Point of care diaphragm ultrasound in infants with bronchiolitis

A prospective study

Danilo Buonsenso, Maria C Supino, Emanuele Giglioni, Massimo Battaglia, Alessia Mesturino, Simona Scateni, Barbara Scialanga, Antonino Reale, Anna M C Musolino

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Bronchiolitis is the most common reason for hospitalization of children worldwide. Many scoring systems have been developed to quantify respiratory distress and predict outcome, but none of them have been validated. We hypothesized that the ultrasound evaluation of the diaphragm could quantify respiratory distress and therefore we correlated the ultrasound diaphragm parameters with outcome.

METHODS: Prospective study of infants with bronchiolitis (1-12 months) evaluated in a pediatric emergency department. Ultrasonography examinations of the diaphragm was performed (diaphragm excursion [DE], inspiratory excursion [IS], inspiratory/expiratory relationship [I/E], and thickness at end-expiration [TEE] and at end-inspiration [TEI]; thickening fraction [TF]).

RESULTS: We evaluated 61 infants, 50.8 % males. Mean TF was 47% (IQR 28.6-64.7), mean I/E 0.47 (± 0.15), mean DE 10.39 ± 4 mm. There was a linear correlation between TF and oxygen saturation at first evaluation (P = 0.006, r = 0.392). All children with lower values of TF required HFNC and one of them required CPAP. A higher IS was associated with the future need of respiratory support during admission (P = 0.007). IS correlated with the hours of oxygen delivery needed (P = 0.032, r = 0.422). TEI (t = 3.701, P = 0.002) was found to be main predictor of hours of oxygen delivery needed.

CONCLUSION: This study described ultrasound diaphragmatic values of previously healthy infants with bronchiolitis. DE, IS, and TEI correlated with outcome. If confirmed in larger studies, bedside ultrasound semiology of the diaphragm can be a new objective tool for the evaluation and outcome prediction of infants with bronchiolitis.

Original languageEnglish
Pages (from-to)778-786
Number of pages9
JournalPediatric Pulmonology
Volume53
Issue number6
DOIs
Publication statusPublished - Jun 2018

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Point-of-Care Systems
Bronchiolitis
Diaphragm
Prospective Studies
Oxygen
Hospital Emergency Service
Ultrasonography
Hospitalization
Pediatrics

Cite this

Buonsenso, D., Supino, M. C., Giglioni, E., Battaglia, M., Mesturino, A., Scateni, S., ... Musolino, A. M. C. (2018). Point of care diaphragm ultrasound in infants with bronchiolitis: A prospective study. Pediatric Pulmonology, 53(6), 778-786. https://doi.org/10.1002/ppul.23993

Point of care diaphragm ultrasound in infants with bronchiolitis : A prospective study. / Buonsenso, Danilo; Supino, Maria C; Giglioni, Emanuele; Battaglia, Massimo; Mesturino, Alessia; Scateni, Simona; Scialanga, Barbara; Reale, Antonino; Musolino, Anna M C.

In: Pediatric Pulmonology, Vol. 53, No. 6, 06.2018, p. 778-786.

Research output: Contribution to journalArticle

Buonsenso, D, Supino, MC, Giglioni, E, Battaglia, M, Mesturino, A, Scateni, S, Scialanga, B, Reale, A & Musolino, AMC 2018, 'Point of care diaphragm ultrasound in infants with bronchiolitis: A prospective study', Pediatric Pulmonology, vol. 53, no. 6, pp. 778-786. https://doi.org/10.1002/ppul.23993
Buonsenso, Danilo ; Supino, Maria C ; Giglioni, Emanuele ; Battaglia, Massimo ; Mesturino, Alessia ; Scateni, Simona ; Scialanga, Barbara ; Reale, Antonino ; Musolino, Anna M C. / Point of care diaphragm ultrasound in infants with bronchiolitis : A prospective study. In: Pediatric Pulmonology. 2018 ; Vol. 53, No. 6. pp. 778-786.
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AU - Buonsenso, Danilo

AU - Supino, Maria C

AU - Giglioni, Emanuele

AU - Battaglia, Massimo

AU - Mesturino, Alessia

AU - Scateni, Simona

AU - Scialanga, Barbara

AU - Reale, Antonino

AU - Musolino, Anna M C

N1 - © 2018 Wiley Periodicals, Inc.

