Feasibility and Interest of Continuous Diaphragmatic Fatigue Monitoring Using Wavelet Denoising in ICU and Anesthesia

Measures of diaphragmatic electromyography (Edi), and respiratory mechanics, have demonstrated early changes before clinical complications. However, automatic Edi data collection is not adequate today due mainly to severe artefacts as well as to loss of signal. We thus intended to develop a new device with embedded artificial intelligence to optimize automatic Edi recordings independantly of artefacts and of probe displacement. We first chose the best mathematical tool to denoise Edi, using an established database, giving multiresolution wavelets as the best, resulting in the permanent availability of the H/L spectral index, a recognized representative of diaphragmatic fatigue. Fatigue was simultaneously measured using the classical mechanical f/Vt index (Rapid Shallow Breathing Index, RSBI), as well as the transdiaphragmatic pressure. We then performed a comparison of real-time H/L and RSBI in a group of seven healthy volunteers, before and during midazolam sedation infusion 0.1 mg.kg-1, with a parallel CPAP administration (2.5, 5.0, and 10 cm H2O) intended to compensate for airways resistance due to midazolam. Procedure was ended by delivering the antagonistic flumazenil 0.2 to 0.5 mg.kg-1. Progressive fatigue due to midazolam, the relief due to CPAP, as well as the answer to the anatgonist flumazenil, were shown earlier by the H/L index than by the RSBI change. Our new H/L monitoring device may greatly improve clinical follow-up of anesthetized patients as well as help to determine the optimal period for ventilatory weaning in ICU (Clinical Trials NCT00133939).

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Effect of inspiratory muscle fatigue on breathing pattern during inspiratory resistive loading

Journal of Applied Physiology ◽

10.1152/jappl.1991.70.4.1627 ◽

1991 ◽

Vol 70 (4) ◽

pp. 1627-1632 ◽

Cited By ~ 11

Author(s):

M. J. Mador ◽

F. A. Acevedo

Keyword(s):

Muscle Fatigue ◽

Breathing Pattern ◽

Inspiratory Muscle ◽

Transdiaphragmatic Pressure ◽

Inspiratory Muscles ◽

Resistive Loading ◽

Diaphragmatic Fatigue ◽

Shallow Breathing ◽

Resistive Loads ◽

Inspiratory Muscle Fatigue

The purpose of this study was to determine whether induction of either inspiratory muscle fatigue (expt 1) or diaphragmatic fatigue (expt 2) would alter the breathing pattern response to large inspiratory resistive loads. In particular, we wondered whether induction of fatigue would result in rapid shallow breathing during inspiratory resistive loading. The breathing pattern during inspiratory resistive loading was measured for 5 min in the absence of fatigue (control) and immediately after induction of either inspiratory muscle fatigue or diaphragmatic fatigue. Data were separately analyzed for the 1st and 5th min of resistive loading to distinguish between immediate and sustained effects. Fatigue was achieved by having the subjects breathe against an inspiratory threshold load while generating a predetermined fraction of either the maximal mouth pressure or maximal transdiaphragmatic pressure until they could no longer reach the target pressure. Compared with control, there were no significant alterations in breathing pattern after induction of fatigue during either the 1st or 5th min of resistive loading, regardless of whether fatigue was induced in the majority of the inspiratory muscles or just in the diaphragm. We conclude that the development of inspiratory muscle fatigue does not alter the breathing pattern response to large inspiratory resistive loads.

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Product of driving pressure and respiratory rate for predicting weaning outcomes

Journal of International Medical Research ◽

10.1177/03000605211010045 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110100

Author(s):

Ju Gong ◽

Bibo Zhang ◽

Xiaowen Huang ◽

Bin Li ◽

Jian Huang

Keyword(s):

Mechanical Ventilation ◽

Respiratory Rate ◽

Spontaneous Breathing ◽

Spontaneous Breathing Trial ◽

Plateau Pressure ◽

Driving Pressure ◽

Failure Group ◽

Rapid Shallow Breathing Index ◽

Weaning Failure ◽

Shallow Breathing

Objective Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3

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Detection of diaphragmatic fatigue in man by phrenic stimulation

Journal of Applied Physiology ◽

10.1152/jappl.1981.50.3.538 ◽

1981 ◽

Vol 50 (3) ◽

pp. 538-544 ◽

Cited By ~ 126

Author(s):

M. Aubier ◽

G. Farkas ◽

A. De Troyer ◽

R. Mozes ◽

C. Roussos

Keyword(s):

Phrenic Nerve ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Low Frequencies ◽

