Diaphragm thickening fraction predicts noninvasive ventilation outcome: a preliminary physiological study

Abstract

Background A correlation between unsuccessful noninvasive ventilation (NIV) and poor outcome has been suggested in de-novo Acute Respiratory Failure (ARF) patients. Consequently, it is of paramount importance to identify accurate predictors of NIV outcome. The aim of our preliminary study is to evaluate the Diaphragmatic Thickening Fraction (DTF) and the respiratory rate/DTF ratio as predictors of NIV outcome in de-novo ARF patients. Methods Over 36 months, we studied patients admitted to the emergency department with a diagnosis of de-novo ARF and requiring NIV treatment. DTF and respiratory rate/DTF ratio were measured by 2 trained operators at baseline, at 1, 4, 12, 24, 48, 72 and 96 h of NIV treatment and/or until NIV discontinuation or intubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of DTF and respiratory rate/DTF ratio to distinguish between patients who were successfully weaned and those who failed. Results Eighteen patients were included. We found overall good repeatability of DTF assessment, with Intra-class Correlation Coefficient (ICC) of 0.82 (95% confidence interval 0.72–0.88). The cut-off values of DTF for prediction of NIV failure were < 36.3% and < 37.1% for the operator 1 and 2 (p < 0.0001), respectively. The cut-off value of respiratory rate/DTF ratio for prediction of NIV failure was > 0.6 for both operators (p < 0.0001). Conclusion DTF and respiratory rate/DTF ratio may both represent valid, feasible and noninvasive tools to predict NIV outcome in patients with de-novo ARF. Trial registration ClinicalTrials.gov Identifier: NCT02976233, registered 26 November 2016.

Comfort During Non-invasive Ventilation

“…Non-invasive ventilation has been shown to be effective in preventing intubation and improving survival of patients with ARF ( 9 ) when compared to conventional oxygen therapy ( 10 , 11 ). Accordingly, NIV has been progressively employed outside the emergency department, in both clinical and surgical wards in the early treatment of ARF ( 12 , 13 ).…”

Effect of awake prone position on diaphragmatic thickening fraction in patients assisted by noninvasive ventilation for hypoxemic acute respiratory failure related to novel coronavirus disease

“…The present study has several limitations. First, our study population was relatively small, but similar to the sample size of a recent investigation describing the impact of NIV on diaphragmatic thickening fraction in patients admitted with de novo hypoxemic ARF [17]. Second, the study population was not standardized for the COVID-19 ARDS phenotype or disease history and thus NIV might have been applied in patients with different lung involvements.…”

“…Diaphragmatic ultrasound has been used for assessing diaphragm activity both in hypercapnic [16] and hypoxemic ARF patients [17,18] undergoing noninvasive respiratory support. In patients assisted by NIV for de novo hypoxemic non-COVID-19 ARF, a diaphragmatic thickening fraction < 36% predicted NIV failure [17].…”

“…Diaphragmatic ultrasound has been used for assessing diaphragm activity both in hypercapnic [16] and hypoxemic ARF patients [17,18] undergoing noninvasive respiratory support. In patients assisted by NIV for de novo hypoxemic non-COVID-19 ARF, a diaphragmatic thickening fraction < 36% predicted NIV failure [17]. We hypothesized that in ICU patients requiring NIV for COVID-19-related ARDS, the transition from supine to prone position may be responsible of an increase in diaphragmatic thickening fraction as a consequence of comfort modifications.…”

Indice De Respiracion Rapida Superficial Diafragmatica Como Predictor Weaning De La Ventilacion Mecanica

“…Aunque las tasas de fracaso del destete y la extubación difieren considerablemente entre las UCI, aproximadamente el 15% de los pacientes en los que se interrumpe la ventilación mecánica requieren reintubación dentro de las 48 h. En consecuencia, es fundamental para los médicos de cuidados intensivos diferenciar entre la preparación para la interrupción de la ventilación y los ensayos exitosos de respiración espontánea (25).…”