Effect of different modes of mechanical ventilation on chronic obstructive pulmonary disease patients with respiratory failure regarding echocardiographic changes and diaphragmatic ultrasound

Objectives and aim:Recently, a concern has emerged with regard to the potential adverse effects of invasive mechanical ventilation on the respiratory muscles. This entity was originally termed ventilator-induced diaphragmatic dysfunction (VIDD). This study aimed to detect the impact of different modes of mechanical ventilation on diaphragmatic performance and echocardiographic parameters of COPD patients by using diaphragmatic ultrasound and ECHO.Patients and methods: The present study was carried out on 100 mechanically ventilated chronic obstructive pulmonary disease patients. Diaphragmatic ultrasonography for the assessment of diaphragmatic performance in addition to echocardiography was performed on different modes of mechanical ventilation. These patients were randomly allocated according to modes of mechanical ventilation that used into four groups, each one included 25 patients. Results:There was a highly statistically significant decrease in diaphragmatic performance when controlled mechanical ventilation (CMV) was applied only on patients, in contrary diaphragmatic performance was improved when pressure support ventilation (PSV) combined with CMV where no significant change in diaphragmatic mobility parameters occurred. And also no significant correlation was detected between echocardiographic parameters (left ventricular ejection fraction, right ventricular size, tricuspid annular plane systolic excursion, right ventricular systolic pressure) and different modes of mechanical ventilation. Conclusion: The best diaphragmatic performance was on PSV, which improved lung volumes and ventilation, and may increase the rate of success of the weaning a Department of chest disease, Benha faculty of medicine, Banha University, Egypt. b Department of cardio-thoracic surgery, Benha faculty of medicine, Banha University, Egypt. c Department of anesthesia and intensive care unit, Benha faculty of medicine, Banha University, Egypt. Correspondence to: Enas W. Mahdy, Department of anesthesia and intensive care unit, Benha faculty of medicine, Banha University, Egypt