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Point of care diaphragm ultrasound in mechanically ventilated children: A predictive tool to detect extubation failure
  • Gazi Arslan,
  • tolga besci,
  • Murat Duman
Gazi Arslan
Dokuz Eylül University

Corresponding Author:[email protected]

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tolga besci
Dokuz Eylül University
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Murat Duman
Dokuz Eylul University Faculty of Medicine
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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.
10 Feb 2022Submitted to Pediatric Pulmonology
11 Feb 2022Submission Checks Completed
11 Feb 2022Assigned to Editor
12 Feb 2022Reviewer(s) Assigned
03 Mar 2022Review(s) Completed, Editorial Evaluation Pending
07 Mar 2022Editorial Decision: Revise Major
14 Mar 20221st Revision Received
15 Mar 2022Submission Checks Completed
15 Mar 2022Assigned to Editor
15 Mar 2022Reviewer(s) Assigned
23 Mar 2022Review(s) Completed, Editorial Evaluation Pending
27 Mar 2022Editorial Decision: Revise Minor
29 Mar 20222nd Revision Received
29 Mar 2022Submission Checks Completed
29 Mar 2022Assigned to Editor
29 Mar 2022Reviewer(s) Assigned
29 Mar 2022Review(s) Completed, Editorial Evaluation Pending
31 Mar 2022Editorial Decision: Accept
Jun 2022Published in Pediatric Pulmonology volume 57 issue 6 on pages 1432-1439. 10.1002/ppul.25916