Serial sonographic assessment of diaphragmatic atrophy and lung injury patterns in mechanically ventilated preterm infants to predict extubation failure: a prospective observational study.

IF 3 3区医学 Q1 PEDIATRICS

European Journal of Pediatrics Pub Date : 2024-12-18 DOI:10.1007/s00431-024-05927-3

Shohood Ibraheem, Mazhar Bustami, Marwa Jaffer Ahmed, Mohamed Abdou Alzanqaly, Ismail Ali, Ali Salah Alsaadi, Islam Nour, Adel Mohamed, Nehad Nasef

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引用次数: 0

Abstract

Diaphragmatic atrophy (DA) and lung injury (LI) have been associated with mechanical ventilation (MV). We aimed to assess the ultrasonographic changes in diaphragmatic thickness and LI during MV and their prediction for extubation failure in preterm infants. In this prospective observational study, mechanically ventilated preterm infants, < 30 weeks gestation, within the first 24 h of life underwent a baseline, within 24 h of MV, and serial diaphragmatic and lung ultrasounds scans until their first extubation attempt. DA was defined as a decline in pre-extubation expiratory diaphragmatic thickness (DT_exp) by ≥ 10% compared to baseline. A total of 251 ultrasound scans were performed on 38 preterm infants with a mean gestational age of 26.6 ± 1.7 weeks. Of these, 18 infants (47%) had DA. Among infants with DA, a pattern of progressive decline in DT_exp was associated with a concomitant pattern of increase in the lung ultrasound score (LUS). Infants in the DA group experienced a significantly higher percentage of extubation failure [13 (72%) versus 5 (25%), p = 0.004] compared to the no-DA group. Pre-extubation LUS was significantly higher in the DA compared to the no-DA group (14.2 ± 6.0 versus 10.3 ± 5.2, p = 0.04). Logistic regression analysis controlling for gestational age, pre-extubation weight, and mean airway pressure at extubation showed that LUS [OR 1.27, 95% CI (1.04-1.56), p = 0.02] was an independent predictor of for extubation failure.

Conclusion: In this cohort of preterm infants, lung ultrasound score has proved to be a stronger predictor of successful extubation compared to diaphragmatic thickness.

What is known: • Ultrasonographic assessment of the diaphragm and lungs is a sensitive tool in diagnosis of ventilator induced diaphragmatic atrophy and lung injury in preterm infants. Accuracy of lung and diaphragmatic ultrasound in predicting extubation outcome in preterm infants is questionable.

What is new: • A pattern of progressive decline in diaphragmatic thickness was associated with a concomitant pattern of increase in the lung ultrasound score in mechanically ventilated preterm infants. Lung ultrasound score has proved to be a stronger predictor of successful extubation compared to diaphragmatic thickness.

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膈肌萎缩（DA）和肺损伤（LI）与机械通气（MV）有关。我们的目的是评估早产儿在机械通气过程中横膈膜厚度和肺损伤的超声变化及其对拔管失败的预测。在这项前瞻性观察研究中，与基线相比，机械通气的早产儿（exp）≥ 10%。共对 38 名早产儿进行了 251 次超声扫描，平均胎龄为 26.6 ± 1.7 周。其中，18 名婴儿（47%）患有 DA。在患有 DA 的婴儿中，DTexp 的逐渐下降模式与肺部超声评分（LUS）的增加模式相关。与无DA组相比，DA组婴儿发生拔管失败的比例明显更高[13（72%）对5（25%），P = 0.004]。DA组拔管前LUS明显高于无DA组（14.2 ± 6.0对10.3 ± 5.2，p = 0.04）。控制胎龄、拔管前体重和拔管时平均气道压力的逻辑回归分析表明，LUS[OR 1.27，95% CI (1.04-1.56)，p = 0.02]是拔管失败的独立预测因素：结论：在这批早产儿中，与膈肌厚度相比，肺部超声评分更能预测拔管是否成功：- 膈肌和肺的超声评估是诊断早产儿因呼吸机引起的膈肌萎缩和肺损伤的敏感工具。肺部和膈肌超声波在预测早产儿拔管结果方面的准确性值得怀疑：- 在机械通气的早产儿中，膈肌厚度逐渐下降的模式与肺部超声评分同时增加的模式相关。与膈肌厚度相比，肺部超声评分被证明是预测成功拔管的更有力指标。

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来源期刊

European Journal of Pediatrics 医学-小儿科

CiteScore

5.90

自引率

2.80%

发文量

367

审稿时长

3-6 weeks

期刊介绍： The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.