Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support.
Electrical activity of the diaphragm
Extradiaphragmatic inspiratory muscle activity
Respiratory drive
Surface electromyography
Ventilated critically ill patients
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
29 May 2020
29 May 2020
Historique:
received:
18
12
2019
accepted:
16
05
2020
entrez:
31
5
2020
pubmed:
31
5
2020
medline:
31
5
2020
Statut:
epublish
Résumé
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. 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 cmH 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 (r 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.
Sections du résumé
BACKGROUND
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
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 cmH
RESULTS
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 (r
CONCLUSIONS
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.
Identifiants
pubmed: 32472272
doi: 10.1186/s13613-020-00684-6
pii: 10.1186/s13613-020-00684-6
pmc: PMC7256918
doi:
Types de publication
Journal Article
Langues
eng
Pagination
67Références
Am J Respir Crit Care Med. 2014 Mar 1;189(5):520-31
pubmed: 24467647
N Engl J Med. 2008 Mar 27;358(13):1327-35
pubmed: 18367735
Anesthesiology. 2014 Nov;121(5):1028-36
pubmed: 25208082
J Electromyogr Kinesiol. 2010 Jun;20(3):542-9
pubmed: 19692270
Br J Anaesth. 2011 Jun;106(6):913-4
pubmed: 21576107
J Appl Physiol (1985). 2009 Aug;107(2):621-9
pubmed: 19390004
Respir Physiol Neurobiol. 2008 Dec 31;164(3):441-8
pubmed: 18952011
Am J Respir Crit Care Med. 2001 Aug 1;164(3):419-24
pubmed: 11500343
Intensive Care Med. 2013 Aug;39(8):1368-76
pubmed: 23575612
Am J Respir Crit Care Med. 1998 Mar;157(3 Pt 1):736-42
pubmed: 9517584
Am J Respir Crit Care Med. 2015 May 15;191(10):1126-38
pubmed: 25760684
Crit Care. 2014 Oct 13;18(5):550
pubmed: 25307894
Intensive Care Med. 2016 Sep;42(9):1360-73
pubmed: 27334266
Curr Opin Crit Care. 2014 Jun;20(3):352-8
pubmed: 24722059
Lancet Respir Med. 2019 Jan;7(1):90-98
pubmed: 30455078
Crit Care Med. 2012 Apr;40(4):1254-60
pubmed: 22425820
Am J Respir Crit Care Med. 2015 Nov 1;192(9):1080-8
pubmed: 26167730
J Neurophysiol. 2010 Mar;103(3):1622-9
pubmed: 20089818
J Appl Physiol Respir Environ Exerc Physiol. 1980 Oct;49(4):638-42
pubmed: 6777347
Am Rev Respir Dis. 1989 Feb;139(2):513-21
pubmed: 2643905
Crit Care Med. 2013 Jun;41(6):1483-91
pubmed: 23478659
Respir Care. 2018 Nov;63(11):1341-1349
pubmed: 30389829
Respir Physiol Neurobiol. 2007 Nov 15;159(2):115-26
pubmed: 17660051
Clin Neurophysiol. 2002 Jan;113(1):57-63
pubmed: 11801425
Crit Care. 2013 Dec 05;17(6):245
pubmed: 24314000
Am J Respir Crit Care Med. 2011 Feb 1;183(3):364-71
pubmed: 20813887
Am J Respir Crit Care Med. 2002 Jan 15;165(2):221-8
pubmed: 11790659
J Appl Physiol (1985). 2007 Jul;103(1):140-7
pubmed: 17395760
J Appl Physiol (1985). 2010 Dec;109(6):1939-49
pubmed: 20947713
Curr Opin Crit Care. 2015 Feb;21(1):34-41
pubmed: 25546533
Intensive Care Med. 2017 Oct;43(10):1441-1452
pubmed: 28917004
Am J Respir Crit Care Med. 2017 Apr 15;195(8):1033-1042
pubmed: 27748627
Physiol Rev. 2005 Apr;85(2):717-56
pubmed: 15788709
J Electromyogr Kinesiol. 2011 Feb;21(1):1-12
pubmed: 20869882
Anesthesiology. 2015 Jul;123(1):181-90
pubmed: 25955983
Am J Respir Crit Care Med. 2013 Jan 1;187(1):20-7
pubmed: 23103733
BMJ. 1995 Feb 18;310(6977):446
pubmed: 7873953
Respir Physiol Neurobiol. 2019 Jan;259:45-52
pubmed: 30041019
J Neurophysiol. 2011 Oct;106(4):1622-8
pubmed: 21753028
Respir Physiol Neurobiol. 2011 Sep 15;178(2):341-5
pubmed: 21699998
Anesthesiology. 2018 Sep;129(3):490-501
pubmed: 29771711
J Appl Physiol (1985). 1994 Jan;76(1):176-84
pubmed: 8175503
J Physiol. 2007 Oct 1;584(Pt 1):261-70
pubmed: 17690147
Am J Respir Crit Care Med. 2020 Jan 1;201(1):20-32
pubmed: 31437406
J Appl Physiol (1985). 2007 Feb;102(2):772-80
pubmed: 17053105