This is the case of a 66-year-old man admitted to the ICU due to COVID-19 after high-flow nasal oxygen failure at the conventional hospital ward setting. Non-invasive support (non-invasive ventilation) is initiated with the following parameters: BiPAP mode with IPAP of 12, EPAP of 9, and a FiO2 of 100% with a tidal volume of approximately 350−450 mL (6.25−8 mL/kg of ideal weight) with respiratory rate dropping from 30 to 23 breaths/min. The diaphragmatic ultrasound performed at admission reveals the presence of a regular diaphragmatic excursion of 2 cm. The patient is asked to take a deep breath (*). Inverted diaphragm motion occurs that triggers the use of accessory muscles. M mode is used. Diaphragmatic thickening of only 3% is reported. Nor the pressure or the volume change dramatically. Twenty-four hours later, failed later non-invasive ventilation is confirmed followed by the need for intubation. Figs. 1 and 2.
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Non-invasive support (non-invasive ventilation) is initiated with the following parameters: BiPAP mode with IPAP of 12, EPAP of 9, and a FiO2 of 100% with a tidal volume of approximately 350−450 mL (6.25−8 mL/kg of ideal weight) with respiratory rate dropping from 30 to 23 breaths/min. The diaphragmatic ultrasound performed at admission reveals the presence of a regular diaphragmatic excursion of 2 cm. The patient is asked to take a deep breath (*). Inverted diaphragm motion occurs that triggers the use of accessory muscles. M mode is used. Diaphragmatic thickening of only 3% is reported. Nor the pressure or the volume change dramatically. Twenty-four hours later, failed later non-invasive ventilation is confirmed followed by the need for intubation. <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1267 "Ancho" => 1675 "Tamanyo" => 189102 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1005 "Ancho" => 1680 "Tamanyo" => 138777 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004700000003/v1_202303031053/S2173572722001990/v1_202303031053/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004700000003/v1_202303031053/S2173572722001990/v1_202303031053/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722001990?idApp=WMIE" ]