Title: Diaphragmatic dysfunction evaluation using ultrasonography as a predictor of weaning for patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease from mechanical ventilation
Authors: Akram Muhammad Fayed, Mohammed Samy Barakat, Emadeldin Mahmoud Zakaria
DOI: http://dx.doi.org/10.18535/jmscr/v4i6.44
Abstract
Introduction: Diaphragmatic Excursion (DE) was used as a predictor for weaning of mechanical ventilation (MV) but not for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.
Objectives: To correlate between Diaphragmatic dysfunction (DD) and outcome of mechanically ventilated AECOPD patients.
Materials and Methods: 60 wean able mechanically ventilated patients with AECOPD were prospectively enrolled. M-mode U/S evaluation of the diaphragm was done using convex probe 3.5-5 MHZ in the supine position at the start of spontaneous breath trial on T-piece. Patients were randomized into two groups; DD (< 1 cm excursion) and non-DD (> 1 cm excursion). Outcomes of the ICU stay were determined.
Results: Ten patients with DD had primary weaning failure versus two in the non-DD group, while six patients with DD had secondary weaning failure. There was significant reduction in duration of weaning, ICU and hospital length of stay in favor of non-DD group (2.5, 5 and 6 days, respectively; (p < 0.001)). For predicting weaning failure, the test showed 88.89% sensitivity, 97.62% specificity, 94.12% positive predictive value and 95.35% negative predictive value.
Conclusions: DD detected by M-mode U/S was associated with prolonged duration of mechanical ventilation, ICU, hospital stay, and weaning failure in AECOPD patients.
Key words: Acute exacerbation of COPD, Diaphragmatic dysfunction, Ultrasonography, Diaphragmatic excursion, weaning failure, and Rapid Shallow Breathing Index.
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