Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
Biostatistics, Office of the Scientific Director, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Crit Care. 2021 Jun 26;25(1):219. doi: 10.1186/s13054-021-03638-x.
A correlation between unsuccessful noninvasive ventilation (NIV) and poor outcome has been suggested in de-novo Acute Respiratory Failure (ARF) patients. Consequently, it is of paramount importance to identify accurate predictors of NIV outcome. The aim of our preliminary study is to evaluate the Diaphragmatic Thickening Fraction (DTF) and the respiratory rate/DTF ratio as predictors of NIV outcome in de-novo ARF patients.
Over 36 months, we studied patients admitted to the emergency department with a diagnosis of de-novo ARF and requiring NIV treatment. DTF and respiratory rate/DTF ratio were measured by 2 trained operators at baseline, at 1, 4, 12, 24, 48, 72 and 96 h of NIV treatment and/or until NIV discontinuation or intubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of DTF and respiratory rate/DTF ratio to distinguish between patients who were successfully weaned and those who failed.
Eighteen patients were included. We found overall good repeatability of DTF assessment, with Intra-class Correlation Coefficient (ICC) of 0.82 (95% confidence interval 0.72-0.88). The cut-off values of DTF for prediction of NIV failure were < 36.3% and < 37.1% for the operator 1 and 2 (p < 0.0001), respectively. The cut-off value of respiratory rate/DTF ratio for prediction of NIV failure was > 0.6 for both operators (p < 0.0001).
DTF and respiratory rate/DTF ratio may both represent valid, feasible and noninvasive tools to predict NIV outcome in patients with de-novo ARF. Trial registration ClinicalTrials.gov Identifier: NCT02976233, registered 26 November 2016.
在新发急性呼吸衰竭（ARF）患者中，无创通气（NIV）失败与不良预后之间存在相关性。因此，准确预测 NIV 结局至关重要。我们的初步研究旨在评估膈肌增厚分数（DTF）和呼吸频率/DFT 比值作为新发 ARF 患者 NIV 结局的预测指标。
在 36 个月的时间里，我们研究了因新发 ARF 而被收入急诊并需要 NIV 治疗的患者。两名经过培训的操作人员在基线、NIV 治疗 1、4、12、24、48、72 和 96 小时时以及在 NIV 停止或插管时测量 DTF 和呼吸频率/DFT 比值。进行受试者工作特征（ROC）曲线分析以评估 DTF 和呼吸频率/DFT 比值区分成功撤机和失败的能力。
共纳入 18 例患者。我们发现 DTF 评估的整体重复性较好，组内相关系数（ICC）为 0.82（95%置信区间 0.72-0.88）。操作员 1 和 2 预测 NIV 失败的 DTF 截断值分别为 < 36.3%和 < 37.1%（p < 0.0001）。预测 NIV 失败的呼吸频率/DFT 比值截断值对于两名操作员均为 > 0.6（p < 0.0001）。
DTF 和呼吸频率/DFT 比值均可能是预测新发 ARF 患者 NIV 结局的有效、可行和无创工具。临床试验注册ClinicalTrials.gov 标识符：NCT02976233，注册于 2016 年 11 月 26 日。
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