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Electrical activity of diaphragm

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https://www.readbyqxmd.com/read/29276229/severe-acute-respiratory-distress-syndrome-using-electrical-activity-of-the-diaphragm-on-weaning-from-extracorporeal-membrane-oxygenation
#1
Shuji Okahara, Kazuyoshi Shimizu, Hiroshi Morimatsu
The electrical activity of the diaphragm (EAdi) shows global diaphragmatic activation and power output from the central nervous system. We measured the EAdi as an indicator of breathing workload in a 40-year-old man suffering from severe acute respiratory distress syndrome (ARDS) secondary to influenza pneumonia in the process of weaning from extracorporeal membrane oxygenation (ECMO). Turning off the sweep gas flow immediately led to EAdi elevation, followed by hypoxia. The patient was successfully weaned from ECMO by reference to EAdi...
December 2017: Acta Medica Okayama
https://www.readbyqxmd.com/read/29247545/neurally-adjusted-ventilatory-assist-can-be-used-to-wean-infants-with-congenital-diaphragmatic-hernias-off-respiratory-support
#2
Arata Oda, Liisa Lehtonen, Hanna Soukka
Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that triggers, cycles and delivers assistance in response to the electrical activity of the diaphragm (EAdi). The EAdi signal is measured with an EAdi catheter (Maquet, Solna, Sweden) that includes nine miniaturised electrodes and is positioned in the oesophagus at the level of the diaphragm. NAVA has been shown to decrease peak inspiratory pressures, which are potentially harmful for immature lungs (1,2) and, therefore, it may decrease ventilator induced lung injury, particularly pulmonary hypoplasia in congenital diaphragmatic hernia (CDH)...
December 16, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29209502/monitoring-diaphragm-function-in-a-patient-with-myasthenia-gravis-electrical-activity-of-the-diaphragm-vs-maximal-inspiratory-pressure
#3
Yukiko Koyama, Takeshi Yoshida, Akinori Uchiyama, Yuji Fujino
Background: Maximal inspiratory pressure (MIP) is used to assess respiratory muscle strength of patients with myasthenia gravis (MG) requiring ventilatory support. Electrical activity of the diaphragm (E-di) has been used to guide weaning. Case presentation: The MIP and tidal volume/ΔE-di (the patient-to-ventilator breath contribution) were monitored in a 12-year-old girl with MG requiring ventilator support. The same ventilatory settings were maintained until extubation...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/29204431/efficacy-of-ventilator-waveform-observation-for-detection-of-patient-ventilator-asynchrony-during-niv-a-multicentre-study
#4
Federico Longhini, Davide Colombo, Lara Pisani, Francesco Idone, Pan Chun, Jonne Doorduin, Liu Ling, Moreno Alemani, Andrea Bruni, Jin Zhaochen, Yu Tao, Weihua Lu, Eugenio Garofalo, Luca Carenzo, Salvatore Maurizio Maggiore, Haibo Qiu, Leo Heunks, Massimo Antonelli, Stefano Nava, Paolo Navalesi
The objective of this study was to assess ability to identify asynchronies during noninvasive ventilation (NIV) through ventilator waveforms according to experience and interface, and to ascertain the influence of breathing pattern and respiratory drive on sensitivity and prevalence of asynchronies. 35 expert and 35 nonexpert physicians evaluated 40 5-min NIV reports displaying flow-time and airway pressure-time tracings; identified asynchronies were compared with those ascertained by three examiners who evaluated the same reports displaying, additionally, tracings of diaphragm electrical activity...
October 2017: ERJ Open Research
https://www.readbyqxmd.com/read/29190622/classifying-apnea-of-prematurity-by-transcutaneous-electromyography-of-the-diaphragm
#5
Juliette V Kraaijenga, Gerard J Hutten, Cornelia G de Waal, Frans H de Jongh, Wes Onland, Anton H van Kaam
BACKGROUND: Treatment of apnea is highly dependent on the type of apnea. Chest impedance (CI) has inaccuracies in monitoring respiration, which compromises accurate apnea classification. Electrical activity of the diaphragm measured by transcutaneous electromyography (EMG) is feasible in preterm infants and might improve the accuracy of apnea classification. OBJECTIVES: To compare the accuracy of apnea classification based on diaphragmatic EMG (dEMG) and CI tracings in preterm infants...
December 1, 2017: Neonatology
https://www.readbyqxmd.com/read/29189671/neural-breathing-pattern-and-patient-ventilator-interaction-during-neurally-adjusted-ventilatory-assist-and-conventional-ventilation-in-newborns
#6
Pradeep V Mally, Jennifer Beck, Christer Sinderby, Martha Caprio, Sean M Bailey
OBJECTIVE: To compare neurally adjusted ventilatory assist and conventional ventilation on patient-ventilator interaction and neural breathing patterns, with a focus on central apnea in preterm infants. DESIGN: Prospective, observational cross-over study of intubated and ventilated newborns. Data were collected while infants were successively ventilated with three different ventilator conditions (30 min each period): 1) synchronized intermittent mandatory ventilation (SIMV) combined with pressure support at the clinically prescribed, SIMV with baseline settings (SIMVBL), 2) neurally adjusted ventilatory assist, 3) same as SIMVBL, but with an adjustment of the inspiratory time of the mandatory breaths (SIMV with adjusted settings [SIMVADJ]) using feedback from the electrical activity of the diaphragm)...
January 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29184049/does-diaphragmatic-electrical-activity-in-preterm-infants-predict-extubation-success
#7
Neetu Singh, Matthew J McNally, Robert A Darnall
BACKGROUND: Despite many advances in respiratory care and mechanical ventilation, neonatologists lack an objective tool to aid in decision making for timely extubation. Electrical activity of the diaphragm (EAdi), a measure of neural respiratory drive and inspiratory load, may be a useful predictor of extubation success in preterm neonates. The objective of this work was to investigate whether peak EAdi could distinguish successful versus failed extubation in mechanically ventilated preterm infants...
November 28, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29115949/neurally-adjusted-ventilatory-assist-nava-or-pressure-support-ventilation-psv-during-spontaneous-breathing-trials-in-critically-ill-patients-a-crossover-trial
#8
Juliana C Ferreira, Fabia Diniz-Silva, Henrique T Moriya, Adriano M Alencar, Marcelo B P Amato, Carlos R R Carvalho
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs...
November 7, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29077984/neurally-adjusted-ventilatory-assist-compared-to-other-forms-of-triggered-ventilation-for-neonatal-respiratory-support
#9
REVIEW
Thomas E Rossor, Katie A Hunt, Sandeep Shetty, Anne Greenough
BACKGROUND: Effective synchronisation of infant respiratory effort with mechanical ventilation may allow adequate gas exchange to occur at lower peak airway pressures, potentially reducing barotrauma and volutrauma and development of air leaks and bronchopulmonary dysplasia. During neurally adjusted ventilatory assist ventilation (NAVA), respiratory support is initiated upon detection of an electrical signal from the diaphragm muscle, and pressure is provided in proportion to and synchronous with electrical activity of the diaphragm (EADi)...
October 27, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29056361/compensatory-plasticity-in-diaphragm-and-intercostal-muscle-utilization-in-a-rat-model-of-als
#10
Yasin B Seven, Nicole L Nichols, Mia N Kelly, Orinda R Hobson, Irawan Satriotomo, Gordon S Mitchell
In SOD1(G93A) transgenic rat model of ALS, breathing capacity is preserved until late in disease progression despite profound respiratory motor neuron (MN) cell death. To explore mechanisms preserving breathing capacity, we assessed inspiratory EMG activity in diaphragm and external intercostal T2 (EIC2) and T5 (EIC5) muscles in anesthetized SOD1(G93A) rats at disease end-stage (20% decrease in body mass). We hypothesized that despite significant phrenic motor neuron loss and decreased phrenic nerve activity, diaphragm electrical activity and trans-diaphragmatic pressure (Pdi) are maintained to sustain ventilation...
