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Bedside Ultrasound for the Diagnosis of Abnormal Diaphragmatic Motion in Children After Heart Surgery

Gil-Juanmiquel, Laura MD1; Gratacós, Margarida MD2; Castilla-Fernández, Yolanda MD3; Piqueras, Joaquim MD4; Baust, Tracy5; Raguer, Nuria MD2; Balcells, Joan MD1; Perez-Hoyos, Santiago PhD6; Abella, Raul F. MD7; Sanchez-de-Toledo, Joan MD5,8

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p 159-164
doi: 10.1097/PCC.0000000000001015
Cardiac Intensive Care
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Objective: To assess the utility of bedside ultrasound combining B- and M-mode in the diagnosis of abnormal diaphragmatic motion in children after heart surgery.

Design: Prospective post hoc blinded comparison of ultrasound performed by two different intensivists and fluoroscopy results with electromyography.

Setting: Tertiary university hospital.

Subjects: Children with suspected abnormal diaphragmatic motion after heart surgery.

Interventions: None.

Measurements and Main Results: Abnormal diaphragmatic motion was suspected in 26 children. Electromyography confirmed the diagnosis in 20 of 24 children (83.3%). The overall occurrence rate of abnormal diaphragmatic motion during the study period was 7.5%. Median patient age was 5 months (range, 16 d to 14 yr). Sensitivity and specificity of chest ultrasound performed at the bedside by the two intensivists (91% and 92% and 92% and 95%, respectively) were higher than those obtained by fluoroscopy (87% and 83%). Interobserver agreement (k) between both intensivists was 0.957 (95% CI, 0.87–100).

Conclusions: Chest ultrasound performed by intensivists is a valid tool for the diagnosis of diaphragmatic paralysis, presenting greater sensitivity and specificity than fluoroscopy. Chest ultrasound should be routinely used after pediatric heart surgery given its reliability, reproducibility, availability, and safety.

1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

2Department of Clinical Neurophysiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

3Department of neonatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

4Department of Pediatric Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

5Cardiac Intensive Care Unit, Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.

6Unit of Clinical Research Support, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.

7Department of Pediatric Cardiothoracic Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

8Department of Pediatric Cardiology, Sant Joan de Deu Barcelona Children’s Hospital, University of Barcelona, Barcelona, Spain.

Dr. Perez-Hoyos disclosed work for hire. Dr. Abella disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: joansdt@gmail.com

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies