Diaphragmatic excursion measurement in emergency department patients with acute dyspnea to predict mechanical ventilation use
| Autor: | Jean Emmanuel de La Coussaye, Laurent Zieleskiewicz, Aude Clément, Jean-Marie Bonnec, Alain Boussuges, Bob-Valéry Occéan, Xavier Bobbia, Pierre Géraud Claret, Sophie Bastide, Laurent Muller |
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| Přispěvatelé: | Unité de réanimation médicale [CHU de Carémeau, Nîmes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Assistance Publique - Hôpitaux de Marseille (APHM), Centre Hospitalier Saint Jean de Perpignan, Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes] (BESPIM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut de Recherche Biomédicale des Armées [Antenne Marseille] (IRBA) |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Youden's J statistic Diaphragm 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Odds Ratio Humans Prospective Studies Prospective cohort study Aged Ultrasonography Mechanical ventilation Aged 80 and over business.industry 030208 emergency & critical care medicine General Medicine Emergency department Predictive value Respiration Artificial Dyspnea Logistic Models ROC Curve Area Under Curve Cardiology Emergency medicine Female France Diaphragmatic excursion business Acute dyspnea Emergency Service Hospital [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology |
| Zdroj: | American Journal of Emergency Medicine American Journal of Emergency Medicine, Elsevier, 2020, 38 (10), pp.2081-2087. ⟨10.1016/j.ajem.2020.06.044⟩ |
| ISSN: | 1532-8171 0735-6757 |
| DOI: | 10.1016/j.ajem.2020.06.044⟩ |
| Popis: | International audience; Introduction: Ultrasound is a feasible and reproducible method for measuring right diaphragmatic excursion (RDE) in ED patients with acute dyspnea (AD). In AD patients, the correlation between the RDE value and the need for mechanical ventilation (MV) is not known.Materials: This was a bicentric, observational prospective study. The RDE measurement was done at admission. The need for MV was defined by the use of MV within 4 h of AD management. An optimal threshold for RDE was determined as the value that minimized the incorrect predictions of the use of MV in the first 4 h as the highest Youden index.Results: We analyzed 102 patients (79 [70; 86] years), 38 (37%) of whom had been ventilated. The RDE value was 1.7 cm [1.4; 2.0] and 2.2 cm [1.8; 2.6] in the ventilated and non-ventilated groups, respectively (p = 0.06). The AUC was 0.68 95% CI [0.57; 0.80]. With a threshold of 2 cm, the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 76% [60%; 89%], 59% [46%; 71%], 81% [67%; 91%], and 53% [39%; 66%], respectively. In the non-COPD patients, the RDE values were 1.5 cm [1.2; 1.9] and 2.2 cm [1.8; 2.6] (p < 0.01) in the ventilated and not-ventilated groups, respectively. The AUC was 0.77 95% CI [0.64; 0.90]. With a threshold of 2.18 cm, the sensitivity, specificity, NPV, and PPV were 91% [71%; 99%], 51% [36%; 66%], 92% [75%; 99%], and 54% [38%; 69%], respectively.Conclusion: The RDE values at ED admission were unable to define a prognostic threshold value associated with subsequent MV need in the AD patients. In non-COPD patients, the NPV was 92%. |
| Databáze: | OpenAIRE |
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