Diaphragmatic excursion measurement in emergency department patients with acute dyspnea to predict mechanical ventilation use

Clément, Aude; Zieleskiewicz, Laurent; Bonnec, Jean-Marie; Occean, Bob-valery; Bastide, Sophie; Muller, Laurent; Coussaye, J.-E. de La; Boussuges, Alain; Claret, Pierre Géraud; Bobbia, Xavier

doi:10.1016/j.ajem.2020.06.044

Cited by 6 publications

(20 citation statements)

References 22 publications

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“…[8][9][10][11][12]99 This phase is heralded by fever and shortness of breath. A pulse oximeter should be used to monitor for early detection of silent hypoxemia in both asymptomatic and symptomatic persons 103,104 ; if the oxygen saturation falls below 90%, admission to a hospital for oxygen therapy (and other appropriate therapy) is advised. [8][9][10][11][12]104 SARS-CoV-2 infects alveolar type II cells in the lung.…”

Section: Initial Infection Of the Upper Respiratory Tractmentioning

confidence: 99%

“…A pulse oximeter should be used to monitor for early detection of silent hypoxemia in both asymptomatic and symptomatic persons 103,104 ; if the oxygen saturation falls below 90%, admission to a hospital for oxygen therapy (and other appropriate therapy) is advised. [8][9][10][11][12]104 SARS-CoV-2 infects alveolar type II cells in the lung. 31,105 Autopsy studies provide valuable insights into the pathogenesis of pulmonary infection by SARS-CoV-2.…”

Section: Initial Infection Of the Upper Respiratory Tractmentioning

confidence: 99%

“…213 Patients that are self-isolating at home after testing positive for SARS-CoV-2 often suffer from silent hypoxia. 103,104 Due to this delay, admitted patients often require transfer to an intensive care unit and mechanical ventilation within the first several days. 104…”

Section: Therapy Of Sars-cov-2 Infections Based On the Pathogenesismentioning

confidence: 99%

“…103,104 Due to this delay, admitted patients often require transfer to an intensive care unit and mechanical ventilation within the first several days. 104…”

Section: Therapy Of Sars-cov-2 Infections Based On the Pathogenesismentioning

confidence: 99%

“…214 Stage I is an early viral infection for which antiviral therapy would be appropriate for reducing the viral load. 214 103,104 In addition, stage II involves an early host inflammatory response for which anti-inflammatory therapy would be appropriate. 214 Stage III is the hyperinflammation phase that often results in acute respiratory distress syndrome.…”

Section: Approach To Covid-19 Therapymentioning

confidence: 99%

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Pathogenesis‐directed therapy of 2019 novel coronavirus disease

Stratton

Tang

2020

Journal of Medical Virology

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The 2019 novel coronavirus disease (COVID‐19) now is considered a global public health emergency. One of the unprecedented challenges is defining the optimal therapy for those patients with severe pneumonia and systemic manifestations of COVID‐19. The optimal therapy should be largely based on the pathogenesis of infections caused by this novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Since the onset of COVID‐19, there have been many prepublications and publications reviewing the therapy of COVID‐19 as well as many prepublications and publications reviewing the pathogenesis of SARS‐CoV‐2. However, there have been no comprehensive reviews that link COVID‐19 therapies to the pathogenic mechanisms of SARS‐CoV‐2. To link COVID‐19 therapies to pathogenic mechanisms of SARS‐CoV‐2, we performed a comprehensive search through MEDLINE, PubMed, medRxiv, EMBASE, Scopus, Google Scholar, and Web of Science using the following keywords: COVID‐19, SARS‐CoV‐2, novel 2019 coronavirus, pathology, pathologic, pathogenesis, pathophysiology, coronavirus pneumonia, coronavirus infection, coronavirus pulmonary infection, coronavirus cardiovascular infection, coronavirus gastroenteritis, coronavirus autopsy findings, viral sepsis, endotheliitis, thrombosis, coagulation abnormalities, immunology, humeral immunity, cellular immunity, inflammation, cytokine storm, superantigen, therapy, treatment, therapeutics, immune‐based therapeutics, antiviral agents, respiratory therapy, oxygen therapy, anticoagulation therapy, adjuvant therapy, and preventative therapy. Opinions expressed in this review also are based on personal experience as clinicians, authors, peer reviewers, and editors. This narrative review linking COVID‐19 therapies with pathogenic mechanisms of SARS‐CoV‐2 has resulted in six major therapeutic goals for COVID‐19 therapy based on the pathogenic mechanisms of SARS‐CoV‐2. These goals are listed below: The first goal is identifying COVID‐19 patients that require both testing and therapy. This is best accomplished with a COVID‐19 molecular test from symptomatic patients as well as determining the oxygen saturation in such patients with a pulse oximeter. Whether a symptomatic respiratory illness is COVID‐19, influenza, or another respiratory pathogen, an oxygen saturation less than 90% means that the patient requires medical assistance. The second goal is to correct the hypoxia. This goal generally requires hospitalization for oxygen therapy; other respiratory‐directed therapies such as prone positioning or mechanical ventilation are often used in the attempt to correct hypoxemia due to COVID‐19. The third goal is to reduce the viral load of SARS‐CoV‐2. Ideally, there would be an oral antiviral agent available such as seen with the use of oseltamivir phosphate for influenza. This oral antiviral agent should be taken early in the course of SARS‐CoV‐2 infection. Such an oral agent is not available yet. Currently, two options are available for reducing the viral load of SARS‐CoV‐2. These are post‐Covid‐1...