October 19, 2017: Experimental Neurology
https://www.readbyqxmd.com/read/28833570/neural-breathing-pattern-in-newborn-infants-pre-and-postextubation
#11
Narayan P Iyer, John Dickson, Michelle E Ruiz, Robert Chatburn, Jennifer Beck, Chister Sinderby, Ricardo J Rodriguez
AIM: To describe the neural breathing pattern before and after extubation in newborn infants. METHODS: Prospective, observational study. In infants deemed ready for extubation, the diaphragm electrical activity (EAdi) was continuously recorded from 30 minute before to two hours after extubation. RESULTS: Total of 25 neonates underwent 29 extubations; 10 extubations resulted in re-intubation within 72 hours. Postextubation, there was an increase in peak EAdi (EAdi-max) and EAdi-delta (peak minus minimum EAdi) in both groups...
August 22, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28699995/procedures-for-measuring-and-verifying-gastric-tube-placement-in-newborns-an-integrative-review
#12
Flávia de Souza Barbosa Dias, Suellen Cristina Dias Emidio, Maria Helena Baena de Moraes Lopes, Antonieta Keiko Kakuda Shimo, Ana Raquel Medeiros Beck, Elenice Valentim Carmona
Objective: to investigate evidence in the literature on procedures for measuring gastric tube insertion in newborns and verifying its placement, using alternative procedures to radiological examination. Method: an integrative review of the literature carried out in the Cochrane, LILACS, CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors "Intubation, gastrointestinal" and "newborns" in original articles. Results: seventeen publications were included and categorized as "measuring method" or "technique for verifying placement"...
July 10, 2017: Revista Latino-americana de Enfermagem
https://www.readbyqxmd.com/read/28683763/new-setting-of-neurally-adjusted-ventilatory-assist-for-noninvasive-ventilation-by-facial-mask-a-physiologic-study
#13
Federico Longhini, Chun Pan, Jianfeng Xie, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Yi Yang, Paolo Navalesi, Haibo Qiu
BACKGROUND: Noninvasive ventilation (NIV) is generally delivered using pneumatically-triggered and cycled-off pressure support (PSP) through a mask. Neurally adjusted ventilatory assist (NAVA) is the only ventilatory mode that uses a non-pneumatic signal, i.e., diaphragm electrical activity (EAdi), to trigger and drive ventilator assistance. A specific setting to generate neurally controlled pressure support (PSN) was recently proposed for delivering NIV by helmet. We compared PSN with PSP and NAVA during NIV using a facial mask, with respect to patient comfort, gas exchange, and patient-ventilator interaction and synchrony...
July 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28673877/remifentanil-effects-on-respiratory-drive-and-timing-during-pressure-support-ventilation-and-neurally-adjusted-ventilatory-assist
#14
Roberta Costa, Paolo Navalesi, Gianmaria Cammarota, Federico Longhini, Giorgia Spinazzola, Flora Cipriani, Giuliano Ferrone, Olimpia Festa, Massimo Antonelli, Giorgio Conti
We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.05, 0.08, and 0.1μg·Kg(-1)·min(-)1) during both PSV and NAVA. We measured the patient's (Ti/Ttotneu) and ventilator (Ti/Ttotmec) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delaytrinsp) and expiratory (Delaytrexp) trigger delays and the Asynchrony Index (AI)...
July 1, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28623885/monitoring-the-electric-activity-of-the-diaphragm-during-noninvasive-positive-pressure-ventilation-a-case-report
#15
Fabia Diniz-Silva, Anna Miethke-Morais, Adriano M Alencar, Henrique T Moriya, Pedro Caruso, Eduardo L V Costa, Juliana C Ferreira
BACKGROUND: In patients with post-extubation respiratory distress, delayed reintubation may worsen clinical outcomes. Objective measures of extubation failure at the bedside are lacking, therefore clinical parameters are currently used to guide the need of reintubation. Electrical activity of the diaphragm (EAdi) provides clinicians with valuable, objective information about respiratory drive and could be used to monitor respiratory effort. CASE PRESENTATION: We describe the case of a patient with Chronic Obstructive Pulmonary Disease (COPD), from whom we recorded EAdi during four different ventilatory conditions: 1) invasive mechanical ventilation, 2) spontaneous breathing trial (SBT), 3) unassisted spontaneous breathing, and 4) Noninvasive Positive Pressure Ventilation (NPPV)...
