Measurement of Diaphragmatic Electrical Activity by Surface Electromyography in Intubated Subjects and Its Relationship With Inspiratory Effort

Bellani, Giacomo; Bronco, Alfio; Marocco, Stefano Arrigoni; Pozzi, Matteo; Sala, V.; Eronia, Nilde; Villa, Giulia; Tagliabue, Giovanni; Eger, Marcus; Pesenti, Antonio

doi:10.4187/respcare.06176

Cited by 43 publications

(79 citation statements)

References 29 publications

(28 reference statements)

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“…Shear wave elastography is an ultrasound-based imaging technique that noninvasively measures shear wave velocity propagating in a target tissue and shear wave velocity is directly correlated with stiffness index (shear modulus) (32). (34). EAdi can be interpreted together with the breathing pattern in order to evaluate the transformation of drive (EAdi) into pressure or tidal volume (VT) (neuromechanical coupling).…”

Section: Diaphragm Ultrasoundmentioning

confidence: 99%

Monitoring diaphragm function in the ICU

Dres

Demoule

2020

Current Opinion in Critical Care

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This article reviews the clinical problem of diaphragm function in critically ill patients and describes recent advances in bedside monitoring of diaphragm function. Recent findings Diaphragm weakness, a consequence of diaphragm dysfunction and atrophy, is a common condition in the intensive care unit and is associated with serious clinical consequences. Bedside diaphragm function monitoring can now be performed by means of two approaches: diaphragm electrical activity and diaphragm ultrasound. The use of ultrasound to assess diaphragm structure (thickness, thickening) and mobility (caudal displacement) appears to be feasible and reproducible, but no large-scale "real-life" study is available. Diaphragm ultrasound can also be used to evaluate diaphragm muscle stiffness by means of shear wave elastography and strain by means of speckle tracking, both of which are correlated with diaphragm function in healthy subjects. Electrical activity of the diaphragm is correlated with diaphragm function during brief airway occlusion, but the repeatability of these measurements exhibits high within-subject variability.

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Section: Diaphragm Ultrasoundmentioning

confidence: 99%

Monitoring diaphragm function in the ICU

Dres

Demoule

2020

Current Opinion in Critical Care

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“…However, both techniques are invasive and the multi-electrode esophageal catheter is only available with one specific ventilator (Servo-i/u). However, EAdi can also be obtained using surface electrodes [17,18], although with specific challenges, especially in obese patients, or after abdominal surgery. Therefore, it is of interest to investigate surrogate markers for respiratory drive, such as activity of extradiaphragmatic inspiratory muscles [19].…”

Section: Introductionmentioning

confidence: 99%

Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support

Roesthuis

Hoeven

Hees

et al. 2020

Ann. Intensive Care

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Background: Inappropriate ventilator assist plays an important role in the development of diaphragm dysfunction. Ventilator under-assist may lead to muscle injury, while over-assist may result in muscle atrophy. This provides a good rationale to monitor respiratory drive in ventilated patients. Respiratory drive can be monitored by a nasogastric catheter, either with esophageal balloon to determine muscular pressure (gold standard) or with electrodes to measure electrical activity of the diaphragm. A disadvantage is that both techniques are invasive. Therefore, it is interesting to investigate the role of surrogate markers for respiratory dive, such as extradiaphragmatic inspiratory muscle activity. The aim of the current study was to investigate the effect of different inspiratory support levels on the recruitment pattern of extradiaphragmatic inspiratory muscles with respect to the diaphragm and to evaluate agreement between activity of extradiaphragmatic inspiratory muscles and the diaphragm. Methods: Activity from the alae nasi, genioglossus, scalene, sternocleidomastoid and parasternal intercostals was recorded using surface electrodes. Electrical activity of the diaphragm was measured using a multi-electrode nasogastric catheter. Pressure support (PS) levels were reduced from 15 to 3 cmH 2 O every 5 min with steps of 3 cmH 2 O. The magnitude and timing of respiratory muscle activity were assessed. Results: We included 17 ventilated patients. Diaphragm and extradiaphragmatic inspiratory muscle activity increased in response to lower PS levels (36 ± 6% increase for the diaphragm, 30 ± 6% parasternal intercostals, 41 ± 6% scalene, 40 ± 8% sternocleidomastoid, 43 ± 6% alae nasi and 30 ± 6% genioglossus). Changes in diaphragm activity correlated best with changes in alae nasi activity (r 2 = 0.49; P < 0.001), while there was no correlation between diaphragm and sternocleidomastoid activity. The agreement between diaphragm and extradiaphragmatic inspiratory muscle activity was low due to a high individual variability. Onset of alae nasi activity preceded the onset of all other muscles. Conclusions: Extradiaphragmatic inspiratory muscle activity increases in response to lower inspiratory support levels. However, there is a poor correlation and agreement with the change in diaphragm activity, limiting the use of surface electromyography (EMG) recordings of extradiaphragmatic inspiratory muscles as a surrogate for electrical activity of the diaphragm.

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“…In this issue of the Journal, Bellani et al 16 report a solution to this problem. They used surface EMG electrodes to record the diaphragm EA di on the skin surface (surface EA di ) and the EMG activity of the intercostal and sternocleidomastoid muscles, and they measured simultaneously the esophageal pressure, airway pressure, airway flow, and the EA di using esophageal electrodes.…”

mentioning

confidence: 99%

“…Certainly, these data from Bellani and colleagues 16 should generate enthusiasm for the use of the surface EA di signal, both to manage gas delivery and to monitor patient response to mechanical ventilation, as well as to assess patient efforts and probability of weaning from ventilatory support. However, there is a long way to go before we will see this technology available for everyday use.…”

mentioning

confidence: 99%

“…However, there is a long way to go before we will see this technology available for everyday use. Nevertheless, the data from Bellani et al 16 indicate that there is a high probability that patients receiving patient-triggered ventilation can have gas delivery initiated and regulated noninvasively by the patient's diaphragmatic EMG signal, thus allowing easily obtained monitoring data that are not available at the bedside today. We are clearly on the road to having surface EMG diaphragmatic monitoring and gas delivery regulation.…”

mentioning

confidence: 99%

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