Value of Diaphragmatic Motion Measurement at Ultrasonography to Predict Poor Prognosis in Emergency Department Patients With Acute Respiratory Failure

Study Overview
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Brief Summary
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Acute respiratory failure is one of the most common diagnosis in patients admitted in the Emergency Department. Acute respiratory failure is associated with morbidity and mortality. Fifteen percent of patient will require ventilatory support and among them 40% will die. Measurement of diaphragmatic motion (excursion) at ultrasonography is a noninvasive measure, allowing to assess diaphragm dysfunction. It could be useful in predicting poor prognosis in ED patients with respiratory failure . In this study the investigators will compare the prognostic value of diaphragmatic excursion measurement at ultrasonography to that of the National Early Warning Score (NEWS) 2 in patients presenting with acute respiratory failure in the ED The Investigators made the hypothesis that measurement of diaphragmatic excursion in ED patients with acute respiratory failure could be of value in predicting the need for ventilatory support or mortality within 28 days from ED admission

Detailed Description
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Diaphragmatic dysfunction can be explored by measuring diaphragmatic excursion using ultrasonography in spontaneous ventilation patients. Patients in spontaneous ventilation will undergo both diaphragmatic excursion measurement at ultrasonography and assessment of the News2 score as part of standard care.

Official Title
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Pronostic Value of Diaphragmatic Excursion Measurement in Patients With Acute Respiratory Failure in the ED.

Conditions
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Dyspnea, Acute Respiratory Failure

Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Age equal or over 18 y.o Signs of acute respiratory failure defined by RR equal or over 25 br/min and/or signs of increased work of breathing Patients on spontaneous breathing Exclusion criteria: Medical history of diaphragmatic dysfunction including stroke or diaphragmatic paralysis Patients on ventilatory support at ED admission or prior to inclusion Patients treated with curare Trauma patients

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients with adverse events | Adverse events are defined as a composite of mortality and/or cardiac arrest and/or need for ventilatory support (including invasive and/or noninvasive ventilation and/or high flow nasal cannula therapy) within 28 days from ED admission. | 28 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delay to initiation of ventilatory support | Ventilatory support is defined as invasive mechanical ventilation or non invasive ventilation or high-flow nasal cannula | at day 28 | 
| Number of patients with adverse events at ED discharge | Adverse events are defined as a composite of mortality and/or cardiac arrest and/or need for ventilatory support (including invasive and/or noninvasive ventilation and/or high flow nasal cannula therapy). | through ED stay (up to a day) | 
| Number of patients with adverse events at hospital discharge | Adverse events are defined as a composite of mortality and/or cardiac arrest and/or need for ventilatory support (including invasive and/or noninvasive ventilation and/or high flow nasal cannula therapy). | through hospital stay (up to a week) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diaphragmatic Excursion, Diaphragmatic Dysfunction, Emergency Department, Respiratory insufficiency, Acute respiratory failure