Abstract Rationale Oropharyngeal dysphagia is a frequent and serious complication of acute brain injury (ABI), increasing the risk of aspiration pneumonia, prolonged ventilation, and mortality. However, reliable bedside predictors of dysphagia are scarce. Since the diaphragm is critical in coordinating respiration and swallowing, we hypothesized that diaphragmatic dysfunction might signal impaired swallow-breathing integration. This study aimed to determine whether diaphragmatic ultrasound parameters can predict the risk of dysphagia in adults with ABI. Methods We performed a cross-sectional, of consecutive adults admitted with an ABI such as ischemic or hemorrhagic stroke or traumatic brain injury. Dysphagia risk was stratified using the validated PARD bedside scale. Bilateral diaphragmatic ultrasound (B-mode and M-mode) was used to assess thickness, excursion, and contraction/relaxation velocities. A single trained examiner, blinded to the swallowing assessment, averaged the measurements over ≥5 respiratory cycles. Statistical analyses included a Spearman correlation for ordinal PARD scores and nonparametric comparisons between dysphagia categories. Significance was set at α = 0.05. Institutional ethics approval was obtained. Results Among 107 patients (mean age 53.1 ± 17 years; 63.6% male), dysphagia was identified in 43.9%. Diaphragm thickness showed no association with dysphagia (p = 0.14). In contrast, reduced diaphragmatic mobility and slower dynamics were correlated significantly with higher dysphagia scores: inspiratory excursion (r = -0.318, p 0.001), expiratory excursion (r = -0.352, p 0.001), contraction velocity (r = -0.190, p = 0.025), and relaxation velocity (r = -0.227, p = 0.009). Logistic regression analysis revealed that diaphragmatic excursion is a significant predictor of dysphagia (odds ratio OR = 1.42, 95% confidence interval CI 1.10-1.84, p = 0.006). Prior intubation and pneumonia were also associated with worse dysphagia (p 0.001). Conclusions This study demonstrates that bedside diaphragmatic ultrasound can predict the risk of clinical dysphagia in patients with acute brain injury. Reduced diaphragmatic excursion and slower contractile dynamics were independently associated with greater dysphagia severity, providing a quantifiable marker of impaired swallow-breathing coordination. This noninvasive biomarker offers practical value for early dysphagia detection and timely intervention, potentially reducing aspiration and improving outcomes in neurocritical care. This abstract is funded by: Fundação de Amparo a Ciência e Tecnologia do Estado de Pernambuco (FACEPE)
Magalhães et al. (2026) studied this question.