Observational studyCritical care (London, England)2018
Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation.
Observational study in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 43 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Predictive Value of Diaphragmatic Excursion by Echographic Assessment at the Bedside on Need for Endotracheal Intubation in COPD Patients With Acute Dyspnea in Emergency Medicine
Prognostic Value of Transthoracic Diaphragmatic Echography in COVID-19 Pneumonia Patients With Acute Respiratory Failure
Use of Simplified Lung Ultrasound Score for Predicting ICU Outcomes in Patients With Acute Respiratory Failure
Who cites it
43 citing papers in PubMed, 4 syntheses or guidelines pooled it, 113 citations in OpenAlex.
- Diaphragm ultrasound to predict weaning outcome: systematic review and meta-analysis.Anaesthesiology intensive therapy · 2022Pooled it
- Diagnostic and clinical values of non-cardiac ultrasound in COPD: A systematic review.BMJ open respiratory research · 2020Pooled it
- Recommendations for Lung Ultrasound in Internal Medicine.Diagnostics (Basel, Switzerland) · 2020Guideline
- Thoracic Imaging at Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review.International journal of chronic obstructive pulmonary disease · 2020Pooled it
- Effect of awake prone position on diaphragmatic thickening fraction in patients assisted by noninvasive ventilation for hypoxemic acute respiratory failure related to novel coronavirus disease.Critical care (London, England) · 2021Trial
- Neurally adjusted ventilatory assist after surgical treatment of intracerebral hemorrhage: a randomized crossover study.The Journal of international medical research · 2020Trial
- Diaphragm thickening fraction as a predictor of the need for ventilatory support in the emergency department: an observational pilot study.Journal of ultrasonography · 2026Article
- Sarcopenia and diaphragmatic motility in patients with acute respiratory failure treated with high-flow nasal cannula and non-invasive ventilation.European geriatric medicine · 2026Observational
- Diaphragm ultrasound and surface electromyography as predictors of clinical deterioration in acute exacerbations of COPD: a prospective observational study.ERJ open research · 2026Article
- Prediction of noninvasive ventilation failure: a narrative review.Annals of intensive care · 2026Review
- Beyond blood gases: diaphragm-guided sequential non-invasive ventilation for COPD with type II respiratory failure.Frontiers in medicine · 2026Review
- The lung-muscle axis in COPD: a conceptual framework integrating evidence, mechanisms, and therapeutic perspectives.Frontiers in immunology · 2026Review
- Diaphragmatic Thickening Fraction and Excursion: Different Clinical Values in Non-Critically Ill Patients with AECOPD - An Exploratory Study.International journal of chronic obstructive pulmonary disease · 2026Observational
- Ventilator-induced diaphragmatic dysfunction: pathophysiology, monitoring and advances in potential treatment and prevention.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Management of Asthma and COPD Exacerbations in Adults in the ICU.CHEST critical care · 2025Article
- Diaphragm dysfunction: how to diagnose and how to treat?Breathe (Sheffield, England) · 2025Review
- Pre-injection of saline on the anterior scalene muscle reduced brachial plexus nerve block-induced hemidiaphragmatic paralysis.Frontiers in medicine · 2025Article
- Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study.BMC pediatrics · 2024Article
- Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease.World journal of clinical cases · 2024Article
- Effect of high-flow nasal cannula at different flow rates on diaphragmatic function in subjects recovering from an acute exacerbation of COPD: a physiological prospective pilot study.Journal of anesthesia, analgesia and critical care · 2024Article
Corrections and comments
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUltrasound (US) evaluation of diaphragmatic dysfunction (DD) has proved to be a reliable technique in critical care. In this single-center prospective study, we investigated the impact of US-assessed DD on noninvasive ventilation (NIV) failure in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and its correlation with the transdiaphragmatic pressure assessed using the invasive sniff maneuver (Pdi sniff).
methodsA population of 75 consecutive patients with AECOPD with hypercapnic acidosis admitted to our respiratory intensive care unit (RICU) were enrolled. Change in diaphragm thickness (ΔTdi) < 20% during tidal volume was the predefined cutoff for identifying DD+/- status. Correlations between ΔTdi < 20% NIV failure and other clinical outcomes were investigated. Correlation between ΔTdi and Pdi sniff values was analyzed in a subset of ten patients.
resultsDD+ patients had a higher risk for NIV failure than DD- patients (risk ratio, 4.4; p < 0.001), and this finding was significantly associated with higher RICU, in-hospital, and 90-day mortality rates; longer mechanical ventilation duration; higher tracheostomy rate; and longer RICU stay. Huge increases in NIV failure (HR, 6.2; p < 0.0001) and 90-day mortality (HR, 4.7; p = 0.008) in DD+ patients were found by Kaplan-Meier analysis. ΔTdi highly correlated with Pdi sniff (Pearson's r = 0.81; p = 0.004). ΔTdi < 20% showed better accuracy in predicting NIV failure than baseline pH value and early change in both arterial blood pH and partial pressure of carbon dioxide following NIV start (AUCs 0.84 to DTdi < 20%, 0.51 to pH value at baseline, 0.56 to early change in arterial blood pH following NIV start, and 0.54 to early change in partical pressure of carbon dioxide following NIV start, respectively; p < 0.0001).
conclusionsEarly and noninvasive US assessment of DD during severe AECOPD is reliable and accurate in identifying patients at major risk for NIV failure and worse prognosis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.