Information conveyed by electrical diaphragmatic activity during unstressed, stressed and assisted spontaneous breathing: a physiological study - 08/01/26
, François Beloncle 1 , Jean-Christophe M. Richard 3, 4 , Jordi Mancebo 5 , Alain Mercat 1 , Laurent Brochard 6, 7
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
This study is registered with ClinicalTrials.gov as NCT01818219.
Abstract |
Background |
The electrical activity of the crural diaphragm (Eadi), a surrogate of respiratory drive, can now be measured at the bedside in mechanically ventilated patients with a specific catheter. The expected range of Eadi values under stressed or assisted spontaneous breathing is unknown. This study explored Eadi values in healthy subjects during unstressed (baseline), stressed (with a resistance) and assisted spontaneous breathing. The relation between Eadi and inspiratory effort was analyzed.
Methods |
Thirteen healthy male volunteers were included in this randomized crossover study. Eadi and esophageal pressure (Peso) were recorded during unstressed and stressed spontaneous breathing and under assisted ventilation delivered in pressure support (PS) at low and high assist levels and in neurally adjusted ventilatory assist (NAVA). Overall eight different situations were assessed in each participant (randomized order). Peak, mean and integral of Eadi, breathing pattern, esophageal pressure–time product (PTPeso) and work of breathing (WOB) were calculated offline.
Results |
Median [interquartile range] peak Eadi at baseline was 17 [13–22] μV and was above 10 μV in 92% of the cases. Eadi max defined as Eadi measured at maximal inspiratory capacity reached 90 [63 to 99] μV. Median peak Eadi/Eadi max ratio was 16.8 [15.6–27.9]%. Compared to baseline, respiratory rate and minute ventilation were decreased during stressed non-assisted breathing, whereas peak Eadi and PTPeso were increased. During unstressed assisted breathing, peak Eadi decreased during high-level PS compared to unstressed non-assisted breathing and to NAVA ( p = 0.047). During stressed breathing, peak Eadi was lower during all assisted ventilation modalities compared to stressed non-assisted breathing. During assisted ventilation, across the different conditions, peak Eadi changed significantly, whereas PTPeso and WOB/min were not significantly modified. Finally, Eadi signal was still present even when Peso signal was suppressed due to high assist levels.
Conclusion |
Eadi analysis provides complementary information compared to respiratory pattern and to Peso monitoring, particularly in the presence of high assist levels.
Trial registration The study was registered as NCT01818219 in clinicaltrial.gov. Registered 28 February 2013
Le texte complet de cet article est disponible en PDF.Keywords : Electrical activity of the diaphragm, Respiratory drive, Esophageal pressure, Inspiratory effort, Work of breathing, Respiratory pattern, Assisted ventilation
Plan
Vol 9 - N° 1
Article 89- 2019 Retour au numéro
Article précédent
- The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis
- Jie Cui, Xuxia Wei, Haijin Lv, Yuntao Li, Ping Li, Zhen Chen, Genglong Liu
- Prediction of mortality in adult patients with sepsis using six biomarkers: a systematic review and meta-analysis
- Andreas Pregernig, Mattia Müller, Ulrike Held, Beatrice Beck-Schimmer
Bienvenue sur EM-consulte, la référence des professionnels de santé.