TY - JOUR
T1 - Transesophageal Versus Surface Electromyography of the Diaphragm in Ventilated Subjects
AU - Lokin, Joost Lc
AU - Dulger, Soray
AU - Glas, Gerie J.
AU - Horn, Janneke
PY - 2020/9/1
Y1 - 2020/9/1
N2 - BACKGROUND: Detection of diaphragmatic muscle activity during invasive ventilation may provide valuable information about patient-ventilator interactions. Transesophageal electromyography of the diaphragm (tEA di ) is used in neurally adjusted ventilatory assist. This technique is invasive and can only be applied with one specific ventilator. Surface electromyography of the diaphragm (sEA di ) is noninvasive and can potentially be applied with all types of ventilators. The primary objective of our study was to compare the ability of diaphragm activity detection between sEA di and tEA di . METHODS: In this single-center pilot study, sEA di and tEA di recordings were obtained simultaneously for 15 min in adult subjects in the ICU who were invasively ventilated. The number of breathing efforts detected by sEA di and tEA di were determined. The percentage of detected breathing efforts by sEA di compared with tEA di was calculated. Temporal and signal strength relations on optimum recordings of 10 breaths per subject were also compared. The Spearman correlation coefficient was used to determine the correlation between sEA di and tEA di . Agreement was calculated by using Bland-Altman statistics. RESULTS: Fifteen subjects were included. The tEA di detected 3,675 breathing efforts, of which 3,162 (86.0%) were also detected by sEA di . A statistically significant temporal correlation (r 5 0.95, P < .001) was found between sEA di and tEA di in stable recordings. The mean difference in the time intervals between both techniques was 10.1 ms, with limits of agreement from – 410 to 430 ms. CONCLUSIONS: Analysis of our results showed that sEA di was not reliable for breathing effort detection in subjects who were invasively ventilated compared with tEA di .Instable recordings, however, sEA di and tEA di had excellent temporal correlation and good agreement. With optimization of signal stability, sEA di may become a useful monitoring tool.
AB - BACKGROUND: Detection of diaphragmatic muscle activity during invasive ventilation may provide valuable information about patient-ventilator interactions. Transesophageal electromyography of the diaphragm (tEA di ) is used in neurally adjusted ventilatory assist. This technique is invasive and can only be applied with one specific ventilator. Surface electromyography of the diaphragm (sEA di ) is noninvasive and can potentially be applied with all types of ventilators. The primary objective of our study was to compare the ability of diaphragm activity detection between sEA di and tEA di . METHODS: In this single-center pilot study, sEA di and tEA di recordings were obtained simultaneously for 15 min in adult subjects in the ICU who were invasively ventilated. The number of breathing efforts detected by sEA di and tEA di were determined. The percentage of detected breathing efforts by sEA di compared with tEA di was calculated. Temporal and signal strength relations on optimum recordings of 10 breaths per subject were also compared. The Spearman correlation coefficient was used to determine the correlation between sEA di and tEA di . Agreement was calculated by using Bland-Altman statistics. RESULTS: Fifteen subjects were included. The tEA di detected 3,675 breathing efforts, of which 3,162 (86.0%) were also detected by sEA di . A statistically significant temporal correlation (r 5 0.95, P < .001) was found between sEA di and tEA di in stable recordings. The mean difference in the time intervals between both techniques was 10.1 ms, with limits of agreement from – 410 to 430 ms. CONCLUSIONS: Analysis of our results showed that sEA di was not reliable for breathing effort detection in subjects who were invasively ventilated compared with tEA di .Instable recordings, however, sEA di and tEA di had excellent temporal correlation and good agreement. With optimization of signal stability, sEA di may become a useful monitoring tool.
KW - Electromyography of the diaphragm (EAdi)
KW - Mechanical ventilation
KW - Neurally adjusted ventilatory assist (NAVA)
KW - Surface electromyography
UR - http://www.scopus.com/inward/record.url?scp=85090270741&partnerID=8YFLogxK
U2 - https://doi.org/10.4187/respcare.07094
DO - https://doi.org/10.4187/respcare.07094
M3 - Article
C2 - 32234771
SN - 0020-1324
VL - 65
SP - 1309
EP - 1314
JO - Respiratory care
JF - Respiratory care
IS - 9
ER -