51. The use of bedside critical care US to detect occult diaphragmatic paresis in post-operative cardiac children

摘要

Background/Aim Diaphragmatic dysfunctions after pediatric cardiac surgery are not rare. The use of bedside diaphragmatic US to evaluate motion abnormalities was reported in small series of children. To evaluate the role of bedside US performed in PCICU by intensivist in detecting occult diaphragm dysfunction after cardiac surgery in children. Methods Prospective analysis of diaphragm US performed from June 2014 till September 2014, in pilot group of children admitted to PCICU after cardiac surgery with CXR not suggesting of diaphragm abnormalities. The initial screening was performed by PCICU intensivists and verified by independent blind radiologists. Results During the study period, 31 PCICU patients were selected to have bedside focus US to assess diaphragm motion. Their average age 15 months and average post day was 5 ± 2 days. Out of 31 selected pilot cases: 4/31 had occult diaphragm paresis (12%). 2/31 had Right diaphragm paresis after sternotomy, 1/31 Left diaphragm paresis after left thoracotomy,1/31 bilateral diaphragm paresis after redo-sternotomy. Bedside diaphragm US of performed by intensivists was highly sensitive and reliable. Conclusions Bed side critical care US assessment of diaphragms is a simple tool that can be easily learn and performed by PCICU intensivist. The tool can help in early detection of diaphragm motion abnormality related to cardiac surgery. Early detection can help putting management plan that may involve need for surgery or require prolong positive invasive and non-invasive ventilator support.