Abstract:
Background: To study the impact of ultrasound-assessed Diaphragmatic impairment on
predicting the need for invasive mechanical ventilation in patients with Acute Exacerbations of
Chronic Obstructive Pulmonary disease (AECOPD) and also, its impact on invasive
mechanical ventilatory days, length of ICU stays and outcome.
Methodology: A total 95 patients with AECOPD requiring NIV support in the ICU were
included in the study in our hospital from April 2023 to November 2024. This was a prospective
observational study. Ultrasound-assessed Diaphragm Thickness Fraction (DTF) was done to
assess the Diaphragmatic Impairment (DI). Either the patient was weaned off from NIV or put
on IMV based on clinical condition and ABG analysis.
Results: ROC curve analysis of diaphragmatic thickness fraction on the Right & Left-side
gives a cut off 31.88% and 28.2% with 100% sensitivity and 20.9% specificity for the need of
IMV. It predicted that there is a requirement of IMV below this cut-off. Out of 43 patients that
were put on IMV, 34 were below and 9 were above the cutoff. Mean Duration of IMV was
significantly higher in expired patients compared to survived patients. (8.56+/-2.11 vs 2.78+/
0.83 days). Mean Duration of ICU stay was also significantly higher in expired patients
compared to survived patients. (9.95+/-2.46 vs 5.37+/-1.17 days).
Conclusion: From this prospective observational study, we concluded that USG guided
assessment of Diaphragmatic thickness fraction is a good indicator in determining the
diaphragmatic impairment and predicting the need for invasive mechanical ventilation in
AECOPD patients with 100% sensitivity and 20.9% specificity. DI as assessed by DTF can be
used as a prognostic factor for determining Invasive Mechanical Ventilatory days, ICU stay
and Outcome of the patient.
