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

Abstract

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.

Perioperative Diaphragm Dysfunction

“…The incidence of DD is yet to be accurately established and may vary depending on the study population and diagnostic method used. For example, depending on the ultrasound technique applied, DD incidence among dyspneic patients in emergency departments may range between 22.4 and 31.7% [14]. Additionally, DD prevalence was reported to exceed 60% (at admission) in critically ill patients requiring intubation, and was as high as 80% in patients experiencing difficult weaning, requiring prolonged Mechanical Ventilation (MV) [15].…”

ERS International Congress 2023: highlights from the Allied Respiratory Professionals Assembly

“…Dyspnoea is a cardinal symptom in various disease conditions [86]. Schaeffer et al [87] explored the effect of a six-month inspiratory muscle training (IMT) programme in unilateral diaphragm dysfunction, which is an important underdiagnosed cause of dyspnoea [88]. In this RCT, the IMT group (30 breaths at 50% maximal inspiratory pressure, 2x/day, monthly progression) showed meaningful improvements in dyspnoea (between-group difference of -3.0 points, 95% CI [-5.1;-0.9] on Transitional Dyspnoea Index), exercise endurance time (between-group difference of 6.0 min, 95% CI [0.4;11.5]), and respiratory muscle function (between-group difference of maximal inspiratory mouth pressure and diaphragm sniff pressure; 28 cmH 2 O, 95% CI [13;43] and 12 cmH 2 O 95% CI [0;23], respectively) compared to the control group.…”

Diagnosis of hemidiaphragm paralysis: refine ultrasound criteria

“…Hemidiaphragm paralysis is widely underestimated and can cause dyspnea or delayed recovery after respiratory distress or thoracic surgery. The interest of the assessment of diaphragm function by ultrasound at admission to the emergency room or intensive care unit has recently been highlighted ( 1–4 ).…”