{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T20:58:47Z","timestamp":1786395527563,"version":"build-2736575974"},"reference-count":48,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL124666"],"award-info":[{"award-number":["R01HL124666"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journal.chestnet.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["CHEST"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.chest.2026.01.032","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:07:48Z","timestamp":1774310868000},"page":"420-431","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diaphragm Thickening Fraction for Predicting Esophageal Pressure and Ventilator Weaning in Children"],"prefix":"10.1016","volume":"170","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6618-5093","authenticated-orcid":false,"given":"Daniel J.","family":"Chang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marsha","family":"Elkhunovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin C.","family":"Hotz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinnel","family":"Bornstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Kohler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anabel","family":"Armenta-Quiroz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy","family":"Vu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Suresh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukie","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoopindar","family":"Bhalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.L.","family":"Newth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robinder G.","family":"Khemani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"8","key":"10.1016\/j.chest.2026.01.032_bib1","doi-asserted-by":"crossref","first-page":"2471","DOI":"10.1002\/ppul.25518","article-title":"A narrative review of diaphragmatic ultrasound in pediatric critical care","volume":"56","author":"Weber","year":"2021","journal-title":"Pediatr Pulmonol"},{"issue":"4","key":"10.1016\/j.chest.2026.01.032_bib2","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1007\/s00134-015-3687-3","article-title":"Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity","volume":"41","author":"Goligher","year":"2015","journal-title":"Intensive Care Med"},{"issue":"7","key":"10.1016\/j.chest.2026.01.032_bib3","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1164\/rccm.202003-0655CP","article-title":"Lung- and diaphragm-protective ventilation","volume":"202","author":"Goligher","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"10.1016\/j.chest.2026.01.032_bib4","doi-asserted-by":"crossref","first-page":"164","DOI":"10.5114\/ait.2022.117273","article-title":"Diaphragm ultrasound to predict weaning outcome: systematic review and meta-analysis","volume":"54","author":"Mahmoodpoor","year":"2022","journal-title":"Anaesthesiol Intensive Ther"},{"key":"10.1016\/j.chest.2026.01.032_bib5","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2023.1211306","article-title":"Accuracy of lung and diaphragm ultrasound in predicting infant weaning outcomes: a systematic review and meta-analysis","volume":"11","author":"Gao","year":"2023","journal-title":"Front Pediatr"},{"issue":"9","key":"10.1016\/j.chest.2026.01.032_bib6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-021189","article-title":"Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: a systematic review and meta-analysis","volume":"8","author":"Qian","year":"2018","journal-title":"BMJ Open"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib7","first-page":"59","article-title":"Patient self-inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathing","volume":"26","author":"Yoshida","year":"2020","journal-title":"Curr Opin Crit Care"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib8","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1186\/s13054-023-04754-6","article-title":"Estimation of inspiratory effort using airway occlusion maneuvers in ventilated children: a secondary analysis of an ongoing randomized trial testing a lung and diaphragm protective ventilation strategy","volume":"27","author":"Ito","year":"2023","journal-title":"Crit Care"},{"key":"10.1016\/j.chest.2026.01.032_bib9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40560-023-00671-6","article-title":"Fundamental concepts and the latest evidence for esophageal pressure monitoring","volume":"11","author":"Shimatani","year":"2023","journal-title":"J Intensive Care"},{"issue":"13","key":"10.1016\/j.chest.2026.01.032_bib10","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1056\/NEJMoa070447","article-title":"Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans","volume":"358","author":"Levine","year":"2008","journal-title":"N Engl J Med"},{"issue":"9","key":"10.1016\/j.chest.2026.01.032_bib11","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1164\/rccm.201503-0620OC","article-title":"Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort","volume":"192","author":"Goligher","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"10.1016\/j.chest.2026.01.032_bib12","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1097\/PCC.0000000000003248","article-title":"The relationship between esophageal pressure and diaphragm thickening fraction in spontaneously breathing sedated children: a feasibility study","volume":"24","author":"De Meyer","year":"2023","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib13","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s13054-020-2777-y","article-title":"Monitoring patient respiratory effort during mechanical ventilation: lung and diaphragm-protective ventilation","volume":"24","author":"Bertoni","year":"2020","journal-title":"Crit Care Lond Engl"},{"issue":"5","key":"10.1016\/j.chest.2026.01.032_bib14","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/PCC.0000000000001485","article-title":"Progressive diaphragm atrophy in pediatric acute respiratory