Hubara Evyatar, Reynaud Stephanie, Gionfriddo Ashley, Runeckles Kyle, Mueller Brigitte, Floh Alejandro
Department of Critical Care Medicine, Division of Cardiac Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
Pediatric Cardiac Critical Care Medicine, The Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel.
J Clin Ultrasound. 2025 Jan;53(1):36-43. doi: 10.1002/jcu.23792. Epub 2024 Sep 15.
Lung edema is a significant factor in prolonged mechanical ventilation and extubation failure after cardiac surgery. This study assessed the predictive capability of point-of-care Lung Ultrasound (LUS) for the duration of mechanical ventilation and extubation failure in infants following cardiac procedures.
We conducted a prospective observational trial on infants under 1 year, excluding those with pre-existing conditions or requiring extracorporeal membrane oxygenation. LUS was performed upon intensive care unit (ICU) admission and prior to extubation attempts. B-line density was scored by two independent observers. The primary outcomes included the duration of mechanical ventilation and extubation failure, the latter defined as the need for reintubation or non-invasive ventilation within 48 h post-extubation.
The study included 42 infants, with findings indicating no correlation between initial LUS scores and extubation timing. Extubation failure occurred in 21% of the patients, with higher LUS scores observed in these cases (p = 0.046). However, interobserver variability was high, impacting the reliability of LUS scores to predict extubation readiness.
LUS was ineffective in determining the length of postoperative ventilation and extubation readiness, highlighting the need for further research and enhanced training in LUS interpretation.
肺水肿是心脏手术后机械通气时间延长和拔管失败的一个重要因素。本研究评估了床旁肺部超声（LUS）对心脏手术后婴儿机械通气时间和拔管失败的预测能力。
我们对1岁以下婴儿进行了一项前瞻性观察性试验，排除了有既往病史或需要体外膜肺氧合的婴儿。在重症监护病房（ICU）入院时和拔管尝试前进行LUS检查。由两名独立观察者对B线密度进行评分。主要结局包括机械通气时间和拔管失败，后者定义为拔管后48小时内需要重新插管或无创通气。
该研究纳入了42名婴儿，结果表明初始LUS评分与拔管时间之间无相关性。21%的患者发生拔管失败，这些病例的LUS评分较高（p = 0.046）。然而，观察者间的变异性较高，影响了LUS评分预测拔管准备情况的可靠性。
LUS在确定术后通气时间和拔管准备情况方面无效，这突出表明需要进一步研究并加强LUS解读方面的培训。
