Relationship of Ultrasonically Assessed Diaphragmatic Weakness with the Need for Postoperative Mechanical Ventilation in Older Adult Patients after Major Abdominal Surgeries: An Observational Study

Objective This study aimed to analyze the association between preoperative diaphragmatic weakness in older adult patients and the need for postoperative mechanical ventilation after major surgery. We hypothesized that preoperative diaphragmatic weakness would significantly increase the need for postoperative mechanical ventilation.Methods It was a single-center, prospective, observational study that included 90 older adult patients aged more than 50 years who underwent abdominal surgery under general anaesthesia. A portable ultrasound was used to assess the percentage increase in the diaphragm thickening fraction (TFdi) during a maximal inspiratory effort, preoperatively and before extubation. The perioperative change in diaphragmatic function, the development of outcomes, i.e., extubation/mechanical ventilation, and the optimal cut-off of TFdi to predict outcomes were analyzed.Results The patients with a preoperative TFdi 2=0.71). The optimal cut-off value of TFdi (preoperative) ≤28.9 predicted intensive care unit stay with 73% sensitivity and 73% specificity, and a high negative predictive value (93.2%).Conclusion Our study found that a significant percentage of older adult patients had a preexisting diaphragmatic weakness that was associated with extubation failure and the need for postoperative mechanical ventilation.