PY - 2018/6

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N2 - BACKGROUND: Bronchiolitis is the most common reason for hospitalization of children worldwide. Many scoring systems have been developed to quantify respiratory distress and predict outcome, but none of them have been validated. We hypothesized that the ultrasound evaluation of the diaphragm could quantify respiratory distress and therefore we correlated the ultrasound diaphragm parameters with outcome.METHODS: Prospective study of infants with bronchiolitis (1-12 months) evaluated in a pediatric emergency department. Ultrasonography examinations of the diaphragm was performed (diaphragm excursion [DE], inspiratory excursion [IS], inspiratory/expiratory relationship [I/E], and thickness at end-expiration [TEE] and at end-inspiration [TEI]; thickening fraction [TF]).RESULTS: We evaluated 61 infants, 50.8 % males. Mean TF was 47% (IQR 28.6-64.7), mean I/E 0.47 (± 0.15), mean DE 10.39 ± 4 mm. There was a linear correlation between TF and oxygen saturation at first evaluation (P = 0.006, r = 0.392). All children with lower values of TF required HFNC and one of them required CPAP. A higher IS was associated with the future need of respiratory support during admission (P = 0.007). IS correlated with the hours of oxygen delivery needed (P = 0.032, r = 0.422). TEI (t = 3.701, P = 0.002) was found to be main predictor of hours of oxygen delivery needed.CONCLUSION: This study described ultrasound diaphragmatic values of previously healthy infants with bronchiolitis. DE, IS, and TEI correlated with outcome. If confirmed in larger studies, bedside ultrasound semiology of the diaphragm can be a new objective tool for the evaluation and outcome prediction of infants with bronchiolitis.

AB - BACKGROUND: Bronchiolitis is the most common reason for hospitalization of children worldwide. Many scoring systems have been developed to quantify respiratory distress and predict outcome, but none of them have been validated. We hypothesized that the ultrasound evaluation of the diaphragm could quantify respiratory distress and therefore we correlated the ultrasound diaphragm parameters with outcome.METHODS: Prospective study of infants with bronchiolitis (1-12 months) evaluated in a pediatric emergency department. Ultrasonography examinations of the diaphragm was performed (diaphragm excursion [DE], inspiratory excursion [IS], inspiratory/expiratory relationship [I/E], and thickness at end-expiration [TEE] and at end-inspiration [TEI]; thickening fraction [TF]).RESULTS: We evaluated 61 infants, 50.8 % males. Mean TF was 47% (IQR 28.6-64.7), mean I/E 0.47 (± 0.15), mean DE 10.39 ± 4 mm. There was a linear correlation between TF and oxygen saturation at first evaluation (P = 0.006, r = 0.392). All children with lower values of TF required HFNC and one of them required CPAP. A higher IS was associated with the future need of respiratory support during admission (P = 0.007). IS correlated with the hours of oxygen delivery needed (P = 0.032, r = 0.422). TEI (t = 3.701, P = 0.002) was found to be main predictor of hours of oxygen delivery needed.CONCLUSION: This study described ultrasound diaphragmatic values of previously healthy infants with bronchiolitis. DE, IS, and TEI correlated with outcome. If confirmed in larger studies, bedside ultrasound semiology of the diaphragm can be a new objective tool for the evaluation and outcome prediction of infants with bronchiolitis.

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DO - 10.1002/ppul.23993

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VL - 53

SP - 778

EP - 786

JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

SN - 8755-6863

IS - 6

ER -