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Background  Critical illness has detrimental effects on the diaphragm, but the impact of critical illness on other major muscles of the respiratory pump has been largely neglected. This study aimed to determine the impact of critical illness on the most important muscles of the respiratory muscle pump, especially on the expiratory muscles in children during mechanical ventilation. In addition, the correlation between changes in thickness of the expiratory muscles and the diaphragm was assessed.    Methods  This longitudinal observational cohort study performed at a tertiary pediatric intensive care unit included 34 mechanical ventilated children (&gt; 1 month– &lt; 18 years). Thickness of the diaphragm and expiratory muscles (obliquus interna, obliquus externa, transversus abdominis and rectus abdominis) was assessed daily using ultrasound. Contractile activity was estimated from muscle thickening fraction during the respiratory cycle.    Results  Over the first 4 days, both diaphragm and expiratory muscles thickness decreased (&gt; 10%) in 44% of the children. Diaphragm and expiratory muscle thickness increased (&gt; 10%) in 26% and 20% of the children, respectively. No correlation was found between contractile activity of the muscles and the development of atrophy. Furthermore, no correlation was found between changes in thickness of the diaphragm and the expiratory muscles ( P  = 0.537). Decrease in expiratory muscle thickness was significantly higher in patients failing extubation compared to successful extubation (− 34% vs − 4%,  P  = 0.014).    Conclusions  Changes in diaphragm and expiratory muscles thickness develop rapidly after the initiation of mechanical ventilation. Changes in thickness of the diaphragm and expiratory muscles were not significantly correlated. These data provide a unique insight in the effects of critical illness on the respiratory muscle pump in children.

The impact of critical illness on the expiratory muscles and the diaphragm assessed by ultrasound in mechanical ventilated children