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Point of care diaphragm ultrasound in mechanically ventilated children: A predictive tool to detect extubation
Gazi Arslan1, Tolga Besci1, Murat Duman2
1Division of Pediatric Intensive Care, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey.
Insights
Diaphragm ultrasound (DUS) can predict successful extubation in children. Key indicators like diaphragmatic thickening fraction (DTF) and diaphragmatic excursion (DE) show high accuracy, aiding clinicians in ventilator weaning decisions.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Medical imaging and diagnostics
Background:
- Extubation failure in children is linked to adverse clinical outcomes.
- Predictive tools for successful extubation are crucial for pediatric mechanical ventilation.
- This study investigates diaphragm ultrasound as a predictor of weaning success.
Purpose of the Study:
- To evaluate the predictive value of ultrasonographic diaphragm imaging for successful extubation in children.
- To identify specific diaphragmatic ultrasound parameters that correlate with extubation outcomes.
Main Methods:
- A prospective, observational study included children aged 1 month to 10 years, mechanically ventilated for over 48 hours.
- Diaphragm ultrasound (DUS) was performed after a 2-hour extubation readiness test (ERT).
- Evaluated parameters included diaphragmatic thickening fraction (DTF) and diaphragmatic excursion (DE).
Main Results:
- 60% of patients were successfully extubated; 40% experienced extubation failure.
- Significantly higher DTF (p < 0.001) and DE (p < 0.001) were observed in the successful extubation group.
- DTF and DE demonstrated high sensitivity and specificity for predicting extubation failure.
Conclusions:
- Diaphragm ultrasound is a feasible and promising tool for guiding ventilator weaning in children.
- Diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF) are effective predictors of extubation success.
- These DUS parameters can assist physicians in managing pediatric mechanical ventilation weaning.
Background:
Children should be weaned from the ventilator once their clinical condition improves. Extubation failure is associated with poorer clinical outcomes in children. Predictive indicators of successful extubation are needed. This study aims to evaluate the predictive value of ultrasonographic diaphragm imaging could help predict weaning success.
Methods:
In this prospective, observational study conducted between March and December 2021, children between 1 month and 10 years of age who were mechanically ventilated for more than 48 h were included. Diaphragm ultrasound (DUS) examinations were performed at the end of 2-h extubation readiness test (ERT). The end-inspiratory thickness (DTi), end-expiratory thickness (DTe), diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), inspiratory slope (IS), and expiratory slope (ES) were evaluated.
Results:
Twenty-four (60%) patients were successfully extubated, while 16 (40%) required invasive or noninvasive mechanical ventilation support which were classified as failed extubation group. Three of the sixteen patients in the failed extubation group required reintubation. DTF was significantly greater in the successful weaning group (55.05 ± 23.75% vs. 30.9 ± 10.38%) (p < 0.001). DE was significantly greater in the successful weaning group (14 ± 4.4 mm vs. 11.05 ± 3.25 mm) (p < 0.001). DTF and DE were found to have a sensitivity and specificity of 91.67%, 87.50%, 83.33%, and 81.25%, respectively.
Conclusion:
Diaphragm ultrasound is a feasible and promising tool to guide physicians during weaning from invasive mechanical ventilation. Among all DUS measurements, the DE and DTF indexes showed better performance in extubation failure than other diaphragmatic parameters.
