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Diaphragm electromyographic activity as a predictor of weaning failure

Martin Dres| Matthieu Schmidt| Alexis Ferre| Julien Mayaux| Thomas Similowski| Alexandre Demoule
Original
Volume 38, Issue 12 / December , 2012

Pages 2017 - 2025

Abstract

Purpose

To compare breathing pattern descriptors and diaphragm electromyographic activity (EAdi)-derived indices obtained from a neurally adjusted ventilatory assist catheter during a spontaneous breathing trial (SBT) in patients successfully and unsuccessfully separated from the ventilator and to assess their performance as a potential marker to discriminate these two categories of patients.

Methods

Fifty-seven ready-to-wean patients were included in a prospective observational study. During a 30-min SBT (pressure support 7 cmH2O, zero end expiratory pressure), tidal volume (VT) and respiratory rate (RR) were obtained from the flow signal at baseline and at 3, 10, 20 and 30 min during the SBT. EAdi-derived indices were simultaneously computed: maximum of the EAdi (EAdimax), area under the inspiratory curve of EAdi (EAdiAUC), the difference between EAdimax and EAdimin (∆EAdi), EAdimax/VT, EAdiAUC/VT and ∆EAdi/VT. Patients, successfully (success group; n = 35) and unsuccessfully (failure group; n = 22) separated from the ventilator were compared.

Results

At baseline, the breathing pattern was similar in the two groups, whereas EAdimax and EAdiAUC were significantly lower in the success group (p < 0.05). In the failure group, RR and RR/VT increased significantly during the trial, VT decreased, whereas EAdimax and EAdiAUC did not change. At 3 min, the areas under the receiver operating characteristic-curve of RR/VT and the EAdi-derived indices to predict weaning outcome were 0.83 for the rapid shallow breathing index (RSBI), 0.84 for EAdimax/VT , 0.80 for EAdiAUC/VT (0.80) and 0.82 for ∆EAdi/VT. The coefficient of variation for VT decreased in the failure group while that for EAdimax remained unchanged.

Conclusions

EAdi-derived indices provide reliable and early predictors of weaning outcome. However, the performance of these indices is not better than the RR/VT.

