Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: A single-center pilot study

Corradi, Francesco; Vetrugno, Luigi; Orso, Daniele; Bove, Tiziana; Schreiber, Annia; Boero, Enrico; Santori, Gregorio; Isirdi, Alessandro; Barbieri, Greta; Forfori, Francesco

doi:10.1016/j.resp.2020.103585

Cited by 43 publications

(57 citation statements)

References 40 publications

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“…On the other hand, little data can be found regarding the usefulness of DUS in the ED for the evaluation of patients with acute respiratory failure, especially among patients affected by COVID-19. A pilot study from Corradi and co-authors was previously performed in order to evaluate the role of DUS in 27 patients with COVID-19 pneumonia who underwent non-invasive ventilation; DTF was identified as a predictor of CPAP failure, as its values inversely correlate with its success (i.e., the lower the DTF values, the more likely the CPAP failure) [10]. This is a proof-of-concept study designed to evaluate the feasibility of LUS and DUS evaluation in a third-level ED in Italy, during the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Pivetta

Cara

Paglietta

et al. 2021

JCM

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Background: Lung Ultrasound Evaluation (LUS) is usefully applied in the Emergency Department (ED) to patients with suspected or confirmed COVID-19. Diaphragmatic Ultrasound (DUS) may provide additional insight into ventilatory function. This proof-of-concept study aimed to evaluate the feasibility of LUS and DUS in a third level ED during the COVID-19 pandemic. Methods: Adult patients presenting with COVID-19 symptoms were eligible. After the physical examination, both LUS and DUS (i.e., diaphragmatic motion and thickness) were performed. All patients were followed after 30 days to determine their need for ventilation, admission, and/or a new ED evaluation after discharge. The diagnostic accuracies of diaphragm measurements in assessing the risk of the 30-day outcome were calculated as well as the measurements’ usefulness. Bland–Altman plots were used for comparing bedside and off-line diaphragm measurements. Results: 118 patients were enrolled. Median thickness and motion were 1.7 mm (iqr 0.4) and 1.8 cm (iqr 0.7), respectively, with a mean difference of 0.009 mm (95% CI −0.037–0.056 mm) and −0.051 cm (95% CI −0.108–0.006 cm), respectively. The 30-day outcome was associated with an increase in thickness (OR 5.84, 95% CI 0.96–35.4), and a lower motion (OR 0.49, 95% CI 0.2–1.21). Conclusion: DUS seemed to be feasible and reliable in the ED in a population of patients presenting with symptoms related to COVID-19 infection.

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Section: Introductionmentioning

confidence: 99%

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Pivetta

Cara

Paglietta

et al. 2021

JCM

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Section: Methodsmentioning

confidence: 99%

“…Recent work reports a median diaphragmatic thickening fraction of 27% prior to CPAP onset in awake COVID-19 patients in supine position [ 18 ]. In the absence of data on diaphragm thickening fraction in awake COVID-19 patients undergoing NIV and prone positioning, we hypothesized that a mean 30% increase in diaphragmatic thickening fraction would occur after transition from supine to prone position, assuming a standard deviation of 10% in both conditions [ 18 ]. Accordingly, an overall sample size of 20 patients would be adequate for demonstrating an increase in diaphragmatic thickening fraction varying patient position from supine to prone, with type I error rate = 0.05, type II error rate = 0.20 and power 80%.…”

Section: Methodsmentioning

confidence: 99%

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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

et al. 2021

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Background Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV. Methods We enrolled all COVID-19 adult critically ill patients, admitted to intensive care unit (ICU) for hypoxemic ARF and undergoing NIV, deserving of awake prone positioning as a rescue therapy. Exclusion criteria were pregnancy and any contraindication to awake prone position and NIV. On ICU admission, after NIV onset, in supine position, and at 1 h following awake prone position application, diaphragmatic thickening fraction was obtained on the right side. Across all the study phases, NIV was maintained with the same setting present at study entry. Vital signs were monitored throughout the entire study period. Comfort was assessed through numerical rating scale (0 the worst comfort and 10 the highest comfort level). Data were presented in median and 25th–75th percentile range. Results From February to May 2021, 20 patients were enrolled and finally analyzed. Despite peripheral oxygen saturation improvement [96 (94–97)% supine vs 98 (96–99)% prone, p = 0.008], turning to prone position induced a worsening in comfort score from 7.0 (6.0–8.0) to 6.0 (5.0–7.0) (p = 0.012) and an increase in diaphragmatic thickening fraction from 33.3 (25.7–40.5)% to 41.5 (29.8–50.0)% (p = 0.025). Conclusions In our COVID-19 patients assisted by NIV in ICU, the application of awake prone position improved the oxygenation at the expense of a greater diaphragmatic thickening fraction compared to supine position. Trial registration ClinicalTrials.gov, number NCT04904731. Registered on 05/25/2021, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04904731.

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“… 6 In addition, diaphragm dysfunction has been reported to predict the onset of invasive mechanical ventilation in COVID‐19 pneumonia 7 and ultrasound diaphragm thickening can predict the response to noninvasive ventilation therapy in COVID‐19 pneumonia. 8 In the context of COVID‐19 pneumonia, diaphragm dysfunction can be related to sepsis, lung insult severity, hypoperfusion in relation with severe cardio‐circulatory failure. In the context of fewer availability ICU beds, stratifying COVID‐19 patients in crucial and diaphragm ultrasound may help physicians.…”

Section: Figurementioning

confidence: 99%

Diaphragm ultrasound to stratify COVID‐19 patients in the emergency department?

Fayssoil

Beaune

Mansencal

2021

J of Clinical Ultrasound

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Diaphragm ultrasound to stratify COVID-19 patients in the emergency department? Dear EditorThe COVID-19 affects particularly the respiratory system with the onset of pneumonia that can lead to acute respiratory insufficiency.Patients with COVID-19 pneumonia disclose a hypoxemic respiratory failure associated with an increase of the work of breathing. 1 Ultrasound can be used to evaluate the work of breathing with the analysis

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Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: A single-center pilot study

Cited by 43 publications

References 40 publications

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

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

Diaphragm ultrasound to stratify COVID‐19 patients in the emergency department?

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