• Francesco Corradi, Luigi Vetrugno, Daniele Orso, Tiziana Bove, Annia Schreiber, Enrico Boero, Gregorio Santori, Alessandro Isirdi, Greta Barbieri, and Francesco Forfori.
• Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy; Department of Anesthesiology. Ente Ospedaliero Ospedali Galliera, Genova, Italy. Electronic address: francesco.corradi@unipi.it.
• Respir Physiol Neurobiol. 2021 Feb 1; 284: 103585.

BackgroundIn 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.MethodsWe 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.ResultsEighteen 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 %).ConclusionsIn 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.Copyright © 2020 Elsevier B.V. All rights reserved.

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