intervals and a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Substantial agreement was identified in the measurement of DE in the splenic and hepatic windows because the ICC was greater than 0.6 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). The measurement of the DTF in the hepatic window showed slight agreement in both 2D and M modes (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05). In the splenic window, the measurement of the DTF in the 2D mode was found to be moderate agreement and for the M mode a slight agreement was found (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The diaphragmatic US constitutes a reproducible method with acceptable inter-rater reliability for the measurement of inspiratory/expiratory thickness, and with little reliability for the measurement of DTF.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Participants and methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes y objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Determinar la confiabilidad inter-evaluador en la medición ultrasonográfica (US) de la excursión diafragmática (ED) y la fracción de engrosamiento diafragmático (FED) realizada por profesionales de salud no médicos en voluntarios sanos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Participantes y métodos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional prospectivo en un Hospital de tercer nivel en Cali, Colombia. Se realizaron mediciones a 30 voluntarios sanos escogidos mediante muestreo a conveniencia, sin antecedentes de enfermedades pulmonares, con edades entre los 18–60 años. Previamente se realizó una prueba piloto con 8 voluntarios sanos. Las mediciones US de ED, y FED se basaron en protocolos publicados anteriormente. Cada evaluador observaba independientemente varios ciclos de respiración tranquila normal durante 3 minutos para establecer una línea de base. Para evaluar la confiabilidad inter-evaluador en las mediciones de ED y FED se utilizó el Índice de Correlación Intraclase (ICC), con intervalos de confianza del 95% y un p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Se identificó concordancia sustancial en la medición de la ED en las ventanas esplénica y hepática debido a que el ICC fueron mayores a 0,6 (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). La medición de la FED en la ventana hepática mostró concordancia leve tanto en el modo 2D como en el modo M (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,05). En la ventana esplénica, la medición de la FED en el modo 2D se identificó concordancia regular y para el modo M se encontró una concordancia leve (p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,05).</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">La US diafragmática constituye un método reproducible con aceptable confiabilidad inter-evaluador, para la medición del grosor inspiratorio/espiratorio, y con confiabilidad pobre para la medición de FED.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Participantes y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1704 "Ancho" => 2927 "Tamanyo" => 201352 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">End-inspiratory thickness (IT) in the splenic and hepatic windows, in 2D and M mode, measured by the 3 raters. The values are given in centimetres. The number and location of asterisks represent outliers.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1817 "Ancho" => 2927 "Tamanyo" => 180297 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">End-expiratory thickness (ET) in the splenic and hepatic windows in 2D and M mode, measured by the 3 raters. The values are given in centimetres. The number and location of asterisks represent outliers.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CI: Confidence interval.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Suitable ultrasound window</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Kappa Index \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatic window \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–0.16 to 0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.876 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Splenic window \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–0.17 to 0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.929 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Concordance analysis of the choice of hepatic and splenic window.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; ICC: intraclass correlation coefficient.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M-mode diaphragmatic excursion (cm)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatic window \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27−0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Splenic window \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.22−0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intraclass correlation coefficient of ET in the hepatic and splenic window.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; DTf: diaphragmatic thickening fraction; ET: expiratory thickness; ICC: intraclass correlation coefficient; IT: inspiratory thickness.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hepatic window</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2D mode</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M-mode</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC 95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC 95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.19 to 0.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52 to 0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ET \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09 to 0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.41 to 0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DTf \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–0.42 to 0.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.379 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–0.22 to 0.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.203 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Intraclass correlation coefficient of IT, ET and DTf measured in centimetres. 2D and M mode.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; DTf: diaphragmatic thickening fraction; ET: expiratory thickness; ICC: intraclass correlation coefficient; IT: inspiratory thickness.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Splenic window</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2D mode</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M-mode</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC 95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC 95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–0.22 to 0.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.49 to 0.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ET \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17 to 0.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 to 0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DTf \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–0.19 to 0.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.125 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.15 to 0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.205 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Intraclass correlation coefficient of IT, ET and<span class="elsevierStyleHsp" style=""></span> DTf measured in centimetres. 