Background
During the use of CPAP  ( Continuos Positive Airway Pressure), with contained pressures, the excursion of the diaphragm tends to increase. Conversely during NIMV ( Non Invasive  Mechanical Ventilation ), with the increase in pressure support, there is a decrease in work of breathing  (WOB) and in diaphragm excursion.

Aims
The purpose of the study was to evaluate whether diaphragm sonography could be a useful aid to promote adaptation during the ventilation  of patients in CPAP or NIV who have difficulty on accepting this treatment.

Methods
We studied the diaphragmatic excursion of 20 patients using a portable sonography with a convex probe from 1 to 5 MgHz. The patient's position was generally supine at 45°. The probe was placed in the right subcostal position (the window of the liver  is  larger than that of the spleen). The patient breathes spontaneously and the machine  record the excursion from the maximum inspiratory point to the lowest expiratory point. The monitor was turned towards the patient's face so he can see what happens during each breath.Subsequently the patient was vented with nasal or oronasal mask and the measurement was remade during CPAP/NIMV  ventilation. The modification, breath on breath, of the diaphragmatic excursions, seen by the patient live, facilitated the approach to the use of the ventilatory device.

Results
All 20  patients evaluated with this method accepted more easily  to use the ventilator device.

Conclusion
The Diaphragm  sonography can be an excellent, safe, fast, not expensive method to be performed, at the patient's bed,     to reinforce  an  respiratory  educational  program   in patient's with problem's of   adaptation to  CPAP/NIMV   ventilation.