Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium.
Department of Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium.
Pediatr Crit Care Med. 2023 Aug 1;24(8):652-661. doi: 10.1097/PCC.0000000000003248. Epub 2023 Apr 24.
Diaphragm ultrasound is a novel alternative to esophageal pressure measurements in the evaluation of diaphragm function and activity, but data about its reliability in a pediatric setting are lacking. We aimed to compare the esophageal pressure swing (∆P es , gold standard) with the diaphragmatic thickening fraction (DTF) as a measure of inspiratory effort in sedated children. Additionally, we studied the effect of positive end-expiratory pressure (PEEP) on the end-expiratory thickness of the diaphragm (DT ee ).
Prospective open-label non-randomized interventional physiological cohort study.
Operating room in tertiary academic hospital.
Children 28 days to 13 years old scheduled for elective surgery with general anesthesia, spontaneously breathing through a laryngeal mask airway, were eligible for inclusion. Exclusion criteria were disorders or previous surgery of the diaphragm, anticipated difficult airway or acute cardiopulmonary disease. All measurements were performed prior to surgery.
Patients were subjected to different levels of respiratory load, PEEP and anesthetic depth in a total of seven respiratory conditions.
The esophageal pressure and diaphragm thickening fraction were simultaneously recorded for five breaths at each respiratory condition. The relation between ∆P es and DTF was studied in a mixed model. We analyzed 407 breaths in 13 patients. Both DTF ( p = 0.03) and ∆Pes ( p = 0.002) could detect respiratory activity, and ∆P es and DTF were associated across respiratory conditions ( p < 0.001; R2 = 31%). With increasing inspiratory load, ∆P es increased significantly, while DTF did not ( p = 0.08). Additionally, DT ee did not differ significantly between 10, 5, and 0 cm H 2 O PEEP ( p = 0.08).
In spontaneously breathing sedated children and across different respiratory conditions, DTF could differentiate minimal or no inspiratory effort from substantial inspiratory effort and was associated with ∆P es . Increased efforts resulted in higher ∆P es but not larger DTF.
膈肌超声是一种评估膈肌功能和活动的新方法，可替代食管压力测量，但在儿科环境下其可靠性的数据尚缺乏。我们旨在比较食管压力摆动（∆P es ，金标准）与膈肌增厚分数（DTF），以评估镇静儿童的吸气努力。此外，我们研究了呼气末正压（PEEP）对呼气末膈肌厚度（DT ee ）的影响。
前瞻性开放标签非随机干预生理队列研究。
三级学术医院的手术室。
年龄 28 天至 13 岁，择期行全身麻醉下手术，通过喉罩气道自主呼吸的儿童符合纳入标准。排除标准为膈肌疾病或手术史、预计气道困难或急性心肺疾病。所有测量均在手术前进行。
在总共 7 种呼吸状态下，患者接受不同水平的呼吸负荷、PEEP 和麻醉深度。
在每种呼吸状态下，同时记录 5 次呼吸的食管压力和膈肌增厚分数。在混合模型中研究了 ∆P es 与 DTF 的关系。我们分析了 13 名患者的 407 次呼吸。DTF（p=0.03）和 ∆Pes（p=0.002）均能检测到呼吸活动，且在不同呼吸状态下，DTF 和 ∆Pes 存在关联（p<0.001；R2=31%）。随着吸气负荷的增加，∆P es 显著增加，而 DTF 则没有（p=0.08）。此外，10、5 和 0 cm H 2 O PEEP 之间的 DT ee 差异无统计学意义（p=0.08）。
在自主呼吸镇静的儿童中，在不同的呼吸状态下，DTF 可区分最小或无吸气努力与显著吸气努力，与 ∆P es 相关。增加的努力导致更高的 ∆P es ，但不会导致更大的 DTF。
