Diaphragmatic dysfunction and its association with postoperative respiratory support in patients with acute secondary peritonitis : A retrospective cohort study
- 1Intensive Care Unit, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China.
Abstract
This study aimed to investigate postoperative diaphragmatic function in patients with acute secondary peritonitis and evaluate its association with respiratory support requirements, pulmonary complications, and clinical outcomes. A total of 100 patients with acute secondary peritonitis who underwent emergency surgical intervention and were subsequently admitted to the ICU between January 2022 and February 2024 were retrospectively enrolled. Based on postoperative 24 to 48 hours diaphragm ultrasonography, patients were categorized into preserved diaphragmatic function (n = 42) and impaired function groups (n = 58). Demographics, inflammatory biomarkers, severity scores (APACHE II, SOFA), TFdi, Ddi, ventilation modality and duration, extubation outcome, pulmonary complications, ICU/hospital length of stay, and 28-day mortality were collected. Intergroup comparisons were performed using t-test, χ2 test, or Mann–Whitney U test. Pearson correlation was applied to evaluate the relationship between diaphragmatic function and inflammatory markers/severity scores, and multivariate logistic regression was used to identify independent predictors of extubation failure and prolonged mechanical ventilation. Among the 100 enrolled patients, the impaired diaphragmatic function group showed significantly higher levels of PCT, CRP, IL-6 (all P < .05), and increased SOFA and APACHE II scores (both P < .01) compared to the preserved function group. TFdi demonstrated moderate negative correlations with PCT, IL-6, and SOFA scores (r=−0.55, −0.50, −0.49; all P < .001), while Ddi was also negatively correlated with inflammation and clinical severity (all P < .01). Multivariate analysis indicated that reduced TFdi (OR = 2.82, P = .001) and decreased Ddi (OR = 1.97, P = .009) were independent predictors of extubation failure, and reduced TFdi markedly increased the risk of mechanical ventilation dependence (OR = 3.21, P < .001). Clinically, the impaired diaphragmatic function group had higher rates of pulmonary infection (41.4 vs 19.0%, P = .018), ARDS (25.9 vs 9.5%, P = .032), and re-intubation (27.6 vs 9.5%, P = .014), as well as prolonged ICU and hospital stays (both P < .01). The 28-day mortality was also significantly higher (13.8 vs 4.8%, P = .048). Diaphragmatic function is a critical determinant of postoperative respiratory outcomes in acute secondary peritonitis. Reduced TFdi and Ddi are strongly associated with failed extubation, prolonged mechanical ventilation, a heightened inflammatory response, and increased pulmonary complications. Early bedside ultrasonographic assessment of diaphragmatic performance may assist in identifying high-risk patients, tailoring respiratory management strategies, and improving postoperative prognosis.
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BibTeX
@article{feng2026diaphragmatic,
title = {{Diaphragmatic dysfunction and its association with postoperative respiratory support in patients with acute secondary peritonitis : A retrospective cohort study}},
author = {Quanrui Feng and Wenxing Zhang and Wei Dai},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051410},
url = {https://europepmc.org/article/PMC/PMC13727249},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diaphragmatic dysfunction and its association with postoperative respiratory support in patients with acute secondary peritonitis : A retrospective cohort study
AU - Quanrui Feng
AU - Wenxing Zhang
AU - Wei Dai
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051410
UR - https://europepmc.org/article/PMC/PMC13727249
AB - This study aimed to investigate postoperative diaphragmatic function in patients with acute secondary peritonitis and evaluate its association with respiratory support requirements, pulmonary complications, and clinical outcomes. A total of 100 patients with acute secondary peritonitis who underwent emergency surgical intervention and were subsequently admitted to the ICU between January 2022 and February 2024 were retrospectively enrolled. Based on postoperative 24 to 48 hours diaphragm ultrasonography, patients were categorized into preserved diaphragmatic function (n = 42) and impaired function groups (n = 58). Demographics, inflammatory biomarkers, severity scores (APACHE II, SOFA), TFdi, Ddi, ventilation modality and duration, extubation outcome, pulmonary complications, ICU/hospital length of stay, and 28-day mortality were collected. Intergroup comparisons were performed using t-test, χ2 test, or Mann–Whitney U test. Pearson correlation was applied to evaluate the relationship between diaphragmatic function and inflammatory markers/severity scores, and multivariate logistic regression was used to identify independent predictors of extubation failure and prolonged mechanical ventilation. Among the 100 enrolled patients, the impaired diaphragmatic function group showed significantly higher levels of PCT, CRP, IL-6 (all P < .05), and increased SOFA and APACHE II scores (both P < .01) compared to the preserved function group. TFdi demonstrated moderate negative correlations with PCT, IL-6, and SOFA scores (r=−0.55, −0.50, −0.49; all P < .001), while Ddi was also negatively correlated with inflammation and clinical severity (all P < .01). Multivariate analysis indicated that reduced TFdi (OR = 2.82, P = .001) and decreased Ddi (OR = 1.97, P = .009) were independent predictors of extubation failure, and reduced TFdi markedly increased the risk of mechanical ventilation dependence (OR = 3.21, P < .001). Clinically, the impaired diaphragmatic function group had higher rates of pulmonary infection (41.4 vs 19.0%, P = .018), ARDS (25.9 vs 9.5%, P = .032), and re-intubation (27.6 vs 9.5%, P = .014), as well as prolonged ICU and hospital stays (both P < .01). The 28-day mortality was also significantly higher (13.8 vs 4.8%, P = .048). Diaphragmatic function is a critical determinant of postoperative respiratory outcomes in acute secondary peritonitis. Reduced TFdi and Ddi are strongly associated with failed extubation, prolonged mechanical ventilation, a heightened inflammatory response, and increased pulmonary complications. Early bedside ultrasonographic assessment of diaphragmatic performance may assist in identifying high-risk patients, tailoring respiratory management strategies, and improving postoperative prognosis.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -