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Electrical activity of diaphragm

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https://www.readbyqxmd.com/read/28063121/monitoring-of-electrical-activity-of-the-diaphragm-shows-failure-of-t-piece-trial-earlier-than-protocol-based-parameters-in-prolonged-weaning-in-non-communicative-neurological-patients
#1
Oliver Trapp, Mascha Fiedler, Michael Hartwich, Martin Schorl, Armin Kalenka
BACKGROUND: The weaning target in tracheotomised patients is not extubation, but spontaneous breathing without the support of a ventilator. Overloading the respiratory pump during such spontaneous breathing trials is unfavorable, prolongs weaning time, and increases morbidity and mortality. The goal of this study was to evaluate the electrical activity of the diaphragm during a t-piece trial in non-communicative neurological patients and the comparison to clinical parameters of exhaustion...
January 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28013057/neural-control-of-ventilation-prevents-both-over-distension-and-de-recruitment-of-experimentally-injured-lungs
#2
Lukas Brander, Onnen Moerer, Göran Hedenstierna, Jennifer Beck, Jukka Takala, Arthur S Slutsky, Christer Sinderby
BACKGROUND: Endogenous pulmonary reflexes may protect the lungs during mechanical ventilation. We aimed to assess integration of continuous neurally adjusted ventilatory assist (cNAVA), delivering assist in proportion to diaphragm's electrical activity during inspiration and expiration, and Hering-Breuer inflation and deflation reflexes on lung recruitment, distension, and aeration before and after acute lung injury (ALI). METHODS: In 7 anesthetised rabbits with bilateral pneumothoraces, we identified adequate cNAVA level (cNAVAAL) at the plateau in peak ventilator pressure during titration procedures before (healthy lungs with endotracheal tube, [HLETT]) and after ALI (endotracheal tube [ALIETT] and during non-invasive ventilation [ALINIV])...
December 22, 2016: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/27940767/effective-neurally-adjusted-ventilatory-assist-nava-ventilation-in-a-child-with-jeune-syndrome
#3
Gianluca Cosi, Giulia Genoni, Alice Monzani, Barbara Pilan, Maria Lavrano, Federica Ferrero
Jeune syndrome (asphyxiating thoracic dystrophy) is a rare skeletal dysplasia mainly characterized by dystrophy of the thoracic cage. Neurally adjusted ventilatory assist (NAVA) is a respiratory support in which pressure assistance is provided in proportion to and synchronous with the electrical activity of the diaphragm. We present the case of a 4-month-old infant with asphyxiating thoracic dystrophy and respiratory failure successfully ventilated with NAVA. In this case, NAVA improved patient-ventilator synchrony, reducing endotracheal secretion and gastric overdistention...
November 2016: Pediatrics
https://www.readbyqxmd.com/read/27922742/the-diaphragm-acts-as-a-brake-during-expiration-to-prevent-lung-collapse
#4
Mariangela Pellegrini, Göran Hedenstierna, Agneta Roneus, Monica Segelsjö, Anders Larsson, Gaetano Perchiazzi
RATIONALE: The diaphragm is the major inspiratory muscle and is assumed to relax during expiration. However, electrical post-inspiratory activity has been observed. Whether or not there is an expiratory diaphragmatic contraction that preserves lung patency has yet to be explored. OBJECTIVE: We hypothesized the occurrence of an expiratory diaphragmatic contraction directed at stabilizing peripheral airways and preventing or reducing cyclic expiratory lung collapse...
December 6, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27891095/differential-rna-expression-profile-of-skeletal-muscle-induced-by-experimental-autoimmune-myasthenia-gravis-in-rats
#5
Henry J Kaminski, Keiichi Himuro, Jumana Alshaikh, Bendi Gong, Georgiana Cheng, Linda L Kusner
The differential susceptibility of skeletal muscle by myasthenia gravis (MG) is not well understood. We utilized RNA expression profiling of extraocular muscle (EOM), diaphragm (DIA), and extensor digitorum (EDL) of rats with experimental autoimmune MG (EAMG) to evaluate the hypothesis that muscles respond differentially to injury produced by EAMG. EAMG was induced in female Lewis rats by immunization with acetylcholine receptor purified from the electric organ of the Torpedo. Six weeks later after rats had developed weakness and serum antibodies directed against the AChR, animals underwent euthanasia and RNA profiling performed on DIA, EDL, and EOM...
