Sonographic Evaluation of Diaphragmatic Excursion and Thickness in Healthy Infants and Children

El-Halaby, Hanan; Abdel‐Hady, Hesham; Alsawah, Gehan Attia; Abdelrahman, Ashraf; El-Tahan, H.

doi:10.7863/ultra.15.01082

Cited by 67 publications

(86 citation statements)

References 32 publications

(60 reference statements)

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“…To our knowledge, our study is the first one evaluating all the evaluable parameters in every single patients and the only one evaluating otherwise healthy pediatric patients with respiratory conditions. In fact, in current literature we found three studies conducted on pediatric ill patients (either post operative or mechanically ventilated patients), and only one study on pediatric healthy patients . Using these last literature parameters and comparing them to our findings, we found that mean right DE was 10.38 ± 4 mm in our bronchiolitis patients compared to 6.4 ± 2.1 in healthy reference children.…”

Section: Discussionsupporting

confidence: 53%

“…In fact, in current literature we found three studies 61,64,65 conducted on pediatric ill patients (either post operative or mechanically ventilated patients), 67 and only one study on pediatric healthy patients. 68 Using these last literature parameters and comparing them to our findings, we found that mean right DE was 10.38 ± 4 mm in our bronchiolitis patients compared to 6. We acknowledge some limitations.…”

supporting

confidence: 59%

“…Diaphragmatic ultrasound has been proven to be a noninvasive, easily performed and learned with a short learning curve, and a reliable tool in assessing diaphragm function . Most of the described studies have been performed in adult patients in intensive care unit (either mechanically ventilated or post operative patients) and very few studies have been performed in children …”

Section: Discussionmentioning

confidence: 99%

“…[48][49] Most of the described studies have been performed in adult 50-67 patients in intensive care unit (either mechanically ventilated or post operative patients) and very few studies have been performed in children. 61,[64][65]68 In particular, a recent review by Zambon et al 48 found 17 studies on adult patients that evaluated diaphragm dysfunction (DD) or paralysis in critically ill patients 44 ; DD to predict success/failure from mechanical ventilation 44,[50][51][52] ; and to assess the performance of DD measurements as indexes of respiratory effort in mechanically ventilated patients. [53][54][55][56] To our knowledge, our study is the first one evaluating all the evaluable parameters in every single patients and the only one evaluating otherwise healthy pediatric patients with respiratory conditions.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Point of care diaphragm ultrasound in infants with bronchiolitis: A prospective study

Buonsenso

Supino

Giglioni

et al. 2018

Pediatric Pulmonology

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Section: Discussionsupporting

confidence: 53%

supporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Point of care diaphragm ultrasound in infants with bronchiolitis: A prospective study

Buonsenso

Supino

Giglioni

et al. 2018

Pediatric Pulmonology

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“…Num estudo prospetivo transversal, 14 foram estabelecidos valores de referência segundo a idade para a espessura diafragmática, em crianças saudáveis. No nosso estudo, a mediana da espessura inicial foi de 2,3 mm, encontrandose abaixo do valor médio de referência para qualquer faixa etária.…”

Section: Discussionunclassified

Avaliação Ecográfica da Disfunção Diafragmática Induzida pelo Ventilador em Idade Pediátrica

