Author Of 2 Presentations
ULTRASOUND ASSESSMENT OF DIAPHRAGM ATROPHY IN MECHANICALLY VENTILATED PAEDIATRIC PATIENTS
Abstract
Background
Mechanical ventilation (MV) is associated with atrophy and weakness of the diaphragm. Ultrasound is a feasible, noninvasive method to check it.
Objectives
To quantify diaphragm atrophy (DA) in mechanically ventilated patients and to analyze the risk factors for its development.
Methods
Prospective observational single-center study. Patients: Newly intubated critically ill children. Diaphragm thickness at end-inspiration (TEI) and end-expiration (TEE) in the zone of apposition was measured (first 24 hours, at 72 h, weekly thereafter, and seven days after extubation) with ultrasound. A descriptive (median and IQR) and a bivariate analysis was performed.
Results
From June to December 2018, 47 subjects [median age 3 months (1-17)] underwent 164 ultrasonographic evaluations. Median duration of MV was 168 hours (96–196). At baseline, TEI was 2.2 mm (1.8–2.5) and TEE 1.8 mm (1.5–2.0). The change in TEE during MV was –14% (–33% to -3%), with a –2% daily atrophy rate (–4.2% to 0%). 31 subjects received neuromuscular blockade, with a significant reduction in TEE (-25% [-45% to 0%] vs -6% [-42% to 0%], p=0.001) and an increase in daily atrophy rate (-2.2%, -11 to 0%) compared with unexposed patients (-1.4%,[-4 to 0], p=.049). Children with a short period of spontaneous breathing (<12 hours) had a significant decrease in TEE compared with those with higher spontaneous breathing fraction [-26% (-45-0%) versus -9.5% (-45-0%), p=0.011].
Conclusion
A strong association between DA, MV and neuromuscular blockade and an inverse relation with the spontaneous breathing fraction was found. Ultrasound seems to be useful in detecting progressive DA.
POINT OF CARE ULTRASOUND (POCUS) IN PICUS: ANALYSIS OF ITS USE AND CLINICAL IMPACT
- Rafael González Cortés, Spain
- Pilar Sanchez Yáñez,
- Patricia García-Soler, Spain
- Juan J. Menéndez Suso,
- Raul Montero Yéboles,
- Jose L. Vázquez Martínez,
- Jorge López, Spain
- Borja De Paz Vaquero,
- Ana M. Llorente De La Fuente,
- Laia Vega,
- Daniel Palanca Arias,
- Nuria Chaves Caro,
- Paula Santos Herraiz, Spain
- Sonia Sanchiz Cárdenas,
- Ignacio Oulego Erroz,
- Alberto Salas Ballestin,
- Antonio Rodríguez Núñez,
- Patricia Rodríguez Campoy,
- Javier Gil Antón,
- Eva Rodríguez Carrasco,
- Juan Mayordomo Colunga, Spain
- Marta Muñoyerro Sesmero,
- Clara Sorribes Ortí,
- Ángela Ferrer Barba,
- Jorge Rodríguez Ozcodi,
- Jose M. Gómez Luque,
- Carolina González Miño,
- Renata Marqués Rodríguez,
Abstract
Background
Point of care ultrasound (POCUS) use is becoming widespread tool in the management of critically ill patients. Despite its increasing use there are not clear recommendations for the use of POCUS by pediatric intensive care providers.
Objectives
Describe current use of POCUS in Pediatric Intensive Care Units (PICUs) in an European country. Define factors related to clinical impact of explorations.
Methods
A prospective cross-sectional multicenter study was carried out in 26 PICUs. During 7 consecutive days data from all POCUS explorations performed by the medical and nursing staff of the participating units were registered.
Results
269 POCUS explorations were registered involving 136 patients. POCUS operators were attending physicians (73.6%), residents (20.8%) and nurses (5.6%). 57.6% of explorations included thorax and 29.4% echocardiography. A new diagnosis was obtained in 53.9%, resulting in therapeutic modifications (TM) in 36.4%. Explorations were more likely to result in TM when performed by attending physicians (82.7% vs 17.3%, p=0.031), in cardiac patients (52.1% vs 34.6%, p=0.011), including thorax (45.6% vs 29.4%, p=0.010) or urological examination (77.8% vs 37.6%, p=0.015). TM were also more likely when the objective of the exploration was diagnostic (46.2% vs 18.5%, p<0.001), and less likely when objective was teaching (18.4% vs 42.7%, p=0.005). Operator previous experience on POCUS teaching was related with TM (59.2% vs 40.8%, p=0.003).
Conclusion
POCUS is becoming a highly used tool in PICUS frequently resulting in new diagnostic findings and therapeutic modifications. Clinical experience and previous training in POCUS seem to be related to clinical impact of POCUS explorations.
Presentation files
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ULTRASOUND ASSESSMENT OF DIAPHRAGM ATROPHY IN MECHANICALLY VENTILATED PAEDIATRIC PATIENTS
Abstract
Background
Mechanical ventilation (MV) is associated with atrophy and weakness of the diaphragm. Ultrasound is a feasible, noninvasive method to check it.
Objectives
To quantify diaphragm atrophy (DA) in mechanically ventilated patients and to analyze the risk factors for its development.
Methods
Prospective observational single-center study. Patients: Newly intubated critically ill children. Diaphragm thickness at end-inspiration (TEI) and end-expiration (TEE) in the zone of apposition was measured (first 24 hours, at 72 h, weekly thereafter, and seven days after extubation) with ultrasound. A descriptive (median and IQR) and a bivariate analysis was performed.
Results
From June to December 2018, 47 subjects [median age 3 months (1-17)] underwent 164 ultrasonographic evaluations. Median duration of MV was 168 hours (96–196). At baseline, TEI was 2.2 mm (1.8–2.5) and TEE 1.8 mm (1.5–2.0). The change in TEE during MV was –14% (–33% to -3%), with a –2% daily atrophy rate (–4.2% to 0%). 31 subjects received neuromuscular blockade, with a significant reduction in TEE (-25% [-45% to 0%] vs -6% [-42% to 0%], p=0.001) and an increase in daily atrophy rate (-2.2%, -11 to 0%) compared with unexposed patients (-1.4%,[-4 to 0], p=.049). Children with a short period of spontaneous breathing (<12 hours) had a significant decrease in TEE compared with those with higher spontaneous breathing fraction [-26% (-45-0%) versus -9.5% (-45-0%), p=0.011].
Conclusion
A strong association between DA, MV and neuromuscular blockade and an inverse relation with the spontaneous breathing fraction was found. Ultrasound seems to be useful in detecting progressive DA.