2016: Frontiers in Physiology
https://www.readbyqxmd.com/read/27850693/1055-titrating-nava-levels-affects-peak-pressure-and-electrical-activity-of-diaphragm-in-picu-patients
#6
Laura Nguyen, Erica Morgan, Rajat Kaul, Susan Tourner, Howard Stein
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27821162/physiological-effects-of-invasive-ventilation-with-neurally-adjusted-ventilatory-assist-nava-in-a-crossover-study
#7
Jean-Michel Liet, François Barrière, Bénédicte Gaillard-Le Roux, Pierre Bourgoin, Arnaud Legrand, Nicolas Joram
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a mode of assisted mechanical ventilation that delivers inspiratory pressure proportionally to the electrical activity of the diaphragm. To date, no pediatric study has focused on the effects of NAVA on hemodynamic parameters. This physiologic study with a randomized cross-over design compared hemodynamic parameters when NAVA or conventional ventilation (CV) was applied. METHODS: After a baseline period, infants received NAVA and CV in a randomized order during two consecutive 30-min periods...
November 8, 2016: BMC Pediatrics
https://www.readbyqxmd.com/read/27799323/diaphragmatic-activity-during-weaning-from-respiratory-support-in-preterm-infants
#8
Juliette V Kraaijenga, Cornelia G de Waal, Gerard J Hutten, Frans H de Jongh, Anton H van Kaam
OBJECTIVE: To determine if weaning from nasal continuous positive airway pressure (nCPAP) to lesser supportive low flow nasal cannula (LFNC) results in a change in electrical activity of the diaphragm in preterm infants. DESIGN: Prospective observational study. SETTING: Neonatal intensive care unit. PATIENTS: Stable preterm infants weaned from nCPAP to LFNC (1 L/min). MAIN OUTCOME MEASURES: Change in diaphragmatic activity, expressed as amplitude, peak and tonic activity, measured by transcutaneous electromyography (dEMG) from 30 min before (baseline) until 180 min after weaning...
October 31, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/27784315/intraoperative-hemidiaphragm-electrical-stimulation-reduces-oxidative-stress-and-upregulates-autophagy-in-surgery-patients-undergoing-mechanical-ventilation-exploratory-study
#9
Robert T Mankowski, Shakeel Ahmed, Thomas Beaver, Marvin Dirain, Chul Han, Phillip Hess, Tomas Martin, Barbara K Smith, Shinichi Someya, Christiaan Leeuwenburgh, A Daniel Martin
BACKGROUND: Mechanical ventilation (MV) during a cardio-thoracic surgery contributes to diaphragm muscle dysfunction that impairs weaning and can lead to the ventilator- induced diaphragm dysfunction. Especially, it is critical in older adults who have lower muscle reparative capacity following MV. Reports have shown that the intraoperative intermittent hemidiaphragm electrical stimulation can maintain and/or improve post-surgery diaphragm function. In particular, from a molecular point of view, intermittent ES may reduce oxidative stress and increase regulatory autophagy levels, and therefore improve diaphragm function in animal studies...
October 26, 2016: Journal of Translational Medicine
https://www.readbyqxmd.com/read/27748627/partial-neuromuscular-blockade-during-partial-ventilatory-support-in-sedated-patients-with-high-tidal-volumes
#10
Jonne Doorduin, Joeke L Nollet, Lisanne H Roesthuis, Hieronymus W H van Hees, Laurent J Brochard, Christer A Sinderby, Johannes G van der Hoeven, Leo M A Heunks
RATIONALE: Controlled mechanical ventilation is used to deliver lung-protective ventilation in patients with acute respiratory distress syndrome. Despite recognized benefits, such as preserved diaphragm activity, partial support ventilation modes may be incompatible with lung-protective ventilation due to high tidal volume and high transpulmonary pressure. As an alternative to high dose sedatives and controlled mechanical ventilation, pharmacologically induced neuromechanical uncoupling of the diaphragm should facilitate lung-protective ventilation under partial support modes...
