Elevated Diaphragmatic Tonic Activity in PICU Patients: Age-Specific Definitions, Prevalence, and Associations.
Journal
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
ISSN: 1529-7535
Titre abrégé: Pediatr Crit Care Med
Pays: United States
ID NLM: 100954653
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
medline:
5
6
2023
pubmed:
9
3
2023
entrez:
8
3
2023
Statut:
ppublish
Résumé
Tonic diaphragmatic activity (tonic Edi, i.e., sustained diaphragm activation throughout expiration) reflects diaphragmatic effort to defend end-expiratory lung volumes. Detection of such elevated tonic Edi may be useful in identifying patients who need increased positive end-expiratory pressure. We aimed to: 1) identify age-specific definitions for elevated tonic Edi in ventilated PICU patients and 2) describe the prevalence and factors associated with sustained episodes of high tonic Edi. Retrospective study using a high-resolution database. Single-center tertiary PICU. Four hundred thirty-one children admitted between 2015 and 2020 with continuous Edi monitoring. None. We characterized our definition of tonic Edi using data from the recovery phase of respiratory illness (i.e., final 3 hr of Edi monitoring, excluding patients with significant persistent disease or with diaphragm pathology). High tonic Edi was defined as population data exceeding the 97.5th percentile, which for infants younger than 1 year was greater than 3.2 μV and for older children as greater than 1.9 μV. These thresholds were then used to identify patients with episodes of sustained elevated tonic Edi in the first 48 hours of ventilation (acute phase). Overall, 62 of 200 (31%) of intubated patients and 138 of 222 (62%) of patients on noninvasive ventilation (NIV) had at least one episode of high tonic Edi. These episodes were independently associated with the diagnosis of bronchiolitis (intubated patients: adjusted odds [aOR], 2.79 [95% CI, 1.12-7.11]); NIV patients: aOR, 2.71 [1.24-6.0]). There was also an association with tachypnea and, in NIV patients, more severe hypoxemia. Our proposed definition of elevated tonic Edi quantifies abnormal diaphragmatic activity during expiration. Such a definition may help clinicians to identify those patients using abnormal effort to defend end-expiratory lung volume. In our experience, high tonic Edi episodes are frequent, especially during NIV and in patients with bronchiolitis.
Identifiants
pubmed: 36883829
doi: 10.1097/PCC.0000000000003193
pii: 00130478-202306000-00003
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
447-457Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Déclaration de conflit d'intérêts
Drs. Plante’s, Sauthier’s, and Emeriaud’s research programs are supported by scholarship awards from the Fonds de Recherche du Québec – Santé (FRQS). Drs. Sauthier and Emeriaud received funding from FRQS. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Santschi M, Jouvet PA, Leclerc F, et al.: Acute lung injury in children: Therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med. 2010; 11:681–689
Levine S, Nguyen T, Taylor N, et al.: Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008; 358:1327–1335
Goligher EC, Dres M, Fan E, et al.: Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med. 2018; 197:204–213
Trachsel D, Erb TO, Hammer J, et al.: Developmental respiratory physiology. Pediatr Anesth. 2022; 32:108–117
Stark AR, Cohlan BA, Waggener TB, et al.: Regulation of end-expiratory lung volume during sleep in premature infants. J Appl Physiol (1985). 1987; 62:1117–1123
Kosch PC, Stark AR: Dynamic maintenance of end-expiratory lung volume in full-term infants. J Appl Physiol. 1984; 57:1126–1133
Colin AA, Wohl ME, Mead J, et al.: Transition from dynamically maintained to relaxed end-expiratory volume in human infants. J Appl Physiol (1985). 1989; 67:2107–2111
Emeriaud G, Beck J, Tucci M, et al.: Diaphragm electrical activity during expiration in mechanically ventilated infants. Pediatr Res. 2006; 59:705–710
Larouche A, Massicotte E, Constantin G, et al.: Tonic diaphragmatic activity in critically ill children with and without ventilatory support: Tonic diaphragmatic activity in children. Pediatr Pulmonol. 2015; 50:1304–1312
Ducharme-Crevier L, Du Pont-Thibodeau G, Emeriaud G: Interest of monitoring diaphragmatic electrical activity in the pediatric intensive care unit. Crit Care Res Pract. 2013; 2013:384210
Beck J, Sinderby C, Lindström L, et al.: Influence of bipolar esophageal electrode positioning on measurements of human crural diaphragm electromyogram. J Appl Physiol (1985). 1996; 81:1434–1449
Beck J, Sinderby C, Weinberg J, et al.: Effects of muscle-to-electrode distance on the human diaphragm electromyogram. J Appl Physiol (1985). 1995; 79:975–985
