IntroductionA reliable prediction of successful weaning from respiratory support may be crucial for the overall outcome of the critically ill patient. The electrical activity of the diaphragm (EAdi) allows one to monitor the patients’ respiratory drive and their ability to meet the increased respiratory demand. In this pilot study, we compared the EAdi with conventional parameters of weaning failure, such as the ratio of respiratory rate to tidal volume.MethodsWe studied 18 mechanically ventilated patients considered difficult to wean. For a spontaneous breathing trial (SBT), the patients were disconnected from the ventilator and given oxygen through a T-piece. The SBT was evaluated by using standard criteria.ResultsTwelve patients completed the SBT successfully, and six failed. The EAdi was significantly different in the two groups. We found an early increase in EAdi in the failing patients that was more pronounced than in any of the patients who successfully passed the SBT. Changes in EAdi predicted an SBT failure earlier than did conventional parameters.ConclusionsEAdi monitoring adds valuable information during weaning from the ventilator and may help to identify patients who are not ready for discontinuation of respiratory support.

PurposeNeurally adjusted ventilatory assist (NAVA) relies on the patient’s electrical activity of the diaphragm (EAdi) for actuating the ventilator. Thus a reliable positioning of the oesophageal EAdi catheter is mandatory. We aimed to evaluate the effects of body position (BP), positive end-expiratory pressure (PEEP) and intra-abdominal pressure (IAP) on catheter positioning.MethodsTwenty-one patients were enrolled in this study. In six different situations [supine or 45° head of bed elevation (HBE) at PEEP 5 and 15 cmH2O; left lateral anti-decubitus at PEEP 5 cmH2O; supine at PEEP 5 cmH2O with abdominal surgical belt (ASB)] the catheter position was evaluated for the stability of the EAdi signal and information provided by a catheter positioning tool (highlighted electrical activity in central leads, absence of p waves in the distal lead).ResultsWith an optimal catheter position EAdi signals were stable for all tested situations. During “45° PEEP 15” and “supine PEEP 15” absence of p waves in the distal lead revealed a difference compared with “supine PEEP 5” (p = 0.03), suggesting a caudal shift of the diaphragm relative to the oesophagus. The analysis of the highlighted electrical activity in the central leads supports this finding, revealing an influence of PEEP, BP and IAP on EAdi catheter position (p < 0.01).ConclusionPEEP, BP and IAP may affect the EAdi catheter position, although not compromising a stable signal. Additional information as provided by the catheter positioning tool is needed to ensure an optimal EAdi catheter position.

The role of caregivers in homecare settings is relevant to the patient’s wellbeing and quality of life. This phenomenon is well described in the literature for the oncological setting but not specifically for that of hematological malignancies. The aim of this study was to explore the experience of primary caregivers of patients with hematological malignancies within home care. We conducted a phenomenological study based on interviews with 17 primary caregivers of hematological patients. Analysis of the contents led to the identification of five main themes. Perhaps, the innovative aspects of this study can be summarized in three points: This service was demonstrated to fulfil the ethical aspects of providing the patient with a dignified accompaniment to the end of life. Secondly, the efficiency of the service and the benefit are directly dependent on the caregivers’ wellbeing, so knowledge of the dynamics and emotions involved can lead to the development and implementation of programs for hematological malignancies. Lastly, a collaborative caregivers–professionals relationship can improve a sense of accomplishment for all parties involved, lessening the family’s frustration related to not having done their best. Home care brings significant benefits for both the patient and the caregivers and fulfils the ethical obligation of providing the patient dignified end-of-life care.