ReviewJournal of thoracic disease2026
Application of bedside ultrasound assessment of diaphragmatic function in preparing tracheostomised patients for ventilator liberation and decannulation: a narrative review.
Review in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
6 authors.
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Abstract
Background and Objective: In tracheostomised patients, achieving successful liberation from mechanical ventilation (MV) and subsequent decannulation remains challenging. Diaphragmatic performance directly affects decannulation outcomes, and its monitoring is especially useful in prolonged MV. Bedside ultrasound is non‑invasive, dynamic, and repeatable, enabling quantitative assessment of diaphragmatic excursion, thickness, and thickening fraction. This narrative review summarises current evidence on diaphragm ultrasound during weaning preparation in tracheostomised patients and clarifies how evidence from endotracheal tube (ETT) extubation studies may translate to this population. Methods: A literature search of PubMed, Web of Science, and Wanfang Data identified 87 records. After screening, 17 studies were included. Data were extracted on ultrasound parameters [diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), thickness] and ventilator liberation outcomes. The search used keywords "bedside ultrasound", "diaphragmatic function", "tracheotomy", "MV", and "decannulation", limited to English/Chinese publications within the last 10 years, with no age or country restrictions. Key Content and Findings: Main ultrasound parameters include DE and DTF. Higher DTF and adequate DE are generally associated with successful ventilator liberation, yet reported thresholds vary by patient population, ventilator support level, spontaneous breathing trial (SBT) protocol, and measurement technique. Evidence directly derived from tracheostomised cohorts is limited; thus, external validity of cut‑offs derived from extubation cohorts should be interpreted with caution in tracheostomised patients. Integrating diaphragm ultrasound with lung and cardiac ultrasound may improve prediction of weaning outcomes. Conclusions: Bedside diaphragm ultrasound is a practical adjunct for assessing respiratory pump function during ventilator liberation planning. In tracheostomised patients, it should be used to support multidisciplinary decision-making for ventilator liberation and, as a separate step, decannulation readiness. Reported ultrasound cut-offs are context-dependent and should not be used as standalone criteria. Future research should prioritize standardized measurement protocols and prospective validation in tracheostomised populations.
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