October 17, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27649505/new-setting-of-neurally-adjusted-ventilatory-assist-during-noninvasive-ventilation-through-a-helmet
#11
Gianmaria Cammarota, Federico Longhini, Raffaella Perucca, Chiara Ronco, Davide Colombo, Antonio Messina, Rosanna Vaschetto, Paolo Navalesi
BACKGROUND: Compared to pneumatically controlled pressure support (PSP), neurally adjusted ventilatory assist (NAVA) was proved to improve patient-ventilator interactions, while not affecting comfort, diaphragm electrical activity (EAdi), and arterial blood gases (ABGs). This study compares neurally controlled pressure support (PSN) with PSP and NAVA, delivered through two different helmets, in hypoxemic patients receiving noninvasive ventilation for prevention of extubation failure. METHODS: Fifteen patients underwent three (PSP, NAVA, and PSN) 30-min trials in random order with both helmets...
September 19, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27629375/comparing-changing-neurally-adjusted-ventilatory-assist-nava-levels-in-intubated-and-recently-extubated-neonates
#12
B LoVerde, K S Firestone, H M Stein
OBJECTIVE: Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers ventilatory support in synchrony to the patient's respiratory needs using NAVA level, a proportionality constant that converts the electrical activity of the diaphragm (Edi) into a peak pressure (PIP). Recent published studies suggest that neonates can control the delivered ventilatory support through neural feedback. Systematically increasing the NAVA level initially increases the PIP while maintaining a constant Edi until an inflection point or breakpoint (BrP) is reached, at which time the PIP plateaus and the Edi signal decreases...
December 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27405054/impact-of-feeding-method-on-diaphragm-electrical-activity-and-central-apnea-in-preterm-infants-feadi-study
#13
Eugene Ng, Patti Schurr, Maureen Reilly, Michael Dunn, Jennifer Beck
BACKGROUND: In preterm infants, it is unknown whether feeding affects neural breathing pattern. OBJECTIVES: By measuring the diaphragm electrical activity (Edi) waveform, we evaluated the effect of enteral feeding and compared the effects of feeding methods on neural breathing pattern and central apnea in very low birth weight preterm infants. METHODS: In a prospective, randomized, crossover study, ten non-ventilated preterm infants with birth weights<1250g and tolerating full feeds were randomized to either bolus feeding (BF) or slow infusion feeding (SF) over 90min, followed by crossover to the other method at the next feed...
October 2016: Early Human Development
https://www.readbyqxmd.com/read/27390463/neurally-adjusted-ventilation-assist-in-weaning-difficulty-first-case-report-from-india
#14
Milind Baldi, Inderpaul Singh Sehgal, Sahajal Dhooria, Digambar Behera, Ritesh Agarwal
Invasive mechanical ventilation is an integral component in the management of critically ill patients. In certain situations, liberation from mechanical ventilation becomes difficult resulting in prolonged ventilation. Patient-ventilator dyssynchrony is a frequently encountered reason for difficult weaning. Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that utilizes the electrical activity of diaphragm to pick up respiratory signals and delivers assistance in proportion to the ventilatory requirement of a patient...
June 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27368279/effects-of-dexmedetomidine-and-propofol-on-patient-ventilator-interaction-in-difficult-to-wean-mechanically-ventilated-patients-a-prospective-open-label-randomised-multicentre-study
#15
Giorgio Conti, Vito Marco Ranieri, Roberta Costa, Chris Garratt, Andrew Wighton, Giorgia Spinazzola, Rosario Urbino, Luciana Mascia, Giuliano Ferrone, Pasi Pohjanjousi, Gabriela Ferreyra, Massimo Antonelli
BACKGROUND: Dexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects. The aim of this study was to compare the incidence of patient-ventilator dyssynchronies during sedation with dexmedetomidine or propofol. METHODS: We conducted a multicentre, prospective, open-label, randomised clinical trial, comparing dexmedetomidine with standard propofol sedation at three intensive care units of university hospitals in Italy...
