Assessment of weaning indexes based on diaphragm activity in mechanically ventilated subjects after cardiovascular surgery. A pilot study

Abstract

ObjectiveThe aim of this pilot study was to evaluate the feasibility of surface electromyographic signal derived indexes for the prediction of weaning outcomes among mechanically ventilated subjects after cardiac surgery.MethodsA sample of 10 postsurgical adult subjects who received cardiovascular surgery that did not meet the criteria for early extubation were included. Surface electromyographic signals from diaphragm and ventilatory variables were recorded during the weaning process, with the moment determined by the medical staff according to their expertise. Several indexes of respiratory muscle expenditure from surface electromyography using linear and non-linear processing techniques were evaluated. Two groups were compared: successfully and unsuccessfully weaned patients.ResultsThe obtained indexes allow estimation of the diaphragm activity of each subject, showing a correlation between high expenditure and weaning test failure.ConclusionSurface electromyography is becoming a promising procedure for assessing the state of mechanically ventilated patients, even in complex situations such as those that involve a patient after cardiovascular surgery.

Electromiografía de superficie (EMGs) en pacientes adultos en cuidados intensivos: revisión exploratoria

“…Con respecto a los criterios 3 y 5, que hacen referencia al marco muestral basado en población apropiada y al cálculo de la muestra, los tres artículos no cumplieron con estos criterios. El artículo de Muñoz Ortega et al 22 no cumplió con el criterio 6, que corresponde a la selección representativa de la muestra, y con respecto al criterio 10, que corresponde al reporte para estimar la precisión y significancia de los datos, no se identificó cumplimento en el artículo de May et al 23 .…”

“…El objetivo de esta revisión fue explorar las publicaciones científicas relacionadas con el uso de EMGs en pacientes adultos en cuidados intensivos, con o sin ventilación mecánica (VM). La evidencia revisada permitió identificar que el mayor uso reportado se relaciona con fines diagnósticos de eventos neuromusculares 22,23,25 -incluida la DMA-UCI-, así que con el seguimiento durante la evaluación muscular, tanto respiratoria como periférica, en procesos de destete ventilatorio y en el seguimiento de intervenciones terapéuticas. 24,26,27,29 Fueron identificados nueve artículos publicados entre los años 2015 y 2019 en los que se involucraron 88 pacientes en total; además se registró un aumento de publicaciones a partir del año 2017: tres artículos relacionados con el diagnóstico y cuatro con el seguimiento de la DAM-UCI, lo que podría sugerir un creciente interés en el uso de la EMGs como complemento a las estrategias diagnósticas convencionales, tal vez por la relación que tiene la DAM-UCI con el destete difícil y el aumento de días de estancia en UCI identificados por algunos autores [29][30][31] .…”

Removal of ECG Artifacts Affects Respiratory Muscle Fatigue Detection—A Simulation Study

“…In many cases, and especially regarding separability and low EMG levels , the intra-heartbeat approach was significantly worse. Unfortunately, it was not possible for us to include the RLS approach suggested by Ortega et al [ 11 ] into the comparison.…”

“…This work provides guidance for clinical studies to select optimal signal processing to detect fatigue from respiratory sEMG signals. This seems especially important since the algorithms from existing clinical trials are considerably underperforming [ 10 ] or not sufficiently described to be reproduced [ 11 ] in our test scenarios. When the determination of fatigue from respiratory sEMG signals becomes robust and reliable, it will become an interesting tool in clinical decisions.…”

“…They suggested utilizing only signal segments from between 50% and 75% of the RR interval for fatigue analysis and detrended selected segments. Ortega et al [ 11 ] proposed utilizing a fifth order recursive least squares (RLS) filter to produce an artificial electrocardiographic (ECG) signal. This artificial signal claims to cancel cardiogenic interferences by subtraction.…”