Sinderby C, Friberg S, Comtois N, et al.: Chest wall muscle cross talk in canine costal diaphragm electromyogram. J Appl Physiol (1985). 1996; 81:2312–2327
Yan S, Sinderby C, Bielen P, et al.: Expiratory muscle pressure and breathing mechanics in chronic obstructive pulmonary disease. Eur Respir J. 2000; 16:684–690
Pellegrini M, Hedenstierna G, Roneus A, et al.: The diaphragm acts as a brake during expiration to prevent lung collapse. Am J Respir Crit Care Med. 2016; 195:1608–1616
Allo J-C, Beck JC, Brander L, et al.: Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med. 2006; 34:2997–3004
Brossier D, El Taani R, Sauthier M, et al.: Creating a high-frequency electronic database in the PICU: The perpetual patient. Pediatr Crit Care Med. 2018; 19:e189–e198
Sauthier M, Landry-Hould F, Leteurtre S, et al.: Comparison of the automated pediatric logistic organ dysfunction-2 versus manual pediatric logistic organ dysfunction-2 score for critically ill children. Pediatr Crit Care Med. 2020; 21:e160–e169
Khemani RG, Smith LS, Zimmerman JJ, et al.: Pediatric acute respiratory distress syndrome: Definition, incidence, and epidemiology: Proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015; 16:S23–S40
Sauthier MS, Jouvet PA, Newhams MM, et al.: Machine learning predicts prolonged acute hypoxemic respiratory failure in pediatric severe influenza. Crit Care Explor. 2020; 2:e0175
Young PJ, Beasley RW, Capellier G, et al.: Oxygenation targets, monitoring in the critically ill: A point prevalence study of clinical practice in Australia and New Zealand. Crit Care Resusc. 2015; 17:202–207
Panwar R, Capellier G, Schmutz N, et al.: Current oxygenation practice in ventilated patients-an observational cohort study. Anaesth Intensive Care. 2013; 41:505–514
Slater A, Straney L, Alexander J, et al.: The Effect of Imputation of PaO2/FIO2 from SpO2/FIO2 on the performance of the pediatric index of mortality 3. Pediatr Crit Care Med. 2020; 21:520–525
Sauthier M, Tuli G, Jouvet PA, et al.: Estimated Pao2: A continuous and noninvasive method to estimate Pa o2 and oxygenation index. Crit Care Explor. 2021; 3:e0546
Horn PS, Feng L, Li Y, et al.: Effect of outliers and nonhealthy individuals on reference interval estimation. Clin Chem. 2001; 47:2137–2145
Tukey JW: Exploratory Data Analysis. Reading, MA, Addison-Wesley, 1977
Kallio M, Peltoniemi O, Anttila E, et al.: Electrical activity of the diaphragm during neurally adjusted ventilatory assist in pediatric patients. Pediatr Pulmonol. 2015; 50:925–931
Lopes J, Muller NL, Bryan MH, et al.: Importance of inspiratory muscle tone in maintenance of FRC in the newborn. J Appl Physiol. 1981; 51:830–834
Muller N, Bryan AC, Zamel N: Tonic inspiratory muscle activity as a cause of hyperinflation in asthma. J Appl Physiol. 1981; 50:279–282
American Thoracic Society/European Respiratory Society: ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002; 166:518–624
Pellegrino R, Brusasco V: On the causes of lung hyperinflation during bronchoconstriction. Eur Respir J. 1997; 10:468–475
Seidenberg J, Masters IB, Hudson I, et al.: Disturbance in respiratory mechanics in infants with bronchiolitis. Thorax. 1989; 44:660–667
Essouri S, Durand P, Chevret L, et al.: Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive Care Med. 2011; 37:2002–2007
Gorini M, Iandelli I, Misuri G, et al.: Chest wall hyperinflation during acute bronchoconstriction in asthma. Am J Respir Crit Care Med. 1999; 160:808–816
Beck J, Brander L, Slutsky AS, et al.: Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury. Intensive Care Med. 2008; 34:316–323
García-Muñoz Rodrigo F, Urquía Martí L, Galán Henríquez G, et al.: Neural breathing patterns in preterm newborns supported with non-invasive neurally adjusted ventilatory assist. J Perinatol. 2018; 38:1235–1241
Gupta A, Lumba R, Bailey S, et al.: Electrical activity of the diaphragm in a small cohort of preterm infants on noninvasive neurally adjusted ventilatory assist and continuous positive airway pressure: A prospective comparative pilot study. Cureus. 2019; 11:e6291
D’Angelo E, Pecchiari M, Acocella F, et al.: Effects of abdominal distension on breathing pattern and respiratory mechanics in rabbits. Respir Physiol Neurobiol. 2002; 130:293–304
Meessen NE, van der Grinten CP, Luijendijk SC, et al.: Continuous negative airway pressure increases tonic activity in diaphragm and intercostal muscles in humans. J Appl Physiol (1985). 1994; 77:1256–1262
van Leuteren RW, de Waal CG, de Jongh FH, et al.: Diaphragm activity pre and post extubation in ventilated critically ill infants and children measured with transcutaneous electromyography. Pediatr Crit Care Med. 2021; 22:950–959