et al. 2019

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Introduction: Invasive mechanical ventilation contributes to ventilator-induced diaphragmatic dysfunction, delaying extubation and increasing mortality in adults. Despite the possibility of having a higher impact in paediatrics, this dysfunction is not routinely monitored. Diaphragm ultrasound has been proposed as a safe and non-invasive technique for this purpose. The aim of this study was to describe the evolution of diaphragmatic morphology and functional measurements by ultrasound in ventilated children.Material and Methods: Prospective exploratory study. Children admitted to Paediatric Intensive Care Unit requiring mechanical ventilation > 48 hours were included. The diaphragmatic thickness, excursion and the thickening fraction were assessed by ultrasound.Results: Seventeen cases were included, with a median age of 42 months. Ten were male, seven had comorbidities and three in seventeen had malnutrition at admission. The median time under mechanical ventilation was seven days. The median of the initial and minimum diaphragmatic thickness was 2.3 mm and 1.9 mm, respectively, with a median decrease in thickness of 13% under pressure-regulated volume control. Diaphragmatic atrophy was observed in 14/17 cases. Differences in the median thickness variation were found between patients with sepsis and without (0.70 vs 0.25 mm; p = 0.019). During pressure support ventilation there was a tendency to increase diaphragmatic thickness and excursion. Extubation failure occurred for diaphragmatic thickening fraction ≤ 35%.Discussion: Under pressure-regulated volume control there was a tendency for a decrease in diaphragmatic thickness. In the pre-extubation stage under pressure support, there was a tendency for it to increase. These results suggest that, by titrating ventilation using physiological levels of inspiratory effort, we can reduce the diaphragmatic morphological changes associated with ventilation.Conclusion: The early recognition of diaphragmatic changes may encourage a targeted approach, namely titration of ventilation, in order to reduce ventilator-induced diaphragmatic dysfunction and its clinical repercussions.

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Pulmonary Atelectasis After Sedation With Propofol vs Propofol-Ketamine for Magnetic Resonance Imaging in Children

Bang,

Kim,

Gil

et al. 2024

JAMA Netw Open

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ImportanceLittle is known about the impact of different anesthetic agents used for routine magnetic resonance imaging (MRI) sedation on pulmonary function in children.ObjectiveTo compare the incidence of pulmonary atelectasis after MRI sedation with propofol vs propofol-ketamine.Design, Setting, and ParticipantsThis double-masked randomized clinical trial screened 117 consecutive pediatric patients aged 3 to 12 years with American Society of Anesthesiologists physical status I to II undergoing elective MRI under deep sedation from November 2, 2022, to April 28, 2023, at a tertiary referral center. Four patients met the exclusion criteria, and 5 patients refused to participate. The participants and outcome assessors were masked to the group allocation.InterventionsDuring the MRI, the propofol group received 0.2 mL/kg of 1% propofol and 2 mL of 0.9% saline followed by a continuous infusion of propofol (200 μg/kg/min) and 0.9% saline (0.04 mL/kg/min). The propofol-ketamine group received 0.2 mL/kg of 0.5% propofol and 1 mg/kg of ketamine followed by a continuous infusion of propofol (100 μg/kg/min) and ketamine (20 μg/kg/min).Main Outcome and MeasureThe incidence of atelectasis assessed by lung ultrasonography examination.ResultsA total of 107 children (median [IQR] age, 5 [4-6] years; 62 male [57.9%]), with 54 in the propofol group and 53 in the propofol-ketamine group, were analyzed in this study. Notably, 48 (88.9%) and 31 (58.5%) patients had atelectasis in the propofol and propofol-ketamine groups, respectively (relative risk, 0.7; 95% CI, 0.5-0.8; P &lt; .001). The incidence of desaturation and interruption of the MRI due to airway intervention or spontaneous movement did not significantly differ between the groups. The propofol-ketamine group showed a faster emergence time than the propofol group (15 [9-23] vs 25 [22-27] minutes in the propofol-ketamine vs propofol group; median difference in time, 9.0 minutes; 95% CI, 6.0-12.0 minutes; P &lt; .001). No patient was withdrawn from the trial due to adverse effects.Conclusions and RelevanceIn this randomized clinical trial, the propofol-ketamine combination reduced sedation-induced atelectasis while allowing for faster emergence compared with propofol alone.Trial Registrationcris.nih.go.kr Identifier: KCT0007699

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Sonographic Evaluation of Diaphragmatic Excursion and Thickness in Healthy Infants and Children

Abstract: This study provides reference values for diaphragmatic excursion and thickness in healthy infants and children. Percentile curves for right diaphragmatic excursion plotted against body weight were plotted.

Cited by 67 publications

References 32 publications

Point of care diaphragm ultrasound in infants with bronchiolitis: A prospective study

Point of care diaphragm ultrasound in infants with bronchiolitis: A prospective study

Avaliação Ecográfica da Disfunção Diafragmática Induzida pelo Ventilador em Idade Pediátrica

Pulmonary Atelectasis After Sedation With Propofol vs Propofol-Ketamine for Magnetic Resonance Imaging in Children

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