2D and M mode.</p>" ] ] 6 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "DTf=IT-ETET*100" "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 943 "Alto" => 18 "Ancho" => 96 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside ultrasound education in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Flick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7863/ultra.15.08073" "Revista" => array:6 [ "tituloSerie" => "J ultrasound Med" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "1369" "paginaFinal" => "1371" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27208203" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.L. Moore" 1 => "J.A. Copel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra0909487" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "749" "paginaFinal" => "757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21345104" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S073510971935154X" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Matamis" 1 => "E. Soilemezi" 2 => "M. Tsagourias" 3 => "E. Akoumianaki" 4 => "S. Dimassi" 5 => "F. Boroli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-013-2823-1" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2013" "volumen" => "39" "paginaInicial" => "801" "paginaFinal" => "810" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23344830" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Zambon" 1 => "M. Greco" 2 => "S. Bocchino" 3 => "L. Cabrini" 4 => "P.F. Beccaria" 5 => "A. Zangrillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-016-4524-z" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2017" "volumen" => "43" "paginaInicial" => "29" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27620292" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diaphragm and lung ultrasound to predict weaning outcome: Systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. Llamas-Álvarez" 1 => "E.M. Tenza-Lozano" 2 => "J. Latour-Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2017.08.028" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2017" "volumen" => "152" "paginaInicial" => "1140" "paginaFinal" => "1150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28864053" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Pirompanich" 1 => "S. Romsaiyut" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40560-018-0277-9" "Revista" => array:6 [ "tituloSerie" => "J intensive care" "fecha" => "2018" "volumen" => "6" "paginaInicial" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29435329" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002870315003051" "estado" => "S300" "issn" => "00028703" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Boussuges" 1 => "S. Rives" 2 => "J. Finance" 3 => "F. Brégeon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12998/wjcc.v8.i12.2408" "Revista" => array:7 [ "tituloSerie" => "World J Clin cases" "fecha" => "2020" "volumen" => "8" "paginaInicial" => "2408" "paginaFinal" => "2424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32607319" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109721002035" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Testa" 1 => "G. Soldati" 2 => "R. Giannuzzi" 3 => "S. Berardi" 4 => "G. Portale" 5 => "N. Gentiloni Silveri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ultrasmedbio.2010.10.004" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Med Biol" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "44" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21144957" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reproducibility and clinical correlates of supine diaphragmatic motion measured by M-mode ultrasonography in healthy volunteers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Scarlata" 1 => "D. Mancini" 2 => "A. Laudisio" 3 => "A. Benigni" 4 => "R. Antonelli Incalzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000489229" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2018" "volumen" => "96" "paginaInicial" => "259" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30114702" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interpreting diaphragmatic movement with bedside imaging, review article" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Haji" 1 => "A. Royse" 2 => "C. Green" 3 => "J. Botha" 4 => "D. Canty" 5 => "C. Royse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2016.03.006" "Revista" => array:6 [ "tituloSerie" => "J Crit Care" "fecha" => "2016" "volumen" => "34" "paginaInicial" => "56" "paginaFinal" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27288611" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Boussuges" 1 => "Y. Gole" 2 => "P. Blanc" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-1541" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2009" "volumen" => "135" "paginaInicial" => "391" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19017880" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reproducibility of diaphragmatic thickness measured by M-mode ultrasonography in healthy volunteers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Scarlata" 1 => "D. Mancini" 2 => "A. Laudisio" 3 => "A.I. Raffaele" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resp.2018.12.004" "Revista" => array:6 [ "tituloSerie" => "Respir Physiol Neurobiol" "fecha" => "2019" "volumen" => "260" "paginaInicial" => "58" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30553945" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standardization of sonographic diaphragm thickness evaluations in healthy volunteers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Carrillo-Esper" 1 => "ÁA. Pérez-Calatayud" 2 => "E. Arch-Tirado" 3 => "M.A. Díaz-Carrillo" 4 => "E. Garrido-Aguirre" 5 => "R. Tapia-Velazco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.03999" "Revista" => array:5 [ "tituloSerie" => "Respir Care" "fecha" => "2016" "volumen" => "61" "paginaInicial" => "920" "paginaFinal" => "924" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of diaphragm thickening by diaphragm ultrasonography: a reproducibility and a repeatability study [Online ahead of print]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Cappellini" 1 => "F. Picciafuochi" 2 => "M. Bartolucci" 3 => "S. Matteini" 4 => "G. Virgili" 5 => "C. Adembri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40477-020-00462-x" "Revista" => array:3 [ "tituloSerie" => "J Ultrasound" "fecha" => "2020" "itemHostRev" => array:3 [ "pii" => "S0735109718386820" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Confiabilidad intra e inter evaluador de la medición de la presión inspiratoria máxima (Pimáx) en treinta sujetos sanos de la ciudad de Cali" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.C. Wilches-Luna" 1 => "L.M. Sandoval" 2 => "D.J. López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12804/revsalud14.03.2016.02" "Revista" => array:5 [ "tituloSerie" => "Rev Cienc Salud" "fecha" => "2016" "volumen" => "14" "paginaInicial" => "331" "paginaFinal" => "340" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of diaphragm ultrasonography in pulmonary physiotherapy of COPD patients: A literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Lewińska" 1 => "K. Shahnazaryan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/jcm9113525" "Revista" => array:4 [ "tituloSerie" => "J Clin Med" "fecha" => "2020" "volumen" => "9" "paginaInicial" => "3525" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COSMIN Risk of Bias checklist for systematic reviews of patient-reported outcome measures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.B. Mokkink" 1 => "H.C.W. de Vet" 2 => "C.A.C. Prinsen" 3 => "D.L. Patrick" 4 => "J. Alonso" 5 => "L.M. Bouter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11136-017-1765-4" "Revista" => array:6 [ "tituloSerie" => "Qual Life Res" "fecha" => "2018" "volumen" => "27" "paginaInicial" => "1171" "paginaFinal" => "1179" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29260445" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of anthropometric measurements and weight status perceptions reported by parents of 4-year-old children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Esteban-Vasallo" 1 => "I. Galán" 2 => "M.A. Ortiz-Pinto" 3 => "A. Astray San Martín" 4 => "E.M. Cabrero López" 5 => "M.T. Morales San José" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S1368980019003008" "Revista" => array:7 [ "tituloSerie" => "Public Health Nutr" "fecha" => "2020" "volumen" => "23" "paginaInicial" => "589" "paginaFinal" => "598" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31685044" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673610608288" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Review of the ultrasound assessment of diaphragmatic function in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.F. Sferrazza Papa" 1 => "G.M. Pellegrino" 2 => "F. Di Marco" 3 => "G. Imeri" 4 => "L. Brochard" 5 => "E. Goligher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000446518" "Revista" => array:7 [ "tituloSerie" => "Respiration" "fecha" => "2016" "volumen" => "91" "paginaInicial" => "403" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27216909" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109718303280" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of thickness of normal diaphragm by B mode ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.T. Thimmaiah" 1 => "G. Mj" 2 => "K.P. Jain" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Contemp Med Res" "fecha" => "2016" "volumen" => "343" "paginaInicial" => "2393" "paginaFinal" => "2915" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Vivier" 1 => "A. Mekontso Dessap" 2 => "S. Dimassi" 3 => "F. Vargas" 4 => "A. Lyazidi" 5 => "A.W. Thille" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2547-7" "Revista" => array:5 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "796" "paginaFinal" => "803" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonido diafragmático como predictor de extubación en paciente crítico: revisión exploratoria [Online ahead of print]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.F. Caballero-Lozada" 1 => "F.E. Pabón Muñoz" 2 => "J.M. Arias Campo" 3 => "C. Zorrilla Vaca" 4 => "E.C. Wilches Luna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acci.2020.10.003" "Revista" => array:5 [ "tituloSerie" => "Acta Colomb Cuid Intensivo" "fecha" => "2022" "volumen" => "22" "paginaInicial" => "35" "paginaFinal" => "43" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The measurement of observer agreement for categorical data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Landis" 1 => "G. Koch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Biometrics" "fecha" => "1977" "volumen" => "33" "paginaInicial" => "159" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/843571" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002934320305234" "estado" => "S300" "issn" => "00029343" ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inability of diaphragm ultrasound to predict extubation failure: A multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Vivier" 1 => "M. Muller" 2 => "J.B. Putegnat" 3 => "J. Steyer" 4 => "S. Barrau" 5 => "F. Boissier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2019.03.004" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2019" "volumen" => "155" "paginaInicial" => "1131" "paginaFinal" => "1139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30910636" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of thoracic ultrasound by physiotherapists: A scoping review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.A. Hayward" 1 => "J. Janssen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.physio.2018.01.001" "Revista" => array:6 [ "tituloSerie" => "Physiotherapy" "fecha" => "2018" "volumen" => "104" "paginaInicial" => "367" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29958691" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound for critical care physiotherapists: A narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Leech" 1 => "B. Bissett" 2 => "M. Kot" 3 => "G. Ntoumenopoulos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/pri.1607" "Revista" => array:5 [ "tituloSerie" => "Physiother Res Int J Res Clin Phys Ther" "fecha" => "2015" "volumen" => "20" "paginaInicial" => "69" "paginaFinal" => "76" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Le Neindre" 1 => "S. Mongodi" 2 => "F. Philippart" 3 => "B. Bouhemad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2015.10.014" "Revista" => array:6 [ "tituloSerie" => "J Crit Care" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "101" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26613650" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.C. See" 1 => "V. Ong" 2 => "S.H. Wong" 3 => "R. Leanda" 4 => "J. Santos" 5 => "J. Taculod" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-015-4102-9" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "63" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26474994" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound identification of diaphragm by novices using ABCDE technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Khurana" 1 => "S.C. Gartner" 2 => "L. Naik" 3 => "B.C.H. Tsui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0000000000000718" "Revista" => array:5 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2018" "volumen" => "43" "paginaInicial" => "161" "paginaFinal" => "165" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diafragmatic ultrasound, a new tool for the anesthesiologist" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.M. Acosta" 1 => "M.S. Urbano" 2 => "G. Tusman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.25237/revchilanestv47n02.08" "Revista" => array:5 [ "tituloSerie" => "Rev Chil Anest" "fecha" => "2018" "volumen" => "47" "paginaInicial" => "110" "paginaFinal" => "124" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006900000009/v1_202211040623/S2341192922001585/v1_202211040623/en/main.assets" "Apartado" => array:4 [ "identificador" => "34051" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006900000009/v1_202211040623/S2341192922001585/v1_202211040623/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192922001585?idApp=UINPBA00004N" ]
- •
Acceptable inter-rater reliability of diaphragmatic US among non-physicians.
- •
Substantial agreement in DE measurement in splenic and hepatic windows.
- •
Slight agreement in measuring DTf in the hepatic window.
- •
Fair concordance in measurement of DTf in 2D mode in the splenic window.