Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients

Sklar, Michael C.; Madotto, Fabiana; Jonkman, Annemijn H.; Rauseo, Michela; Soliman, Ibrahim; Damiani, L Felipe; Telias, Irene; Dubó, Sebastián; Lu, Chen; Rittayamai, Nuttapol; Chen, Guang-Qiang; Goligher, Ewan C.; Dres, Martin; Coudroy, Rémi; Pham, Tài; Artigas, Ricard Mellado; Friedrich, Jan O.; Sinderby, Christer A.; Heunks, Leo; Brochard, Laurent

doi:10.1186/s13054-020-03435-y

Cited by 18 publications

(11 citation statements)

References 36 publications

(59 reference statements)

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“…The current study uses data collected in a study conducted at St. Michael’s Hospital in Toronto, Canada, to detect the timing of resumption of diaphragm activity after intubation. 13 Patients were enrolled between June 2015 and August 2017. Electrical activity of the diaphragm was measured by using an esophageal catheter (neurally adjusted ventilator assist catheter and feeding tube) placed within 12 h after endotracheal intubation and initiation of mechanical ventilation.…”

Section: Methodsmentioning

confidence: 99%

Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation

et al. 2021

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Background Reverse triggering is a delayed asynchronous contraction of the diaphragm triggered by passive insufflation by the ventilator in sedated mechanically ventilated patients. The incidence of reverse triggering is unknown. This study aimed at determining the incidence of reverse triggering in critically ill patients under controlled ventilation. Methods In this ancillary study, patients were continuously monitored with a catheter measuring the electrical activity of the diaphragm. A method for automatic detection of reverse triggering using electrical activity of the diaphragm was developed in a derivation sample and validated in a subsequent sample. The authors assessed the predictive value of the software. In 39 recently intubated patients under assist-control ventilation, a 1-h recording obtained 24 h after intubation was used to determine the primary outcome of the study. The authors also compared patients’ demographics, sedation depth, ventilation settings, and time to transition to assisted ventilation or extubation according to the median rate of reverse triggering. Results The positive and negative predictive value of the software for detecting reverse triggering were 0.74 (95% CI, 0.67 to 0.81) and 0.97 (95% CI, 0.96 to 0.98). Using a threshold of 1 μV of electrical activity to define diaphragm activation, median reverse triggering rate was 8% (range, 0.1 to 75), with 44% (17 of 39) of patients having greater than or equal to 10% of breaths with reverse triggering. Using a threshold of 3 μV, 26% (10 of 39) of patients had greater than or equal to 10% reverse triggering. Patients with more reverse triggering were more likely to progress to an assisted mode or extubation within the following 24 h (12 of 39 [68%]) vs. 7 of 20 [35%]; P = 0.039). Conclusions Reverse triggering detection based on electrical activity of the diaphragm suggests that this asynchrony is highly prevalent at 24 h after intubation under assist-control ventilation. Reverse triggering seems to occur during the transition phase between deep sedation and the onset of patient triggering. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Methodsmentioning

confidence: 99%

Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation

et al. 2021

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“…Recent work showed that the later was significantly related to TFdi (R 2 = 0.62). 51 TFdi may be more related to diaphragm electrical activity than the pressure it generates, although within-individual analysis are yet to be performed.…”

Section: Generalization Of Findingsmentioning

confidence: 99%

Poor Correlation between Diaphragm Thickening Fraction and Transdiaphragmatic Pressure in Mechanically Ventilated Patients and Healthy Subjects

