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Transcutaneous electromyographic respiratory muscle recordings to quantify patient-ventilator interaction in
Alette A Koopman1, Robert G T Blokpoel2, Leo A van Eykern3
1Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, The University of Groningen, Internal Postal Code CA 62, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Insights
This study shows that a new non-invasive method using electromyography (EMG) can reliably assess patient-ventilator breath synchrony in children. This tool helps improve breathing support for pediatric patients on mechanical ventilators.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Biomedical engineering
Background:
- Patient-ventilator asynchrony is a common issue in pediatric intensive care units.
- Accurate quantification of this interaction is crucial for optimizing mechanical ventilation.
- Current methods may be invasive or ventilator-specific.
Purpose of the Study:
- To assess the feasibility of transcutaneous electromyographic (EMG) respiratory muscle recordings.
- To automatically quantify patient-ventilator breath synchrony in mechanically ventilated children.
- To introduce the dEMG-phase scale for evaluating breath synchrony.
Main Methods:
- A prospective observational study was conducted in a pediatric intensive care unit.
- Transcutaneous EMG signals of the diaphragm and ventilator pressure waveforms were recorded continuously for 5 minutes in children < 18 years.
- Neural inspiration and ventilator pressurization timings were analyzed to calculate trigger and cycle-off errors, displayed using the dEMG-phase scale.
Main Results:
- Data from 23 pediatric patients were analyzed.
- The dEMG-phase scale classified breaths as synchronous (median 12.2%), dyssynchronous (median 47.5%), and asynchronous (median 28.9%).
- Automated analysis provided quantitative insights into breath synchrony.
Conclusions:
- The dEMG-phase scale is a feasible and reliable non-invasive tool for quantifying patient-ventilator breath synchrony in pediatric patients.
- Its non-ventilator-specific nature allows for easy clinical implementation.
- Further studies are needed to correlate surface EMG measurements with esophageal catheter data.
Background:
To explore the feasibility of transcutaneous electromyographic respiratory muscle recordings to automatically quantify the synchronicity of patient-ventilator interaction in the pediatric intensive care unit.
Methods:
Prospective observational study in a tertiary paediatric intensive care unit in an university hospital. Spontaneous breathing mechanically ventilated children < 18 years of age were eligible for inclusion. Patients underwent a 5-min continuous recording of ventilator pressure waveforms and transcutaneous electromyographic signal of the diaphragm. To evaluate patient-ventilator interaction, the obtained neural inspiration and ventilator pressurization timings were used to calculate trigger and cycle-off errors of each breath. Calculated errors were displayed in the dEMG-phase scale.
Results:
Data of 23 patients were used for analysis. Based on the dEMG-phase scale, the median rates of synchronous, dyssynchronous and asynchronous breaths as classified by the automated analysis were 12.2% (1.9-33.8), 47.5% (36.3-63.1), and 28.9% (6.6-49.0).
Conclusions:
The dEMG-phase scale quantifying patient-ventilator breath synchronicity was demonstrated to be feasible and a reliable scale for mechanically ventilated children, reflected by high intra-class correlation coefficients. As this non-invasive tool is not restricted to a type of ventilator, it could easily be clinical implemented in the ventilated pediatric population. However; correlation studies between the EMG signal measured by surface EMG and esophageal catheters have to be performed.
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