Measurement of Diaphragmatic Electrical Activity by Surface Electromyography in Intubated Subjects and Its Relationship With Inspiratory Effort

Giacomo Bellani, Alfio Bronco, Stefano Arrigoni Marocco, Matteo Pozzi, Vittoria Sala, Nilde Eronia, Giulia Villa, Giuseppe Foti, Giovanni Tagliabue, Marcus Eger, Antonio Pesenti

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Quantification of patient effort during spontaneous breathing is important to tailor ventilatory assistance. Because a correlation between inspiratory muscle pressure (Pmus) and electrical activity of the diaphragm (EAdi) has been described, we aimed to assess the reliability of surface electromyography (EMG) of the respiratory muscles for monitoring diaphragm electrical activity and subject effort during assisted ventilation. METHODS: At a general ICU of a single university-affiliated hospital, we enrolled subjects who were intubated and on pressure support ventilation (PSV) and were on mechanical ventilation for > 48 h. The subjects were studied at 3 levels of pressure support. Airway flow and pressure; esophageal pressure; EAdi; and surface EMG of the diaphragm (surface EAdi), intercostal, and sternocleidomastoid muscles were recorded. Respiratory cycles were sampled for off-line analysis. The Pmus/EAdi index (PEI) was calculated by relying on EAdi and surface EAdi (surface PEI) from an airway pressure drop during end-expiratory occlusions performed every minute. RESULTS: surface EAdi well correlated with EAdi and Pmus, in particular, after averaging breaths into deciles (R = 0.92 and R = 0.84). When surface PEI was used with surface EAdi, it provided a reliable estimation of Pmus (R = 0.94 in comparison with measured Pmus). CONCLUSIONS: During assisted mechanical ventilation, EAdi can be reliably monitored by both EAdi and surface EMG. The measurement of Pmus based on the calibration of EAdi was also feasible by the use of surface EMG.

Original languageEnglish
Pages (from-to)1341-1349
Number of pages9
JournalRespiratory Care
Volume63
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

Fingerprint

Electromyography
Diaphragm
Pressure
Artificial Respiration
Ventilation
Intercostal Muscles
Respiratory Muscles
Calibration
Respiration

Keywords

  • electrical activity of the diaphragm
  • esophageal pressure
  • mechanical ventilation
  • pressure-support ventilation
  • surface electromyography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Measurement of Diaphragmatic Electrical Activity by Surface Electromyography in Intubated Subjects and Its Relationship With Inspiratory Effort. / Bellani, Giacomo; Bronco, Alfio; Arrigoni Marocco, Stefano; Pozzi, Matteo; Sala, Vittoria; Eronia, Nilde; Villa, Giulia; Foti, Giuseppe; Tagliabue, Giovanni; Eger, Marcus; Pesenti, Antonio.

In: Respiratory Care, Vol. 63, No. 11, 01.11.2018, p. 1341-1349.