et al. 2021

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Background The relationship between the diaphragm thickening fraction and the transdiaphragmatic pressure, the reference method to evaluate the diaphragm function, has not been clearly established. This study investigated the global and intraindividual relationship between the thickening fraction of the diaphragm and the transdiaphragmatic pressure. The authors hypothesized that the diaphragm thickening fraction would be positively and significantly correlated to the transdiaphragmatic pressure, in both healthy participants and ventilated patients. Methods Fourteen healthy individuals and 25 mechanically ventilated patients (enrolled in two previous physiologic investigations) participated in the current study. The zone of apposition of the right hemidiaphragm was imaged simultaneously to transdiaphragmatic pressure recording within different breathing conditions, i.e., external inspiratory threshold loading in healthy individuals and various pressure support settings in patients. A blinded offline breath-by-breath analysis synchronously computed the changes in transdiaphragmatic pressure, the diaphragm pressure-time product, and diaphragm thickening fraction. Global and intraindividual relationships between variables were assessed. Results In healthy subjects, both changes in transdiaphragmatic pressure and diaphragm pressure-time product were moderately correlated to diaphragm thickening fraction (repeated measures correlation = 0.40, P < 0.0001; and repeated measures correlation = 0.38, P < 0.0001, respectively). In mechanically ventilated patients, changes in transdiaphragmatic pressure and thickening fraction were weakly correlated (repeated measures correlation = 0.11, P = 0.008), while diaphragm pressure-time product and thickening fraction were not (repeated measures correlation = 0.04, P = 0.396). Individually, changes in transdiaphragmatic pressure and thickening fraction were significantly correlated in 8 of 14 healthy subjects (ρ = 0.30 to 0.85, all P < 0.05) and in 2 of 25 mechanically ventilated patients (ρ = 0.47 to 0.64, all P < 0.05). Diaphragm pressure-time product and thickening fraction correlated in 8 of 14 healthy subjects (ρ = 0.41 to 0.82, all P < 0.02) and in 2 of 25 mechanically ventilated patients (ρ = 0.63 to 0.66, all P < 0.01). Conclusions Overall, diaphragm function as assessed with transdiaphragmatic pressure was weakly related to diaphragm thickening fraction. The diaphragm thickening fraction should not be used in healthy subjects or ventilated patients when changes in diaphragm function are evaluated. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Mechanical ventilation depends on the interaction of three key factors: central respiratory drive, respiratory muscle strength, and the load exerted on the respiratory muscle [18]. EAdi is the sum of action potentials of diaphragmatic muscle bers and is therefore the best index to re ect the central drive [19].…”

Section: Discussionmentioning

confidence: 99%

The predictive value of neurally adjusted ventilatory assist indexes for the outcome of patients with severe hemorrhagic stroke

Tang

Niu

et al. 2023

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Objective: This study assessed the predictive value of electrical activity of the diaphragm (EAdi) and the EAdi-derived monitoring index in the outcome of patients with severe hemorrhagic stroke. Methods: Ninety patients with severe hemorrhagic stroke were admitted to the neurosurgery intensive care unit of Yijishan Hospital from April 2019 to June 2021 and were divided into the good outcome group (Glasgow Outcome Scale [GOS] ≥4) and poor outcome group [GOS]≤3). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate prediction accuracy. Results: EAdi, neuro-ventilatory efficiency (NVE), and neuro-muscular efficiency (NME) in patients with good outcome were significantly higher than those in patients with poor outcome (4.707 µV vs 2.80 µV, P < 0.001; 141.85 ml/µV vs 66.01 ml/µV, P = 0.000; 2.57 cm H2O/µV vs 1.37 cm H2O/µV, P = 0.000). The area under the ROC curve for the EAdi score was 0.719, with sensitivity of 69.70% and specificity of 68.42% when EAdi was 3.6 µV. The AUC for NVE score was 0.793, with sensitivity of 75.76% and specificity of 77.19% when the NVE value was 95.32 ml/µV. The AUC for NME score was 0.792, with sensitivity of 69.70% and specificity of 78.95% when the NME value was 2.06 H2O/µV. The 6-month survival time of patients with higher EAdi, NVE, and NME was significantly longer than that of patients with lower EAdi, NVE, and NME. Conclusion: EAdi, NVE, and NME can be used as indices for predicting the outcome of patients with severe hemorrhagic stroke. Trial registration: No.ChiCTR1900022861. Registered April 28, 2016, http:// www.chictr.org.cn

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Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients

Cited by 18 publications

References 36 publications

Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation

Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation

Poor Correlation between Diaphragm Thickening Fraction and Transdiaphragmatic Pressure in Mechanically Ventilated Patients and Healthy Subjects

The predictive value of neurally adjusted ventilatory assist indexes for the outcome of patients with severe hemorrhagic stroke

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