Keywords

References

  1. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056
    • View reference on PubMed
    • View reference on publisher's website
  2. Tobin MJ, Jubran A (2006) Weaning from mechanical ventilation. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 1185–1220
  3. Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324:1445–1450
    • View reference on PubMed
    • View reference on publisher's website
  4. MacIntyre N (2007) Discontinuing mechanical ventilatory support. Chest 132:1049–1056
    • View reference on PubMed
    • View reference on publisher's website
  5. Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C, Mancebo J, Esteban A, Epstein S (2001) Predicting success in weaning from mechanical ventilation. Chest 120:400S–424S
    • View reference on PubMed
    • View reference on publisher's website
  6. Wysocki M, Cracco C, Teixeira A, Mercat A, Diehl JL, Lefort Y, Derenne JP, Similowski T (2006) Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation. Crit Care Med 34:2076–2083
    • View reference on PubMed
    • View reference on publisher's website
  7. Sassoon CS, Te TT, Mahutte CK, Light RW (1987) Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135:107–113
    • View reference on PubMed
  8. Sassoon CS, Mahutte CK, Te TT, Simmons DH, Light RW (1988) Work of breathing and airway occlusion pressure during assist-mode mechanical ventilation. Chest 93:571–576
    • View reference on PubMed
    • View reference on publisher's website
  9. Fernandez R, Cabrera J, Calaf N, Benito S (1990) P 0.1/PIMax: an index for assessing respiratory capacity in acute respiratory failure. Intensive Care Med 16:175–179
  10. Gandia F, Blanco J (1992) Evaluation of indexes predicting the outcome of ventilator weaning and value of adding supplemental inspiratory load. Intensive Care Med 18:327–333
  11. Montgomery AB, Holle RH, Neagley SR, Pierson DJ, Schoene RB (1987) Prediction of successful ventilator weaning using airway occlusion pressure and hypercapnic challenge. Chest 91:496–499
    • View reference on PubMed
    • View reference on publisher's website
  12. Sassoon CS, Mahutte CK (1993) Airway occlusion pressure and breathing pattern as predictors of weaning outcome. Am Rev Respir Dis 148:860–866
    • View reference on PubMed
    • View reference on publisher's website
  13. Fernandez MD, Piacentini E, Blanch L, Fernandez R (2004) Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure. Intensive Care Med 30:2210–2215
  14. Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433–1436
    • View reference on PubMed
    • View reference on publisher's website
  15. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843
    • View reference on PubMed
  16. Jubran A, Tobin MJ (1997) Pathophysiology basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 155:906–915
    • View reference on PubMed
  17. Laghi F, Cattapan SE, Jubran A, Parthasarathy S, Warshawsky P, Choi YS, Tobin MJ (2003) Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 167:120–127
    • View reference on PubMed
    • View reference on publisher's website
  18. Parthasarathy S, Jubran A, Laghi F, Tobin MJ (2007) Sternomastoid, rib cage, and expiratory muscle activity during weaning failure. J Appl Physiol 103:140–147
    • View reference on PubMed
    • View reference on publisher's website
  19. Lee KH, Hui KP, Chan TB, Tan WC, Lim TK (1994) Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest 105:540–543
    • View reference on PubMed
    • View reference on publisher's website
  20. El-Khatib MF, Zeineldine SM, Jamaleddine GW (2008) Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients. Intensive Care Med 34:505–510
  21. Wolf GK, Walsh BK, Green ML, Arnold JH (2011) Electrical activity of the diaphragm during extubation readiness testing in critically ill children. Pediatr Crit Care Med 12:e220–e224
    • View reference on PubMed
    • View reference on publisher's website
  22. Bien MY, Lin YS, Shih CH, Yang YL, Lin HW, Bai KJ, Wang JH, Kou YR (2011) Comparisons of predictive performance of breathing pattern variability measured during T-piece, automatic tube compensation, and pressure support ventilation for weaning intensive care unit patients from mechanical ventilation. Crit Care Med 39:2253–2262
    • View reference on PubMed
    • View reference on publisher's website
  23. Khoo MC (2000) Determinants of ventilatory instability and variability. Respir Physiol 122:167–182
    • View reference on PubMed
    • View reference on publisher's website
  24. Schmidt M, Demoule A, Cracco C, Gharbi A, Fiamma MN, Straus C, Duguet A, Gottfried SB, Similowski T (2010) Neurally adjusted ventilatory assist increases respiratory variability and complexity in acute respiratory failure. Anesthesiology 112:670–681
    • View reference on PubMed
    • View reference on publisher's website
  25. Cabello B, Thille AW, Roche-Campo F, Brochard L, Gomez FJ, Mancebo J (2010) Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients. Intensive Care Med 36:1171–1179
  26. O’Donnell DE, Banzett RB, Carrieri-Kohlman V, Casaburi R, Davenport PW, Gandevia SC, Gelb AF, Mahler DA, Webb KA (2007) Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable. Proc Am Thorac Soc 4:145–168
    • View reference on PubMed
    • View reference on publisher's website
  27. O’Donnell DE, Hamilton AL, Webb KA (2006) Sensory-mechanical relationships during high-intensity, constant-work-rate exercise in COPD. J Appl Physiol 101:1025–1035
    • View reference on PubMed
    • View reference on publisher's website
  28. Murphy PB, Kumar A, Reilly C, Jolley C, Walterspacher S, Fedele F, Hopkinson NS, Man WD, Polkey MI, Moxham J, Hart N (2011) Neural respiratory drive as a physiological biomarker to monitor change during acute exacerbations of COPD. Thorax 66:602–608
    • View reference on PubMed
    • View reference on publisher's website
  29. De Troyer A, Peche R, Yernault JC, Estenne M (1994) Neck muscle activity in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 150:41–47
    • View reference on PubMed
  30. Brochard L, Harf A, Lorino H, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139:513–521
    • View reference on PubMed
    • View reference on publisher's website
  31. Cohen CA, Zagelbaum G, Gross D, Roussos C, Macklem PT (1982) Clinical manifestations of inspiratory muscle fatigue. Am J Med 73:308–316
    • View reference on PubMed
    • View reference on publisher's website

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