Evaluation of diaphragmatic function in mechanically ventilated children: An ultrasound study

• Published in: PloS one Vol. 12; no. 8; p. e0183560
• Main Authors: Lee, En-Pei, Hsia, Shao-Hsuan, Hsiao, Hsiu-Feng, Chen, Min-Chi, Lin, Jainn-Jim, Chan, Oi-Wa, Lin, Chia-Ying, Yang, Mei-Chin, Liao, Sui-Ling, Lai, Shen-Hao
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.08.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adults; Anesthesia; Assessments; Atrophy; Biology and Life Sciences; Case-Control Studies; Child; Child, Preschool; Children; Critical care; Diaphragm; Diaphragm (Anatomy); Diaphragm - physiopathology; Engineering and Technology; Extubation; Generalized linear models; Health aspects; Hospitals; Humans; Infant; Intensive care; Intubation; Mechanical ventilation; Medicine; Medicine and Health Sciences; Pediatrics; People and Places; Physicians; Prospective Studies; Recovery; Reproducibility of Results; Research and Analysis Methods; Respiration, Artificial; Respiratory distress syndrome; Respiratory therapy; Thickening; Ultrasonic imaging; Ultrasonic testing; Ultrasound; Ventilation; Ventilators; Weaning; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0183560

The recovery of diaphragmatic function is vital for successful extubation from mechanical ventilation. Recent studies have detected diaphragm atrophy in ventilated adults by using ultrasound, but no similar report has been conducted in children. In the current study, we hypothesized that mechanically ventilated children may also develop diaphragm atrophy and diaphragmatic dysfunction. Children who were admitted to the pediatric intensive care unit and were newly intubated for mechanical ventilation were enrolled into this prospective case-control study. Diaphragm ultrasound assessments were performed daily to evaluate diaphragmatic function in the enrolled children until their discharge from the pediatric intensive care unit. Diaphragm thickness and the diaphragmatic thickening fraction (DTF) were measured through these assessments. A total of 31 patients were enrolled, and overall, 1389 ultrasound assessments were performed. Immediately after intubation, the initial diaphragm thickness and DTF were measured to be 1.94 ± 0.44 mm and 25.85% ± 3.29%, respectively. In the first 24 hours of mechanical ventilation, diaphragm thickness and the DTF decreased substantially and decreased gradually thereafter. After extubation, the DTF was significantly different between the successful and failed extubation groups (P < 0.001), and a DTF value of <17% was associated with extubation failure. Diaphragm ultrasound is a noninvasive method for measuring diaphragmatic function in mechanically ventilated children. In this study, significant diaphragm atrophy and a decreased DTF were observed within 24 hours of mechanical ventilation. The recovery of diaphragm thickness and the DTF may be a potential predictor of successful extubation from mechanical ventilation.