Evaluation of Diaphragmatic Dysfunction by Ultrasound Technique among Patients with Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Among all diseases, chronic obstructive pulmonary disease(COPD) ranks third in terms of mortality rates globally. Both infectious and noninfectious factors can trigger acute exacerbations of chronic obstructive pulmonary disease(AECOPD). However, the cause of up to 30% of cases is still a mystery. Aim and objectives: To evaluate the diaphragmatic function of patients admitted to the respiratory intensive care unit(RICU) with severe AECOPD using ultrasound imaging and to determine whether this function can predict the success or failure of non-invasive ventilation in these patients. Patients and methods: One hundred patients admitted to the RICU at Al-Azhar University Hospitals with severe AECOPD between October 2022 and June 2024 were the subjects of this prospective observational study. Each participant understood the purpose of the study and gave their signed consent after hearing about it. Results: DTF is very good at discriminating between patients failed and successful NIV at a cut-off level of≤22 % with 83.3% sensitivity and 92.1% specificity. High statistically significant increased duration of staying at ICU, Days of MV, and RICU mortality among patients of the failed NIV group when compared with that of patients of the successful NIV group. Conclusion: Diaphragmatic dysfunction is a common pathophysiological finding in COPD patients. Ultrasound evaluation of diaphragmatic dysfunction has recently gained popularity as a means to forecast NIV effectiveness or failure in patients with severe AECOPD. Diaphragmatic dysfunction is associated with an increased risk of longer ICU admission, MV length, and RICU mortality in patients with severe AECOPD compared to individuals without the condition.