Ultrasound of the Diaphragm Excursion Ratio as Physiological Biomarker in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

3.1 Introduction and rationale In 2020 an estimate of 562.700 people had Chronic Obstructive Pulmonary Disease (COPD) in the Netherlands, resulting in 21.335 hospital admissions.\[1\] An acute exacerbation COPD (AECOPD) in combination with hospital admission is associated with high mortality and morbidity. \[2\] Noninvasive ventilation (NIV) has been very effective in the context of AECOPD, since it efficiently offloads respiratory muscles and counteracts dynamic hyperinflation. This method often prevents intubation as a bridge to administering effective therapies (e.g., glucocorticoids, bronchodilators, and antibiotic agents)\[3\], and may reduce mortality.\[4\] Current guidelines recommend NIV for the treatment of acute respiratory failure in patients with respiratory distress, pH \< 7.35, and PaCO2 \> 6 kPA (with exclusion of patients requiring invasive ventilation, see guideline).\[5,6\] National guidelines do not recommend NIV in AECOPD with increased work of breathing without respiratory acidosis due to lack of evidence. \[5\] Ultrasound of the diaphragm can identify atrophy and impaired motion or contractility of the diaphragm\[10\], and has been shown to predict mortality and NIV failure during NIV treatment for respiratory acidosis due to AECOPD.\[11-15\] Whether ultrasound of the diaphragm may predict mortality or need for (non-)invasive ventilation in AECOPD without respiratory acidosis on initial presentation is unknown. During exploratory analysis of a previou…

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Wytze S de Boer, MD  ·  +31646312031  ·  w.s.de.boer@isala.nl

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