Diaphragm ultrasound in assessing and predicting ventilator liberation in critically ill adults: A narrative review
DOI:
https://doi.org/10.62827/fb.v27i8.1292Keywords:
Respiratory Muscles; Ventilator Weaning; Critical Care; Ultrasonography.Abstract
Introduction: Diaphragm ultrasound enables bedside examination of the inspiratory muscles, but the term weaning encompasses distinct outcomes, including spontaneous breathing trial tolerance, extubation success, reintubation, and sustained ventilator liberation. Objective: To critically analyze the contribution of diaphragm ultrasound to respiratory muscle assessment and distinct ventilator liberation outcomes in critically ill adults, considering acquisition conditions, outcome definitions, and demonstrated clinical benefit. Methods: A narrative review was conducted through searches in PubMed and Europe PubMed Central in September 2026, supplemented by reference tracking. Publications from 2021 to 2026 were prioritized, while earlier foundational studies were retained. The synthesis distinguished measurement reliability, physiological validity, prognostic performance, and clinical utility. Results: Thickness, thickening fraction, and excursion provide distinct information influenced by ventilatory support, sedation, and respiratory load. Accuracy studies yielded favorable but heterogeneous results; investigations performed after a successful spontaneous breathing trial did not consistently confirm prediction of extubation failure. A meta-analysis of trials suggested reduced reintubation within 48 hours, with low certainty of evidence. Multimodal assessments showed promising results in selected populations. Conclusion: Diaphragm ultrasound may add information in specific contexts according to the parameter, assessment timing, and outcome analyzed. It should be used as a complementary component, with standardized acquisition and integration with the spontaneous breathing trial, airway protection, cough, secretions, and cardiopulmonary status.
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Copyright (c) 2026 Rafael Viana dos Santos Coutinho, Alessandra Leão Fonseca Silva, Paulo de Oliveira Abrantes, Luana Fernandes Nogueira (Autor)
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