Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 24:11:1147309.
doi: 10.3389/fped.2023.1147309. eCollection 2023.

No association between thickening fraction of the diaphragm and extubation success in ventilated children

Anita Duyndam  1 , Joke Smit  1 , Robert Jan Houmes  1 , Leo Heunks  2 , Jeroen Molinger  2   3 , Marloes IJland  4 , Joost van Rosmalen  5   6 , Monique van Dijk  1   2 , Dick Tibboel  1   2 , Erwin Ista  1
Affiliations

No association between thickening fraction of the diaphragm and extubation success in ventilated children

Anita Duyndam et al. Front Pediatr. .

Abstract

Introduction: In mechanically ventilated adults, thickening fraction of diaphragm (dTF) measured by ultrasound is used to predict extubation success. Whether dTF can also predict extubation success in children is unclear.

Aim: To investigate the association between dTF and extubation success in children. Second, to assess diaphragm thickness during ventilation and the correlation between dTF, diaphragm thickness (Tdi), age and body surface.

Method: Prospective observational cohort study in children aged 0-18 years old with expected invasive ventilation for >48 h. Ultrasound was performed on day 1 after intubation (baseline), day 4, day 7, day 10, at pre-extubation, and within 24 h after extubation. Primary outcome was the association between dTF pre-extubation and extubation success. Secondary outcome measures were Tdi end-inspiratory and Tdi end-expiratory and atrophy defined as <10% decrease of Tdi end-expiratory versus baseline at pre-extubation. Correlations were calculated with Spearman correlation coefficients. Inter-rater reliability was calculated with intraclass correlation (ICC).

Results: Fifty-three patients, with median age 3.0 months (IQR 0.1-66.0) and median duration of invasive ventilation of 114.0 h (IQR 55.5-193.5), were enrolled. Median dTF before extubation with Pressure Support 10 above 5 cmH2O was 15.2% (IQR 9.7-19.3). Extubation failure occurred in six children, three of whom were re-intubated and three then received non-invasive ventilation. There was no significant association between dTF and extubation success; OR 0.33 (95% CI; 0.06-1.86). Diaphragmatic atrophy was observed in 17/53 cases, in three of extubation failure occurred. Children in the extubation failure group were younger: 2.0 months (IQR 0.81-183.0) vs. 3.0 months (IQR 0.10-48.0); p = 0.045. At baseline, pre-extubation and post-extubation there was no significant correlation between age and BSA on the one hand and dTF, Tdi- insp and Tdi-exp on the other hand. The ICC representing the level of inter-rater reliability between the two examiners performing the ultrasounds was 0.994 (95% CI 0.970-0.999). The ICC of the inter-rater reliability between the raters in 36 paired assessments was 0.983 (95% CI 0.974-0.990).

Conclusion: There was no significant association between thickening fraction of the diaphragm and extubation success in ventilated children.

Keywords: diaphragm; mechanical ventilation; pediatric; thickening fraction; ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Khemani RG, Sekayan T, Hotz J, Flink RC, Rafferty GF, Iyer N, et al. Risk factors for pediatric extubation failure: the importance of respiratory muscle strength. Crit Care Med. (2017) 45(8):e798–805. 10.1097/CCM.0000000000002433 - DOI - PMC - PubMed
    1. Kurachek SC, Newth CJ, Quasney MW, Rice T, Sachdeva RC, Patel NR, et al. Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes. Crit Care Med. (2003) 31(11):2657–64. 10.1097/01.CCM.0000094228.90557.85 - DOI - PubMed
    1. Edmunds S, Weiss I, Harrison R. Extubation failure in a large pediatric ICU population. Chest. (2001) 119(3):897–900. 10.1378/chest.119.3.897 - DOI - PubMed
    1. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. (2007) 29(5):1033–56. 10.1183/09031936.00010206 - DOI - PubMed
    1. Gomes Cordeiro AM, Fernandes JC, Troster EJ. Possible risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation. Pediatr Crit Care Med. (2004) 5(4):364–8. 10.1097/01.PCC.0000128894.59583.66 - DOI - PubMed

LinkOut - more resources