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Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: A single-center pilot study
Respiratory Physiology & Neurobiology ( IF 2.3 ) Pub Date : 2020-11-13 , DOI: 10.1016/j.resp.2020.103585
Francesco Corradi , Luigi Vetrugno , Daniele Orso , Tiziana Bove , Annia Schreiber , Enrico Boero , Gregorio Santori , Alessandro Isirdi , Greta Barbieri , Francesco Forfori

Background

In a variable number of Covid-19 patients with acute respiratory failure, non-invasive breathing support strategies cannot provide adequate oxygenation, thus making invasive mechanical ventilation necessary. Factors predicting this unfavorable outcome are unknown, but we hypothesized that diaphragmatic weakness may contribute.

Methods

We prospectively analyzed the data of 27 consecutive patients admitted to the general Intensive Care Unit (ICU) from March 19, 2020, to April 20, 2020 and submitted to continuous positive airway pressure (CPAP) before considering invasive ventilation. Diaphragmatic thickening fraction (DTF) inferred by ultrasound was determined before applying CPAP.

Results

Eighteen patients recovered with CPAP, whereas nine required invasive mechanical ventilation with longer stay in ICU (p < 0.001) and hospital (p = 0.003). At univariate logistic regression analysis, CPAP failure was significantly associated with low DTF [β: -0.396; OR: 0.673; p < 0.001] and high respiratory rate [β: 0.452; OR: 1.572; p < 0.001] but only DTF reached statistical significance at multivariate analysis [β: -0.384; OR: 0.681; p < 0.001]. The DTF best threshold predicting CPAP failure was 21.4 % (AUC: 0.944; sensitivity: 94.4 %, specificity: 88.9 %).

Conclusions

In critically ill patients with Covid-19 respiratory failure admitted to ICU, a reduced DTF could be a potential predictor of CPAP failure and requirement of invasive ventilation.



中文翻译:

膜片增厚分数可作为Covid-19肺炎持续气道正压通气反应的潜在预测指标:单中心先导研究

背景

在可变数量的Covid-19急性呼吸衰竭患者中,无创呼吸支持策略无法提供足够的氧合作用,因此有创机械通气成为必要。尚不清楚预测这种不良结果的因素,但我们假设diaphragm肌无力可能是造成这种情况的原因。

方法

我们前瞻性分析了2020年3月19日至2020年4月20日入院重症监护室(ICU)并接受持续气道正压通气(CPAP)的连续27例患者的数据,然后才考虑进行有创通气。在应用CPAP之前,先确定通过超声推断出的肌增厚分数(DTF)。

结果

18例CPAP康复,而9例需要有创机械通气,并在ICU(p <0.001)和医院(p = 0.003)停留时间更长。在单因素逻辑回归分析中,CPAP失败与低DTF显着相关[β:-0.396; P> 0.05。或:0.673;p <0.001]和高呼吸频率[β:0.452; 或:1.572;p <0.001],但只有DTF在多变量分析中达到统计学显着性[β:-0.384; 或:0.681;p <0.001]。预测CPAP失败的DTF最佳阈值为21.4%(AUC:0.944;灵敏度:94.4%,特异性:88.9%)。

结论

在重症监护病房并接受ICU的Covid-19呼吸衰竭患者中,DTF降低可能是CPAP衰竭和有创通气需求的潜在预测指标。

更新日期:2020-11-25
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