Transdiaphragmatic Pressure ◽

Control Value ◽

Transcutaneous Stimulation ◽

Diaphragmatic Fatigue ◽

Residual Capacity ◽

Stimulation Of

Transdiaphragmatic pressure (Pdi) was measured at functional residual capacity (FRC) in four normal seated subjects during supramaximal, supraclavicular transcutaneous stimulation of one phrenic nerve (10, 20, 50, and 100 Hz--0.1 ms duration) before and after diaphragmatic fatigue, produced by breathing through a high alinear inspiratory resistance. Constancy of chest wall configuration was achieved by placing a cast around the abdomen and the lower one-fourth of the rib cage. Pdi increased with frequency of stimulation, so that at 10, 20, and 50 Hz, the Pdi generated was 32 +/- 4 (SE), 70 +/- 3, and 98 +/- 2% of Pdi at 100 Hz, respectively. After diaphragmatic fatigue, Pdi was less than control at all frequencies of stimulation. Recovery for high stimulation frequencies was complete at 10 min, but at low stimulation frequencies recovery was slow: after 30 min of recovery, Pdi at 20 Hz was 31 +/- 7% of the control value. It is concluded that diaphragmatic fatigue can be detected in man by transcutaneous stimulation of the phrenic nerve and that diaphragmatic strength after fatigue recovers faster at high than at low frequencies of stimulation. Furthermore, it is suggested that this long-lasting element of fatigue might occur in patients with chronic obstructive lung disease, predisposing them to respiratory failure.

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Use of a hygroscopic heat-and-moisture exchanger during the rapid shallow breathing index

Critical Care ◽

10.1186/cc14704 ◽

2015 ◽

Vol 19 (S2) ◽

Author(s):

Rodrigo C Borges ◽

Leda TY Silveira ◽

Juliana B Fernandes ◽

Natalia S Arco ◽

Samira P Furtado ◽

...

Keyword(s):

Heat And Moisture Exchanger ◽

Moisture Exchanger ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Heat And Moisture ◽

Rapid Shallow Breathing

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Rapid Shallow Breathing Index and Its Predictive Accuracy Measured under Five Different Ventilatory Strategies in the Same Patient Group

The Chinese Journal of Physiology ◽

10.4077/cjp.2010.amk013 ◽

2010 ◽

Vol 53 (1) ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Mauo-Ying Bien

Keyword(s):

Patient Group ◽

Predictive Accuracy ◽

Under Five ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing

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The Rapid Shallow Breathing Index as a Predictor of Failure of Noninvasive Ventilation for Patients With Acute Respiratory Failure

Respiratory Care ◽

10.4187/respcare.01597 ◽

2012 ◽

Vol 57 (10) ◽

pp. 1548-1554 ◽

Cited By ~ 16

Author(s):

Katherine M Berg ◽

Gerald R Lang ◽

Justin D Salciccioli ◽

Eske Bak ◽

Michael N Cocchi ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Noninvasive Ventilation ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing

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Regulation of breathing pattern by IL-10

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00065.2019 ◽

2019 ◽

Vol 317 (1) ◽

pp. R190-R202 ◽

Cited By ~ 1

Author(s):

Charoula Eleni Giannakopoulou ◽

Adamantia Sotiriou ◽

Maria Dettoraki ◽

Michael Yang ◽

Fotis Perlikos ◽

...

Keyword(s):

