Using Ultrasound to detect diaphragm dysfunction in patients with acute deterioration of chronic obstructive lung disease and assessing its utility in estimating failure of Non invasive ventilation in such patients

Not yet recruiting

Conditions: Chronic obstructive pulmonary disease with (acute) exacerbation,

Brief Summary: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is defined as an acute event characterized by a worsening of the patientâ€™s respiratory symptoms. Noninvasive (NIV) is the first-line management in AECOPD. Diaphragmatic dysfunction (DD) is a common reason for dyspnoea in COPD. Ultrasound is a cheap, safe, non-invasive, less time consuming, bedside tool for detecting DD. Among various USG parameters, change in the diaphragmatic thickness (Î”TDI) has been found to be the most sensitive parameter of DD. The aim of our study will be to assess the utility of ultrasound assessed DD (continuous and new-onset) in estimating the NIV failure of patients with AECOPD.

Recruitment & Eligibility

Inclusion Criteria

Patients with Acute exacerbation of chronic obstructive lung disease with acidosis (PaCO2 >45mm Hg, pH <7.25) in need of non-invasive ventilation.

Exclusion Criteria

Patients with acute pulmonary edema.
History of interstitial lung disease.
History of neuromuscular disease.
Chest wall deformities.
Previously diagnosed diaphragmatic palsy.
Hemodynamic instability (Systolic blood pressure <90 mm Hg).
Intracranial hypertension.
Any contraindication to Non-invasive ventilation, 10.
Need for immediate endotracheal intubation or invasive mechanical ventilation at ICU admission.

Primary Outcome Measures

Name	Time	Method
Non-invasive ventilation (NIV) failure rate with respect to new onset or continuous diaphragmatic dysfunction assessed by ultrasound guided measurement of change in diaphragmatic thickness (Î”TDI).	Î”TDI assessed at 2 hrs on NIV or immediately prior to intubation if patient requires intubation before 2 hrs of NIV. \| NIV failure assessed during ICU stay

Secondary Outcome Measures

Name	Time	Method
Diaphragmatic dysfunction assessed by ultrasound guided measurement of change in diaphragmatic thickness (Î”TDI).	At ICU admission
Time to NIV failure.	ICU admission (Day 1) to time point of intubation.
Ventilation days (Non - invasive).	Duration of non-invasive ventilation
Ventilation days (invasive).	Duration of invasive ventilation
Length of stay in ICU.	ICU admission ( Day 1) to patients ICU discharge or death or 30 days whichever is earlier
In hospital length of stay.	ICU admission (Day 1) to patient discharge or death or 30 days whichever is earlier.
ICU mortality, In hospital mortality and 30 day mortality.	ICU admission (Day 1) to 30 days follow up or death whichever is earlier.

Locations (1): Critical Care Unit
🇮🇳
Dehradun, UTTARANCHAL, India
Critical Care Unit
🇮🇳Dehradun, UTTARANCHAL, India
Nupur B Patel
Principal investigator
8489926988
nupurbpatel@yahoo.co.in