Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support

Autor: Lisanne H Roesthuis, Jonne Doorduin, H.W.H. van Hees, J.G. van der Hoeven, Leo M. A. Heunks, Willem-Jan M. Schellekens
Přispěvatelé: Intensive care medicine, ACS - Pulmonary hypertension & thrombosis
Jazyk: angličtina
Rok vydání: 2020
Předmět:
medicine.medical_specialty
Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0]
Electromyography
Critical Care and Intensive Care Medicine
Electrical activity of the diaphragm
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Respiratory muscle
Surface electromyography
Respiratory system
Genioglossus
medicine.diagnostic_test
business.industry
Research
Ventilated critically ill patients
Other Research Radboud Institute for Health Sciences [Radboudumc 0]
lcsh:Medical emergencies. Critical care. Intensive care. First aid
030208 emergency & critical care medicine
Extradiaphragmatic inspiratory muscle activity
lcsh:RC86-88.9
Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3]
Muscle atrophy
Diaphragm (structural system)
Respiratory drive
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
030228 respiratory system
Control of respiration
Parasternal line
Cardiology
medicine.symptom
business
Zdroj: Annals of Intensive Care, Vol 10, Iss 1, Pp 1-10 (2020)
Annals of Intensive Care
Annals of Intensive Care, 10(1):67. Springer-Verlag GmbH and Co. KG
Roesthuis, L H, van der Hoeven, J G, van Hees, H W H, Schellekens, W J M, Doorduin, J & Heunks, L M A 2020, ' Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support ', Annals of Intensive Care, vol. 10, no. 1, 67 . https://doi.org/10.1186/s13613-020-00684-6
Annals of Intensive Care, 10, 1
Annals of Intensive Care, 10
ISSN: 2110-5820
Popis: Background Inappropriate ventilator assist plays an important role in the development of diaphragm dysfunction. Ventilator under-assist may lead to muscle injury, while over-assist may result in muscle atrophy. This provides a good rationale to monitor respiratory drive in ventilated patients. Respiratory drive can be monitored by a nasogastric catheter, either with esophageal balloon to determine muscular pressure (gold standard) or with electrodes to measure electrical activity of the diaphragm. A disadvantage is that both techniques are invasive. Therefore, it is interesting to investigate the role of surrogate markers for respiratory dive, such as extradiaphragmatic inspiratory muscle activity. The aim of the current study was to investigate the effect of different inspiratory support levels on the recruitment pattern of extradiaphragmatic inspiratory muscles with respect to the diaphragm and to evaluate agreement between activity of extradiaphragmatic inspiratory muscles and the diaphragm. Methods Activity from the alae nasi, genioglossus, scalene, sternocleidomastoid and parasternal intercostals was recorded using surface electrodes. Electrical activity of the diaphragm was measured using a multi-electrode nasogastric catheter. Pressure support (PS) levels were reduced from 15 to 3 cmH2O every 5 min with steps of 3 cmH2O. The magnitude and timing of respiratory muscle activity were assessed. Results We included 17 ventilated patients. Diaphragm and extradiaphragmatic inspiratory muscle activity increased in response to lower PS levels (36 ± 6% increase for the diaphragm, 30 ± 6% parasternal intercostals, 41 ± 6% scalene, 40 ± 8% sternocleidomastoid, 43 ± 6% alae nasi and 30 ± 6% genioglossus). Changes in diaphragm activity correlated best with changes in alae nasi activity (r2 = 0.49; P < 0.001), while there was no correlation between diaphragm and sternocleidomastoid activity. The agreement between diaphragm and extradiaphragmatic inspiratory muscle activity was low due to a high individual variability. Onset of alae nasi activity preceded the onset of all other muscles. Conclusions Extradiaphragmatic inspiratory muscle activity increases in response to lower inspiratory support levels. However, there is a poor correlation and agreement with the change in diaphragm activity, limiting the use of surface electromyography (EMG) recordings of extradiaphragmatic inspiratory muscles as a surrogate for electrical activity of the diaphragm.
Databáze: OpenAIRE
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