Diaphragmatic dysfunction assessed by ultrasound: a key predictor of prolonged ventilation in emergency department

Abstract

This study aimed to evaluate the feasibility and diagnostic value of diaphragmatic ultrasound in the management of respiratory failure in the emergency department (ED), with a focus on its potential to guide treatment decisions and improve patient outcomes.We conducted an observational study at the ED of Santa Maria delle Grazie Hospital in Pozzuoli, Italy, from November 2023 to April 2024. Patients with type 1 or type 2 respiratory failure requiring non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) were included. The Diaphragmatic ultrasound was performed at baseline to assess diaphragmatic excursion and thickening fraction, alongside arterial blood gas (ABG) measurements. The follow-up ABGs were taken at 1, 3, 6, and 12 h.A total of 44 patients were included in the study. Patients with diaphragmatic dysfunction (defined as excursion < 10 mm or thickening fraction < 30%) had significantly longer in-ED and in-hospital ventilation times (p = 0.002 and p < 0.001, respectively). Power-type regression analysis showed a significant correlation between diaphragmatic excursion and ventilation time (p = 0.003 for in-ED and p = 0.003 for in-hospital ventilation time).Diaphragmatic ultrasound is a feasible and valuable tool for assessing diaphragmatic function in the ED. Its use provides important prognostic information, potentially guiding ventilatory strategies and improving patient outcomes by identifying those at risk for prolonged ventilation.

Keywords: Continuous positive airway pressure (CPAP); Diaphragmatic ultrasound; Emergency department (ED); Non-invasive ventilation (NIV); PoCUS; Respiratory failure.