Diaphragmatic ultrasonographic evaluation as an assessment guide for predicting noninvasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine Pub Date : 2025-03-17 DOI:10.1016/j.ajem.2025.03.025

Karn Suttapanit MD, Peeraya Lerdpaisarn MD, Chanakan Charoensuksombun MD, Pitsucha Sanguanwit MD, Praphaphorn Supatanakij

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引用次数: 0

Abstract

Background

Dynamic hyperinflation in severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to diaphragmatic fatigue and causes acute respiratory failure. Ultrasound is reliable for evaluating diaphragmatic function. In this study, we aimed to assess the ability of diaphragmatic ultrasound to predict noninvasive ventilation (NIV) failure.

Methods

This prospective single-center observational cohort study was performed on patients with AECOPD who required NIV in the emergency department between October 1, 2020, and September 30, 2022, at a tertiary healthcare center. The diaphragmatic ultrasound was measured using diaphragmatic excursion (DE) before applying NIV and diaphragmatic thickening fraction (DTF) during NIV use for 2 h. The area under the receiver-operating characteristic (AUROC) curves analysis and multivariable logistic regression was performed to assess the ability of diaphragmatic ultrasound to predict NIV failure in 48 h.

Results

111 patients were included in this study. DTF was an independent variable associated with NIV failure, with an adjusted odds ratio of 0.91 (95 % confidence interval [CI] 0.85–0.98), with a p-value of 0.009. DE and DTF had AUROC of 0.905 (95 % CI 0.835–0.975) and 0.940 (95 % CI 0.894–0.986), respectively, to predict NIV failure within 48 h. The lower DE and DTF increased the probability of NIV failure. The cutoff value of the DTF was 20 %, with a sensitivity of 92.0 % (95 % CI 74.0 % – 99.0 %) and a specificity of 93.0 % (95 % CI 85.4 % – 97.4 %) and the cutoff of the DE was 1.2 cm, with a sensitivity of 88.0 % (95 % CI 68.8 % – 97.5 %) and a specificity of 84.9 % (95 % CI 75.5 % – 91.7 %).

Conclusion

Diaphragmatic ultrasound, especially DTF at 2 h during NIV use, is a validated tool for predicting NIV failure in patients with AECOPD. Early detection of diaphragmatic dysfunction with diaphragmatic ultrasound in AECOPD with NIV could help identify high-risk patients and guide clinical decisions. However, further benefits from its implementation in management are required.

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膈超声评价对慢性阻塞性肺疾病急性加重期无创通气衰竭的预测价值

慢性阻塞性肺疾病（AECOPD）严重急性加重期的动态恶性通货膨胀可导致膈肌疲劳并引起急性呼吸衰竭。超声对评估膈功能是可靠的。在这项研究中，我们旨在评估膈超声预测无创通气（NIV）失败的能力。方法本前瞻性单中心观察队列研究对2020年10月1日至2022年9月30日在三级医疗中心急诊科需要NIV的AECOPD患者进行了研究。应用NIV前采用膈偏移（DE）测量膈超声，使用NIV期间使用膈增厚分数（DTF）测量膈超声，并进行受者-操作特征（AUROC）曲线下面积分析和多变量logistic回归评估膈超声预测48 h NIV失效的能力。DTF是与NIV失败相关的独立变量，调整后的优势比为0.91(95%可信区间[CI] 0.85-0.98)， p值为0.009。DE和DTF预测48 h内NIV失效的AUROC分别为0.905 （95% CI 0.835-0.975）和0.940 (95% CI 0.894-0.986)，较低的DE和DTF增加了NIV失效的概率。DTF的截断值为20%，敏感性为92.0% (95% CI 74.0% ~ 99.0%)，特异性为93.0% (95% CI 85.4% ~ 97.4%)； DE的截断值为1.2 cm，敏感性为88.0% (95% CI 68.8% ~ 97.5%)，特异性为84.9% （95% CI 75.5% ~ 91.7%）。结论膈超声，特别是在使用NIV时2 h的DTF，是预测AECOPD患者NIV失效的有效工具。膈超声在急性阻塞性肺疾病合并NIV患者中早期发现膈功能障碍有助于识别高危患者，指导临床决策。但是，需要在管理中实施它的进一步好处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Emergency Medicine 医学-急救医学

CiteScore

6.00

自引率

5.60%

发文量

730

审稿时长

42 days

期刊介绍： A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.