Comparative Role of Diaphragmatic Ultrasound in Predicting Weaning Outcomes: A Case-Control Study in Pediatric Patients on Mechanical Ventilation

Background: In the treatment of critically ill children, mechanical ventilation (MV) is a crucial life support method, with weaning being a key process. Currently, predicting successful weaning in mechanically ventilated children presents numerous challenges. Traditional predictors have notable shortcomings, including instability of specificity, inconsistency of thresholds, and limited clinical applicability. There is an urgent need for more accurate and reliable methods to predict weaning to prevent ventilator-related lung injury and ventilator-induced diaphragmatic dysfunction (VIDD) in children due to improper weaning. Objectives: This study aims to assess the prognostic value of diaphragmatic ultrasound parameters in predicting successful weaning outcomes in pediatric patients undergoing MV, compared to healthy controls. Patients and Methods: This was a retrospective case-control study. Sixty critically ill pediatric patients undergoing MV in our hospital's Pediatric Intensive Care Unit (PICU) were included in the study as the observation group (MV group), which was subdivided into a successful weaning group (39 cases) and a failed weaning group (21 cases) based on clinical weaning outcomes. Additionally, forty age-, gender-, and Body Mass Index (BMI)-matched healthy children undergoing routine health examinations were selected as the control group. Diaphragmatic ultrasound parameters measured included diaphragmatic excursion (DE), diaphragmatic end-inspiratory thickness (Tei), diaphragmatic end-expiratory thickness (Tee), diaphragmatic thickening fraction (DTF), diaphragmatic excursion to rapid shallow breathing index (DE-RSBI), and diaphragmatic thickening fraction to rapid shallow breathing index (DTF-RSBI). The changes in diaphragmatic function in MV patients were assessed by comparing these parameters between the control and MV groups. Furthermore, the diaphragmatic ultrasound parameters between the successful and failed weaning groups were compared, and the predictive accuracy for weaning outcomes was assessed through receiver operating characteristic (ROC) curve analysis, determining the area under the curve (AUC), sensitivity, and specificity. Results: (1) The control group exhibited significantly higher DE, Tei, Tee, and DTF values compared to the MV group, while DE-RSBI and DTF-RSBI were significantly lower, indicating statistically significant differences (P < 0.05). (2) The failed weaning group had longer durations of MV and total hospital stays compared to the successful weaning group (P < 0.05); the successful weaning group exhibited higher DE and DTF, and lower DE-RSBI and DTF-RSBI than the failed weaning group (P < 0.05). (3) ROC curve analysis revealed that the AUCs for DE, DE-RSBI, DTF, and DTF-RSBI in predicting weaning outcomes were 0.882, 0.810, 0.723, and 0.725, respectively, suggesting their value in guiding clinical weaning decisions. Conclusion: Diaphragmatic ultrasound provides an effective method for assessing diaphragmatic function in pediatric patients on MV and offers a valuable reference for clinicians in making weaning decisions.