July 2, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27334266/esophageal-and-transpulmonary-pressure-in-the-clinical-setting-meaning-usefulness-and-perspectives
#16
REVIEW
Tommaso Mauri, Takeshi Yoshida, Giacomo Bellani, Ewan C Goligher, Guillaume Carteaux, Nuttapol Rittayamai, Francesco Mojoli, Davide Chiumello, Lise Piquilloud, Salvatore Grasso, Amal Jubran, Franco Laghi, Sheldon Magder, Antonio Pesenti, Stephen Loring, Luciano Gattinoni, Daniel Talmor, Lluis Blanch, Marcelo Amato, Lu Chen, Laurent Brochard, Jordi Mancebo
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning...
September 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27274216/a-randomized-clinical-trial-of-neurally-adjusted-ventilatory-assist-versus-conventional-weaning-mode-in-patients-with-copd-and-prolonged-mechanical-ventilation
#17
RANDOMIZED CONTROLLED TRIAL
Nai-Ying Kuo, Mei-Lien Tu, Tsai-Yi Hung, Shih-Feng Liu, Yu-Hsiu Chung, Meng-Chih Lin, Chao-Chien Wu
BACKGROUND: Patient-ventilator asynchrony is a common problem in mechanically ventilated patients; the problem is especially obvious in COPD. Neutrally adjusted ventilatory assist (NAVA) can improve patient-ventilator asynchrony; however, the effect in COPD patients with prolonged mechanical ventilation is still unknown. The goals of this study are to evaluate the effect of NAVA and conventional weaning mode in patients with COPD during prolonged mechanical ventilation. METHODS: The study enrolled a total of 33 COPD patients with ventilator dependency for more than 21 days in the weaning center...
2016: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/27134770/diaphragm-assessment-in-mice-overexpressing-phospholamban-in-slow-twitch-type-i-muscle-fibers
#18
Val Andrew Fajardo, Ian Curtis Smith, Eric Bombardier, Paige J Chambers, Joe Quadrilatero, Allan Russell Tupling
AIMS: Phospholamban (PLN) and sarcolipin (SLN) are small inhibitory proteins that regulate the sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA) pump. Previous work from our laboratory revealed that in the soleus and gluteus minimus muscles of mice overexpressing PLN (Pln (OE)), SERCA function was impaired, dynamin 2 (3-5 fold) and SLN (7-9 fold) were upregulated, and features of human centronuclear myopathy (CNM) were observed. Here, we performed structural and functional experiments to evaluate whether the diaphragm muscles of the Pln (OE) mouse would exhibit CNM pathology and muscle weakness...
June 2016: Brain and Behavior
https://www.readbyqxmd.com/read/27070802/monitoring-patient-ventilator-asynchrony
#19
Martin Dres, Nuttapol Rittayamai, Laurent Brochard
PURPOSE OF REVIEW: This article describes and discusses the importance of monitoring patient-ventilator asynchrony, and the advantages and limitations of the specific techniques available at the bedside to evaluate it. RECENT FINDINGS: Signals provided by esophageal catheters (pressure or electromyogram) are the most reliable and accurate instruments to detect asynchronies. Esophageal signals (providing electrical activity of the diaphragm or/and esophageal pressure) have allowed the recent description of reverse triggering, a new kind of asynchrony, in which mechanical insufflation repeatedly triggers diaphragmatic contractions...
June 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27027934/acute-non-traumatic-gastrothorax-presentation-of-a-case-with-chest-pain-and-atypical-radiologic-findings
#20
Deepwant Singh, Pieter Mackeith, Dipesh Pravin Gopal
A previously well 71-year-old woman presented to the Emergency Department with acute-onset left-sided chest pain. She was haemodynamically stable with unremarkable systemic examination. Her electrocardiogram and troponin were within normal limits and her chest radiograph showed a raised left hemi-diaphragm. Two hours after admission, this woman became acutely breathless, and suffered a pulseless electrical activity cardiac arrest. After cardiopulmonary resuscitation, there was a return of spontaneous circulation and regained consciousness...
March 23, 2016: Medwave
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