Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: A single-center pilot study.
Covid-19
Diaphragmatic thickening fraction
ICU
Non-invasive ventilation
Prediction
Respiratory failure
Journal
Respiratory physiology & neurobiology
ISSN: 1878-1519
Titre abrégé: Respir Physiol Neurobiol
Pays: Netherlands
ID NLM: 101140022
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
14
08
2020
revised:
10
11
2020
accepted:
11
11
2020
pubmed:
17
11
2020
medline:
8
1
2021
entrez:
16
11
2020
Statut:
ppublish
Résumé
In a variable number of Covid-19 patients with acute respiratory failure, non-invasive breathing support strategies cannot provide adequate oxygenation, thus making invasive mechanical ventilation necessary. Factors predicting this unfavorable outcome are unknown, but we hypothesized that diaphragmatic weakness may contribute. We prospectively analyzed the data of 27 consecutive patients admitted to the general Intensive Care Unit (ICU) from March 19, 2020, to April 20, 2020 and submitted to continuous positive airway pressure (CPAP) before considering invasive ventilation. Diaphragmatic thickening fraction (DTF) inferred by ultrasound was determined before applying CPAP. Eighteen patients recovered with CPAP, whereas nine required invasive mechanical ventilation with longer stay in ICU (p < 0.001) and hospital (p = 0.003). At univariate logistic regression analysis, CPAP failure was significantly associated with low DTF [β: -0.396; OR: 0.673; p < 0.001] and high respiratory rate [β: 0.452; OR: 1.572; p < 0.001] but only DTF reached statistical significance at multivariate analysis [β: -0.384; OR: 0.681; p < 0.001]. The DTF best threshold predicting CPAP failure was 21.4 % (AUC: 0.944; sensitivity: 94.4 %, specificity: 88.9 %). In critically ill patients with Covid-19 respiratory failure admitted to ICU, a reduced DTF could be a potential predictor of CPAP failure and requirement of invasive ventilation.
Sections du résumé
BACKGROUND
In a variable number of Covid-19 patients with acute respiratory failure, non-invasive breathing support strategies cannot provide adequate oxygenation, thus making invasive mechanical ventilation necessary. Factors predicting this unfavorable outcome are unknown, but we hypothesized that diaphragmatic weakness may contribute.
METHODS
We prospectively analyzed the data of 27 consecutive patients admitted to the general Intensive Care Unit (ICU) from March 19, 2020, to April 20, 2020 and submitted to continuous positive airway pressure (CPAP) before considering invasive ventilation. Diaphragmatic thickening fraction (DTF) inferred by ultrasound was determined before applying CPAP.
RESULTS
Eighteen patients recovered with CPAP, whereas nine required invasive mechanical ventilation with longer stay in ICU (p < 0.001) and hospital (p = 0.003). At univariate logistic regression analysis, CPAP failure was significantly associated with low DTF [β: -0.396; OR: 0.673; p < 0.001] and high respiratory rate [β: 0.452; OR: 1.572; p < 0.001] but only DTF reached statistical significance at multivariate analysis [β: -0.384; OR: 0.681; p < 0.001]. The DTF best threshold predicting CPAP failure was 21.4 % (AUC: 0.944; sensitivity: 94.4 %, specificity: 88.9 %).
CONCLUSIONS
In critically ill patients with Covid-19 respiratory failure admitted to ICU, a reduced DTF could be a potential predictor of CPAP failure and requirement of invasive ventilation.
Identifiants
pubmed: 33197604
pii: S1569-9048(20)30244-5
doi: 10.1016/j.resp.2020.103585
pmc: PMC7664482
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
103585Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
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