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Point of care diaphragm ultrasound in infants with bronchiolitis: A prospective study
Author(s) -
Buonsenso Danilo,
Supino Maria C.,
Giglioni Emanuele,
Battaglia Massimo,
Mesturino Alessia,
Scateni Simona,
Scialanga Barbara,
Reale Antonino,
Musolino Anna M.C.
Publication year - 2018
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23993
Subject(s) - medicine , diaphragm (acoustics) , respiratory distress , bronchiolitis , prospective cohort study , ultrasound , expiration , respiratory system , anesthesia , radiology , physics , acoustics , loudspeaker
Background Bronchiolitis is the most common reason for hospitalization of children worldwide. Many scoring systems have been developed to quantify respiratory distress and predict outcome, but none of them have been validated. We hypothesized that the ultrasound evaluation of the diaphragm could quantify respiratory distress and therefore we correlated the ultrasound diaphragm parameters with outcome. Methods Prospective study of infants with bronchiolitis (1‐12 months) evaluated in a pediatric emergency department. Ultrasonography examinations of the diaphragm was performed (diaphragm excursion [DE], inspiratory excursion [IS], inspiratory/expiratory relationship [I/E], and thickness at end‐expiration [TEE] and at end‐inspiration [TEI]; thickening fraction [TF]). Results We evaluated 61 infants, 50.8 % males. Mean TF was 47% (IQR 28.6‐64.7), mean I/E 0.47 (± 0.15), mean DE 10.39 ± 4 mm. There was a linear correlation between TF and oxygen saturation at first evaluation ( P = 0.006, r = 0.392). All children with lower values of TF required HFNC and one of them required CPAP. A higher IS was associated with the future need of respiratory support during admission ( P = 0.007). IS correlated with the hours of oxygen delivery needed ( P = 0.032, r = 0.422). TEI ( t = 3.701, P = 0.002) was found to be main predictor of hours of oxygen delivery needed. Conclusion This study described ultrasound diaphragmatic values of previously healthy infants with bronchiolitis. DE, IS, and TEI correlated with outcome. If confirmed in larger studies, bedside ultrasound semiology of the diaphragm can be a new objective tool for the evaluation and outcome prediction of infants with bronchiolitis.