Tonic diaphragmatic activity in critically ill children with and without ventilatory support

Larouche, Alexandrine; Massicotte, Erika; Constantin, Gabrielle; Ducharme‐Crevier, Laurence; Essouri, Sandrine; Sinderby, Christer A.; Beck, Jennifer; Émériaud, Guillaume

doi:10.1002/ppul.23182

Cited by 20 publications

(19 citation statements)

References 36 publications

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“…We have determined that a major part of the mechanism behind this unique activity involves the raphe-spinal system. Excesses in the amount of 5HT, brought about only by the IH/enzyme combination, could result in large depolarisations and enhanced membrane resistance in the phrenic motoneurons acting, in turn, to increase end-expiratory lung volume facilitating ventilation 44 , 45 . Alternatively, the ipsilateral spasm-like activity may be detrimental to ventilation by compromising lung function.…”

Section: Discussionmentioning

confidence: 99%

Rapid and robust restoration of breathing long after spinal cord injury

Warren¹,

Steiger²,

Dick³

et al. 2018

Nat Commun

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There exists an abundance of barriers that hinder functional recovery following spinal cord injury, especially at chronic stages. Here, we examine the rescue of breathing up to 1.5 years following cervical hemisection in the rat. In spite of complete hemidiaphragm paralysis, a single injection of chondroitinase ABC in the phrenic motor pool restored robust and persistent diaphragm function while improving neuromuscular junction anatomy. This treatment strategy was more effective when applied chronically than when assessed acutely after injury. The addition of intermittent hypoxia conditioning further strengthened the ventilatory response. However, in a sub-population of animals, this combination treatment caused excess serotonergic (5HT) axon sprouting leading to aberrant tonic activity in the diaphragm that could be mitigated via 5HT2 receptor blockade. Through unmasking of the continuing neuroplasticity that develops after injury, our treatment strategy ensured rapid and robust patterned respiratory recovery after a near lifetime of paralysis.

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Section: Discussionmentioning

confidence: 99%

Rapid and robust restoration of breathing long after spinal cord injury

Warren¹,

Steiger²,

Dick³

et al. 2018

Nat Commun

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“…As previously described [ 12 , 16 , 17 ], for each recording, Edi and ventilator pressure curves were analyzed in a breath-by-breath manner over a continuous 5-min period exempt of artifacts linked to agitation or patient care. Timings of the beginning and the end of inspiration and expiration phases on the Edi and the ventilatory pressure signals were semiautomatically identified: Main timings were automatically identified, and a visual inspection was performed breath by breath, permitting to validate and/or adjust the timing cursors if necessary.…”

Section: Methodsmentioning

confidence: 99%

Patient–ventilator asynchrony during conventional mechanical ventilation in children

Mortamet

Larouche

Ducharme‐Crevier

et al. 2017

Ann. Intensive Care

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BackgroundWe aimed (1) to describe the characteristics of patient–ventilator asynchrony in a population of critically ill children, (2) to describe the risk factors associated with patient–ventilator asynchrony, and (3) to evaluate the association between patient–ventilator asynchrony and ventilator-free days at day 28.MethodsIn this single-center prospective study, consecutive children admitted to the PICU and mechanically ventilated for at least 24 h were included. Patient–ventilator asynchrony was analyzed by comparing the ventilator pressure curve and the electrical activity of the diaphragm (Edi) signal with (1) a manual analysis and (2) using a standardized fully automated method.ResultsFifty-two patients (median age 6 months) were included in the analysis. Eighteen patients had a very low ventilatory drive (i.e., peak Edi < 2 µV on average), which prevented the calculation of patient–ventilator asynchrony. Children spent 27% (interquartile 22–39%) of the time in conflict with the ventilator. Cycling-off errors and trigger delays contributed to most of this asynchronous time. The automatic algorithm provided a NeuroSync index of 45%, confirming the high prevalence of asynchrony. No association between the severity of asynchrony and ventilator-free days at day 28 or any other clinical secondary outcomes was observed, but the proportion of children with good synchrony was very low.ConclusionPatient–ventilator interaction is poor in children supported by conventional ventilation, with a high frequency of depressed ventilatory drive and a large proportion of time spent in asynchrony. The clinical benefit of strategies to improve patient–ventilator interactions should be evaluated in pediatric critical care.

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“…A single set of measurements, very close to intubation, was done, because we did not want to use long term or multiple doses of neuromuscular blockade. Also, patients were on controlled MV without respiratory muscle activity, can influence in the low Inspiratory resistance and measured autoPEEP, because patient efforts may increase the lung volume, facilitating hyperinflation [25], being frequent the coexistence between intrinsic PEEP and active expiration. Finally, we have to acknowledge that setting of MV parameters can directly modify the component of the equation of motion (i.e.…”

Section: Discussionmentioning

confidence: 99%

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Cruces

González‐Dambrauskas

Quilodran³

et al. 2017

BMC Pulm Med

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Background: Analysis of respiratory mechanics during mechanical ventilation (MV) is able to estimate resistive, elastic and inertial components of the working pressure of the respiratory system. Our aim was to discriminate the components of the working pressure of the respiratory system in infants on MV with severe bronchiolitis admitted to two PICU's. Methods: Infants younger than 1 year old with acute respiratory failure caused by severe bronchiolitis underwent neuromuscular blockade, tracheal intubation and volume controlled MV. Shortly after intubation studies of pulmonary mechanics were performed using inspiratory and expiratory breath hold. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory (PIP), plateau (PPL) and total expiratory pressures (tPEEP) were measured. Inspiratory and expiratory resistances (RawI and RawE) and Time Constants (K TI and K TE ) were calculated. Results: We included 16 patients, of median age 2.5 (1-5.8) months. Bronchiolitis due to respiratory syncytial virus was the main etiology (93.8%) and 31.3% had comorbidities. Measured respiratory pressures were PIP 29 (26-31), PPL 24 (20-26), tPEEP 9 [8-11] cmH2O. Elastic component of the working pressure was significantly higher than resistive and both higher than threshold (tPEEP -PEEP) (P < 0.01). QI was significantly lower than Conclusions: Analysis of respiratory mechanics of infants with severe bronchiolitis receiving MV shows that the elastic component of the working pressure of the respiratory system is the most important. The elastic and resistive components in conjunction with flow profile are characteristic of restrictive diseases. A better understanding of lung mechanics in this group of patients may lead to change the traditional ventilatory approach to severe bronchiolitis.

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Tonic diaphragmatic activity in critically ill children with and without ventilatory support

Cited by 20 publications

References 36 publications

Rapid and robust restoration of breathing long after spinal cord injury

Rapid and robust restoration of breathing long after spinal cord injury

Patient–ventilator asynchrony during conventional mechanical ventilation in children

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

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