• Gregory R De Meyer, Loïc Flamey, Ine Adriaensens, Marjan Van der Aerschot, Hanne Van de Walle, Ignace Vanmarsenille, Philippe G Jorens, Ewan C Goligher, Vera Saldien, and Tom Schepens.
• Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium.
• Pediatr Crit Care Me. 2023 Aug 1; 24 (8): 652661652-661.

ObjectivesDiaphragm ultrasound is a novel alternative to esophageal pressure measurements in the evaluation of diaphragm function and activity, but data about its reliability in a pediatric setting are lacking. We aimed to compare the esophageal pressure swing (∆P es , gold standard) with the diaphragmatic thickening fraction (DTF) as a measure of inspiratory effort in sedated children. Additionally, we studied the effect of positive end-expiratory pressure (PEEP) on the end-expiratory thickness of the diaphragm (DT ee ).DesignProspective open-label non-randomized interventional physiological cohort study.SettingOperating room in tertiary academic hospital.PatientsChildren 28 days to 13 years old scheduled for elective surgery with general anesthesia, spontaneously breathing through a laryngeal mask airway, were eligible for inclusion. Exclusion criteria were disorders or previous surgery of the diaphragm, anticipated difficult airway or acute cardiopulmonary disease. All measurements were performed prior to surgery.InterventionsPatients were subjected to different levels of respiratory load, PEEP and anesthetic depth in a total of seven respiratory conditions.Measurements And Main ResultsThe esophageal pressure and diaphragm thickening fraction were simultaneously recorded for five breaths at each respiratory condition. The relation between ∆P es and DTF was studied in a mixed model. We analyzed 407 breaths in 13 patients. Both DTF ( p = 0.03) and ∆Pes ( p = 0.002) could detect respiratory activity, and ∆P es and DTF were associated across respiratory conditions ( p < 0.001; R2 = 31%). With increasing inspiratory load, ∆P es increased significantly, while DTF did not ( p = 0.08). Additionally, DT ee did not differ significantly between 10, 5, and 0 cm H 2 O PEEP ( p = 0.08).ConclusionsIn spontaneously breathing sedated children and across different respiratory conditions, DTF could differentiate minimal or no inspiratory effort from substantial inspiratory effort and was associated with ∆P es . Increased efforts resulted in higher ∆P es but not larger DTF.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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