Bedside Monitoring of Diaphragm Electrical Activity during Mechanical Ventilation

2009 ◽  
pp. 385-393 ◽  
Author(s):  
C. Sinderby ◽  
J. Beck ◽  
L. Brander
Keyword(s):  
Mechanical Ventilation ◽  
Electrical Activity ◽  
Bedside Monitoring ◽  
Diaphragm Electrical Activity

scholarly journals Respiratory Muscle Effort during Expiration in Successful and Failed Weaning from Mechanical Ventilation

2018 ◽  
Vol 129 (3) ◽  
pp. 490-501 ◽  
Author(s):  
Jonne Doorduin ◽  
Lisanne H. Roesthuis ◽  
Diana Jansen ◽  
Johannes G. van der Hoeven ◽  
Hieronymus W. H. van Hees ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Electrical Activity ◽  
Muscle Activity ◽  
Respiratory Muscle ◽  
Weaning From Mechanical Ventilation ◽  
Expiratory Muscle ◽  
Diaphragm Electrical Activity ◽  
Gastric Pressure ◽  
Weaning Failure ◽  
Expiratory Muscles

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully. Methods Twenty adult patients receiving mechanical ventilation (more than 72 h) performed a spontaneous breathing trial. Tidal volume, transdiaphragmatic pressure, diaphragm electrical activity, and diaphragm neuromechanical efficiency were calculated on a breath-by-breath basis. Inspiratory (and expiratory) muscle efforts were calculated as the inspiratory esophageal (and expiratory gastric) pressure–time products, respectively. Results Nine patients failed weaning. The contribution of the expiratory muscles to total respiratory muscle effort increased in the “failure” group from 13 ± 9% at onset to 24 ± 10% at the end of the breathing trial (P = 0.047); there was no increase in the “success” group. Diaphragm electrical activity (expressed as the percentage of inspiratory peak) was low at end expiration (failure, 3 ± 2%; success, 4 ± 6%) and equal between groups during the entire expiratory phase (P = 0.407). Diaphragm neuromechanical efficiency was lower in the failure versus success groups (0.38 ± 0.16 vs. 0.71 ± 0.36 cm H2O/μV; P = 0.054). Conclusions Weaning failure (vs. success) is associated with increased effort of the expiratory muscles and impaired neuromechanical efficiency of the diaphragm but no difference in tonic activity of the diaphragm.

scholarly journals Feasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental lung injury

2021 ◽  
Author(s):  
Ling Liu ◽  
Daijiro Takahashi ◽  
Haibo Qui ◽  
Arthur S. Slutsky ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Lung Injury ◽  
Electrical Activity ◽  
Esophageal Pressure ◽  
Neurally Adjusted Ventilatory Assist ◽  
Diaphragm Electrical Activity ◽  
New Zealand White Rabbits ◽  
Ventilatory Assist ◽  
Resistive Loading ◽  
Inspiratory Activity ◽  
The Mean

Background During conventional Neurally Adjusted Ventilatory Assist (NAVA), the electrical activity of the diaphragm (EAdi) is used for triggering and cycling-off inspiratory assist, with a fixed PEEP (so called “Triggered Neurally Adjusted Ventilatory Assist” or “tNAVA”). However, significant post-inspiratory activity of the diaphragm can occur, believed to play a role in maintaining end-expiratory lung volume. Adjusting pressure continuously, in proportion to both inspiratory and expiratory EAdi (Continuous NAVA, or cNAVA), would not only offer inspiratory assist for tidal breathing, but also may aid in delivering a “neurally adjusted PEEP”, and more specific breath-by-breath unloading. Methods Nine adult New Zealand white rabbits were ventilated during independent conditions of: resistive loading (RES1 or RES2), CO2 load (CO2) and acute lung injury (ALI), either via tracheotomy (INV) or non-invasively (NIV). There were a total of six conditions, applied in a non-randomized fashion: INV-RES1, INV-CO2, NIV-CO2, NIV-RES2, NIV-ALI, INV-ALI. For each condition, tNAVA was applied first (3 min), followed by 3 min of cNAVA. This comparison was repeated 3 times (repeated cross-over design). The NAVA level was always the same for both modes, but was newly titrated for each condition. PEEP was manually set to zero during tNAVA. During cNAVA, the assist during expiration was proportional to the EAdi. During all runs and conditions, ventilator-delivered pressure (Pvent), esophageal pressure (Pes), and diaphragm electrical activity (EAdi) were measured continuously. The tracings were analyzed breath-by-breath to obtain peak inspiratory and mean expiratory values. Results For the same peak Pvent, the distribution of inspiratory and expiratory pressure differed between tNAVA and cNAVA. For each condition, the mean expiratory Pvent was always higher (for all conditions 4.0 ± 1.1 vs. 1.1 ± 0.5 cmH2O, P < 0.01) in cNAVA than in tNAVA. Relative to tNAVA, mean inspiratory EAdi was reduced on average (for all conditions) by 19 % (range 14 %–25 %), p < 0.05. Mean expiratory EAdi was also lower during cNAVA (during INV-RES1, INV-CO2, INV-ALI, NIV-CO2 and NIV-ALI respectively, P < 0.05). The inspiratory Pes was reduced during cNAVA all 6 conditions (p < 0.05). Unlike tNAVA, during cNAVA the expiratory pressure was comparable with that predicted mathematically (mean difference of 0.2 ± 0.8 cmH2O). Conclusion Continuous NAVA was able to apply neurally adjusted PEEP, which led to a reduction in inspiratory effort compared to triggered NAVA.

