Point of care ultrasound (POCUS) to detect diaphragmatic dysfunction in adult patients undergoing cervical spine surgery: A prospective observational study

Introduction

Perioperative diaphragmatic dysfunction is often an incidental diagnosis. It is most commonly reported in high-level traumatic cervical spinal cord injury patients where the cervical spinal cord ischemia is the cause and also in cardiothoracic surgeries where the aetiology is phrenic nerve injury. It is not well studied in chronic cervical myelopathies and cranio-vertebral junction anomalies, where both these mechanisms can cause diaphragmatic dysfunction. Diaphragmatic ultrasound is a bedside, user-friendly and non-invasive method to detect diaphragmatic dysfunction routinely used in critical settings to predict weaning failure in critically ill patients. In our study, we plan to screen for diaphragmatic dysfunction in all adult patients undergoing cervical spine surgery in the perioperative period with the help of diaphragmatic ultrasound. We also plan to study its association with preoperative respiratory function, clinical myelopathy grading and postoperative respiratory complications.

Purpose

In our study, we plan to look at the prevalence of diaphragmatic dysfunction in the population undergoing cervical spine surgery in our hospital. Our primary objective is to identify those with diaphragmatic dysfunction in the perioperative period. Secondarily, we plan to examine the association between patients’ functional status, including their functional grading, bedside pulmonary function tests, and diaphragmatic dysfunction on the ultrasound. We hope to identify risk factors for postoperative respiratory complications in these patients. This study aims to identify patients at risk for diaphragmatic dysfunction and plan perioperative management and optimisation strategies in these patients.

Study design: Prospective, observational study.