Identification of prolonged phrenic nerve conduction time in the ICU: magnetic versus electrical stimulation
| Autor: | Thomas Similowski, Capucine Morélot-Panzini, Alexandre Duguet, Hélène Prodanovic, Julien Mayaux, Christophe Cracco, Alexandre Demoule |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Magnetic Field Therapy Point-of-Care Systems Diaphragm Neural Conduction Stimulation Electric Stimulation Therapy Electromyography Critical Care and Intensive Care Medicine Young Adult Intensive care Anesthesiology Medicine Humans Prospective Studies Latency (engineering) Phrenic nerve Aged Retrospective Studies medicine.diagnostic_test business.industry Peripheral Nervous System Diseases Gold standard (test) Middle Aged Neurofeedback Diaphragm (structural system) Phrenic Nerve Intensive Care Units Anesthesia Female France business |
| Zdroj: | Intensive care medicine. 37(12) |
| ISSN: | 1432-1238 |
| Popis: | Retrospective study of prospectively collected data to assess the reliability of cervical magnetic stimulation (CMS) to detect prolonged phrenic nerve (PN) conduction time at the bedside. Because PN injuries may cause diaphragm dysfunction, their diagnosis is relevant in intensive care units (ICU). This is achieved by studying latency and amplitude of diaphragm response to PN stimulation. Electrical stimulation (ES) is the gold standard, but it is difficult to perform in the ICU. CMS is an easy noninvasive tool to assess PN integrity, but co-activates muscles that could contaminate surface chest electromyographic recordings. In a first set of 56 ICU patients with suspected PN injury, presence and latency of compound motor action potentials elicited by CMS and ES were compared. With ES as the reference method, CMS was evaluated as a test designed to indicate presence or absence of PN injury. In eight additional patients, intramuscular diaphragm recordings were compared with surface diaphragm recordings and with the electromyograms of possible contamination sources. The sensitivity of CMS to diagnose abnormal PN conduction was 0.91, and specificity was 0.84, whereas positive and negative predictive values were 0.81 and 0.92, respectively. Passing–Bablok regression analysis suggested no differences between the two measures. The correlation between PN latency in response to CMS and ES was significant. The “diaphragm surface” and “needle” latencies were close, and were significantly different from those of possibly contaminating muscles. One hemidiaphragm showed likely signal contamination. CMS provides an easy reliable tool to detect prolonged PN conduction time in the ICU. |
| Databáze: | OpenAIRE |
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