Heart & lung : the journal of critical care · 2025
Diaphragm excursion as a predictor of noninvasive ventilation failure in the emergency department: A prospective study.
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Sagmal Yunus Emre, Eksioglu Merve, Kaymak Burcu Azapoglu, Ozturk Tuba Cimilli
Аннотация
BACKGROUND: Early identification of noninvasive ventilation (NIV) failure is essential to prevent clinical deterioration and guide timely escalation of care in acute and critical care settings.
OBJECTIVES: This study aimed to evaluate the diagnostic accuracy of right diaphragm excursion measured by point-of-care ultrasound (POCUS) in predicting NIV failure and to identify associated predictors.
METHODS: We conducted a prospective diagnostic accuracy study in the emergency department of a tertiary care hospital between January and October 2024. Adult patients (≥18 years) with acute respiratory failure requiring NIV were included. Exclusion criteria included neuromuscular disease, hemodynamic instability, cardiac or respiratory arrest, or drug-induced respiratory depression. Prior to NIV initiation, right diaphragm excursion was assessed via M-mode POCUS in the subcostal view by five trained emergency medicine residents. NIV failure was defined as the need for intubation due to clinical deterioration or intolerance.
RESULTS: Among 77 patients, 21 (27.3 %) experienced NIV failure. Diaphragm excursion <1.4 cm predicted NIV failure with an area under the curve (AUC) of 0.86 (95 % CI: 0.76-0.93), sensitivity 85.7 %, specificity 85.7 %, positive predictive value 66.7 %, negative predictive value 94.0 %, and accuracy 84.4 %. Right diaphragm excursion <1.4 cm was independently associated with NIV failure (OR: 42.12; 95 % CI: 6.79-261.12), along with older age (OR: 1.15; 95 % CI: 1.04-1.27) and lower base excess (OR: 0.85; 95 % CI: 0.74-0.98).
CONCLUSION: Diaphragm excursion showed high diagnostic accuracy and independently predicted NIV failure. Its integration into early assessment in acute care may support informed decisions and improve outcomes.
OBJECTIVES: This study aimed to evaluate the diagnostic accuracy of right diaphragm excursion measured by point-of-care ultrasound (POCUS) in predicting NIV failure and to identify associated predictors.
METHODS: We conducted a prospective diagnostic accuracy study in the emergency department of a tertiary care hospital between January and October 2024. Adult patients (≥18 years) with acute respiratory failure requiring NIV were included. Exclusion criteria included neuromuscular disease, hemodynamic instability, cardiac or respiratory arrest, or drug-induced respiratory depression. Prior to NIV initiation, right diaphragm excursion was assessed via M-mode POCUS in the subcostal view by five trained emergency medicine residents. NIV failure was defined as the need for intubation due to clinical deterioration or intolerance.
RESULTS: Among 77 patients, 21 (27.3 %) experienced NIV failure. Diaphragm excursion <1.4 cm predicted NIV failure with an area under the curve (AUC) of 0.86 (95 % CI: 0.76-0.93), sensitivity 85.7 %, specificity 85.7 %, positive predictive value 66.7 %, negative predictive value 94.0 %, and accuracy 84.4 %. Right diaphragm excursion <1.4 cm was independently associated with NIV failure (OR: 42.12; 95 % CI: 6.79-261.12), along with older age (OR: 1.15; 95 % CI: 1.04-1.27) and lower base excess (OR: 0.85; 95 % CI: 0.74-0.98).
CONCLUSION: Diaphragm excursion showed high diagnostic accuracy and independently predicted NIV failure. Its integration into early assessment in acute care may support informed decisions and improve outcomes.