Ultrasound Diaphragmatic Assessment as a Predictor of Successful Non-Invasive Mechanical Ventilation in Patients With Acute Exacerbation COPD: an Observational Study

Abstract

Background: Non-invasive ventilation (NIV) is the first-line treatment for patients admitted to hospital with hypercapnic respiratory failure due to AECOPD. Significant diaphragmatic muscle dysfunction (DD) exits in AECOPD. Ultrasonography is considered as a non-invasive and bedside method and commonly applied in intensive care unit (ICU) to assess diaphragmatic function. Objective: To demonstrate the value of diaphragmatic ultrasound assessment for patients with AECOPD undergoing NIMV. Patients and Methods: A population of 24 consecutive patients with AECOPD admitted to Ain Shams University Hospitals’ Intensive Care units (ICU) were enrolled. Change in diaphragmatic thickness fraction (ΔDTF) < 20% and diaphragm excursion< 10 mm during tidal volume was the predefined cut-off for identifying DD. Correlations between ΔDTF < 20%, diaphragm excursion< 10 mm and NIV failure and other clinical outcomes were investigated. Results: 24 cases with AECOPD, 33.3% of them (8 cases) had diaphragm dysfunction (DD+) but after NICPAP 2 cases improved and only 6 cases remain with DD and 16 Patients without DD (DD−). DD+ patients had a higher risk for NIV failure than DD−patients (p< 0.011), and this finding was significantly associated with higher in-hospital, and 30-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer ICU stay Conclusion: AECOPD patients with diaphragmatic dysfunction as diagnosed by US showed higher incidence of NIMV failure.