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Section: Initial Infection Of the Upper Respiratory Tractmentioning

confidence: 99%

Section: Initial Infection Of the Upper Respiratory Tractmentioning

confidence: 99%

Section: Therapy Of Sars-cov-2 Infections Based On the Pathogenesismentioning

confidence: 99%

“…103,104 Due to this delay, admitted patients often require transfer to an intensive care unit and mechanical ventilation within the first several days. 104…”

Section: Therapy Of Sars-cov-2 Infections Based On the Pathogenesismentioning

confidence: 99%

Section: Approach To Covid-19 Therapymentioning

confidence: 99%

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Pathogenesis‐directed therapy of 2019 novel coronavirus disease

Stratton

Tang

2020

Journal of Medical Virology

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Visual Patterns of Diaphragmatic Motion in Acute Respiratory Failure: A Prospective Pilot Study

Markarian,

Daniel,

Guillemet

et al. 2024

J of Clinical Ultrasound

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IntroductionRight diaphragmatic excursion is a reliable and reproducible technique used in intensive care to assess diaphragmatic function. The aim of this study was to investigate the relationship between the appearance of diaphragmatic motion and the etiological diagnosis of patients admitted to the emergency department with acute respiratory failure (ARF).MaterialsA prospective, observational, and multicenter pilot study was conducted. All adult patients admitted in the emergency department with ARF were included. The different visual patterns of diaphragmatic motion were analyzed according to the three main etiologies of ARF encountered in emergency departments.ResultsA total of 39 adult patients were included. We observed a different visual pattern in patients with pneumonia. A sum of plateau times of less than 0.2 s predicted that the main diagnosis was pneumonia, with sensitivity = 89% 95%CI [52%; 100%], specificity = 87% 95%CI [69%; 96%].ConclusionOur study seems to show that the shape of diaphragmatic motion in patients with ARF secondary to pneumonia is different from that in patients with exacerbation of chronic obstructive pulmonary disease or acute heart failure.Trial Registration: ClinicalTrials.gov: NCT04591509

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The Incidence of Diaphragmatic Dysfunction in Patients Presenting With Dyspnea in the Emergency Department

Puchongmart

Nakornchai

Leethotsarat

et al. 2023

J of Ultrasound Medicine

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Objectives Diaphragmatic dysfunction has been reported as a cause of dyspnea, and its diagnosis can be made using ultrasound. Diaphragmatic ultrasound is mainly used to predict respiratory failure in chronic conditions. The use of diaphragmatic ultrasound has also risen in acute settings, such as emergency departments (EDs). However, the number of studies on its use still needs to be increased. The present study aimed to find the incidence of diaphragmatic dysfunction in the ED. Methods This prospective cohort study was conducted in an ED. We enrolled patients aged greater than 18 years who presented with dyspnea. Diaphragmatic excursion and diaphragmatic thickness techniques were performed. The primary outcome was the incidence of diaphragmatic dysfunction. The secondary outcomes were the associations between diaphragmatic dysfunction and the composition of respiratory therapies within 24 hours, intubation within 24 hours, and 7‐day mortality. Results A total of 237 patients were analyzed. The incidences of diaphragmatic dysfunction assessed by diaphragmatic excursion and diaphragm thickness were 22.4 and 32.1%, respectively. Patients with sepsis and cancer had the highest incidences. Diaphragmatic dysfunction assessed by both techniques was not associated with the composition of respiratory support therapies within 24 hours, intubation within 24 hours, or 7‐day mortality. Conclusions The incidence of diaphragmatic dysfunction in dyspneic patients in the ED ranged from 22.4 to 32.1%, depending on the ultrasound technique. Diaphragmatic dysfunction was not associated with the composition of respiratory support therapies, intubation, or mortality.

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Diaphragmatic excursion measurement in emergency department patients with acute dyspnea to predict mechanical ventilation use

Cited by 6 publications

References 22 publications

Pathogenesis‐directed therapy of 2019 novel coronavirus disease

Pathogenesis‐directed therapy of 2019 novel coronavirus disease

Visual Patterns of Diaphragmatic Motion in Acute Respiratory Failure: A Prospective Pilot Study

The Incidence of Diaphragmatic Dysfunction in Patients Presenting With Dyspnea in the Emergency Department

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