{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:01:49Z","timestamp":1790643709367,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,10,14]],"date-time":"2016-10-14T00:00:00Z","timestamp":1476403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2017,2]]},"abstract":"ABSTRACT<\/jats:title>Background and objective<\/jats:title>The prevalence and clinical consequences of diaphragmatic dysfunction (DD<\/jats:styled-content>) during acute exacerbations of COPD<\/jats:styled-content> (AECOPD<\/jats:styled-content>) remain unknown. The aim of this study was (i) to evaluate the prevalence of DD<\/jats:styled-content> as assessed by ultrasonography (US<\/jats:styled-content>) and (ii) to report the impact of DD<\/jats:styled-content> on non\u2010invasive mechanical ventilation (NIV<\/jats:styled-content>) failure, length of hospital stay and mortality in severe AECOPD<\/jats:styled-content> admitted to respiratory intensive care unit (RICU<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>Forty\u2010one consecutive AECOPD<\/jats:styled-content> patients with respiratory acidosis admitted over a 12\u2010month period to the RICU<\/jats:styled-content> of the University Hospital of Modena were studied. Diaphragmatic ultrasound (DU<\/jats:styled-content>) was performed on admission before starting NIV<\/jats:styled-content>. A change in diaphragmatic thickness (\u0394Tdi<\/jats:styled-content>) less than 20% during spontaneous breathing was considered to confirm the presence of dysfunction (DD<\/jats:styled-content>+). NIV<\/jats:styled-content> failure and other clinical outcomes (duration of mechanical ventilation MV<\/jats:styled-content>, tracheostomy, length of hospital stay and mortality) were recorded.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 10 out of 41 patients (24.3%) presented DD<\/jats:styled-content>+, which was significantly associated with steroid use (P<\/jats:italic> = 0.002, R\u2010squared = 0.19). DD<\/jats:styled-content>+ correlated with NIV<\/jats:styled-content> failure (P<\/jats:italic> < 0.001, R\u2010squared = 0.27), longer intensive care unit (ICU)<\/jats:styled-content> stay (P<\/jats:italic> = 0.02, R\u2010squared = 0.13), prolonged MV<\/jats:styled-content> (P<\/jats:italic> = 0.023, R\u2010squared = 0.15) and need for tracheostomy (P<\/jats:italic> = 0.006, R\u2010squared = 0.20). Moreover, the Kaplan\u2013Meyer survival estimates showed that NIV<\/jats:styled-content> failure (log\u2010rank test P<\/jats:italic> value = 0.001, HR<\/jats:styled-content> = 8.09 (95% CI<\/jats:styled-content>: 2.7\u201324.2)) and mortality in RICU<\/jats:styled-content> (log\u2010rank test P<\/jats:italic> value = 0.039, HR<\/jats:styled-content> = 4.08 (95% CI<\/jats:styled-content>: 1.0\u201316.4)) were significantly associated with DD<\/jats:styled-content>+.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>In hospitalized AECOPD<\/jats:styled-content> patients submitted to NIV<\/jats:styled-content>, severe DD<\/jats:styled-content> was seen in almost one\u2010quarter of patients. DD<\/jats:styled-content> may cause NIV<\/jats:styled-content> failure, and impacts on the use of clinical resources and on the patient's short\u2010term mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.12916","type":"journal-article","created":{"date-parts":[[2016,10,15]],"date-time":"2016-10-15T01:16:43Z","timestamp":1476494203000},"page":"338-344","source":"Crossref","is-referenced-by-count":79,"title":["Prevalence and outcomes of diaphragmatic dysfunction assessed by ultrasound technology during acute exacerbation of COPD<\/scp>: A pilot study"],"prefix":"10.1111","volume":"22","author":[{"given":"Federico","family":"Antenora","sequence":"first","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Fantini","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Iattoni","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Castaniere","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Sdanganelli","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Livrieri","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Tonelli","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Zona","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Monelli","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico M.","family":"Clini","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"},{"name":"Rehabilitation Hospital \u201cVilla Pineta\u201d Pavullo Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Marchioni","sequence":"additional","affiliation":[{"name":"Respiratory Disease Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7382.185"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-11-200306030-00007"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199509283331301"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201106-1094OC"},{"key":"e_1_2_6_6_1","unstructured":"ConfalonieriM GarutiG CattaruzzaMS OsbornJF AntonelliM ContiG KodricM RestaO MarcheseS GregorettiCet al.;Italian Non\u2010invasive Positive Pressure Ventilation (NPPV) Study Group. 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