Ecografía diafragmática como predictor de fracaso en Ventilación Mecánica No Invasiva

Resum

Acute dyspnea triggered by acute respiratory failure is one of the most frequent causes of consultation in hospital emergency services. For the management of these patients, non-invasive respiratory support therapy (NISR) is essential, as it has been shown to reduce the need for a more aggressive approach such as orotracheal intubation and the use of invasive mechanical ventilation. Although, on the other hand, a delay in the necessary invasive mechanical ventilation increases mortality. It is in this decision-making paradigm that the EP requires reliable and fast decision-making tools to help them decide on the appropriate type of ventilatory support. The main objective of our study was to establish the association between ultrasound measurements of the diaphragm, diaphragm thickness on inspiration, diaphragm thickness on expiration, their difference, and diaphragm mobility with early respiratory failure in patients undergoing non-invasive ventilatory support. The study was carried out on a cohort of 51 patients selected for presenting with severe respiratory failure secondary to non-invasive mechanical ventilation (NIMV) at the beginning of their care, in the Emergency Department of the Reina Sofía General University Hospital in Murcia between October 1 of 2021 and March 30, 2022. CONCLUSION: We found significant differences (p = 0,002) in the change in thickness of the diaphragm between the wound and the first hour, as well as between 15 min and the hour (p = 0,047), with early respiratory failure. Diaphragmatic mobility (p = 0,045) was also significant when measured at one hour, with a mean of 11,81 mm in the sample that met the criteria for early ventilatory failure, compared to 16,05 mm in those who did not. Along the same lines, the difference between diaphragmatic mobility at one hour and the start of care was also significant (p = 0,013), with a mean difference of 2,45 mm in those with early failure and 4,82 mm among those with early failure. that improve. Lastly, in the 42 patients who presented global respiratory failure, the change in the difference in diaphragmatic thickness was significant between arrival and 15 min (p = 0,011), with a mean among those who met early failure criteria of 0,03 mm, compared to 1,84 mm for those who did not meet these criteria. This leads us to consider this early determination useful among patients with hypercapnic or global respiratory failure.