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Mechanisms of ventilator dependence in children with neuromuscular and respiratory control disorders identified by monitoring diaphragm electrical activity

Miriam R. Fine-Goulden| Naga K. Puppala| Andrew Durward
Physiological and Technical Notes
Volume 38, Issue 12 / December , 2012

Pages 2072 - 2079

Abstract

Objectives

To report on the monitoring of diaphragm electrical activity (Edi) using neurally adjusted ventilator assist (NAVA) technology to investigate the mechanisms of ventilator dependence in children with neuromuscular and respiratory control disorders.

Patients and methods

Using NAVA technology, electrical activity of the diaphragm (Edi) was monitored at the lowest achievable level of respiratory support in six ventilator-dependent patients with neuromuscular and respiratory control disorders, aged 6 weeks to 12 years, admitted to a tertiary paediatric intensive care unit between 2009 and 2011.

Results

Edi monitoring identified markedly abnormal respiratory dynamic patterns that were not always apparent clinically. These were associated with disorders of central respiratory control, muscle weakness and diaphragm pathology.

Conclusions

Edi monitoring using NAVA technology is a valuable, minimally invasive, diagnostic adjunct in children with neuromuscular and respiratory control disorders who are ventilator-dependent.

Keywords

References

  1. Goldstone J (2002) The pulmonary physician in critical care. 10: difficult weaning. Thorax 57:986–991
    • View reference on PubMed
    • View reference on publisher's website
  2. Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindström 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
  3. Sinderby C, Saphija J, Beck J (2004) Neurally adjusted ventilatory assist. In: Slutksy AS, Brochard L (eds) Mechanical ventilation. Update in Intensive Care Medicine, Springer, pp 125–134
  4. http://www.maquet.com/
  5. Barwing J, Ambold M, Linden N, Quintel M, Moerer O (2009) Evaluation of the catheter positioning for neurally adjusted ventilatory assist. Intensive Care Med 35:1809–1814
  6. Ogier M, Katz DM (2008) Breathing dysfunction in Rett syndrome: understanding epigenetic regulation of the respiratory network. Respir Physiol Neurobiol 164:55–63
    • View reference on PubMed
    • View reference on publisher's website
  7. Julu PO, Kerr AM, Apartopoulos F, Al-Rawas S, Engerström IW, Engerström L, Jamal GA, Hansen S (2001) Characterisation of breathing and associated central autonomic dysfunction in the Rett disorder. Arch Dis Child 85:29–37
    • View reference on PubMed
    • View reference on publisher's website
  8. Emeriaud G, Beck J, Tucci M, Lacroix J, Sinderby C (2006) Diaphragm electrical activity during expiration in mechanically ventilated infants. Pediatr Res 59:705–710
    • View reference on PubMed
    • View reference on publisher's website
  9. Forrest KM, Al-Sarraj S, Sewry C, Buk S, Tan SV, Pitt M, Durward A, McDougall M, Irving M, Hanna MG, Matthews E, Sarkozy A, Hudson J, Barresi R, Bushby K, Jungbluth H, Wraige E (2011) Infantile onset myofibrillar myopathy due to recessive CRYAB mutations. Neuromuscul Disord 21:37–40
    • View reference on PubMed
    • View reference on publisher's website
  10. Goldfarb LG, Vicart P, Goebel HH, Dalakas MC (2004) Desmin myopathy. Brain 127:723–734
    • View reference on PubMed
    • View reference on publisher's website
  11. Dubowitz V (1999) Very severe spinal muscular atrophy (SMA type 0): an expanding clinical phenotype. Eur J Paediatr Neurol 3:49–51
    • View reference on PubMed
  12. Bordessoule A, Emeriaud G, Dlenard N, Beck J, Jouvet P (2010) Recording diaphragm activity by an oesophageal probe: a new tool to evaluate the recovery of diaphragmatic paralysis. Intensive Care Med 36:1978–1979

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