Detecting Ventilator‐Induced Diaphragmatic Dysfunction Using Point‐of‐Care Ultrasound in Children With Long‐term Mechanical Ventilation

Abstract

Long‐term mechanical ventilation (MV) is defined as the use of MV for more than 6 hours per day for at least 3 weeks. Children requiring long‐term MV include those with neuromuscular disease, central dysregulation, or lung dysfunction. Such children with medical complexity may be at risk for ventilator‐induced diaphragmatic dysfunction. Ventilator‐induced diaphragmatic dysfunction has been described in adult patients requiring acute MV with ultrasound (US). At this time, diaphragmatic US has not been evaluated in the pediatric post–acute care setting or incorporated into weaning strategies. We present 24 cases of children requiring long‐term MV who underwent diaphragmatic US examinations to evaluate for ventilator‐induced diaphragmatic dysfunction.

Status post‐ECMO: The role of point‐of‐care diaphragmatic ultrasound

“…Two POCUS approaches are commonly employed to evaluate diaphragm function and include visualization of the diaphragm muscle at the zone of apposition (ZOA) to assess diaphragm thickness and contractility, and diaphragm dome using the anterior subcostal approach to evaluate DE 1–3 . In critically ill patients in the intensive care unit setting, both methods have been studied extensively to evaluate DD secondary to ventilator‐induced DD (VIDD), which may result from muscle disuse leading to atrophy and contractile dysfunction 1,2,4,5 . Assessments of diaphragm dysfunction (e.g., decreased diaphragmatic thickness and thickening fraction) at the ZOA in patients receiving MV 6 or in those meeting criteria for a spontaneous beathing trial to evaluate DE 7 have been associated with adverse outcomes including significantly longer weaning time, weaning failure, and prolonged MV 6,7 .…”

Point‐of‐care respiratory muscle ultrasound in a child with medical complexity

“…In a series of 24 children requiring long-term MV ( > 6 h per day for at least 3 weeks), 54% had unilateral or bilateral diaphragmatic dysfunction. 29 While several studies and reviews have focused on measuring diaphragm function with POCUS in patients requiring MV, only one study was performed during an SBT in the evaluation of an adult population. 8 Additionally, the role of the expiratory muscles in respiratory failure has only recently been explored.…”

Point-of-Care Respiratory Muscle Ultrasound in a Child with Medical Complexity

“…In a series of 24 children requiring long-term MV (>6 hours per day for at least 3 weeks), 54% had unilateral or bilateral diaphragmatic dysfunction. 29 While several studies and reviews have focused on measuring diaphragm function with POCUS in patient's requiring MV, the role of the expiratory muscles in respiratory failure has only recently been explored. During tidal breathing, the expiratory muscles of the abdominal wall are largely inactive.…”