Sonographic measurement of diaphragmatic motion after upper abdominal surgery: A comparison of three breathing manoeuvres

The effects of three coached breathing manoeuvres on diaphragm excursion after upper abdominal surgery (UAS) were investigated using sonography: verbal instruction to deep breathe; coached diaphragmatic (abdominal) breathing; and thoracic expansion exercise (lateral costal breathing). Eighteen patients aged 34-89 years, undergoing elective UAS at the Royal Adelaide Hospital, were tested. Diaphragm displacement was measured using sonography the day before and the day after surgery. Measurements were taken during deep breaths from functional residual capacity (FRC) to maximal inspiration. There was no difference in diaphragm displacement between the three types of deep breathing manoeuvres pre-operatively. On the first post-operative day, mean diaphragm displacement from FRC to maximal inspiration fell by 58%. Post-operatively, there were differences between the manoeuvres. A simple verbal instruction to deep breathe resulted in less diaphragm movement than coached diaphragmatic breathing and thoracic expansion breathing. There was no difference between coached diaphragmatic breathing and thoracic expansion breathing. We conclude that the techniques of coached diaphragmatic breathing and thoracic expansion used in this group of patients recovering from UAS elicited a greater excursion from the diaphragm than a simple instruction to deep breathe when measured in a 60° long sitting position.