*Algorithmic approach to diagnose Bilateral Diaphragmatic Dysfunction* *Parameters:* 1. VC < 50% predicted (and) 2. Decrease in VC> 30% on supine or MIP <30% predicted. *Ultrasound* Diaphragmatic Thickening Fraction (TFDi) <20%. *Unilateral phrenic stimulation* shows Twitch Diaphragmatic pressure (Pdi tw) <20 cm H20. *Management* 1. Non Invasive positive pressure ventilation if the patient has any of the following - PaCo2 > 45mmHg - Spo2 < 88% for more than 5 minutes. - MIP < 60% or VC < 50% predicted. 2. Phrenic Nerve pacing if patient has - Upper level spinal injury with intact phrenic nerve stimulation - persistent respiratory failure. *#medlung Talks 🫁* *#decode & Learn*