TY - JOUR
T1 - Advanced serial analysis of the diaphragm surface EMG
T2 - insights into the effect of pressure support on the neuro-ventilatory response during the ICU stay
AU - Warnaar, R S P
AU - Cornet, A D
AU - Beishuizen, A
AU - Donker, D W
AU - Oppersma, E
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/6/23
Y1 - 2025/6/23
N2 - BACKGROUND: Ventilatory support levels in ICU patients should be tailored to both optimal gas exchange and respiratory muscle loading, as over- and underassistance may cause diaphragm dysfunction. The diaphragm's capacity to overcome mechanical load and deliver ventilatory output is reflected by the patient's neural respiratory drive (NRD), tidal volume (TV) and respiratory rate (RR). Surface electromyography of the diaphragm (sEMGdi) offers a continuous, non-invasive measure of NRD. We investigated the effect of pressure support (PS) level on the coupling of diaphragm electrical activity (sEAdi) and ventilatory output during the ICU stay.METHODS: In clinically stable ICU patients (N = 17), four PS-levels were applied on alternate days, based on the clinical value (- 3, + 0, + 3, and + 6 cmH
2O). sEAdi time-product (ETPdi) was calculated from high-quality sEAdi waveforms, using a novel, advanced signal analysis approach. The breath-by-breath correlation between ETPdi and TV was defined as neuro-ventilatory coupling (NVC), enabling quantification of the neuro-ventilatory response.
RESULTS: On group level (13 patients, 26 PS-trials), ETPdi and RR increased with decreasing PS-levels (2.4 and 1.6 percentage point (pp)/cmH
2O), whereas TV decreased (2.5 pp/cmH
2O). Longitudinal analysis (4 patients, 14 PS-trials) showed strengthened coupling between ETPdi and TV during weaning, reflected by an increase in median NVC from 3.4% (IQR 2.9) to 26.3% (IQR 21.7) between the first and last PS-trial.
CONCLUSION: Advanced sEMGdi analysis allows for non-invasive quantification of NVC, reflecting the diaphragm's capacity to overcome mechanical load. In patients approaching liberation from MV, increasing NVC indicates the shift from near-passive to active breathing. This study demonstrates the potential of NVC to inform tailoring of ventilatory support levels.TRIAL REGISTRATION NUMBER: Dutch Trial Register NL9654. Registered August 05, 2021.
AB - BACKGROUND: Ventilatory support levels in ICU patients should be tailored to both optimal gas exchange and respiratory muscle loading, as over- and underassistance may cause diaphragm dysfunction. The diaphragm's capacity to overcome mechanical load and deliver ventilatory output is reflected by the patient's neural respiratory drive (NRD), tidal volume (TV) and respiratory rate (RR). Surface electromyography of the diaphragm (sEMGdi) offers a continuous, non-invasive measure of NRD. We investigated the effect of pressure support (PS) level on the coupling of diaphragm electrical activity (sEAdi) and ventilatory output during the ICU stay.METHODS: In clinically stable ICU patients (N = 17), four PS-levels were applied on alternate days, based on the clinical value (- 3, + 0, + 3, and + 6 cmH
2O). sEAdi time-product (ETPdi) was calculated from high-quality sEAdi waveforms, using a novel, advanced signal analysis approach. The breath-by-breath correlation between ETPdi and TV was defined as neuro-ventilatory coupling (NVC), enabling quantification of the neuro-ventilatory response.
RESULTS: On group level (13 patients, 26 PS-trials), ETPdi and RR increased with decreasing PS-levels (2.4 and 1.6 percentage point (pp)/cmH
2O), whereas TV decreased (2.5 pp/cmH
2O). Longitudinal analysis (4 patients, 14 PS-trials) showed strengthened coupling between ETPdi and TV during weaning, reflected by an increase in median NVC from 3.4% (IQR 2.9) to 26.3% (IQR 21.7) between the first and last PS-trial.
CONCLUSION: Advanced sEMGdi analysis allows for non-invasive quantification of NVC, reflecting the diaphragm's capacity to overcome mechanical load. In patients approaching liberation from MV, increasing NVC indicates the shift from near-passive to active breathing. This study demonstrates the potential of NVC to inform tailoring of ventilatory support levels.TRIAL REGISTRATION NUMBER: Dutch Trial Register NL9654. Registered August 05, 2021.
KW - Mechanical ventilation
KW - Neuro-ventilatory response
KW - Respiratory failure
KW - Respiratory surface electromyography
UR - https://www.scopus.com/pages/publications/105008810568
U2 - 10.1186/s13054-025-05424-5
DO - 10.1186/s13054-025-05424-5
M3 - Article
C2 - 40551236
SN - 1466-609X
VL - 29
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
M1 - 258
ER -