Sarcopenia and diaphragmatic motility in patients with acute respiratory failure treated with high-flow nasal cannula and non-invasive ventilation

PurposeA Multicenter prospective observational study to investigate the association between sarcopenia and diaphragmatic motility in patients admitted for acute respiratory failure (ARF) requiring high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV), and to evaluate whether diaphragmatic ultrasound parameters predict short-term outcomes.MethodsA total of 127 patients hospitalized in the Sub-intensive care units of Fondazione Policlinico Universitario Campus Bio-Medico (Rome), Monaldi Hospital (Naples), and University Hospital of Ferrara with ARF due to various respiratory diseases and requiring respiratory support between January 2023 and January 2025. Sarcopenia was defined using EWGSOP2 criteria (reduced handgrip strength and calf circumference). Diaphragmatic excursion (DE) and thickening fraction (TF) were assessed by ultrasonography during spontaneous breathing prior to respiratory support. Logistic regression and Cox models were used to examine associations with sarcopenia, 3-month mortality and hospital outcomes.ResultsSarcopenia was diagnosed in 52.7% of patients. Compared with non-sarcopenic individuals, sarcopenic patients showed lower diaphragmatic excursion (2.04 cm, SD 0.8 vs. 2.58 cm, SD 0.9, p = 0.001) and thickening fraction (20.5%, SD 10 vs. 24.0%, SD 9.9, p = 0.03). Reduced DE remained independently associated with sarcopenia (adjusted OR = 0.28; 95% CI 0.11-0.59; p = 0.002). No significant associations were found between diaphragmatic parameters and 3-month mortality or hospital outcomes.ConclusionOlder adults with sarcopenia hospitalized for ARF exhibit reduced diaphragmatic motility, independently of comorbidities and disease severity. Ultrasonographic assessment of diaphragm excursion may represent a simple bedside tool to identify patients with underlying muscle weakness, supporting a more individualized management approach during acute respiratory failure, although further studies are required to validate its prognostic and clinical utility.