Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2024; 12(26): 5893-5900
Published online Sep 16, 2024. doi: 10.12998/wjcc.v12.i26.5893
Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease
Lei-Lei Qu, Wen-Ping Zhao, Ji-Ping Li, Wei Zhang
Lei-Lei Qu, Ji-Ping Li, Wei Zhang, The First Department of Respiratory and Critical Care Medical Center, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China
Wen-Ping Zhao, Department of Nursing, The First People's Hospital of Baiyin City, Baiyin 730900, Gansu Province, China
Co-first authors: Lei-Lei Qu and Wen-Ping Zhao.
Co-corresponding authors: Ji-Ping Li and Wei Zhang.
Author contributions: Qu LL and Zhao WP performed the research; Li JP and Zhang W contributed new reagents and analytic tools; Qu LL, Zhao WP, Li JP, and Zhang W designed the research study, analyzed the data, and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the First People's Hospital of Baiyin City Institutional Review Board.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No other data is available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Ping Li, MBBS, Doctor, The First Department of Respiratory and Critical Care Medical Center, The First People's Hospital of Baiyin City, No. 222 Silong Road, Baiyin District, Baiyin 730900, Gansu Province, China. f18706985775@163.com
Received: May 7, 2024
Revised: June 7, 2024
Accepted: July 1, 2024
Published online: September 16, 2024
Processing time: 76 Days and 19.2 Hours
Abstract
BACKGROUND

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is often combined with respiratory failure, which increases the patient's morbidity and mortality. Diaphragm ultrasound (DUS) has developed rapidly in the field of critical care in recent years. Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator. Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.

AIM

To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.

METHODS

Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed, and they were divided into a successful ventilation group (68 cases) and a failed ventilation group (26 cases) according to the outcome of ventilation. The clinical data of patients with successful and failed noninvasive ventilation were compared, and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.

RESULTS

There were no significant differences in gender, age, body mass index, complications, systolic pressure, heart rate, mean arterial pressure, respiratory rate, oxygen saturation, partial pressure of oxygen, oxygenation index, or time of inspiration between patients with successful and failed mechanical ventilation (P > 0.05). The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide (PaCO2) than those with failed treatment, while potential of hydrogen (pH), diaphragm thickening fraction (DTF), diaphragm activity, and diaphragm movement time were significantly higher than those with failed treatment (P < 0.05). pH [odds ratio (OR) = 0.005, P < 0.05], PaCO2 (OR = 0.430, P < 0.05), and DTF (OR = 0.570, P < 0.05) were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.

CONCLUSION

The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.

Keywords: Diaphragm ultrasound; Mechanical ventilation; Acute exacerbation of chronic obstructive pulmonary disease; Predictive value; Diaphragm thickening fraction; Diaphragm activity

Core Tip: There are few relevant literature reports on the predictive value of diaphragm ultrasound (DUS) indexes for mechanical ventilation therapy, so we conducted a study in which the clinical data of patients with successful and failed noninvasive ventilation were compared, and the independent predictors of noninvasive ventilation outcomes in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients were identified by multivariate logistic regression analysis. It was found that the DUS index DTF can better predict the outcome of non-invasive ventilation therapy in AECOPD patients.