The effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort study
Abstract Background Respiratory muscle weakness is common in critically ill children. Changes in respiratory muscle structure play pivotal role in the development of weakness. Echogenicity is a non-invasive marker to detect structural changes in skeletal muscles. In this study, we evaluated respirat...
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2025-07-01
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| author | Marloes M. Ijland Jeroen L. M. van Doorn Axel Beukman Johannes G. van der Hoeven Joris Lemson Leo M. A. Heunks Jonne Doorduin |
| author_facet | Marloes M. Ijland Jeroen L. M. van Doorn Axel Beukman Johannes G. van der Hoeven Joris Lemson Leo M. A. Heunks Jonne Doorduin |
| author_sort | Marloes M. Ijland |
| collection | DOAJ |
| description | Abstract Background Respiratory muscle weakness is common in critically ill children. Changes in respiratory muscle structure play pivotal role in the development of weakness. Echogenicity is a non-invasive marker to detect structural changes in skeletal muscles. In this study, we evaluated respiratory muscle echogenicity in critically ill ventilated children at PICU admission compared to a control group and its change over time. Secondary, we explored its association with clinical parameters and outcome. Methods Two cohorts were studied: a secondary analysis of a prospective longitudinal observational cohort study in mechanically ventilated children (n = 32) and a prospective control group (n = 13) for obtaining reference values. Ultrasound images of the diaphragm and expiratory muscles were analysed. Muscle echogenicity, muscle thickness, muscle thickening fraction, clinical parameters (inflammation, fluid balance and protein intake) and clinical outcome measurements (ventilation free days, extubation failure and 28-day mortality) were collected. Results The analysis included 174 diaphragm ultrasounds and 144 expiratory respiratory muscles ultrasounds. Echogenicity at PICU admission was not different from controls; for the diaphragm: 27.3 [20.0–32.0] vs 26.3 [19.3–29.3] (P = 0.488), m. obliquus externus: 32.2 [25.5–37.9] vs 34.0 [28.0–51.3] (P = 0.166), m. obliquus interna: 29.8 [25.8–38.8] vs 33.0 [27.8–39.3] (P = 0.390), m. transversus: 30.0 [20.8–38.8] vs 32.3 [24.7–37.0] (P = 0.762), respectively. There was no increase in respiratory muscle echogenicity after four days of mechanical ventilation, though a substantial interindividual variation existed. No correlation was found between changes in echogenicity and changes in muscle thickness, thickening fraction and echogenicity on day four of mechanical ventilation, or clinical outcome. The intra-observer repeatability of the echogenicity for all the respiratory muscles was excellent (all ≥ 0.97). Conclusion In critically ill children, four days of mechanical ventilation does not result in an increase in respiratory muscle echogenicity. Our findings suggest that short periods of mechanical ventilation with relatively low ventilator setting in moderate critically ill children do not lead to large structural changes in the respiratory muscles. |
| format | Article |
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| institution | Kabale University |
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| publishDate | 2025-07-01 |
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| spelling | doaj-art-7ff3d4fbc17c4e1f9348dd4fa054048f2025-08-20T04:01:36ZengBMCBMC Pediatrics1471-24312025-07-0125111310.1186/s12887-025-05827-xThe effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort studyMarloes M. Ijland0Jeroen L. M. van Doorn1Axel Beukman2Johannes G. van der Hoeven3Joris Lemson4Leo M. A. Heunks5Jonne Doorduin6Department of Intensive Care Medicine, Radboud University Medical CenterDepartment of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterDepartment of Intensive Care Medicine, Radboud University Medical CenterDepartment of Intensive Care Medicine, Radboud University Medical CenterDepartment of Intensive Care Medicine, Radboud University Medical CenterDepartment of Intensive Care Medicine, Radboud University Medical CenterDepartment of Intensive Care Medicine, Radboud University Medical CenterAbstract Background Respiratory muscle weakness is common in critically ill children. Changes in respiratory muscle structure play pivotal role in the development of weakness. Echogenicity is a non-invasive marker to detect structural changes in skeletal muscles. In this study, we evaluated respiratory muscle echogenicity in critically ill ventilated children at PICU admission compared to a control group and its change over time. Secondary, we explored its association with clinical parameters and outcome. Methods Two cohorts were studied: a secondary analysis of a prospective longitudinal observational cohort study in mechanically ventilated children (n = 32) and a prospective control group (n = 13) for obtaining reference values. Ultrasound images of the diaphragm and expiratory muscles were analysed. Muscle echogenicity, muscle thickness, muscle thickening fraction, clinical parameters (inflammation, fluid balance and protein intake) and clinical outcome measurements (ventilation free days, extubation failure and 28-day mortality) were collected. Results The analysis included 174 diaphragm ultrasounds and 144 expiratory respiratory muscles ultrasounds. Echogenicity at PICU admission was not different from controls; for the diaphragm: 27.3 [20.0–32.0] vs 26.3 [19.3–29.3] (P = 0.488), m. obliquus externus: 32.2 [25.5–37.9] vs 34.0 [28.0–51.3] (P = 0.166), m. obliquus interna: 29.8 [25.8–38.8] vs 33.0 [27.8–39.3] (P = 0.390), m. transversus: 30.0 [20.8–38.8] vs 32.3 [24.7–37.0] (P = 0.762), respectively. There was no increase in respiratory muscle echogenicity after four days of mechanical ventilation, though a substantial interindividual variation existed. No correlation was found between changes in echogenicity and changes in muscle thickness, thickening fraction and echogenicity on day four of mechanical ventilation, or clinical outcome. The intra-observer repeatability of the echogenicity for all the respiratory muscles was excellent (all ≥ 0.97). Conclusion In critically ill children, four days of mechanical ventilation does not result in an increase in respiratory muscle echogenicity. Our findings suggest that short periods of mechanical ventilation with relatively low ventilator setting in moderate critically ill children do not lead to large structural changes in the respiratory muscles.https://doi.org/10.1186/s12887-025-05827-xUltrasonographyEchogenicityMechanical ventilationChildrenDiaphragmRespiratory muscles |
| spellingShingle | Marloes M. Ijland Jeroen L. M. van Doorn Axel Beukman Johannes G. van der Hoeven Joris Lemson Leo M. A. Heunks Jonne Doorduin The effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort study BMC Pediatrics Ultrasonography Echogenicity Mechanical ventilation Children Diaphragm Respiratory muscles |
| title | The effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort study |
| title_full | The effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort study |
| title_fullStr | The effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort study |
| title_full_unstemmed | The effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort study |
| title_short | The effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children: an observational cohort study |
| title_sort | effect of mechanical ventilation on respiratory muscle echogenicity in critically ill children an observational cohort study |
| topic | Ultrasonography Echogenicity Mechanical ventilation Children Diaphragm Respiratory muscles |
| url | https://doi.org/10.1186/s12887-025-05827-x |
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