AIM: The aim of the study is to assess the presence and severity of diaphragmatic dysfunction, and its relationship with various clinical and demographic factors, in patients experiencing exacerbations of chronic obstructive pulmonary disease (COPD) or acute heart failure (HF), including both acute decompensated and new onset HF. MATERIALS AND METHODS: The study was conducted between December 1st, 2023 and April 30th, 2024 at the emergency department of the I.R.C.C.S University Hospital Policlinico San Matteo of Pavia. A total of 22 patients were included, with comprehensive data collection including clinical history, physical examination, laboratory and imaging tests. Point-of-care ultrasound was employed to assess diaphragmatic dysfunction through measurements of diaphragmatic excursion, thickness, and thickening variation. Statistical analyses were performed to explore the associations between diaphragmatic dysfunction and various clinical variables. RESULTS: The study found that only smoking had a statistically significant impact on diaphragmatic dysfunction among the key predictor demographic variables examined, such as age, BMI, hypertension, valvulopathy, arrhythmia, and CAD. Notably, ex-smokers exhibited higher DE values. Other variables did not show significant associations, potentially due to the small sample size. The analysis revealed that 50% of the patient cohort had diaphragmatic dysfunction, with a balanced distribution between systolic and diastolic dysfunction. Most patients were elderly, predominantly female, and hypertensive. A significant proportion showed signs of fluid overload and respiratory acidosis, necessitating advanced respiratory support. CONCLUSIONS: The findings suggest that diaphragmatic dysfunction in COPD and ADHF is more related to mobility restriction than muscle thickness, and smoking cessation could improve diaphragmatic function by reducing muscle fatigue. However, further studies with larger cohorts are needed to validate these results.
SCOPO: Lo scopo dello studio è valutare la presenza e la gravità della disfunzione diaframmatica e la sua relazione con vari fattori clinici e demografici nei pazienti che presentano esacerbazioni della broncopneumopatia cronica ostruttiva (BPCO) o insufficienza cardiaca (IC) acuta, comprese sia l'IC acuta scompensata che l'IC a esordio recente. MATERIALI E METODI: Lo studio è stato condotto tra l’1 dicembre 2023 e il 30 aprile 2024 presso il dipartimento di emergenza dell'Ospedale Universitario I.R.C.C.S Policlinico San Matteo di Pavia. Sono stati inclusi un totale di 22 pazienti, con raccolta completa dei dati che includeva anamnesi clinica, esame obiettivo, esami di laboratorio e diagnostici per immagini. L'ecografia point-of-care è stata impiegata per valutare la disfunzione diaframmatica attraverso misurazioni dell'escursione, spessore e variazione dello spessore diaframmatico. Sono state eseguite analisi statistiche per esplorare le associazioni tra la disfunzione diaframmatica e varie variabili cliniche. RISULTATI: Lo studio ha rilevato che solo il fumo ha avuto un impatto statisticamente significativo sulla disfunzione diaframmatica tra le principali variabili predittive demografiche esaminate, come età, BMI, ipertensione, valvulopatia, aritmia e cardiopatia ischemica. È importante notare che gli ex fumatori hanno mostrato valori di escursione diaframmatica più elevati. Le altre variabili non hanno mostrato associazioni significative, potenzialmente a causa delle dimensioni ridotte del campione. L'analisi ha rivelato che il 50% della coorte di pazienti aveva una disfunzione diaframmatica, con una distribuzione equilibrata tra disfunzione sistolica e diastolica. La maggior parte dei pazienti era anziana, prevalentemente di sesso femminile e ipertesa. Una proporzione significativa mostrava segni di sovraccarico di fluidi e acidosi respiratoria, richiedendo un supporto respiratorio avanzato. CONCLUSIONI: I risultati suggeriscono che la disfunzione diaframmatica nella BPCO e nell'ADHF è più correlata alla limitazione della mobilità che allo spessore muscolare, e che smettere di fumare potrebbe migliorare la funzione diaframmatica riducendo la fatica muscolare. Tuttavia, sono necessari ulteriori studi con coorti più ampie per convalidare questi risultati.
Diaphragmatic dysfunction in patients with COPD or HF in the emergency department: a prospective, observational, cohort study
SIGNORI, SIMONA
2023/2024
Abstract
AIM: The aim of the study is to assess the presence and severity of diaphragmatic dysfunction, and its relationship with various clinical and demographic factors, in patients experiencing exacerbations of chronic obstructive pulmonary disease (COPD) or acute heart failure (HF), including both acute decompensated and new onset HF. MATERIALS AND METHODS: The study was conducted between December 1st, 2023 and April 30th, 2024 at the emergency department of the I.R.C.C.S University Hospital Policlinico San Matteo of Pavia. A total of 22 patients were included, with comprehensive data collection including clinical history, physical examination, laboratory and imaging tests. Point-of-care ultrasound was employed to assess diaphragmatic dysfunction through measurements of diaphragmatic excursion, thickness, and thickening variation. Statistical analyses were performed to explore the associations between diaphragmatic dysfunction and various clinical variables. RESULTS: The study found that only smoking had a statistically significant impact on diaphragmatic dysfunction among the key predictor demographic variables examined, such as age, BMI, hypertension, valvulopathy, arrhythmia, and CAD. Notably, ex-smokers exhibited higher DE values. Other variables did not show significant associations, potentially due to the small sample size. The analysis revealed that 50% of the patient cohort had diaphragmatic dysfunction, with a balanced distribution between systolic and diastolic dysfunction. Most patients were elderly, predominantly female, and hypertensive. A significant proportion showed signs of fluid overload and respiratory acidosis, necessitating advanced respiratory support. CONCLUSIONS: The findings suggest that diaphragmatic dysfunction in COPD and ADHF is more related to mobility restriction than muscle thickness, and smoking cessation could improve diaphragmatic function by reducing muscle fatigue. However, further studies with larger cohorts are needed to validate these results.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/17568