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Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes
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Diaphragmatic Thickening Fraction by Ultrasound in Mechanically Ventilated Pediatric Patients: Pilot Observations

Ami J Shah1,2, Kitman Wai2, Matthew P Sharron2

  • 1Hassenfeld Children's Center, New York University Langone - Pediatric Critical Care, New York, NY, USA.

Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
|June 7, 2022
PubMed

Insights

Diaphragm thickening fraction (DTF) measured by ultrasound during spontaneous breathing trials (SBT) can predict weaning success in pediatric patients. Lower DTF indicates a higher risk of SBT failure, aiding in readiness assessment.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Diagnostic Ultrasound

Background:

  • Diaphragmatic atrophy and reduced diaphragmatic thickening fraction (DTF) are linked to poor extubation outcomes in critically ill adults.
  • Similar findings are observed in pediatric patients, highlighting the need for further research.

Purpose of the Study:

  • To assess the feasibility and utility of using DTF during spontaneous breathing trials (SBT) to predict weaning outcomes in pediatric intensive care unit (PICU) patients.
  • To explore the correlation between DTF and SBT success or failure.

Main Methods:

  • A prospective, observational study was conducted in a tertiary noncardiac PICU.
  • 38 mechanically ventilated pediatric patients, excluding those with pre-existing diaphragm issues, were included.
  • Diaphragmatic ultrasound was used to measure DTF during SBTs.

Main Results:

  • Weaning failure occurred in 26% of patients, primarily due to failed SBT (24%).
  • Median DTF was 24%, significantly lower in patients with failed SBT (12%) compared to successful SBT (27%).
  • DTF < 25% and tidal volume < 5 mL/kg were significant predictors of SBT failure.

Conclusions:

  • Ultrasound measurement of DTF during spontaneous breathing in mechanically ventilated pediatric patients shows promise as a tool for predicting weaning readiness.
  • This non-invasive method may aid clinicians in determining when pediatric patients are ready for extubation.
Abstract

Keywords:
atrophydiaphragmextubationthickening fractionultrasoundweaning

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