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Diaphragmatic electromyography in infants: an overview of possible clinical applications
Anouk W J Scholten1,2, Ruud W van Leuteren1,2, Cornelia G de Waal1,2
1Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
Insights
Diaphragm electromyography (dEMG) offers improved cardiorespiratory monitoring for preterm infants. This technique provides crucial insights into breathing effort, aiding in personalized respiratory support and enhancing patient-ventilator synchrony.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Medical Monitoring Technologies
Background:
- Preterm infants exhibit breathing instability and compromised lung function, necessitating cardiorespiratory monitoring and respiratory support.
- Current respiratory monitoring methods lack reliability in detecting obstructive apnea and do not assess breathing effort, complicating optimal ventilator settings.
- Accurate assessment of breathing effort is crucial for tailoring respiratory support in vulnerable preterm neonates.
Purpose of the Study:
- To review the clinical potential of diaphragm electromyography (dEMG) for cardiorespiratory monitoring in preterm infants.
- To evaluate dEMG's capacity to synchronize patient-ventilator interaction and optimize respiratory support.
- To identify knowledge gaps and future directions for implementing dEMG in clinical practice.
Main Methods:
- Systematic review of existing evidence on the application of dEMG in neonatal respiratory care.
- Analysis of dEMG's capability to monitor heart rate (HR) and respiratory rate (RR).
- Assessment of dEMG's utility in quantifying diaphragm activity and breathing effort.
Main Results:
- dEMG demonstrates potential for accurate cardiorespiratory monitoring, including HR and RR.
- dEMG provides valuable insights into respiratory effort, surpassing current monitoring techniques.
- The technique shows promise for improving patient-ventilator synchrony and guiding respiratory support adjustments.
Conclusions:
- Diaphragm electromyography (dEMG) offers a promising advancement in neonatal respiratory monitoring.
- dEMG can enhance the assessment of breathing effort, leading to more individualized respiratory support for preterm infants.
- Further research is needed to facilitate the widespread clinical adoption of dEMG in neonatal intensive care units.
Abstract:
Preterm infants often experience breathing instability and a hampered lung function. Therefore, these infants receive cardiorespiratory monitoring and respiratory support. However, the current respiratory monitoring technique may be unreliable for especially obstructive apnea detection and classification and it does not provide insight in breathing effort. The latter makes the selection of the adequate mode and level of respiratory support difficult. Electromyography of the diaphragm (dEMG) has the potential of monitoring heart rate (HR) and respiratory rate (RR), and it provides additional information on breathing effort. This review summarizes the available evidence on the clinical potential of dEMG to provide cardiorespiratory monitoring, to synchronize patient-ventilator interaction, and to optimize the mode and level of respiratory support in the individual newborn infant. We also try to identify gaps in knowledge and future developments needed to ensure widespread implementation in clinical practice. IMPACT: Preterm infants require cardiorespiratory monitoring and respiratory support due to breathing instability and a hampered lung function. The current respiratory monitoring technique may provide unreliable measurements and does not provide insight in breathing effort, which makes the selection of the optimal respiratory support settings difficult. Measuring diaphragm activity could improve cardiorespiratory monitoring by providing insight in breathing effort and could potentially have an important role in individualizing respiratory support in newborn infants.
