Diaphragmatic Ultrasound Assessment in Subjects With Acute Hypercapnic Respiratory Failure Admitted to the Emergency Department.
BACKGROUND: Early identification of noninvasive ventilation (NIV) outcome predictors in patients with COPD who are experiencing acute hypercapnic respiratory failure consequent to exacerbation or pneumon'a is a critical issue. The primary aim of this study was to investigate the feasibility of perfo...
| Publicado en: | Respiratory Care Vol. 64; no. 12; pp. 1469 - 1478 |
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| Autores principales: | , , , , , , , , , , , , , |
| Formato: | CEU research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Dec2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=140207780&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 140207780 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Dec2019 vid: 64 iid: 12 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 140207780 140207780 140207780 10.4187/respcare.06803 140207780 ppf: 1469 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Diaphragmatic Ultrasound Assessment in Subjects With Acute Hypercapnic Respiratory Failure Admitted to the Emergency Department. aug: au: Cammarota, Gianmaria Sguazzotti, Ilaria Zanoni, Marta Messina, Antonio Colombo, Davide Vignazia, Gian Luca Vetrugno, Luigi Garofalo, Eugenio Bruni, Andrea Navalesi, Paolo Avanzi, Gian Carlo Della Corte, Francesco Volpicelli, Giovanni Vaschetto, Rosanna affil: Department of Anesthesiology and Intensive Care, Maggiore della Carita University Hospital, Novara, Italy sug: subj: Pulmonary Disease, Chronic Obstructive Therapy Respiration, Artificial Diaphragm Physiology Ultrasonography Methods Hypercapnia Respiratory Failure Emergency Service Human Adult Italy Male Aged Aged, 80 and Over Pilot Studies Nonexperimental Studies Prospective Studies Consent (Research) Blood Gas Analysis Time Factors Intubation, Intratracheal Visual Analog Scaling Dyspnea Glasgow Coma Scale Scales APACHE (Acute Physiology and Chronic Health Evaluation) Questionnaires Intraclass Correlation Coefficient Friedman Test Sample Size Variable Mann-Whitney U Test Fisher's Exact Test ROC Curve Data Analysis Software Descriptive Statistics Education, Continuing (Credit) Adult: 19-44 years Aged: 65+ years Aged, 80 & over Male ab: BACKGROUND: Early identification of noninvasive ventilation (NIV) outcome predictors in patients with COPD who are experiencing acute hypercapnic respiratory failure consequent to exacerbation or pneumon'a is a critical issue. The primary aim of this study was to investigate the feasibility of performing diaphragmatic ultrasound for excursion, thickness, and thickening fraction in highly dyspneic subjects with COPD admitted to the emergency department for exacerbation or pneumonia, before starting NIV (T0) and after the first (T1) and second hour (T2) of treatment. Secondarily, we determined whether these variables predicted early NIV failure. METHODS: Adult subjects with COPD admitted to the emergency department for exacerbation or pneumonia requiring NIV were eligible. Right-sided diaphragmatic excursion, bilateral thickness, thickening fraction, and arterial blood gas analyses were performed at T0, T1, and T2. Feasibility was estimated by considering the number of subjects whose diaphragmatic function could be evaluated at each time point. At T2, subjects were classified in 2 sub-groups according to early NIV failure, which was defined as the inability to achieve a pH ≥ 7.35; the ability to achieve pH ≥ 7.35 indicated NIV success. RESULTS: Of the 22 subjects enrolled, 21 under- went complete diaphragm ultrasound evaluation (ie, right excursion and bilateral thickness at T0, T1, and T2) for a total of 63 excursion and 126 thickness assessments. At T2, 12 NIV successes and 9 NIV failures were recorded. Diaphragmatic excursion was greater in NIV successes than in NIV failures at T0 (1.92 [1.22-2.54] cm versus 1.00 [0.60-1.41] cm, P = .02), at T1 (2.14 [1.76-2.77] cm versus 0.93 [0.82-1.27] cm, P = .007), and at T2 (1.99 [1.63-2.54] cm versus 1.20 [0.79-1.41] cm, P = .008), respectively. Diaphragmatic thickness and thickening fraction were similar in both groups. CONCLUSIONS: In our emergency department setting, diaphragm ultrasound was a feasible and reliable tool to monitor highly dyspneic acute hypercapnic respiratory failure subjects with COPD undergoing NIV. (ClinicalTrials.gov registration NCT03314883.) pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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