Transcutaneous monitoring of diaphragm activity as a measure of work of breathing in preterm infants

Leuteren, Ruud W. van; Waal, Cornelia G. de; Hutten, Gerard J.; Jongh, Frans de; Kaam, Anton H. van

doi:10.1002/ppul.25284

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…Such a measurement is difficult to calibrate properly and is affected by signal filtration and, impedance, and by sleep stage 35 . A proper estimation of breathing effort would have required esophageal pressure measurement, 5,36 and diaphragm and esophageal pressure measurement are expected to show only a modest correlation 37 . Despite these limitations, we find diaphragm EMG useful, providing reasonable repeatability 2,16 …”

Section: Discussionmentioning

confidence: 92%

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Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement

Kukkola

Kirjavainen

2022

Pediatric Pulmonology

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Objectives The natural evolution of obstructive sleep apnea (OSA) in young infants is not established. Methods We re‐evaluated 10‐year pediatric sleep center infant polysomnography (PSG) data, excluding infants with syndromes, genetic defects, structural anomalies or periodic breathing > 5% of sleep time. Results Obstructive events > 1 h‐1 were evident in 255 infants, of which 91 were eligible for the study. Of the 38 infants in a follow‐up study, 30 (79%) were male, 15 (40%) were born prematurely, 25 (66%) had observed apneas, and 13 (33%) had experienced a brief, unexplained event or had a sibling of the infant died suddenly. The first PSG was performed at a median corrected age of 4 weeks (interquartile range [IQR] 2−7) and the second at 11 weeks (IQR 9−14). The obstructive apnea and hypopnea index (OAHI) was greater in the supine compared to side‐sleeping position in both recordings (p < 0.001), whereas OAHI dropped from 10 h‐1 (IQR 6−24) in the first PSG to 3 h‐1 (IQR 1−9) in the second PSG (p < 0.001). OSA alleviation was also observable as a decrease in the number of oxygen desaturations (p < 0.001), as a decrease in transcutaneous (p = 0.001) and end‐tidal carbon dioxide (p = 0.01) 95th percentile levels, and work of breathing (p = 0.002). Seven infants had a third PSG to verify a satisfactory improvement of OSA. Conclusions OSA in young infants without a clear syndrome or structural anomaly is sleep position dependent and shows improvement during the following few months.

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Section: Discussionmentioning

confidence: 92%

“…and diaphragm and esophageal pressure measurement are expected to show only a modest correlation. 37 Despite these limitations, we find diaphragm EMG useful, providing reasonable repeatability. 2,16…”

Section: Study Limitationsmentioning

confidence: 90%

Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement

Kukkola

Kirjavainen

2022

Pediatric Pulmonology

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“…In contrast to the study of Helfenbein et al we placed the electrodes at the height of the diaphragm in accordance with previous dEMG studies as we were solely interested in diaphragm activity, which may have improved dEMG‐signal quality as crosstalk at this position is reduced 4,14,15 . On the other hand, the used ECG/CI electrodes were not actively shielded, like in previous dEMG studies in neonates 4,6,16,17 . In these studies, the dedicated dEMG cables were micro coaxial cables using active shielding to prevent capacitive coupling of the measurement wire with the environment 18 .…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 14 , 15 On the other hand, the used ECG/CI electrodes were not actively shielded, like in previous dEMG studies in neonates. 4 , 6 , 16 , 17 In these studies, the dedicated dEMG cables were micro coaxial cables using active shielding to prevent capacitive coupling of the measurement wire with the environment. 18 This reduced power supply interference and cable movement artifacts.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous measurement of diaphragm activity, chest impedance, and ECG using three standard cardiorespiratory monitoring electrodes

