• Federico Antenora, Riccardo Fantini, Andrea Iattoni, Ivana Castaniere, Antonia Sdanganelli, Francesco Livrieri, Roberto Tonelli, Stefano Zona, Marco Monelli, Enrico M Clini, and Alessandro Marchioni.
• Respiratory Disease Unit, University Hospital of Modena, Modena, Italy.
• Respirology. 2017 Feb 1; 22 (2): 338-344.

Background And ObjectiveThe prevalence and clinical consequences of diaphragmatic dysfunction (DD) during acute exacerbations of COPD (AECOPD) remain unknown. The aim of this study was (i) to evaluate the prevalence of DD as assessed by ultrasonography (US) and (ii) to report the impact of DD on non-invasive mechanical ventilation (NIV) failure, length of hospital stay and mortality in severe AECOPD admitted to respiratory intensive care unit (RICU).MethodsForty-one consecutive AECOPD patients with respiratory acidosis admitted over a 12-month period to the RICU of the University Hospital of Modena were studied. Diaphragmatic ultrasound (DU) was performed on admission before starting NIV. A change in diaphragmatic thickness (ΔTdi) less than 20% during spontaneous breathing was considered to confirm the presence of dysfunction (DD+). NIV failure and other clinical outcomes (duration of mechanical ventilation MV, tracheostomy, length of hospital stay and mortality) were recorded.ResultsA total of 10 out of 41 patients (24.3%) presented DD+, which was significantly associated with steroid use (P = 0.002, R-squared = 0.19). DD+ correlated with NIV failure (P < 0.001, R-squared = 0.27), longer intensive care unit (ICU) stay (P = 0.02, R-squared = 0.13), prolonged MV (P = 0.023, R-squared = 0.15) and need for tracheostomy (P = 0.006, R-squared = 0.20). Moreover, the Kaplan-Meyer survival estimates showed that NIV failure (log-rank test P value = 0.001, HR = 8.09 (95% CI: 2.7-24.2)) and mortality in RICU (log-rank test P value = 0.039, HR = 4.08 (95% CI: 1.0-16.4)) were significantly associated with DD+.ConclusionIn hospitalized AECOPD patients submitted to NIV, severe DD was seen in almost one-quarter of patients. DD may cause NIV failure, and impacts on the use of clinical resources and on the patient's short-term mortality.© 2016 Asian Pacific Society of Respirology.

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