failure","volume":"19","author":"Glau","year":"2018","journal-title":"Pediatr Crit Care Med J"},{"issue":"9","key":"10.1016\/j.chest.2026.01.032_bib15","doi-asserted-by":"crossref","first-page":"e672","DOI":"10.1097\/PCC.0000000000002385","article-title":"Diaphragm atrophy during pediatric acute respiratory failure is associated with prolonged noninvasive ventilation requirement following extubation","volume":"21","author":"Glau","year":"2020","journal-title":"Pediatr Crit Care Med"},{"issue":"6","key":"10.1016\/j.chest.2026.01.032_bib16","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.3390\/diagnostics13061116","article-title":"Diaphragm ultrasound in critically ill patients on mechanical ventilation\u2014evolving concepts","volume":"13","author":"Santana","year":"2023","journal-title":"Diagnostics"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib17","first-page":"18","article-title":"Monitoring diaphragm function in the ICU","volume":"26","author":"Dres","year":"2020","journal-title":"Curr Opin Crit Care"},{"key":"10.1016\/j.chest.2026.01.032_bib18","doi-asserted-by":"crossref","DOI":"10.1177\/11795484231165940","article-title":"Diaphragmatic dynamics and thickness parameters assessed by ultrasonography predict extubation success in critically ill patients","volume":"17","author":"Laguado-Nieto","year":"2023","journal-title":"Clin Med Insights Circ Respir Pulm Med"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib19","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12890-023-02392-w","article-title":"The ratio of respiratory rate to diaphragm thickening fraction for predicting extubation success","volume":"23","author":"Eksombatchai","year":"2023","journal-title":"BMC Pulm Med"},{"issue":"6","key":"10.1016\/j.chest.2026.01.032_bib20","doi-asserted-by":"crossref","DOI":"10.36416\/1806-3756\/e20200064","article-title":"Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses","volume":"46","author":"Vieira Santana","year":"2020","journal-title":"J Bras Pneumol"},{"issue":"6","key":"10.1016\/j.chest.2026.01.032_bib21","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2400360","article-title":"Randomized trial of lung and diaphragm protective ventilation in children","volume":"4","author":"Khemani","year":"2025","journal-title":"NEJM Evid"},{"issue":"2","key":"10.1016\/j.chest.2026.01.032_bib22","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4187\/respcare.05685","article-title":"Measurements obtained from esophageal balloon catheters are affected by the esophageal balloon filling volume in children with ARDS","volume":"63","author":"Hotz","year":"2018","journal-title":"Respir Care"},{"issue":"8","key":"10.1016\/j.chest.2026.01.032_bib23","doi-asserted-by":"crossref","first-page":"e798","DOI":"10.1097\/CCM.0000000000002433","article-title":"Risk factors for pediatric extubation failure: the importance of respiratory muscle strength","volume":"45","author":"Khemani","year":"2017","journal-title":"Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib24","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13054-022-03975-5","article-title":"EXpert consensus on diaphragm ultrasonography in the critically ill (EXODUS): a Delphi consensus statement on the measurement of diaphragm ultrasound-derived parameters in a critical care setting","volume":"26","author":"Haaksma","year":"2022","journal-title":"Crit Care Lond Engl"},{"key":"10.1016\/j.chest.2026.01.032_bib25","doi-asserted-by":"crossref","DOI":"10.1016\/j.cct.2019.105893","article-title":"A phase II randomized controlled trial for lung and diaphragm protective ventilation (Real-time Effort Driven VENTilator management)","volume":"88","author":"Khemani","year":"2020","journal-title":"Contemp Clin Trials"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib26","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.chest.2022.08.2212","article-title":"A 30-minute spontaneous breathing trial misses many children who go on to fail a 120-minute spontaneous breathing trial","volume":"163","author":"Knox","year":"2023","journal-title":"Chest"},{"issue":"8","key":"10.1016\/j.chest.2026.01.032_bib27","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1007\/s00134-016-4387-3","article-title":"Pediatric extubation readiness tests should not use pressure support","volume":"42","author":"Khemani","year":"2016","journal-title":"Intensive Care Med"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib28","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/PCC.0b013e3181b0653d","article-title":"Defining acute lung disease in children with the oxygenation saturation index","volume":"11","author":"Thomas","year":"2010","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib29","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s00134-014-3486-2","article-title":"Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk","volume":"41","author":"Khemani","year":"2015","journal-title":"Intensive Care Med"},{"issue":"4","key":"10.1016\/j.chest.2026.01.032_bib30","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1097\/CCM.0b013e31823bc61b","article-title":"Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury","volume":"40","author":"Khemani","year":"2012","journal-title":"Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib31","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/ALN.0000000000004042","article-title":"Poor correlation between diaphragm thickening fraction and transdiaphragmatic pressure in mechanically ventilated patients and healthy subjects","volume":"136","author":"Poulard","year":"2022","journal-title":"Anesthesiology"},{"key":"10.1016\/j.chest.2026.01.032_bib32","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2023.1147309","article-title":"No association between thickening fraction of the diaphragm and extubation success in ventilated children","volume":"11","author":"Duyndam","year":"2023","journal-title":"Front