Point of care diaphragm ultrasound in acute bronchiolitis: a measurable
tool to predict the clinical, sonographic severity of the disease and
outcomes
Abstract
Background: The aim of this study was to evaluate diaphragmatic
parameters in bronchiolitis patients and identify correlations between
clinical and sonographic severity scores and outcomes in order to
develop a more objective and useful tool in the emergency department.
Methods: Children aged between 1 and 24 months and diagnosed with acute
bronchiolitis were included in the study. The Modified Respiratory
Distress Assessment Instrument (mRDAI) score was used to quantify the
clinical severity of the disease. Lung ultrasound was performed and a
bronchiolitis ultrasound score (BUS) was calculated. Diaphragm
ultrasound was then performed and diaphragm thickness at the end of
inspiration and expiration, thickening fraction, diaphragm excursion
(EXC), inspiratory slope (IS), expiratory slope (ES), and total duration
time of the respiratory cycle were measured. Results: There were 104
patients evaluated in this study. The mRDAI score and BUS had a
significant positive correlation. There was a positive correlation
between IS and respiratory rate at admission. As the clinical score
increased, IS, ES, and EXC measurements rose and they were positively
correlated. Values of IS, ES, and EXC were higher in the moderate-severe
group than the mild group for both mRDAI and BUS scores. Inspiratory
slope values were correlated with the length of stay in the hospital.
Conclusion: Values of IS and ES were correlated with clinical and
sonographic severity scores. Moreover, IS was a good predictor of
outcome. Diaphragm ultrasound appears to be an objective and useful tool
to help the physician make decisions regarding the evaluation and
management of bronchiolitis.