急诊科急性高碳酸血症呼吸衰竭患者的膈肌超声评估。

Diaphragmatic Ultrasound Assessment in Subjects With Acute Hypercapnic Respiratory Failure Admitted to the Emergency Department.

机构信息

Department of Anesthesiology and Intensive Care, Maggiore della Carità University Hospital, Novara, Italy.

Department of Translational Medicine, Eastern Piedmont University, Novara, Italy.

出版信息

Respir Care. 2019 Dec;64(12):1469-1477. doi: 10.4187/respcare.06803. Epub 2019 Aug 27.

DOI:10.4187/respcare.06803

PMID:31455684

Abstract

BACKGROUND

Early identification of noninvasive ventilation (NIV) outcome predictors in patients with COPD who are experiencing acute hypercapnic respiratory failure consequent to exacerbation or pneumonia 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 subgroups 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 underwent 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, = .02), at T1 (2.14 [1.76-2.77] cm versus 0.93 [0.82-1.27] cm, = .007), and at T2 (1.99 [1.63-2.54] cm versus 1.20 [0.79-1.41] cm, = .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.).

摘要

背景

在因加重或肺炎而出现急性高碳酸血症性呼吸衰竭的 COPD 患者中，早期识别接受无创通气（NIV）治疗的患者的预测因素是非侵袭性通气的关键问题。本研究的主要目的是探讨在因加重或肺炎而入住急诊科的 COPD 患者出现高度呼吸困难时，在开始 NIV 治疗之前（T0）以及治疗后的第一（T1）和第二小时（T2），进行膈肌超声检查以评估膈肌活动度、厚度和增厚分数的可行性。其次，我们确定这些变量是否可以预测早期 NIV 失败。

方法

符合条件的患者为因加重或肺炎而入住急诊科并需要 NIV 治疗的 COPD 成年患者。在 T0、T1 和 T2 时进行右侧膈肌活动度、双侧厚度、增厚分数和动脉血气分析。通过考虑每个时间点可评估膈肌功能的患者数量来评估可行性。在 T2 时，根据早期 NIV 失败将患者分为 2 个亚组，早期 NIV 失败定义为无法达到 pH 值≥7.35；能够达到 pH 值≥7.35 表示 NIV 成功。

结果

在纳入的 22 名患者中，有 21 名患者进行了完整的膈肌超声评估（即在 T0、T1 和 T2 时进行右侧活动度和双侧厚度评估），总共进行了 63 次活动度评估和 126 次厚度评估。在 T2 时，记录了 12 例 NIV 成功和 9 例 NIV 失败。与 NIV 失败患者相比，NIV 成功患者在 T0 时的膈肌活动度更大（1.92 [1.22-2.54] cm 比 1.00 [0.60-1.41] cm，P=0.02），在 T1 时更大（2.14 [1.76-2.77] cm 比 0.93 [0.82-1.27] cm，P=0.007），在 T2 时更大（1.99 [1.63-2.54] cm 比 1.20 [0.79-1.41] cm，P=0.008）。两组的膈肌厚度和增厚分数相似。