Evaluating diaphragmatic dysfunction and predicting non-invasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease in India
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background Baseline diaphragmatic dysfunction (DD) at the initiation of non-invasive ventilation (NIV) correlates positively with subsequent intubation. We investigated the utility of DD detected 2 hours after NIV initiation in estimating NIV failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods In a prospective-cohort design, we enrolled 60 consecutive patients with AECOPD initiated on NIV at intensive care unit admission, and NIV failure events were noted. The DD was assessed at baseline (T1 timepoint) and 2 hours after initiating NIV (T2 timepoint). We defined DD as ultrasound-assessed change in diaphragmatic thickness (ΔTDI) <20% (predefined criteria [PC]) or its cut-off that predicts NIV failure (calculated criteria [CC]) at both timepoints. A predictive-regression analysis was reported. Results In total, 32 patients developed NIV failure, nine within 2 hours of NIV and remaining in the next 6 days. The ∆TDI cut-off that predicted NIV failure (DD-CC) at T1 was ≤19.04% (area under the curve [AUC], 0.73; sensitivity, 50%; specificity, 85.71%; accuracy; 66.67%), while that at T2 was ≤35.3% (AUC, 0.75; sensitivity, 95.65%; specificity, 57.14%; accuracy, 74.51%, hazard ratio, 19.55). The NIV failure rate was 35.1% in those with normal diaphragmatic function by PC (T2) versus 5.9% by CC (T2). The odds ratio for NIV failure with DD criteria ≤35.3 and <20 at T2 was 29.33 and 4.61, while that for ≤19.04 and <20 at T1 was 6, respectively. Conclusions The DD criterion of ≤35.3 (T2) had a better diagnostic profile compared to baseline and PC in prediction of NIV failure.
Abstract
Background Baseline diaphragmatic dysfunction (DD) at the initiation of non-invasive ventilation (NIV) correlates positively with subsequent intubation. We investigated the utility of DD detected 2 hours after NIV initiation in estimating NIV failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods In a prospective-cohort design, we enrolled 60 consecutive patients with AECOPD initiated on NIV at intensive care unit admission, and NIV failure events were noted. The DD was assessed at baseline (T1 timepoint) and 2 hours after initiating NIV (T2 timepoint). We defined DD as ultrasound-assessed change in diaphragmatic thickness (ΔTDI) <20% (predefined criteria [PC]) or its cut-off that predicts NIV failure (calculated criteria [CC]) at both timepoints. A predictive-regression analysis was reported. Results In total, 32 patients developed NIV failure, nine within 2 hours of NIV and remaining in the next 6 days. The ∆TDI cut-off that predicted NIV failure (DD-CC) at T1 was ≤19.04% (area under the curve [AUC], 0.73; sensitivity, 50%; specificity, 85.71%; accuracy; 66.67%), while that at T2 was ≤35.3% (AUC, 0.75; sensitivity, 95.65%; specificity, 57.14%; accuracy, 74.51%, hazard ratio, 19.55). The NIV failure rate was 35.1% in those with normal diaphragmatic function by PC (T2) versus 5.9% by CC (T2). The odds ratio for NIV failure with DD criteria ≤35.3 and <20 at T2 was 29.33 and 4.61, while that for ≤19.04 and <20 at T1 was 6, respectively. Conclusions The DD criterion of ≤35.3 (T2) had a better diagnostic profile compared to baseline and PC in prediction of NIV failure.
참고문헌 (18)
- Rochwerg B, "Official ERS", ATS clinical practice guidelines : noninvasive ventilation for acute respiratory failure, 2017, pp.50, 1602426~
- Chen T, "Risk factors associated with late failure of noninvasive ventilation in patients with chronic obstructive pulmonary disease", Can Respir J, 2020, pp.8885464~ (2020)
- Marchioni A, "Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation", Crit Care, 22, pp.109~ (2018)
- Antenora F, "Prevalence and outcomes of diaphragmatic dysfunction assessed by ultrasound technology during acute exacerbation of COPD : a pilot study", Respirology, 22, pp.338~344 (2017)
- Laghi FA Jr, "Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction", BMC Pulm Med, 21, pp.85~ (2021)
- Sarwal A, "Neuromuscular ultrasound for evaluation of the diaphragm", Muscle Nerve, 47, pp.319~329 (2013)
- Cammarota G, "Diaphragmatic ultrasound assessment in subjects with acute hypercapnic respiratory failure admitted to the emergency department", Respir Care, 64, pp.1469~1477 (2019)
- Qian Z, "Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation : a systematic review and meta-analysis", BMJ Open, 8, pp.e021189~ (2018)
- Llamas-Álvarez AM, "Diaphragm and lung ultrasound to predict weaning outcome : systematic review and meta-analysis", Chest, 152, pp.1140~1150 (2017)
- Steriade AT, "Predictors of outcome of noninvasive ventilation in severe COPD exacerbation", BMC Pulm Med, 19, pp.131~ (2019)
- Haegens A, "NF-κB activation and polyubiquitin conjugation are required for pulmonary inflammation-induced diaphragm atrophy", Am J Physiol Lung Cell Mol Physiol, 302, pp.L103~10 (2012)
- Troyer AD, "Action of the diaphragm on the rib cage", J Appl Physiol(1985), 121, pp.391~400 (2016)
- Ottenheijm CA, "Diaphragm dysfunction in chronic obstructive pulmonary disease", Am J Respir Crit Care Med, 172, pp.200~205 (2005)
- Lindenauer PK, "Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease", JAMA Intern Med, 174, pp.1982~1993 (2014)
- Shah NM, "Update : non-invasive ventilation in chronic obstructive pulmonary disease", J Thorac Dis, 10(Suppl 1), pp.S71~9 (2018)
- Duan J, "Early prediction of noninvasive ventilation failure in COPD patients : derivation, internal validation, and external validation of a simple risk score", Ann Intensive Care, 9, pp.108~ (2019)
- Lim SY, "Ultrasound Assessment of diaphragmatic function during acute exacerbation of chronic obstructive pulmonary disease : a pilot study", Int J Chron Obstruct Pulmon Dis, 14, pp.2479~2484 (2019)
- Corbellini C, "Diaphragmatic mobility loss in subjects with moderate to very severe COPD may improve after in-patient pulmonary rehabilitation", Respir Care, 63, pp.1271~1280 (2018)