Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation
Alessandro Marchioni,
Ivana Castaniere,
Roberto Tonelli,
Riccardo Fantini,
Matteo Fontana,
Luca Tabbì,
Andrea Viani,
Francesco Giaroni,
Valentina Ruggieri,
Stefania Cerri,
Enrico Clini
Affiliations
Alessandro Marchioni
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Ivana Castaniere
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Roberto Tonelli
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Riccardo Fantini
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Matteo Fontana
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Luca Tabbì
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Andrea Viani
University Hospital of Modena, School of Medicine, University of Modena Reggio Emilia
Francesco Giaroni
University Hospital of Modena, School of Medicine, University of Modena Reggio Emilia
Valentina Ruggieri
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Stefania Cerri
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Enrico Clini
Respiratory Diseases Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena
Abstract Background Ultrasound (US) evaluation of diaphragmatic dysfunction (DD) has proved to be a reliable technique in critical care. In this single-center prospective study, we investigated the impact of US-assessed DD on noninvasive ventilation (NIV) failure in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and its correlation with the transdiaphragmatic pressure assessed using the invasive sniff maneuver (Pdi sniff). Methods A population of 75 consecutive patients with AECOPD with hypercapnic acidosis admitted to our respiratory intensive care unit (RICU) were enrolled. Change in diaphragm thickness (ΔTdi) < 20% during tidal volume was the predefined cutoff for identifying DD+/− status. Correlations between ΔTdi < 20% NIV failure and other clinical outcomes were investigated. Correlation between ΔTdi and Pdi sniff values was analyzed in a subset of ten patients. Results DD+ patients had a higher risk for NIV failure than DD− patients (risk ratio, 4.4; p < 0.001), and this finding was significantly associated with higher RICU, in-hospital, and 90-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer RICU stay. Huge increases in NIV failure (HR, 6.2; p < 0.0001) and 90-day mortality (HR, 4.7; p = 0.008) in DD+ patients were found by Kaplan-Meier analysis. ΔTdi highly correlated with Pdi sniff (Pearson’s r = 0.81; p = 0.004). ΔTdi < 20% showed better accuracy in predicting NIV failure than baseline pH value and early change in both arterial blood pH and partial pressure of carbon dioxide following NIV start (AUCs 0.84 to DTdi < 20%, 0.51 to pH value at baseline, 0.56 to early change in arterial blood pH following NIV start, and 0.54 to early change in partical pressure of carbon dioxide following NIV start, respectively; p < 0.0001). Conclusions Early and noninvasive US assessment of DD during severe AECOPD is reliable and accurate in identifying patients at major risk for NIV failure and worse prognosis.