Role of Ultrasound-Measured Diaphragmatic Excursion and Thickness in Predicting Extubation Outcomes in Perforation Peritonitis Patients: A Comparative Observational Study

TL;DR

This study shows that measuring diaphragm movement and thickness with ultrasound can help predict whether patients with perforation peritonitis will successfully stop using a ventilator after surgery.

Contribution

The study introduces ultrasound-based diaphragm measurements as a novel predictor for extubation outcomes in perforation peritonitis patients.

Findings

Diaphragm excursion was significantly lower in perforation peritonitis patients compared to elective surgery patients.

A diaphragm thickness of 0.15 cm at end-inspiration and 0.14 cm at end-expiration predicted successful extubation in perforation peritonitis patients.

Abstract

Background

Perforation peritonitis, a common surgical emergency, is associated with postoperative respiratory complications. This study aimed to measure diaphragmatic excursion and thickness using preoperative ultrasound in patients undergoing laparotomy for perforation peritonitis, thereby predicting extubation outcomes at the end of the surgery.

Methodology

A total of 80 patients aged 18-60 years, belonging to the American Society of Anesthesiologists physical class I-III, scheduled to undergo laparotomy under general anesthesia were included in this study. The study sample was divided into the following two groups (40 in each group): Group P, perforation peritonitis patients undergoing emergency laparotomy, and Group C, patients undergoing elective laparotomy. Preoperatively, diaphragm excursion on deep inspiration and diaphragmatic thickness at end-inspiration and end-expiration were measured using ultrasound in both groups. Respiratory rate, arterial blood gas analysis, abdominal girth, duration of surgery, extubation outcome, and duration of mechanical ventilation were recorded and compared between the groups.

Results

Diaphragm excursion was significantly reduced in Group P (1.62 cm) compared to Group C (3.3 cm) (p < 0.001). Diaphragm thickness at end-inspiration and end-expiration was significantly reduced in Group P compared to Group C (p = 0.008). In Group P, diaphragm thickness at end-inspiration and end-expiration was significantly higher in those who were successfully extubated. From the receiver operating characteristic curve analysis, a diaphragmatic thickness cut-off value of 0.15 cm at end-inspiration and 0.14 cm at end-expiration predicted successful extubation in Group P.

Conclusions

In this study, diaphragmatic excursion and thickness were significantly reduced in patients with perforation peritonitis. Hence, diaphragmatic thickness can be a useful predictor of extubation outcomes at the end of the surgery.

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