Predictive value analysis of diaphragmatic ultrasound evaluation for mechanical ventilation outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) exacerbations often necessitate mechanical ventilation. Weaning from ventilation poses challenges, especially due to diaphragmatic dysfunction. We evaluated the predictive value of diaphragmatic ultrasound for mechanical ventilation outcomes in COPD patients during acute exacerbations.

Methods: A retrospective analysis was conducted on 200 patients experiencing acute COPD exacerbations between June 2020 and September 2023. We identified these patients using the ICD-10 codes for COPD (J44.x) and acute exacerbations from our electronic medical record system.Patients underwent diaphragmatic ultrasound assessments and were then grouped based on weaning success or failure. The study investigated parameters such as the E-T index, diaphragmatic displacement (DD), and diaphragmatic thickening fraction (DTF), correlating them with weaning outcomes. Correlation and receiver operating characteristic (ROC) analyses were employed to ascertain predictive values.

Results: The E-T index, DD, and DTF were significantly higher in the success group, indicating these parameters as predictors of successful weaning. The E-T index (rho = -0.254, P < 0.001), DD (rho = -0.269, P < 0.001), and DTF (rho = -0.201, P = 0.004) negatively correlated with weaning failure. Conversely, the diaphragmatic Rapid Shallow Breathing Index (D-RSBI) positively correlated with failure (rho = 0.179, P = 0.011). Higher LUS scores predicted weaning failure (P = 0.029). Combined analysis of ultrasound indicators demonstrated an area under the curve (AUC) of 0.905, highlighting the model's predictive utility.Additional correlations showed that higher PaCO₂ before weaning was linked with lower DD, suggesting an association between impaired diaphragmatic mechanics and elevated CO₂ levels.

Conclusion: Diaphragmatic ultrasound was a valuable tool for assessing readiness for mechanical ventilation weaning in COPD exacerbations, enhancing the precision of clinical decisions.Our findings also suggest that a threshold E-T index of ∼ 1.915 and DTF of ∼ 42.475% may have clinical relevance in identifying successful weaners.