Pediatr"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib33","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s43055-024-01285-0","article-title":"Role of diaphragmatic ultrasound in predicting weaning success from mechanical ventilation in pediatric intensive care unit","volume":"55","author":"Eskander","year":"2024","journal-title":"Egypt J Radiol Nucl Med"},{"key":"10.1016\/j.chest.2026.01.032_bib34","first-page":"58","article-title":"Ultrasound assessment of ventilator-induced diaphragmatic dysfunction in mechanically ventilated pediatric patients","volume":"40","author":"Valverde Montoro","year":"2021","journal-title":"Paediatr Respir Rev"},{"issue":"12","key":"10.1016\/j.chest.2026.01.032_bib35","doi-asserted-by":"crossref","first-page":"3457","DOI":"10.1002\/ppul.25076","article-title":"Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children","volume":"55","author":"Mistri","year":"2020","journal-title":"Pediatr Pulmonol"},{"issue":"3","key":"10.1016\/j.chest.2026.01.032_bib36","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1007\/s13312-023-2837-1","article-title":"Evaluation of diaphragmatic thickness and dysfunction by ultrasonography in mechanically ventilated children for assessment of extubation success","volume":"60","author":"Vadivelu","year":"2023","journal-title":"Indian Pediatr"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib37","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1186\/s12890-019-1034-0","article-title":"The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children","volume":"19","author":"Xue","year":"2019","journal-title":"BMC Pulm Med"},{"issue":"12","key":"10.1016\/j.chest.2026.01.032_bib38","doi-asserted-by":"crossref","first-page":"3043","DOI":"10.1002\/jum.16035","article-title":"Diaphragmatic thickening fraction by ultrasound in mechanically ventilated pediatric patients: pilot observations during spontaneous breathing trials","volume":"41","author":"Shah","year":"2022","journal-title":"J Ultrasound Med"},{"issue":"6","key":"10.1016\/j.chest.2026.01.032_bib39","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s12098-019-03177-y","article-title":"Diaphragm and lung ultrasound indices in prediction of outcome of weaning from mechanical ventilation in pediatric intensive care unit","volume":"87","author":"Abdel Rahman","year":"2020","journal-title":"Indian J Pediatr"},{"issue":"8","key":"10.1016\/j.chest.2026.01.032_bib40","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0183560","article-title":"Evaluation of diaphragmatic function in mechanically ventilated children: an ultrasound study","volume":"12","author":"Lee","year":"2017","journal-title":"PloS One"},{"key":"10.1016\/j.chest.2026.01.032_bib41","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/s13054-023-04430-9","article-title":"Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis","volume":"27","author":"Parada-Gereda","year":"2023","journal-title":"Crit Care"},{"issue":"6","key":"10.1016\/j.chest.2026.01.032_bib42","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.chest.2019.03.004","article-title":"Inability of diaphragm ultrasound to predict extubation failure","volume":"155","author":"Vivier","year":"2019","journal-title":"Chest"},{"issue":"4","key":"10.1016\/j.chest.2026.01.032_bib43","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1038\/s41390-021-01529-z","article-title":"Respiratory muscle function in the newborn: a narrative review","volume":"91","author":"Dassios","year":"2022","journal-title":"Pediatr Res"},{"issue":"12","key":"10.1016\/j.chest.2026.01.032_bib44","first-page":"5693","article-title":"Diaphragmatic muscle function in term and preterm infants","volume":"182","author":"Fouzas","year":"2023","journal-title":"Eur J Pediatr"},{"issue":"2","key":"10.1016\/j.chest.2026.01.032_bib45","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1152\/jappl.1991.71.2.458","article-title":"Diaphragm muscle fatigue resistance during postnatal development","volume":"71","author":"Sieck","year":"1991","journal-title":"J Appl Physiol"},{"issue":"4","key":"10.1016\/j.chest.2026.01.032_bib46","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1046\/j.1469-7580.2002.00095.x","article-title":"The diaphragm: two physiological muscles in one","volume":"201","author":"Pickering","year":"2002","journal-title":"J Anat"},{"key":"10.1016\/j.chest.2026.01.032_bib47","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/01.ccm.0000551972.18314.11","article-title":"Reproducibility of diaphragm ultrasound in mechanically ventilated children","volume":"47","author":"Pedigo","year":"2019","journal-title":"Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2026.01.032_bib48","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s13054-025-05436-1","article-title":"Diaphragmatic ultrasound and its relationship to breathing effort and load: a prospective observational study","volume":"29","author":"Menis","year":"2025","journal-title":"Crit Care"}],"container-title":["CHEST"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369226003788?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369226003788?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:19:28Z","timestamp":1786353568000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0012369226003788"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":48,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["S0012369226003788"],"URL":"https:\/\/doi.org\/10.1016\/j.chest.2026.01.032","relation":{},"ISSN":["0012-3692"],"issn-type":[{"value":"0012-3692","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Diaphragm Thickening Fraction for Predicting Esophageal Pressure and Ventilator Weaning in Children","name":"articletitle","label":"Article Title"},{"value":"CHEST","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.chest.2026.01.032","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Published by Elsevier Inc under license from the American College of Chest Physicians.","name":"copyright","label":"Copyright"}]}}