ArticleAnnals of pediatric cardiology
Ultrasound predictors of extubation outcomes in pediatric cardiac surgery: A prospective evaluation of lung, diaphragmatic, and cardiac ultrasound.
Article in Annals of pediatric cardiology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Backgrounds: Extubation failure after pediatric cardiac surgery increases morbidity and intensive care unit (ICU) stay. Conventional indices such as rapid shallow breathing index (RSBI) and PaO2/FiO2 do not account for multi-organ contributors such as cardiac function, pulmonary aeration, and diaphragmatic performance. This study prospectively evaluated bedside ultrasound parameters - lung ultrasound score (LUS), mean diaphragmatic excursion (DE), and E/e' ratio - as predictors of extubation outcomes. Methods: In this prospective, observational study conducted in a tertiary pediatric cardiac ICU, 102 postoperative children undergoing elective extubation were evaluated using ultrasound at three standardized timepoints (M1: SIMV mode, M2: CPAP/PS mode, and M3: NIV/room air). The primary outcome was extubation failure, defined as reintubation within 48 h. Diagnostic accuracy was analyzed using receiver operating characteristic curves and Youden index-derived thresholds. The secondary outcomes included associations with ventilation duration, ICU stay, incremental value over conventional indices (PaO2/FiO2 and RSBI), and timepoint dynamics. Results: Extubation failure occurred in 11 (10.8%) patients. In SIMV mode (M1), the optimal thresholds were LUS ≥12 (area under the curve [AUC] 0.69, sensitivity 63.6%, specificity 64.8%), mean DE ≤0.82 cm (AUC 0.45, specificity 89%), and E/e' ≥8.9 (AUC 0.38). LUS ≥12 trended toward longer mechanical ventilation and ICU stay but did not reach statistical significance. Adding LUS to conventional indices showed a nonsignificant increase in discrimination from AUC 0.66 to 0.71 ( Conclusions: In pediatric cardiac surgical patients, LUS demonstrated a moderate predictive ability for extubation outcomes, whereas diaphragmatic and diastolic parameters were weak predictors. The addition of LUS to conventional indices provided incremental value, supporting its role as a useful bedside adjunct in evaluating extubation readiness.
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