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<p><?noindent??>Weaning from mechanical ventilation is a critical step in intensive care, though predicting readiness remains challenging. Diaphragm ultrasound has become a widely adopted tool, but its limitations underscore the need for complementary methods that capture the broader spectrum of respiratory muscle activity.</p><p><?noindent??>This narrative review synthesizes current evidence on ultrasound assessment of extra-diaphragmatic respiratory muscles, including parasternal intercostals, abdominal wall muscles, and scalenes, during ventilator weaning.</p><p><?noindent??>A non-systematic search of PubMed and Embase was conducted for studies published between 2020 and 2026. Prospective observational studies evaluating ultrasound parameters of extra-diaphragmatic muscles in ICU patients were included. Study characteristics, definitions of weaning outcomes, diagnostic accuracy, and methodological approaches were narratively analyzed.</p><p><?noindent??>Thirteen studies were identified. Parasternal intercostal thickening fraction consistently showed strong predictive accuracy (AUCs of 0.74–0.98), with bilateral assessment and post-spontaneous-breathing-trial measurements improving specificity. Abdominal muscle thickening fractions demonstrated exceptional accuracy (AUC up to 1.00), particularly in neurological patients where cough strength is crucial. Scalene ultrasound provided complementary insights into accessory inspiratory recruitment, with scalene thickening fraction demonstrating AUC values of 0.83–0.94. Combined approaches, such as integrating parasternal intercostal thickening with airway occlusion pressure (AUC 0.87, specificity 90.7%) or calculating the parasternal intercostal-to-diaphragm thickening fraction ratio (AUC 0.89, sensitivity 94%, specificity 76%), further enhanced predictive performance.</p><p><?noindent??>Ultrasound assessment of extra-diaphragmatic respiratory muscles offers a valuable complement to diaphragm imaging, enabling a more comprehensive evaluation of respiratory mechanics during ventilator weaning. Despite promising accuracy, methodological heterogeneity and lack of standardized protocols remain barriers to clinical implementation. Future multicenter studies and standardized approaches are needed to establish its role in personalized weaning strategies.</p>

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Ultrasound evaluation of extra-diaphragmatic respiratory muscles in predicting weaning outcomes: a narrative review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月13日

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  • Mina Adolf Helmy,
  • Kerlous Adolf Helmy,
  • Sara A. Khatab,
  • Lydia Magdy Milad

摘要

Weaning from mechanical ventilation is a critical step in intensive care, though predicting readiness remains challenging. Diaphragm ultrasound has become a widely adopted tool, but its limitations underscore the need for complementary methods that capture the broader spectrum of respiratory muscle activity.

This narrative review synthesizes current evidence on ultrasound assessment of extra-diaphragmatic respiratory muscles, including parasternal intercostals, abdominal wall muscles, and scalenes, during ventilator weaning.

A non-systematic search of PubMed and Embase was conducted for studies published between 2020 and 2026. Prospective observational studies evaluating ultrasound parameters of extra-diaphragmatic muscles in ICU patients were included. Study characteristics, definitions of weaning outcomes, diagnostic accuracy, and methodological approaches were narratively analyzed.

Thirteen studies were identified. Parasternal intercostal thickening fraction consistently showed strong predictive accuracy (AUCs of 0.74–0.98), with bilateral assessment and post-spontaneous-breathing-trial measurements improving specificity. Abdominal muscle thickening fractions demonstrated exceptional accuracy (AUC up to 1.00), particularly in neurological patients where cough strength is crucial. Scalene ultrasound provided complementary insights into accessory inspiratory recruitment, with scalene thickening fraction demonstrating AUC values of 0.83–0.94. Combined approaches, such as integrating parasternal intercostal thickening with airway occlusion pressure (AUC 0.87, specificity 90.7%) or calculating the parasternal intercostal-to-diaphragm thickening fraction ratio (AUC 0.89, sensitivity 94%, specificity 76%), further enhanced predictive performance.

Ultrasound assessment of extra-diaphragmatic respiratory muscles offers a valuable complement to diaphragm imaging, enabling a more comprehensive evaluation of respiratory mechanics during ventilator weaning. Despite promising accuracy, methodological heterogeneity and lack of standardized protocols remain barriers to clinical implementation. Future multicenter studies and standardized approaches are needed to establish its role in personalized weaning strategies.