Diaphragm Disease, Respiratory Failure
Conditions
Keywords
Point of care ultrasound, Diaphragm Disease
Brief summary
This study aims to evaluate the use of POCUS to assess diaphragmatic function and its association with clinical outcomes in patients with respiratory failure who are admitted to the emergency department.
Detailed description
Respiratory failure is a common condition that requires prompt diagnosis and treatment in the emergency department. Diaphragmatic dysfunction (DD) is a potential contributor to respiratory failure, but it is often underdiagnosed and undertreated. Point-of-care ultrasound (POCUS) is a non-invasive and feasible tool that can measure diaphragmatic function using parameters such as diaphragm excursion and diaphragm shortening fraction (DSF). However, the prognostic value of POCUS for DD in patients with respiratory failure is unclear. This study is a prospective observational cohort study that will enroll consecutive patients with respiratory failure who are admitted to the emergency department of a tertiary hospital. All patients will undergo POCUS examination of the diaphragm within 6 hours of admission by trained emergency physicians. The primary outcome will be the composite of mortality, intubation, or noninvasive ventilation failure within 30 days of admission. The secondary outcomes will include length of hospital stay, intensive care unit admission, and ventilator-free days. The association between POCUS parameters of diaphragmatic function and clinical outcomes will be analyzed using multivariate logistic regression and Cox proportional hazards models.
Interventions
OTHERDiaphragm shortening fraction measurement by point-of-care ultrasound.
A noninvasive and feasible method to assess diaphragmatic function and predict the prognosis of patients with respiratory failure presenting to the emergency department. The method consists of measuring the diaphragmatic thickness at the end of inspiration and expiration using a linear probe placed in the subcostal region and calculating the percentage of change using the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100. A value lower than 10% indicates diaphragmatic dysfunction and a higher risk of adverse outcomes.
Sponsors
Azienda Ospedaliero-Universitaria di Modena
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Respiratory failure defined as one or more of the following: respiratory rate \>24 breaths/min, oxygen saturation \<90% on room air, PaO2/FiO2 ratio \<300 mmHg, or need for supplemental oxygen * Ability to provide informed consent or availability of a legal representative
Exclusion criteria
* Pregnancy * History of thoracic surgery or trauma * Known neuromuscular disease affecting the diaphragm * Contraindications for POCUS examination such as chest wall deformity, subcutaneous emphysema, or skin infection
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Composite of mortality, intubation, or noninvasive ventilation failure within 30 days of admission | Patients will be followed up for a maximum of 1 months from admission to the emergency department, until discharge or death |
Contacts
Primary ContactCarmine Cristiano Di Gioia
Outcome results
None listed