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Observational Study
. 2024 Feb;59(2):433-441.
doi: 10.1002/ppul.26768. Epub 2023 Dec 1.

Ultrasound assessment of diaphragm thickness, contractility, and strain in healthy pediatric patients

Christie L Glau  1   2 , Elaina E Lin  1   2 , Thomas W Conlon  1   2 , Adam S Himebauch  1   2 , Garrett P Keim  1   2 , Akira Nishisaki  1   2
Affiliations
Observational Study

Ultrasound assessment of diaphragm thickness, contractility, and strain in healthy pediatric patients

Christie L Glau et al. Pediatr Pulmonol. 2024 Feb.

Abstract

Background: Ultrasound-based diaphragmatic assessments are becoming more common in pediatric acute care, but baseline pediatric diaphragm thickness and contractility values remain unknown.

Methods: We conducted a prospective, observational study of healthy children aged <18 years undergoing elective surgery. Diaphragm thickness at end-expiration (Tdi-exp), thickening fraction (DTF) and excursion were measured by ultrasound during spontaneous breathing and during mechanical ventilation. Diaphragm strain and peak strain rate were ascertained post hoc. Measurements were compared across a priori specified age groups (<1 year, 1 to <3, 3 to <6, 6 to <12, and 12 to <18 years) and with versus without mechanical ventilation.

Results: Fifty subjects were evaluated (n = 10 per age group). Baseline mean Tdi-exp was 0.19 ± 0.04 cm, DTF 0.19 ± 0.09, excursion 1.69 ± 0.97 cm, strain -10.3 ± 4.9, peak strain rate -0.48 ± 0.21 s-1 . No significant difference in Tdi-exp or DTF was observed across age groups (p > .05). Diaphragm excursion increased with age (p < .0001). Diaphragm strain was significantly greater in the 12-17-year age group (-14.3 ± 6.4), p = .048, but there were no age-related differences in peak strain rate (p = .08). During mechanical ventilation, there were significant decreases in DTF 0.12 ± 0.04 (p < .0001), excursion 1.08 ± 0.31 cm (p < .0001), strain -4.60 ± 1.93 (p < .0001), and peak strain rate -0.20 ± 0.10 s-1 (p < .0001) while there was no change in Tdi-exp 0.18 ± 0.03 cm (p = .25) when compared to baseline values.

Conclusion: Pediatric Tdi-exp, DTF, and diaphragm peak strain rate were similar across age groups. Diaphragm excursion and strain varied across age groups. All measures of diaphragm contractility were diminished during mechanical ventilation.

Keywords: child; diaphragm; infant; respiration; respiration artificial; ultrasound.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) Diaphragm thickness measured at end-expiration in B-mode. (B) Diaphragm excursion measured in M-mode. (C) Diaphragm thickness in M-mode measured at maximal inspiration and end-expiration and then used to calculate the diaphragm thickening fraction.
FIGURE 2
FIGURE 2
Change in (A) diaphragm thickening fraction, (B) diaphragm strain, and (C) diaphragm peak strain rate (s−1) during spontaneous ventilation and after intubation and initiation of mechanical ventilation.
FIGURE 3
FIGURE 3
Correlation between (A) diaphragm thickening fraction and diaphragm strain, (B) diaphragm thickening fraction and diaphragm peak strain rate (s−1), and (C) diaphragm strain and diaphragm peak strain rate (s−1).
See this image and copyright information in PMC

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