June 17, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28578708/effects-of-neurally-adjusted-ventilatory-assist-on-air-distribution-and-dead-space-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#16
Qin Sun, Ling Liu, Chun Pan, Zhanqi Zhao, Jingyuan Xu, Airan Liu, Haibo Qiu
BACKGROUND: Neurally adjusted ventilatory assist (NAVA) could improve patient-ventilator interaction; its effects on ventilation distribution and dead space are still unknown. The aim of this study was to evaluate the effects of varying levels of assist during NAVA and pressure support ventilation (PSV) on ventilation distribution and dead space in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Fifteen mechanically ventilated patients with AECOPD were included in the study...
June 2, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28522757/functional-assessment-of-the-diaphragm-by-speckle-tracking-ultrasound-during-inspiratory-loading
#17
Eline Oppersma, Nima Hatam, Jonne Doorduin, Johannes G van der Hoeven, Gernot Marx, Andreas Goetzenich, Sebastian Fritsch, Leo M A Heunks, Christian S Bruells
BACKGROUND: Assessment of diaphragmatic effort is challenging especially in critically ill patients in the phase of weaning. Fractional thickening during inspiration assessed by ultrasound has been used to estimate diaphragm effort. It is unknown whether more sophisticated ultrasound techniques such as speckle tracking are superior in the quantification of inspiratory effort. This study evaluates the validity of speckle tracking ultrasound to quantify diaphragm contractility. METHODS: Thirteen healthy volunteers underwent a randomized stepwise threshold loading protocol of 0 to 50% of the maximal inspiratory pressure...
May 18, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28485314/effects-of-propofol-on-respiratory-drive-and-patient-ventilator-synchrony-during-pressure-support-ventilation-in-postoperative-patients-a-prospective-study
#18
Ling Liu, Ai-Ping Wu, Yi Yang, Song-Qiao Liu, Ying-Zi Huang, Jian-Feng Xie, Chun Pan, Cong-Shan Yang, Hai-Bo Qiu
BACKGROUND: Propofol is increasingly used during partial support mechanical ventilation such as pressure support ventilation (PSV) in postoperative patients. However, breathing pattern, respiratory drive, and patient-ventilator synchrony are affected by the sedative used and the sedation depth. The present study aimed to evaluate the physiologic effects of varying depths of propofol sedation on respiratory drive and patient-ventilator synchrony during PSV in postoperative patients. METHODS: Eight postoperative patients receiving PSV for <24 h were enrolled...
May 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28413621/recent-advances-in-pediatric-ventilatory-assistance
#19
REVIEW
Nicolas Nardi, Guillaume Mortamet, Laurence Ducharme-Crevier, Guillaume Emeriaud, Philippe Jouvet
In this review on respiratory assistance, we aim to discuss the following recent advances: the optimization and customization of mechanical ventilation, the use of high-frequency oscillatory ventilation, and the role of noninvasive ventilation. The prevention of ventilator-induced lung injury and diaphragmatic dysfunction is now a key aspect in the management of mechanical ventilation, since these complications may lead to higher mortality and prolonged length of stay in intensive care units. Different physiological measurements, such as esophageal pressure, electrical activity of the diaphragm, and volumetric capnography, may be useful objective tools to help guide ventilator assistance...
2017: F1000Research
https://www.readbyqxmd.com/read/28390638/treatment-of-idiopathic-diaphragm-flutter-a-case-study
#20
Michael Chiou, María Victoria Herrero, John R Bach, Jeffrey L Cole, Enrique Luis Gonzales
Diaphragm flutter is a rare disorder defined by dyspnea and often thoracoabdominal pain associated with rapid rhythmic involuntary contractions of the diaphragm with no effective treatment. A 35-year-old woman's flutter was triggered by increasing the depth of breathing and by (electrical) stimulation of the diaphragm. Medical therapy, phrenic nerve crush, and diaphragm pacer stimulation were ineffective. Since increasing diaphragm activity was a trigger, resting the diaphragm was tried. A manual resuscitator and, subsequently, mouthpiece and nasal noninvasive ventilatory support (NVS) instantaneously halted the flutter for 3 months and almost instantaneously for another 6 months...
April 2017: Chest
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