Tidal Volume ◽

Minute Ventilation ◽

Control Of Breathing ◽

Neonatal Rat ◽

Whole Body ◽

Wild Type ◽

Rapid Shallow Breathing Index ◽

Regulation Of Breathing ◽

Shallow Breathing

Proinflammatory cytokines like interleukin-1β (IL-1β) affect the control of breathing. Our aim is to determine the effect of the anti-inflammatory cytokine IL-10 οn the control of breathing. IL-10 knockout mice (IL-10−/−, n = 10) and wild-type mice (IL-10+/+, n = 10) were exposed to the following test gases: hyperoxic hypercapnia 7% CO2-93% O2, normoxic hypercapnia 7% CO2-21% O2, hypoxic hypercapnia 7% CO2-10% O2, and hypoxic normocapnia 3% CO2-10% O2. The ventilatory function was assessed using whole body plethysmography. Recombinant mouse IL-10 (rIL-10; 10 μg/kg) was administered intraperitoneally to wild-type mice ( n = 10) 30 min before the onset of gas challenge. IL-10 was administered in neonatal medullary slices (10–30 ng/ml, n = 8). We found that IL-10−/−mice exhibited consistently increased frequency and reduced tidal volume compared with IL-10+/+mice during room air breathing and in all test gases (by 23.62 to 33.2%, P < 0.05 and −36.23 to −41.69%, P < 0.05, respectively). In all inspired gases, the minute ventilation of IL-10−/−mice was lower than IL-10+/+(by −15.67 to −22.74%, P < 0.05). The rapid shallow breathing index was higher in IL-10−/−mice compared with IL-10+/+mice in all inspired gases (by 50.25 to 57.5%, P < 0.05). The intraperitoneal injection of rIL-10 caused reduction of the respiratory rate and augmentation of the tidal volume in room air and also in all inspired gases (by −12.22 to −29.53 and 32.18 to 45.11%, P < 0.05, respectively). IL-10 administration in neonatal rat ( n = 8) in vitro rhythmically active medullary slice preparations did not affect either rhythmicity or peak amplitude of hypoglossal nerve discharge. In conclusion, IL-10 may induce a slower and deeper pattern of breathing.

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Ventilator induced Diaphragmatic Dysfunction assessed by Ultrasonography and its impact on Weaning outcome

QJM ◽

10.1093/qjmed/hcaa039.066 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H M A Fawzy ◽

M H M Hassan ◽

A A M Alkholy

Keyword(s):

Mechanical Ventilation ◽

Operating Characteristics ◽

Diaphragmatic Dysfunction ◽

Rapid Shallow Breathing Index ◽

Weaning Failure ◽

Significant Difference ◽

Shallow Breathing ◽

Ventilation Modes ◽

Weaning Outcome ◽

Rapid Shallow Breathing

Abstract Background Ventilator induced diaphragmatic dysfunction (VIDD), as a loss of diaphragmatic force generating capacity due to the use of mechanical ventilation. Difficulties in discontinuing ventilatory support are encountered in 20–25% of mechanically ventilated patients, with a staggering 40% of time spent in the intensive care unit being devoted to weaning. M-mode ultrasonography is now an accepted qualitative method of assessing diaphragmatic motion in normal and pathological conditions. In this study, we evaluated whether diaphragmatic excursion (DE) as measured by M-mode sonography can be a predictor of weaning and diagnosis of VIDD. Aim The aim of this study is to determine the presence of ventilator induced diaphragmatic dysfunction (VIDD) diagnosed by M-mode ultrasonography and its impact on weaning outcome. Methodology This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 78 patients between August 2017 to August 2018. who required mechanical ventilation ≥72hrs. who fulfilled the spontaneous breath trial (SBT) criteria, at the start of a 1-hr SBT, each hemidiaphragm was evaluated M-mode sonography with the patient in the supine position. Rapid shallow Breathing index (RSBI) was simultaneously calculated at the bedside. Ultrasonographic Diaphragmatic Dysfunction (DD) was diagnosed if an Diaphragmatic Excursion (DE) was <10 mm or negative, the latter indicating paradoxical diaphragmatic movement. Results Diaphragmatic Dysfunction (DD) among the eligible 78 patients was 48% (n = 37). DD group had longer weaning time [39,2 (26-56) hrs. vs. 22.3 (30-16) hrs. p = 0.001) in DD vs. NDD group respectively and total ventilation time [140 (130-150) hrs. vs. 130 (120–140) hrs. p > 0.05) in DD vs. NDD group respectively. Weaning failure was (45.8% vs. 30.8%, p=0.01) in DD vs. NDD group respectively. In NDD group Rt. DE, mean 25.4 ±4.1 mm. While Lt. side was 25.3±4.6 mm, 11.25mm and 22mm (45-15) respectively. In DD group Rt. DE, mean 7.6 ±2.02mm, IQR 2.4 mm and median 8.2mm (10-1.9). While Lt. side was 9.2±0.8mm, 4.3mm and 8.9mm (9.8-5.7) respectively. The area under the receiver operating characteristics curve (ROC) of ultrasonographic criteria in predicting weaning failure was near similar to that of rapid shallow breathing index. Hypercapenic acidosis in NDD group might protect them from VIDD Conclusions DD is present in a significant percentage 48% (nearly half) of our medical ICU patients on MV ≥ 72 hrs which largely account for weaning failure. DD was associated with a significant longer weaning time, and ICU stay, with no significant difference in 30 day mortality Recommendations DE by US measurements is a valuable tool and is recommended as an adjunctive weaning index to aid prediction of weaning outcome. Evaluating the role of spontaneous ventilation modes and advanced ventilation modes as PAV and NAVA effects on decreas ing VIDD versus controlled modes.

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