Diaphragmatic ultrasound as a pre-orotracheal extubation assessment tool in pediatric: pilot study
DOI:
https://doi.org/10.62827/fb.v26i2.1054Keywords:
Ultrasonography; Diaphragm; Respiratory Diseases; Intensive Care Units.Abstract
Introduction: Diaphragmatic ultrasonography has emerged as a promising tool for assessing readiness for orotracheal extubation in pediatrics, since there are no objective tools with high predictive power for its success or failure, and the decision is sometimes based solely on clinical experience. Objective: To describe the ultrasonographic evaluation of the diaphragm before orotracheal extubation in a pediatric ICU. Methods: Prospective exploratory study, approved by the ethics committee. Infants who used invasive mechanical ventilation for a period of 10 months were selected and evaluated after 30 minutes by performing the spontaneous breathing test (SBT). Diaphragmatic ultrasonography (diaphragm excursion and thickness) and measurements of lung mechanics through the mechanical ventilator were performed, in addition to the collection of complementary data from the medical records. Results: The evaluation was performed in 15 patients, with a predominance of males and a diagnosis of bronchiolitis and/or pneumonia. The infant age group was the most prevalent, with a mean intubation time of 8.4 days and hospital stay of 24.5 days. During SBT, the mean diaphragm excursion was 1.0 cm, the mean thickness during inspiration was 0.17 cm, and the mean diaphragmatic thickening fraction (DTF) was 37.7%. The most commonly used post-extubation support was noninvasive ventilation (54%). There were two extubation failures, both due to high obstruction, and no deaths were recorded. Conclusion: Diaphragmatic assessment for orotracheal extubation is feasible at the bedside and may be useful for recognizing readiness for spontaneous ventilation; however, further studies in pediatrics are needed.
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Copyright (c) 2025 da Silva CDA, Terra MA, Magno BLSP, Silva LM, Gomes LSL, Azevedo ZMA, Moore DCBC, Gomes Junior SCS (Autor)
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