ERS Respiratory Failure & Mechanical Ventilation · Rotterdam 2026

From physiological insight to bedside decisions

Professor Alexandre Demoule on continuous diaphragm monitoring — diaphragm dysfunction in the ICU, and how objective, continuous measurement can support safer decisions at the bedside.

Diaphragm dysfunction is one of the most common — and most overlooked — drivers of weaning failure in the ICU. It develops quickly under mechanical ventilation, it is difficult to detect clinically, and it carries real consequences for how long patients stay ventilated.

In this talk from ERS RFMV 2026 in Rotterdam, Professor Alexandre Demoule walks through the physiology of diaphragm dysfunction, the evidence linking it to weaning and extubation failure, and the studies behind continuous, operator-independent diaphragm monitoring.

He closes with the question that matters most at the bedside: what does this actually change in practice?

What the evidence shows

Diaphragm dysfunction is common and consequential. It affects more than 60% of patients on mechanical ventilation — up to around 80% in prolonged ventilation — and is associated with weaning failure, prolonged ventilation and longer ICU stays.

It contributes to weaning and extubation failure. Diaphragm dysfunction is a common —and frequently undetected — driver of failed weaning and reintubation, historically hard to measure reliably and continuously at the bedside.

Guidelines already point this way. ESICM consensus recommends that estimating diaphragmatic excursion with ultrasound should be considered a basic skill for intensivists, particularly in patients being weaned from mechanical ventilation.

DXT gives an objective, validated threshold (DE-RISK WF). Continuous DXT monitoring during the spontaneous breathing trial provides a validated cut-off: a diaphragm excursion below 1.1 cm is associated with an ~8x~ higher risk of extubation failure (relative risk 7.9).

It can lowers the barrier to routine use. Objective and reproducible, DXT reduces inter-operator variability and lowers the technical and training burden versus intermittent, expertise dependent ultrasound.

DE < 1.1 cm = ~8x risk

Higher risk of extubation failure. RESPINOR DXT's validated threshold — measured ccontinuously and objectively at the bedside during the SBT.

Demoule et al. (2024). Continuous diaphragm monitoring during the spontaneous breathing trial identifies patients at risk of extubation failure. (conference abstract). AJRCCM.

See what he's describing — DXT, live

During the session, DXT was demonstrated live on stage: Two sensors placed non-invasively on the chest and back, then continuous, real-time diaphragm excursion and respiratory rate displayed throughout a spontaneous breathing trial — no ultrasound expertise required at the bedside.

About the expert

Professor Alexandre Demoule

is a professor of intensive care medicine at the Sorbonne University, in Paris.

He is the medical director of the medical intensive care unit, the step-down unit and the weaning centre within the Division of Pneumology and Intensive Care Medicine, La Pitié-Salpêtrière teaching hospital in Paris.

As the previous chair of the European Research Network on Mechanical Ventilation (REVA), he is an internationally recognized expert in mechanical ventilation and diaphragm dysfunction and has served as the principal investigator in multiple clinical studies evaluating DXT.

Professor Alexandre Demoule