Ultrasound assessment of diaphragmatic dysfunction in patients with SARS-COVID-19 as a parameterorotracheal intubation

Abstract

Objective: To correlate by ultrasound the diaphragmatic dysfunction in patients with SARS-COVID-19 with the patterns of pulmonary aeration and oxygenation status, as a parameter of orotracheal intubation. Design: Prospective, observational cohort study, carried out between the months of July to September 2020. Setting: emergency area of the “Hospital de Especialidades Dr. Teodoro Maldonado Carbo”. Patients: 15 patients with epidemiological link and clinical picture of respiratory failure due to suspected SARS-COVID-19 were included, who underwent the BLUE protocol, measurement of diaphragmatic excursion, thickness and diaphragmatic thickness delta to perform the correlations having as a cohort point a value of < 1.5 cm of diaphragmatic excursion as the main parameter, in addition to PaFi and gradient Aa as measures of oxygenation status. Variables: Pulmonary involvement and diaphragmatic dysfunction, state of oxygenation by arterial blood gas. Results: Of the patients studied, 10 were men and 5 women, their average age being 44 years old, the average value of the pulmonary aeration score was 27, diaphragmatic excursion 1.29 cm, both diaphragmatic thickness with Delta of diaphragmatic thickening were not presented greater variation. There was a marked decrease in diaphragmatic excursion in patients with greater compromise of oxygenation and perfusion, demonstrating diaphragmatic dysfunction in the presence of hypercapnia and hypoxia hypoxia with an inverse correlation coefficient of -0.841. Conclusions: It was evidenced that patients with higher pulmonary aeration patterns who had lower diaphragmatic excursion and little variability in the Delta of diaphragmatic thickening ended up in orotracheal intubation, so this parameter can be considered when assessing the severity of patients with SARS-COVID 19 especially when deciding orotracheal intubation.