Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Pediatr Pulmonol. 2021 Jun;56(6):1666-1672. doi: 10.1002/ppul.25352. Epub 2021 Mar 22.
Pneumonia is one of the most common serious infections in children. Scoring systems have been adopted to quantify the severity of the disease, but they were based on clinical findings that can vary according to the subjective assessment of the clinician. We hypothesized that diaphragm ultrasound (DUS) parameters may be a new useful tool to objectively score the severity of the disease and predict outcomes in children with pneumonia.
Children diagnosed with pneumonia, aged between 1 month and 18 years, were prospectively evaluated in the pediatric emergency department. The Pediatric Respiratory Severity Score was used to indicate the severity of the disease and DUS was performed. Diaphragm thickness at the end of inspiration and expiration, thickening fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were calculated.
There were 96 patients enrolled in the study. Inspiratory slope and ES measurements had positive correlations with respiratory rate and length of stay in the hospital and negative correlations with oxygen saturation levels. Furthermore, TF values were negatively correlated with respiratory rate and length of stay in the emergency department. Patients with higher clinical scores had increased IS and ES and decreased TF values.
DUS can be a promising and useful tool to assess diaphragmatic dysfunction in patients diagnosed with pneumonia. Diaphragm parameters, especially TF, IS, and ES, may provide objective and reliable information to predict the severity of the illness, the need for respiratory support, and outcomes.
肺炎是儿童最常见的严重感染之一。评分系统已被采用来量化疾病的严重程度，但它们是基于可能因临床医生的主观评估而有所不同的临床发现。我们假设膈肌超声（DUS）参数可能是一种新的有用工具，可以客观地评估疾病的严重程度，并预测肺炎患儿的结局。
在儿科急诊部门，前瞻性评估了诊断为肺炎的 1 个月至 18 岁儿童。采用小儿呼吸严重程度评分来表示疾病的严重程度，并进行 DUS 检查。测量吸气末和呼气末膈肌厚度、增厚分数（TF）、膈肌移动度、吸气斜率（IS）、呼气斜率（ES）和呼吸周期总持续时间。
本研究共纳入 96 例患者。吸气斜率和 ES 测量值与呼吸频率和住院时间呈正相关，与血氧饱和度呈负相关。此外，TF 值与呼吸频率和急诊留观时间呈负相关。临床评分较高的患者，IS 和 ES 增加，TF 值降低。
DUS 可以成为评估肺炎患者膈肌功能障碍的一种有前途且有用的工具。膈肌参数，尤其是 TF、IS 和 ES，可能提供客观、可靠的信息，预测疾病的严重程度、呼吸支持的需求和结局。
