Sonographic evaluation of diaphragmatic thickness and excursion as a predictor for successful extubation in mechanically ventilated preterm infants

Abstract

Sonographic assessment of diaphragmatic thickness and excursion has been found to be an accurate tool in predicting successful extubation of adult patients from invasive mechanical ventilation. We aimed to evaluate the accuracy of sonographic assessment of diaphragmatic thickness and excursion in predicting successful extubation of preterm infants from invasive conventional mechanical ventilation. Preterm infants less than 32 weeks gestation who required invasive conventional mechanical ventilation were evaluated by diaphragmatic sonography within 1 h of their planned extubation. Infants were classified into successful or failed extubation groups based on their ability to stay off invasive mechanical ventilation for 72 h after extubation. Inspiratory and expiratory thickness plus excursion of the right and left hemidiaphragm as well as diaphragmatic thickening fraction (DTF) measures were compared between groups. We included 43 eligible infants, of whom 34 infants succeeded and 9 infants failed extubation. Infants in the successful extubation group had a significantly higher expiratory thickness of the right and left hemidiaphragm, excursion of the right and left hemidiaphragm, inspiratory thickness of the left hemidiaphragm, and DTF of the left hemidiaphragm compared with infants who failed extubation. The receiver-operating characteristic curves showed that excursion of the right and left hemidiaphragm has the highest significant accuracy in predicting successful extubation of preterm infants among all diaphragmatic parameters (AUC is 0.98 and 0.96, respectively; p value < 0.001 for both). Conclusion: We conclude that diaphragmatic excursion is a useful indicator for successful extubation of preterm infants from mechanical ventilation. What is Known: • Invasive mechanical ventilation induces ventilator induced diaphragmatic dysfunction (VIDD) particularly when used for long time. • Assessment of diaphragmatic dimensions and functional activity has been a valuable tool in predicting successful extubation of adult patients from invasive mechanical ventilation. What is New: • Sonographic assessment of diaphragmatic dimensions can be used to predict successful extubation of preterm infants from mechanical ventilation. • Sonographic assessment of diaphragmatic excursion shows the highest sensitivity and specificity in predicting successful extubation of preterm infants.

Evaluation of Diaphragmatic Dysfunction Associated with Ventilator Weaning Failure in Neonates by Diaphragmatic Ultrasound

“…Regarding GA, it is well known that age is negatively correlated with excursion in deep breathing, and that females have less diaphragmatic excursion than male (26) . While in our study no difference in sex was detected yet, a significant difference between full-term and pre-term neonates was detected which matches the study results of Bahgat et al (25) . In the contrary, Johnson et al (27) have revealed that diaphragmatic atrophy in intubated critically ill children have occurred rapidly and irrespectively of age.…”

“…In our study, the mortality rate in the successful weaning group was 4.3% in full term and 8.7% in preterm, while in weaning failure group it was 8% and 24% in full-term and preterm respectively, which matches with the results of other studies (25,27) .…”

“…While, in preterm neonates, the cut off values predicting weaning failure was slightly less specific and sensitive. Similarly, Bahgat et al (25) had revealed a right diaphragmatic excursion of 2.75mm and a left diaphragmatic excursion of 2.45mm with nearly similar predictability using ROC curve in pre-term neonates.…”

“…The right and left diaphragmatic excursion were reported as 2.3± 0.37mm and 2±0.53mm; respectively (25) . This comes in the line with our study results where the level at which weaning failure was detected in full term neonates was 2.7, 2.5 mm while in preterm was 2.4, 3.3 mm on right and left diaphragmatic excursion; respectively (p value >0.05).…”

Direct Effect of Caffeine on Diaphragmatic Muscles in Preterm Babies Through Ultrasonographic Examination

“…This nding is suggested that evaluating excursion can be a sensitive method for determination of diaphragm function in preterm babies. Indeed, a previous study investigating successful extubation in preterm babies by diaphragm US reported higher thicknesses and excursions in the successfully extubated group 23 . The researchers also stated that the excursion was the most useful indicator for successful extubation.…”