Lung Ultrasound and Pulmonary Function Test in Cirrhotic Patients

Lung ultrasound (LU) is useful in the diagnosis of pulmonary interstitial-alveolar syndrome (IAS) when B-lines are detected. Its prevalence and effect in lung function is not well studied in cirrhotic patients. The objective of this study was to detect the prevalence of interstitial-alveolar involvement with LU and correlate with pulmonary function test to distinguish the effect of ascites and B-lines in pulmonary function. This was an observational single-center study with 49 patients listed for liver transplantation submitted for LU and pulmonary function tests. Patients were divided into 4 groups: no ascites and no B-lines (n = 19), B-lines only (n = 19), ascites only (n = 6), and ascites and B-lines (n = 5). There was a worse forced vital capacity (FVC) in patients with B-lines only (76.1% ± 9.2; P = .0058) and ascites only (66.8% ± 10.2; P = .0010). 1-second forced expiratory volume (FEV₁) also was lower in patients with B-lines only (78.5% ± 10.3; P = .0001), ascites only (71.3% ± 13.2; P = .0004), and B-lines and ascites (74.2% ± 7.6; P = .0035). Model for End-Stage Liver Disease score was worse in the group with ascites and B-lines (22.4 ± 10.1; P = .0229). B-Lines reduced FVC and FEV₁ in our study and may be an independent factor in worsening pulmonary function in these patients.

Co-infected HIV/hepatitis patients compared with chronic liver patients and healthy individuals: respiratory assessment through surface electromyography and spirometry

INTRODUCTION

Co-infected HIV and hepatitis subjects are candidates for a liver transplantation because of progressive liver disease. Chronic liver disease, co-infected or not, requires assessment of respiratory function before liver transplantation. The respiratory evaluation of these 2 groups compared with healthy individuals can define deficits, and this can impair a full recovery after transplant surgery.

OBJECTIVE

This study sought to compare the respiratory profile in co-infected patients with chronic liver disease who are candidates for liver transplantation with that of healthy subjects.

METHODS

Through respiratory evaluation of flows and lung volumes (spirometry), muscle activity (surface electromyography), and maximum pressure (manovacuometer), 250 people were distributed into 3 groups: 14 patients with HIV and liver disease, 65 healthy subjects, and 171 patients with chronic liver disease. The mean age (years) was respectively 47.5 ± 6.2, 48.3 ± 14.1, and 52.9 ± 8.5. The average body mass index (kg/m(2)) of the groups was 24.6 ± 4.5, 26.0 ± 3.2, and 28.5 ± 5.3, respectively.

RESULTS

There was a statistical difference among the groups in the root means square (RMS) rectus abdominis (μV) (P = .0016), RMS diaphragm (μV) (P = .0001), maximal inspiratory pressure (cmH2O) (P = .001), forced exhaled volume at the end of first second (%) (P = .002), and maximal mid expiratory flow 25% to 75% (%) (P = .0001) for the Kruskal-Wallis test. The multivariate analysis among the groups showed that the RMS diaphragm had a tendency to discriminate the co-infected subjects.

CONCLUSIONS

The co-infected HIV group showed a muscle deficit of diaphragm and rectus abdominis activity, and the liver disease group showed lower indexes in volumes and respiratory flows.

Comparison of surface electromyography in respiratory muscles of healthy and liver disease patients: preliminary studies

INTRODUCTION

Surface electromyography (SEMG) is described as a technique to detect voluntary muscle activity. In the respiratory muscles, diaphragm and the rectus abdominis-are especially important for respiratory compliance.

OBJECTIVE

We sought to study the activity of muscles using SEMG of the right diaphragm and the right rectus abdominis in healthy subjects versus liver disease patients (LDS).

METHOD

Each group of 30 male patients underwent SEMG with electrodes attached to the dermis surface at the xiphoid and below the right costal margin (channel 1). For the rectus abdominis, we placed the electrodes on the right 5 cm below the umbilicus. The variables studied were: root mean square (RMS), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). We also evaluated age, weight, body mass index, smoking history lifestyle sedentary preexistent chronic lung disease. Nonparametric tests were used for statistical analysis.

RESULTS

There were significant differences (P>0001) between the groups regarding MEP and MIP values showing low pressures in the LDS group. RMS of the rectus abdominis showed a trend (P=.059) toward compliance in the LDS group. Compared with the healthy subjects, there were 18% versus 5% sedentary individuals; only 10% versus 27.3% were smokers or former smokers and chronic lung disease was present in 2% versus 4%.

CONCLUSION

The respiratory muscle evaluation using SEMG detected decreased respiratory muscle strength and a trend to rectus abdominis compliance among LDS.