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العنوان
Lung Ultrasonography as Tool for
Follow Up of Ventilated Neonates
for Prediction of Weaning Readiness /
المؤلف
Shabana,Ayah Mohamed Zaki.
هيئة الاعداد
باحث / Ayah Mohamed Zaki Shabana
مشرف / Hisham Abdel Samie Awad
مشرف / Soha Mohamed Khafagy
مشرف / Nivan Taha Ahmed
تاريخ النشر
2019
عدد الصفحات
167p.:
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
طب الأطفال ، الفترة المحيطة بالولادة وصحة الطفل
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - طب الأطفال
الفهرس
Only 14 pages are availabe for public view

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from 167

Abstract

Timing is crucial when deciding whether a patient can be
successfully weaned from mechanical ventilation or not.
As both premature extubation and unnecessary delay have been
associated with poor outcome (Soliman et al., 2019). There are
no enough guidelines for the assessment of readiness of a
newborn for extubation.
Lung ultrasound can detect reduction in parenchymal
aeration from respiratory, cardiac, or diaphragmatic origin. This
reduction is quantified through LUS score, a scale which values
range from 0 to 36 points, calculated from the sum of the
grades assigned to different aeration patterns observed in every
examined area of the lung (Llamas-Álvarez et al., 2017).
There is increasing interest in the use of diaphragm
ultrasound in adult as a tool to identify and track diaphragm
dysfunction specially to follow patients who will be extubated
from mechanical ventilation, and if they will remain free of
invasive ventilation afterwards (Turton et al., 2019).
Our study was designed to assess the value of lung
ultrasound score and diaphragm ultrasound parameters as
predictor of successful extubation in neonates.
We recruited 39 ventilated newborn patients. They were
13 fullterms and 26 preterms. Mean birth weight was
1.94kg.Twenty two patients were males and 17 were females.The most common diagnosis was respiratory distress syndrome
51.3 % of our patients, followed by congenital pneumonia
25.6%.
We divided the patients into two groups according to
their extubation trial whether succeeded or not (1) Success
group; this group included 25 patients (64.1%) (2) Failure
group which included 14 patients (35.9%).
The differences were not significant between the two
groups as regards both weight and gestational age. The
mortality rate was higher in patients who failed their weaning
trial. Surfactant was required in 50% of the failure group which
was significantly higher than success group (12% only).
Only three of our patients had BPD, yet they were all in
the failure group, which may indicate that BPD is a risk factor
for failure.
As regards initial ventilatory settings higher PIP, PEEP
and MAP were needed for the patients who failed extubation
later in comparison to those who had successful weaning. The
pre-extubation ventilatory settings; respiratory rate, MAP and
FiO2 were higher in the failure group, in comparison to success
group.
There was a significant difference between two groups as
regards ventilation mode chosen for non- invasive ventilation post extubation, where those who required NIPPV rather than
CPAP, where more likely to be in the failure group.
Also those who were put on CPAP in the failure group
required higher PEEP. As for those in the failure group who
required post-extubation NIPPV required higher PIP, PEEP and
respiratory rates in relation to success group.
The failure group had higher LUS score at the time of
intubation and pre- extubation and post-extubation in
comparison to the successful group.
The LUS score pre-extubation was specifically of
interest in the aim of assessing its validity to be a predictor of
extubation success to be used in clincal practice. Using ROC
curve, we concluded that the best cut off value for LUS score
pre-extubation to predict successful extubation was ≤10 with
sensitivity 76% and specificity 64.3% (AUC 75).
We found no atrophy in diaphragm thickness in the
studied patients. On the contrary, there was increase in the
mean thickness of right and left diaphragm in both inspiration
and expiration in all the patients, although not statistically
significant. Still higher left diaphragm inspiration and
expiration thickness pre-extubation were found in the failure
group in comparison to success group.
There was a significant positive correlation between LUS
score pre-extubation and both left diaphragm thickness at inspiration and expiration. Using ROC curve, the best cut off
value for left diaphragm expiration thickness pre-extubation to
predict successful extubation trial was ≤0.22 cm with
sensitivity 70.8% and specificity 71.4% (AUC 75.6).
Also regarding left diaphragm inspiration thickness, the
best cut off value on initiation of ventilation to predict
successful extubation trial was ≤0.28 cm with sensitivity 88%
and specificity 57% (AUC 75.4).
We also demonstrated that SBT can be used as a
predictor of successful extubation with 63.6 % sensitivity and
84.2 % specificity.