The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019

BACKGROUND: We aimed to evaluate the ability of diaphragmatic excursion at hospital admission to predict outcomes in patients with coronavirus disease-2019 (COVID-19). METHODS: In this prospective observational study, we included adult patients with severe COVID-19 admitted to a tertiary hospital. Ultrasound examination of the diaphragm was performed within 12 h of admission. Other collected data included peripheral oxygen saturation (SpO(2)), respiratory rate, and computed tomography (CT) score. The outcomes included the ability of diaphragmatic excursion, respiratory rate, SpO(2), and CT score at admission to predict the need for ventilatory support (need for non-invasive or invasive ventilation) and patient mortality using the area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariable analyses about the need for ventilatory support and mortality were performed. RESULTS: Diaphragmatic excursion showed an excellent ability to predict the need for ventilatory support, which was the highest among respiratory rate, SpO(2), and CT score; the AUCs (95% confidence interval [CI]) was 0.96 (0.85–1.00) for the right diaphragmatic excursion and 0.94 (0.82–0.99) for the left diaphragmatic excursion. The right diaphragmatic excursion also had the highest AUC for predicting mortality in relation to respiratory rate, SpO(2), and CT score. Multivariable analysis revealed that low diaphragmatic excursion was an independent predictor of mortality with an odds ratio (95% CI) of 0.55 (0.31–0.98). CONCLUSION: Diaphragmatic excursion on hospital admission can accurately predict the need for ventilatory support and mortality in patients with severe COVID-19. Low diaphragmatic excursion was an independent risk factor for in-hospital mortality.