Diaphragm Electrical Stimulation and Ultrasound Evaluation: A Narrative Review of Adult Evidence and Pediatrics Research Gap

Abstract

Context: Extubation failure in patients remains a significant clinical challenge, leading to prolonged mechanical ventilation, increased morbidity, and higher healthcare costs. The diaphragm, as the primary inspiratory muscle, plays a central role in successful weaning and extubation. Prolonged mechanical ventilation induces ventilator-induced diaphragm dysfunction (VIDD), characterized by muscle atrophy, reduced contractility, and impaired excursion. Bedside ultrasound has emerged as a reliable tool to assess diaphragmatic function through parameters such as excursion and thickening fraction (TF), which correlate strongly with extubation outcomes. Diaphragm electrical stimulation has been proposed as a therapeutic strategy to preserve muscle strength and mitigate VIDD. Evidence Acquisition: This narrative review synthesizes current evidence on the role of diaphragm electrical stimulation in improving diaphragmatic excursion and thickening, as measured by ultrasound, and explores its association with extubation success in mechanically ventilated patients. The review discusses physiological mechanisms, methodological approaches, clinical studies, and identifies existing gaps in adult and pediatric research. Results: Evidence indicates that ultrasound parameters of diaphragmatic excursion and TF are reliable predictors of extubation success. Electrical stimulation shows promise in preserving diaphragm muscle function and mitigating VIDD. However, pediatric-specific data remain limited, and variability in stimulation protocols and ultrasound assessment methods pose challenges. Conclusions: Combining ultrasound monitoring with diaphragm electrical stimulation represents a promising approach to enhance weaning outcomes in patients. Further pediatric-focused research is needed to standardize protocols and validate efficacy in this vulnerable population.