Point of care diaphragm ultrasound in mechanically ventilated children:
A predictive tool to detect extubation failure
Abstract
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 hours were included. Diaphragm ultrasound (DUS) examinations were
performed at the end of 2-hour extubation readiness test (ERT). The
end-inspiratory thickness, end-expiratory thickness, diaphragmatic
thickening fraction, diaphragmatic excursion, inspiratory slope and
expiratory slope were evaluated. Results: Twenty-four (60%) patients
were successfully extubated, while 16 (40%) required invasive or
non-invasive mechanical ventilation support which were classified as
failed extubation group. Three of the sixteen patients in the failed
extubation group required re-intubation. Diaphragm thickening fraction
was significantly greater in the successful weaning group (55,05 ±
23,75% vs. 30,9 ± 10,38%) (p<0,001). Diaphragm excursion was
significantly greater in the SW 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 %, and 83.33 %, 81.25 %, respectively.
Conclusion: Diaphragm ultrasound is a feasible and promising tool to
guide physicians during weaning from IMV. Among all DUS measurements,
the DE and DTF indexes showed better performance in extubation failure
than other diaphragmatic parameters.