title: Bedside Ultrasound for the Diagnosis of Abnormal Diaphragmatic Motion in Children After Heart Surgery.
abstract: To assess the utility of bedside ultrasound combining B- and M-mode in the diagnosis of abnormal diaphragmatic motion in children after heart surgery.
  
  
  
  Prospective post hoc blinded comparison of ultrasound performed by two different intensivists and fluoroscopy results with electromyography.
  
  
  
  Tertiary university hospital.
  
  
  
  Children with suspected abnormal diaphragmatic motion after heart surgery.
  
  
  
  None.
  
  
  
  Abnormal diaphragmatic motion was suspected in 26 children. Electromyography confirmed the diagnosis in 20 of 24 children (83.3%). The overall occurrence rate of abnormal diaphragmatic motion during the study period was 7.5%. Median patient age was 5 months (range, 16 d to 14 yr). Sensitivity and specificity of chest ultrasound performed at the bedside by the two intensivists (91% and 92% and 92% and 95%, respectively) were higher than those obtained by fluoroscopy (87% and 83%). Interobserver agreement (k) between both intensivists was 0.957 (95% CI, 0.87-100).
  
  
  
  Chest ultrasound performed by intensivists is a valid tool for the diagnosis of diaphragmatic paralysis, presenting greater sensitivity and specificity than fluoroscopy. Chest ultrasound should be routinely used after pediatric heart surgery given its reliability, reproducibility, availability, and safety.
authors: 1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 2Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 3Department of neonatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 4Department of Pediatric Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 5Cardiac Intensive Care Unit, Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA. 6Unit of Clinical Research Support, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain. 7Department of Pediatric Cardiothoracic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 8Department of Pediatric Cardiology, Sant Joan de Deu Barcelona Children's Hospital, University of Barcelona, Barcelona, Spain.
authors: Laura
authors: L
authors: Gil-Juanmiquel
authors: Margarida
authors: M
authors: Gratacós
authors: Yolanda
authors: Y
authors: Castilla-Fernández
authors: Joaquim
authors: J
authors: Piqueras
authors: Tracy
authors: T
authors: Baust
authors: Nuria
authors: N
authors: Raguer
authors: Joan
authors: J
authors: Balcells
authors: Santiago
authors: S
authors: Perez-Hoyos
authors: Raul F
authors: RF
authors: Abella
authors: Joan
authors: J
authors: Sanchez-de-Toledo
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004311:Double-Blind Method; D004576:Electromyography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D000067716:Point-of-Care Testing; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging* / Q000209:etiology; D012680:Sensitivity and Specificity; D014463:Ultrasonography