Ultrasound assessment of ventilator-induced diaphragmatic dysfunction to predict the success of weaning in mechanically ventilated children

Abstract

A great number of patients admitted to the ICU require mechanical ventilation during their process of care. However, there is increasing awareness that ventilator-induced diaphragmatic dysfunction is highly prevalent in critically ill patients and is likely a contributing cause of weaning failure. On the pediatric field, this phenomenon may have a greater impact. Conventional tools to evaluate diaphragm function are not simple or adequate to perform in mechanically ventilated patients. Ultrasonography has recently emerged as a new method for assessment of diaphragm function, prevailing over other imaging modalities. Certain indices of diaphragm function, namely diaphragm thickness, thickening fraction and excursion have been established for mechanically ventilated patients to monitor changes in diaphragm function over time, to detect diaphragmatic dysfunction, and to evaluate if these indices can predict successful weaning from mechanical ventilation. The aims of this narrative review are to summarize the technique and the clinical applications of ultrasonography in the evaluation of diaphragmatic function in ICU pediatric patients, and to assess its utility and accuracy for predicting weaning outcomes.