Role of diaphragmatic ultrasound in predicting weaning success from mechanical ventilation in pediatric intensive care unit

Abstract

Abstract Background Weaning off mechanical ventilation (MV) is a critical step in pediatric ICU; however, it lacks standardized criteria. Diaphragmatic ultrasound parameters like diaphragm thickening fraction (DTF), diaphragmatic excursion (DE) and time to peak inspiratory amplitude (TPIA) can be used to assess diaphragmatic muscle strength and to predict weaning success. Aim of study Is to assess the validity of diaphragmatic ultrasonography as a predictor of weaning outcome from mechanical ventilation in pediatric age group. Methods Prospective cohort study including 30 pediatric patients aged 0–18 years on mechanical ventilation. Ultrasound measurements of diaphragmatic thickening fraction, diaphragmatic excursion and time to peak inspiratory amplitude were taken during the spontaneous breathing trial (SBT) and compared between successful and failed weaning groups. Results Out of the included 30 patients (50% male), 19 patients (63.3%) were successfully weaned. Mechanical ventilation duration was significantly longer in the failed weaning group (P = 0.017). There was significant difference between both groups regarding right DE (P = 0.032) and left DE (P = 0.022) with cutoff values of > 4.1 mm and > 5.5 mm with AUC (Area under curve) of 0.737 and 0.831, respectively. There was no statistically significant difference between both groups regarding DTF or TPIA. Conclusion We have found that DE is a predictor of weaning success, while DTF and diaphragmatic TPIA had no correlation with weaning outcome.

Keywords

• Diaphragmatic ultrasound
• Pediatric intensive care units
• Mechanical ventilation
• Diaphragmatic excursion
• Diaphragmatic thickening fraction