Ibraheem Shohood, Bustami Mazhar, Ahmed Marwa Jaffer, Alzanqaly Mohamed Abdou, Ali Ismail, Alsaadi Ali Salah, Nour Islam, Mohamed Adel, Nasef Nehad
Neonatal Intensive Care Unit, Madina Maternity and Children's Hospital, King Salman Bin Abdulaziz Medical City, Madina, Kingdom of Saudi Arabia.
Department of Radiology and Interventional Radiology, Madina Maternity and Children's Hospital, King Salman Bin Abdulaziz Medical City, Madina, Kingdom of Saudi Arabia.
Eur J Pediatr. 2024 Dec 18;184(1):90. doi: 10.1007/s00431-024-05927-3.
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) 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 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.
In this cohort of preterm infants, lung ultrasound score has proved to be a stronger predictor of successful extubation compared to diaphragmatic thickness.
• 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.
• 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.
膈肌萎缩（DA）和肺损伤（LI）与机械通气（MV）有关。我们旨在评估机械通气期间膈肌厚度和肺损伤的超声变化及其对早产儿拔管失败的预测作用。在这项前瞻性观察研究中，孕周小于30周、出生后24小时内接受机械通气的早产儿在机械通气24小时内进行了基线检查，并进行了系列膈肌和肺部超声扫描，直至首次尝试拔管。DA定义为拔管前呼气时膈肌厚度（DT）较基线下降≥10%。对38例平均孕周为26.6±1.7周的早产儿共进行了251次超声扫描。其中，18例婴儿（47%）发生DA。在发生DA的婴儿中，DT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组婴儿的拔管失败率显著更高[13例（72%）对5例（25%），p = 0.004]。拔管前DA组的LUS显著高于无DA组（14.2±6.0对10.3±5.2，p = 0.04）。在控制孕周、拔管前体重和拔管时平均气道压的逻辑回归分析中，LUS[比值比1.27，95%可信区间（1.04 - 1.56），p = 0.02]是拔管失败的独立预测因素。
在这组早产儿中，与膈肌厚度相比，肺部超声评分已被证明是成功拔管的更强预测指标。
• 超声评估膈肌和肺部是诊断早产儿呼吸机诱导性膈肌萎缩和肺损伤的敏感工具。肺部和膈肌超声预测早产儿拔管结局的准确性存在疑问。
• 在机械通气的早产儿中，膈肌厚度的逐渐下降模式与肺部超声评分的增加模式相关。与膈肌厚度相比，肺部超声评分已被证明是成功拔管的更强预测指标。
