Information conveyed by electrical diaphragmatic activity during unstressed, stressed and assisted spontaneous breathing: a physiological study.

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License: CC BY 4.0
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Serval ID
serval:BIB_F0AAB2E20020
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Information conveyed by electrical diaphragmatic activity during unstressed, stressed and assisted spontaneous breathing: a physiological study.
Journal
Annals of intensive care
Author(s)
Piquilloud L., Beloncle F., Richard J.M., Mancebo J., Mercat A., Brochard L.
ISSN
2110-5820 (Print)
ISSN-L
2110-5820
Publication state
Published
Issued date
14/08/2019
Peer-reviewed
Oui
Volume
9
Number
1
Pages
89
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
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.
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.
Median [interquartile range] peak Eadi at baseline was 17 [13-22] μV and was above 10 μV in 92% of the cases. Eadi <sub>max</sub> defined as Eadi measured at maximal inspiratory capacity reached 90 [63 to 99] μV. Median peak Eadi/Eadi <sub>max</sub> 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.
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.
Keywords
Assisted ventilation, Electrical activity of the diaphragm, Esophageal pressure, Inspiratory effort, Respiratory drive, Respiratory pattern, Work of breathing
Pubmed
Web of science
Open Access
Yes
Create date
11/09/2019 15:14
Last modification date
22/01/2020 7:19
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