Predictive Value of Diaphragmatic Ultrasonography for the Weaning Outcome in Mechanically Ventilated Children Aged 1–3 Years

Abstract

BackgroundThere are estimated 20% of mechanically ventilated patients having difficulty in weaning from the ventilators, and the weaning process accounts for 40% of the whole ventilation time. Reliable tools are urgently needed to estimate the weaning outcome. Diaphragmatic ultrasonography, as a relatively good predictive method for the adults, was measured in this study, assessing the value of each indicator of diaphragmatic ultrasonography to predict the outcomes of ventilator weaning from mechanically ventilated children of 1–3 years old.MethodsBetween November 2018 and November 2019, children who were mechanically ventilated and ready for weaning in the pediatric intensive care unit (PICU) were enrolled in the study. Diaphragmatic ultrasonography was performed to the children to measure the right diaphragm excursion (DE), contraction velocity, thickness, and diaphragm thickening fraction (DTF), which were recorded followed by spontaneous breathing trial (SBT). The receiver operator characteristic (ROC) curves were also used to assess the value of each indicator to predict the weaning outcome.ResultsDuring this study period, a total of 72 children were enrolled, and of them, 56 children passed the weaning process, while 16 children failed. There were significant differences in DE, contraction velocity, thickness, and DTF parameters between the weaning success group and the failure group. The areas under the ROC curves (AUC) and the optimal threshold of the above indicators were as follows: 0.72 and 8.08 mm for DE, 0.71 and 26.1% for right DTF (DTFR), 0.71 and 20.7% for left DTF (DTFL), 0.78 and 14.8% for minimum DTF (DTFMIN), 0.79 and 26.1% for maximum DTF (DTFMAX), 0.71 and 1.24 mm for maximum diaphragm thickness at the end of inspiration (DteiMAX), and 0.65 and 10.0 mm/s for contraction velocity.ConclusionDiaphragmatic ultrasonography is feasible in guiding ventilator weaning, and the indicators of DE, DTF, and DteiMAX guide the weaning more accurately. Among them, DTF may act as a more reliable predictor of weaning by avoiding the influence of diaphragm development in children.

Accuracy of lung and diaphragm ultrasound in predicting infant weaning outcomes: a systematic review and meta-analysis

“…Amrousy's study had two LUS cut-off points ( 24 ), but Jiang's study had four LUS cut-off points ( 31 ). One study looked at left and right DE ( 25 ), while the other looked at left and right DTF ( 29 ).…”

“…The results of the QUADAS-2 tool assessing risk of bias and applicability concerns of the included studies were shown in Figure 2 . The possibility of patient selection bias was mostly related to the fact that four studies included patients who were either eligible for weaning or planned to be weaned rather than patients who were randomly selected ( 21 , 24 , 25 , 29 ). Index test poses a risk since they do not clearly reveal whether the ultrasound was performed without knowledge of the clinical outcomes ( 21 , 23 , 27 , 28 , 31 ).…”

“…Index test poses a risk since they do not clearly reveal whether the ultrasound was performed without knowledge of the clinical outcomes ( 21 , 23 , 27 , 28 , 31 ). Furthermore, the reference standard poses a danger due to the low success rate of clinical weaning events and the omission to identify whether clinical weaning decisions were taken without knowledge of ultrasound findings ( 22 , 27 , 28 , 29 , 30 , 31 ). The Deeks' test revealed no substantial publication bias in LUS, DE, or DTF, with all P values more than 0.05 ( Supplementary Figure S1 ).…”

The increase in diaphragm thickness in preterm infants is related to birth weight: a pilot study

“…Recent research on diaphragm monitoring has focused on the importance of this muscle in many respiratory disorders: diaphragm thickness and diaphragm thickening fraction (DTF) have been related to the time on invasive mechanical ventilation (IMV) in adults [1,2] and pediatric patients [3], as well as with extubation failure [3][4][5]. Being able to reproduce this nding in premature infants may help to reduce extubation failure in this population [6].…”