title: Ultrasound for diaphragmatic dysfunction in postoperative cardiac children.
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.
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Hussam K
authors.initials: HK
authors.lastname: Hamadah
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Kabbani
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Elbarbary
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Omar
authors.initials: O
authors.lastname: Hijazi
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Shaath
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Sameh
authors.initials: S
authors.lastname: Ismail
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Ammar M H
authors.initials: AMH
authors.lastname: Qadi
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Hayan
authors.initials: H
authors.lastname: AlTaweel
authors.affiliation: 1Section of Pediatric Cardiac ICU,King Abdulaziz Cardiac Center,King Abdulaziz Medical City,Ministry of National Guard - Health Affairs,Riyadh,Kingdom of Saudi Arabia.
authors.forename: Abdulraouf
authors.initials: A
authors.lastname: Jijeh
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000067716:Point-of-Care Testing; D011183:Postoperative Complications; D012133:Respiratory Paralysis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*
keywords: Ultrasound; diaphragm; mechanical ventilation; paediatric cardiac surgery; phrenic nerve injury