Ultrasonographic assessment of diaphragm to predict invasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

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.