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Ultrasound for diaphragmatic dysfunction in postoperative cardiac children

Published online by Cambridge University Press:  10 May 2016

Hussam K. Hamadah ,
Mohamed S. Kabbani ,
Mahmoud Elbarbary ,
Omar Hijazi ,
Ghassan Shaath ,
Sameh Ismail ,
Ammar M. H. Qadi ,
Hayan AlTaweel  and
Abdulraouf Jijeh
Hussam K. Hamadah*
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia
Mohamed S. Kabbani
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
Mahmoud Elbarbary
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
Omar Hijazi
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
Ghassan Shaath
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia
Sameh Ismail
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia
Ammar M. H. Qadi
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia
Hayan AlTaweel
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia
Abdulraouf Jijeh
Affiliation:
Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Kingdom of Saudi Arabia
*
Correspondence to: H. K. Hamadah, Section of Pediatric Cardiac ICU, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Mail Code: 1423, P.O. Box 22490, Riyadh 11426, Kingdom of Saudi Arabia. Tel: +966 11 801 1111, ext 13621; Fax: +966 11 801 1111, ext 16773; E-mail: hamadahmo@ngha.med.sa
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Abstract

Introduction

The use of ultrasound for assessing diaphragmatic dysfunction after paediatric cardiac surgery may be under-utilised. This study aimed to evaluate the role of bedside ultrasound performed by an intensivist to diagnose diaphragmatic dysfunction and the need for plication after paediatric cardiac surgery.

Methods

We carried out a retrospective cohort study on prospectively collected data of postoperative children admitted to the paediatric cardiac ICU during 2013. Diaphragmatic dysfunction was suspected based on difficulties in weaning from positive pressure ventilation or chest X-ray findings. Ultrasound studies were performed by the paediatric cardiac ICU intensivist and confirmed by a qualified radiologist.

Results

Out of 344 postoperative patients, 32 needed diaphragm ultrasound for suspected dysfunction. Ultrasound studies confirmed diaphragmatic dysfunction in 17/32 (53%) patients with an average age and weight of 10.8±3.8 months and 6±1 kg, respectively. The incidence rate of diaphragmatic dysfunction was 4.9% in relation to the whole population. Diaphragmatic plication was needed in 9/17 cases (53%), with a rate of 2.6% in postoperative cardiac children. The mean plication time was 15.1±1.3 days after surgery. All patients who underwent plication were under 4 months of age. After plication, they were discharged with mean paediatric cardiac ICU and hospital stay of 19±3.5 and 42±8 days, respectively.

Conclusions

Critical-care ultrasound assessment of diaphragmatic movement is a useful and practical bedside tool that can be performed by a trained paediatric cardiac ICU intensivist. It may help in the early detection and management of diaphragmatic dysfunction after paediatric cardiac surgery through a decision-making algorithm that may have potential positive effects on morbidity and outcome.

Keywords

Ultrasounddiaphragmpaediatric cardiac surgeryphrenic nerve injurymechanical ventilation
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 452 - 458
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Copyright
© Cambridge University Press 2016 

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