Impact of feeding method on diaphragm electrical activity and central apnea in preterm infants (FEAdi study)

2016 ◽  
Vol 101 ◽  
pp. 33-37 ◽  
Author(s):  
Eugene Ng ◽  
Patti Schurr ◽  
Maureen Reilly ◽  
Michael Dunn ◽  
Jennifer Beck
Keyword(s):  
Electrical Activity ◽  
Preterm Infants ◽  
Central Apnea ◽  
Feeding Method ◽  
Diaphragm Electrical Activity

scholarly journals Reference values for diaphragm electrical activity (Edi) in newborn infants

2021 ◽  
Author(s):  
Varappriyangga Gurumahan ◽  
Sriganesh Thavalingam ◽  
Tim Schindler ◽  
John Smyth ◽  
Kei Lui ◽  
...  
Keyword(s):  
Electrical Activity ◽  
Reference Values ◽  
Newborn Infants ◽  
Feeding Tube ◽  
Respiratory Support ◽  
Neurally Adjusted Ventilatory Assist ◽  
Term Infants ◽  
Term Neonates ◽  
Diaphragm Electrical Activity ◽  
The Mean

Background: Neurally adjusted ventilatory assist (NAVA) is an emerging mode of respiratory support that uses the electrical activity of the diaphragm (Edi) to provide synchronised inspiratory pressure support, proportional to an infant’s changing inspiratory effort. Data on Edi reference values for neonates are limited. The objective of this study was to establish reference Edi values for preterm and term neonates. Methods: This was a prospective observational study of newborn infants breathing spontaneously in room air. The Edi signal was monitored by a specialised intragastric feeding tube with embedded electrodes positioned at the level of the diaphragm. Edi minimums and peaks were recorded continuously for four hours. Results: 24 newborn infants (16 preterm [<37 weeks’ gestation]; 8 term) were studied. All infants were breathing comfortably in room air at the time of study. Edi data were successfully captured in all infants. The mean (±SD) Edi minimum was 3.02 (±0.94) µV and the mean Edi peak was 10.13 (±3.50) µV. In preterm infants the mean (±SD) Edi minimum was 3.05 (±0.91) µV and the mean Edi peak was 9.36 (±2.13) µV. In term infants the mean (±SD) Edi minimum was 2.97 (±1.05) µV and the mean Edi peak was 11.66 (±5.14) µV. Conclusion: Reference Edi values were established for both preterm and term neonates. These values can be used as a guide when using diaphragm-triggered modes on respiratory support in newborn infants.

scholarly journals Diaphragm Electrical Activity During Expiration in Mechanically Ventilated Infants

2006 ◽  
Vol 59 (5) ◽  
pp. 705-710 ◽  
Author(s):  
Guillaume Emeriaud ◽  
Jennifer Beck ◽  
Marisa Tucci ◽  
Jacques Lacroix ◽  
Christer Sinderby
Keyword(s):  
Electrical Activity ◽  
Mechanically Ventilated ◽  
Diaphragm Electrical Activity

Continuous neurally adjusted ventilation: a feasibility study in preterm infants

2020 ◽  
Vol 105 (6) ◽  
pp. 640-645
Author(s):  
Marie-Eve Rochon ◽  
Gregory Lodygensky ◽  
Laurence Tabone ◽  
Sandrine Essouri ◽  
Sylvain Morneau ◽  
...  
Keyword(s):  
Electrical Activity ◽  
Preterm Infants ◽  
Feasibility Study ◽  
Neonatal Intensive Care ◽  
Positive Pressure ◽  
Non Invasive ◽  
Diaphragm Electrical Activity ◽  
Registration Number ◽  
Level 3 ◽  
The Impact

ObjectivesTo assess the feasibility and tolerance of NeuroPAP, a new non-invasive ventilation mode which continuously adjusts (during both inspiration and expiration) the pressure support proportionally to the diaphragm electrical activity (Edi), in preterm infants and to evaluate the impact on ventilation pressure and Edi.DesignProspective cross-over single-centre feasibility study.SettingOne level 3 neonatal intensive care unit in Canada.PatientsStable preterm infants ventilated with non-invasive positive pressure ventilation (NIPPV).InterventionsSubjects were successively ventilated in NIPPV with prestudy settings (30 min), in NeuroPAP with minimal pressure similar to NIPPV PEEP (positive end-expiratory pressure) (60 min), in NeuroPAP with minimal pressure reduced by 2 cmH20 (60 min), in continuous positive airway pressure (15 min) and again in NIPPV (30 min). Main outcome measures included tolerance, ventilation pressure, Edi and patient-ventilator synchrony.ResultsTwenty infants born at 28.0±1.0 weeks were included. NeuroPAP was well tolerated and could be delivered during 100% of planned period. During NeuroPAP, the PEEP was continuously adjusted proportionally to tonic diaphragm Edi, although the average PEEP value was similar to the set minimal pressure. During NeuroPAP, 83 (78–86)% breaths were well synchronised vs 9 (6–12)% breaths during NIPPV (p<0.001).ConclusionsNeuroPAP is feasible and well tolerated in stable preterm infants, and it allows transient adaptation in PEEP in response to tonic diaphragm electrical activity changes. Further studies are warranted to determine the impact of these findings on clinical outcomes.Trial registration numberNCT02480205.

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