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Updated: Aug 15, 2025
Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes
Published on: November 3, 2023
Evaluation of Diaphragmatic Thickness and Dysfunction by Ultrasonography in Mechanically Ventilated Children for
Saranya Vadivelu1, Daisy Khera2, Bharat Choudhary1
1Department of Pediatric, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan.
Insights
Diaphragm thickening fraction (DTF) did not differ between children who succeeded or failed extubation. However, longer mechanical ventilation and lower pre-extubation DTF were linked to extubation failure in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Diagnostic imaging
Background:
- Mechanical ventilation (MV) is crucial for critically ill children but can lead to diaphragmatic dysfunction.
- Assessing diaphragmatic function non-invasively is important for predicting extubation outcomes.
Purpose of the Study:
- To evaluate diaphragm thickness (DT) and diaphragmatic thickening fraction (DTF) in mechanically ventilated children.
- To determine the association between these ultrasound measurements and extubation success.
Main Methods:
- Ultrasound measurements of DT and DTF were taken in children (1 month-18 years) on MV for >24 hours.
- Measurements were recorded at baseline, up to 14 days of MV, and post-extubation.
Main Results:
- Of 54 children, 40 underwent extubation trials; 9 (22.5%) failed.
- No significant difference in pre- or post-extubation DTF or diaphragm atrophy rate between success and failure groups.
- Logistic regression indicated that longer total ventilation duration and lower mean DTF% before extubation decreased the probability of successful extubation.
Conclusions:
- While diaphragmatic atrophy occurs in mechanically ventilated children, DTF did not significantly differ between extubation success and failure groups.
- Total ventilation duration and pre-extubation DTF are significant predictors of extubation success in this pediatric population.
Objectives:
This study aimed to evaluate diaphragm thickness (DT) and diaphragmatic thickening fraction (DTF) in mechanically ventilated children, and study the association of these measurements with extubation success.
Methods:
Consecutive children aged one month to 18 years, who required mechanical ventilation (MV) for more than 24 hours at our institution, were enrolled between April, 2019 to October, 2020. Ultrasonographic measure-ments of DT were documented, and DTF was calculated from baseline (within 24 hours of MV) until 14 days of MV, and up to three days post-extubation.
Results:
Of the 54 children-enrolled, 40 underwent planned extubation trial, of which 9 (22.5%) had extubation failure. Pre-extubation and post-extubation DTF between children in extubation-success and extubation-failure groups were comparable (P=0.074). There was no significant difference in the diaphragm atrophy rate between the two groups (P=0.819). Binary logistic regression showed significantly decreased probability of successful extubation with total ventilation duration (P=0.012) and mean DTF% before extubation (P=0.033).
Conclusion:
Despite evidence of diaphragmatic atrophy in critically ill children receiving mechanical ventilation, there was no significant difference in DTF between extubation success and failure groups.
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