Scholten

Leuteren

Jongh

et al. 2022

Pediatric Pulmonology

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Introduction Current cardiorespiratory monitoring in neonates with electrocardiogram (ECG) and chest impedance (CI) has limitations. Adding transcutaneous electromyography of the diaphragm (dEMG) may improve respiratory monitoring, but requires additional hardware. We aimed to determine the feasibility of measuring dEMG and ECG/CI simultaneously using the standard ECG/CI hardware, with its three electrodes repositioned to dEMG electrode locations. Methods Thirty infants (median postmenstrual age 30.4 weeks) were included. First, we assessed the feasibility of extracting dEMG from the ECG‐signal. If successful, the agreement between dEMG‐based respiratory rate (RR), using three different ECG‐leads, and a respiratory reference signal was assessed using the Bland‐Altman analysis and the intraclass correlation coefficient (ICC). Furthermore, we studied the agreement between CI‐based RR and the reference signal with the electrodes placed at the standard and dEMG position. Finally, we explored the quality of the ECG‐signal at the different electrode positions. Results In 15 infants, feasibility of measuring dEMG with the monitoring electrodes was confirmed. In the next 15 infants, comparing dEMG‐based RR to the reference signal resulted in a mean difference and limits of agreement for ECG‐lead I, II and III of 4.2 [−8.2 to 16.6], 4.3 [−10.7 to 19.3] and 5.0 [–14.2 to 24.2] breaths/min, respectively. ICC analysis showed a moderate agreement for all ECG‐leads. CI‐based RR agreement was similar at the standard and dEMG electrode position. An exploratory analysis suggested similar quality of the ECG‐signal at both electrode positions. Conclusion Measuring dEMG using the ECG/CI hardware with its electrodes on the diaphragm is feasible, leaving ECG/CI monitoring unaffected.

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“…Diaphragm electrical activity (Edi) can be measured easily by electromyography using a modified gastric feeding tube or transcutaneous surface electrodes, providing an objective measure of respiratory effort [10][11][12][13]. The maximal Edi during inspiration (Edimax) reflects inspiratory effort and is responsible for the size of a breath, whilst the minimal Edi at end-expiration (Edimin) reflects tonic activity required to maintain functional residual capacity (FRC) and prevent atelectasis [10,14].…”

Section: Introductionmentioning

confidence: 99%

Diaphragm electrical activity during weaning of nasal high-flow therapy in preterm infants

Naples

Fenton

Brodlie

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo determine whether electrical activity of the diaphragm (Edi) changes with weaning nasal high-flow (HF) therapy in preterm infants according to a standardised protocol.DesignProspective observational cohort study.SettingNeonatal intensive care unit.PatientsPreterm infants born at <32 weeks gestation, receiving nasal HF as part of routine clinical care.InterventionsInfants recruited to the study had their HF weaned according to set clinical criteria. Edi was measured using a modified gastric feeding tube serially from baseline (pre-wean) to 24-hours post-wean.Main outcome measuresChange in Edi from baseline was measured at four time points up to 24 hours after weaning. Minimum Edi during expiration, maximum Edi during inspiration and amplitude of the Edi signal (Edidelta) were measured. Clinical parameters (heart rate, respiratory rate and fraction of inspired oxygen) were also recorded.ResultsForty preterm infants were recruited at a mean corrected gestational age of 31.6 (±2.7) weeks. Data from 156 weaning steps were analysed, 91% of which were successful. Edi did not change significantly from baseline during flow reduction steps, but a significant increase in diaphragm activity was observed when discontinuing HF (median increase in Edideltaimmediately post-discontinuation 1.7 µV (95% CI: 0.6 to 3.0)) and at 24 hours 1.9 µV (95% CI: 0.7 to 3.8)). No significant difference in diaphragm activity was observed between successful and unsuccessful weaning steps.ConclusionsA protocolised approach to weaning has a high probability of success. Edi does not change with reducing HF rate, but significantly increases with discontinuation of HF from 2 L/min.

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Transcutaneous monitoring of diaphragm activity as a measure of work of breathing in preterm infants

Cited by 10 publications

References 28 publications

Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement

Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement

Simultaneous measurement of diaphragm activity, chest impedance, and ECG using three standard cardiorespiratory monitoring electrodes

Diaphragm electrical activity during weaning of nasal high-flow therapy in preterm infants

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