Reliability of ultrasonic diaphragm thickness measurement in mechanically ventilated infants and children : a pilot study

CITATION: Terhart, M. N., et al. 2018. Reliability of ultrasonic diaphragm thickness measurement in mechanically ventilated infants and children : a pilot study. Southern African Journal of Critical Care, 34(1):52-66, doi:10.7196/SAJCC.201.v34i1.344.The original publication is available at http://www.sajcc.org.zaBackground: Diaphragmatic atrophy in mechanically ventilated infants and children may be due to ventilator-induced diaphragmatic dysfunction, which could lead to extubation failure. Ultrasound may be used as a means by which diaphragmatic atrophy can be reliably identified. There are currently no data reporting on the use of ultrasound to monitor diaphragm atrophy in the paediatric population. Objectives: To assess the inter- and intra-rater reliability of using ultrasound to measure diaphragm thickness in mechanically ventilated infants and children. Method: Diaphragm thickness measurements were compared between two individual researchers for inter-rater reliability and between multiple measurements from a single researcher for intra-rater reliability. Measurements were compared using Intraclass correlation coefficients and Bland- Altman plots. Results: Results indicated excellent reliability between measurements for both inter-and intra-rater reliability, with slightly better reliability for intra-rater compared with inter-rater reliability. Intraclass correlation coefficients for inter-rater reliability were between 0.77 and 0.98, and 0.94 for intra-rater reliability. Conclusion: Ultrasound measurements of diaphragm thickness can be used to reliably measure diaphragm thickness in mechanically ventilated infants and children. This modality could therefore be used as a reliable outcome measure for future clinical research studies to establish the relationship between ventilator-induced diaphragmatic atrophy and children who are at risk for extubation failure.http://www.sajcc.org.za/index.php/SAJCC/article/view/344Publisher's versio