Point-of-care diaphragm ultrasound: an objective tool to predict the
severity of pneumonia and outcomes in children
Abstract
Background: Pneumonia is one of the most common serious infections in
children. Scoring systems have been adopted to quantify the severity of
the disease, but they were based on clinical findings that can vary
according to the subjective assessment of the clinician. We hypothesized
that diaphragm ultrasound (DUS) parameters may be a new useful tool to
objectively score the severity of the disease and predict outcomes in
children with pneumonia. Methods: Children diagnosed with pneumonia,
aged between 1 month and 18 years, were prospectively evaluated in the
pediatric emergency department. The Pediatric Respiratory Severity Score
was used to indicate the severity of the disease and DUS was performed.
Diaphragm thickness at the end of inspiration and expiration, thickening
fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory
slope (ES), and total duration time of the respiratory cycle were
calculated. Results: There were 96 patients enrolled in the study.
Inspiratory slope and ES measurements had positive correlations with
respiratory rate and length of stay in the hospital and negative
correlations with oxygen saturation levels. Furthermore, TF values were
negatively correlated with respiratory rate and length of stay in the
emergency department. Patients with higher clinical scores had increased
IS and ES and decreased TF values. Conclusion: Diaphragm ultrasound can
be a promising and useful tool to assess diaphragmatic dysfunction in
patients diagnosed with pneumonia. Diaphragm parameters, especially TF,
IS, and ES, may provide objective and reliable information to predict
the severity of the illness, the need for respiratory support, and
outcomes.