Terraneo Silvia, Rinaldo Rocco Francesco, Sferrazza Papa Giuseppe Francesco, Ribolla Fulvia, Gulotta Carlo, Maugeri Laura, Gatti Emiliano, Centanni Stefano, Di Marco Fabiano
Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy.
Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy.
Diagnostics (Basel). 2021 Mar 19;11(3):554. doi: 10.3390/diagnostics11030554.
Discriminating between cardiac and pulmonary dyspnea is essential for patients' management. We investigated the feasibility and ability of forced oscillation techniques (FOT) in distinguishing between acute exacerbation of COPD (AECOPD), and acute decompensated heart failure (ADHF) in a clinical emergency setting. We enrolled 49 patients admitted to the emergency department (ED) for dyspnea and acute respiratory failure for AECOPD, or ADHF, and 11 healthy subjects. All patients were able to perform bedside FOT measurement. Patients with AECOPD showed a significantly higher inspiratory resistance at 5 Hz, Xrs (179% of predicted, interquartile range, IQR 94-224 vs. 100 IQR 67-149; = 0.019), and a higher inspiratory reactance at 5 Hz (151%, IQR 74-231 vs. 57 IQR 49-99; = 0.005) than patients with ADHF. Moreover, AECOPD showed higher heterogeneity of ventilation (respiratory system resistance difference at 5 and 19 Hz, Rrs: 1.49 cmHO/(L/s), IQR 1.03-2.16 vs. 0.44 IQR 0.22-0.76; = 0.030), and a higher percentage of flow limited breaths compared to ADHF (10%, IQR 0-100 vs. 0 IQR 0-12; = 0.030). FOT, which resulted in a suitable tool to be used in the ED setting, has the ability to identify distinct mechanical properties of the respiratory system in AECOPD and ADHF.
区分心源性和肺源性呼吸困难对于患者的治疗至关重要。我们研究了强迫振荡技术（FOT）在临床急诊环境中区分慢性阻塞性肺疾病急性加重（AECOPD）和急性失代偿性心力衰竭（ADHF）的可行性和能力。我们纳入了49例因AECOPD或ADHF导致呼吸困难和急性呼吸衰竭而入住急诊科（ED）的患者，以及11名健康受试者。所有患者均能够进行床边FOT测量。与ADHF患者相比，AECOPD患者在5Hz时的吸气阻力Xrs显著更高（预测值的179%，四分位间距，IQR 94 - 224 vs. 100 IQR 67 - 149；P = 0.019），且在5Hz时的吸气电抗更高（151%，IQR 74 - 231 vs. 57 IQR 49 - 99；P = 0.005）。此外，AECOPD患者的通气异质性更高（5Hz和19Hz时的呼吸系统阻力差值，Rrs：1.49cmH₂O/(L/s)，IQR 1.03 - 2.16 vs. 0.44 IQR 0.22 - 0.76；P = 0.030），与ADHF相比，流量受限呼吸的百分比更高（10%，IQR 0 - 100 vs. 0 IQR 0 - 12；P = 0.030）。FOT是一种适用于ED环境的工具，能够识别AECOPD和ADHF患者呼吸系统的不同力学特性。