Research output: Contribution to journalArticle

Bellani, G, Bronco, A, Arrigoni Marocco, S, Pozzi, M, Sala, V, Eronia, N, Villa, G, Foti, G, Tagliabue, G, Eger, M & Pesenti, A 2018, 'Measurement of Diaphragmatic Electrical Activity by Surface Electromyography in Intubated Subjects and Its Relationship With Inspiratory Effort', Respiratory Care, vol. 63, no. 11, pp. 1341-1349. https://doi.org/10.4187/respcare.06176
Bellani, Giacomo ; Bronco, Alfio ; Arrigoni Marocco, Stefano ; Pozzi, Matteo ; Sala, Vittoria ; Eronia, Nilde ; Villa, Giulia ; Foti, Giuseppe ; Tagliabue, Giovanni ; Eger, Marcus ; Pesenti, Antonio. / Measurement of Diaphragmatic Electrical Activity by Surface Electromyography in Intubated Subjects and Its Relationship With Inspiratory Effort. In: Respiratory Care. 2018 ; Vol. 63, No. 11. pp. 1341-1349.
@article{a9fd14159f6949e6ae9d90e6f0885544,
title = "Measurement of Diaphragmatic Electrical Activity by Surface Electromyography in Intubated Subjects and Its Relationship With Inspiratory Effort",
abstract = "BACKGROUND: Quantification of patient effort during spontaneous breathing is important to tailor ventilatory assistance. Because a correlation between inspiratory muscle pressure (Pmus) and electrical activity of the diaphragm (EAdi) has been described, we aimed to assess the reliability of surface electromyography (EMG) of the respiratory muscles for monitoring diaphragm electrical activity and subject effort during assisted ventilation. METHODS: At a general ICU of a single university-affiliated hospital, we enrolled subjects who were intubated and on pressure support ventilation (PSV) and were on mechanical ventilation for > 48 h. The subjects were studied at 3 levels of pressure support. Airway flow and pressure; esophageal pressure; EAdi; and surface EMG of the diaphragm (surface EAdi), intercostal, and sternocleidomastoid muscles were recorded. Respiratory cycles were sampled for off-line analysis. The Pmus/EAdi index (PEI) was calculated by relying on EAdi and surface EAdi (surface PEI) from an airway pressure drop during end-expiratory occlusions performed every minute. RESULTS: surface EAdi well correlated with EAdi and Pmus, in particular, after averaging breaths into deciles (R = 0.92 and R = 0.84). When surface PEI was used with surface EAdi, it provided a reliable estimation of Pmus (R = 0.94 in comparison with measured Pmus). CONCLUSIONS: During assisted mechanical ventilation, EAdi can be reliably monitored by both EAdi and surface EMG. The measurement of Pmus based on the calibration of EAdi was also feasible by the use of surface EMG.",
keywords = "electrical activity of the diaphragm, esophageal pressure, mechanical ventilation, pressure-support ventilation, surface electromyography",
author = "Giacomo Bellani and Alfio Bronco and {Arrigoni Marocco}, Stefano and Matteo Pozzi and Vittoria Sala and Nilde Eronia and Giulia Villa and Giuseppe Foti and Giovanni Tagliabue and Marcus Eger and Antonio Pesenti",
year = "2018",
month = "11",
day = "1",
doi = "10.4187/respcare.06176",
language = "English",
volume = "63",
pages = "1341--1349",
journal = "Respiratory Care",
issn = "0020-1324",
publisher = "by Daedalus Enterprises",
number = "11",

}

TY - JOUR

T1 - Measurement of Diaphragmatic Electrical Activity by Surface Electromyography in Intubated Subjects and Its Relationship With Inspiratory Effort

AU - Bellani, Giacomo

AU - Bronco, Alfio

AU - Arrigoni Marocco, Stefano

AU - Pozzi, Matteo

AU - Sala, Vittoria

AU - Eronia, Nilde

AU - Villa, Giulia

AU - Foti, Giuseppe

AU - Tagliabue, Giovanni

AU - Eger, Marcus

AU - Pesenti, Antonio

PY - 2018/11/1

Y1 - 2018/11/1

N2 - BACKGROUND: Quantification of patient effort during spontaneous breathing is important to tailor ventilatory assistance. Because a correlation between inspiratory muscle pressure (Pmus) and electrical activity of the diaphragm (EAdi) has been described, we aimed to assess the reliability of surface electromyography (EMG) of the respiratory muscles for monitoring diaphragm electrical activity and subject effort during assisted ventilation. METHODS: At a general ICU of a single university-affiliated hospital, we enrolled subjects who were intubated and on pressure support ventilation (PSV) and were on mechanical ventilation for > 48 h. The subjects were studied at 3 levels of pressure support. Airway flow and pressure; esophageal pressure; EAdi; and surface EMG of the diaphragm (surface EAdi), intercostal, and sternocleidomastoid muscles were recorded. Respiratory cycles were sampled for off-line analysis. The Pmus/EAdi index (PEI) was calculated by relying on EAdi and surface EAdi (surface PEI) from an airway pressure drop during end-expiratory occlusions performed every minute. RESULTS: surface EAdi well correlated with EAdi and Pmus, in particular, after averaging breaths into deciles (R = 0.92 and R = 0.84). When surface PEI was used with surface EAdi, it provided a reliable estimation of Pmus (R = 0.94 in comparison with measured Pmus). CONCLUSIONS: During assisted mechanical ventilation, EAdi can be reliably monitored by both EAdi and surface EMG. The measurement of Pmus based on the calibration of EAdi was also feasible by the use of surface EMG.

AB - BACKGROUND: Quantification of patient effort during spontaneous breathing is important to tailor ventilatory assistance. Because a correlation between inspiratory muscle pressure (Pmus) and electrical activity of the diaphragm (EAdi) has been described, we aimed to assess the reliability of surface electromyography (EMG) of the respiratory muscles for monitoring diaphragm electrical activity and subject effort during assisted ventilation. METHODS: At a general ICU of a single university-affiliated hospital, we enrolled subjects who were intubated and on pressure support ventilation (PSV) and were on mechanical ventilation for > 48 h. The subjects were studied at 3 levels of pressure support. Airway flow and pressure; esophageal pressure; EAdi; and surface EMG of the diaphragm (surface EAdi), intercostal, and sternocleidomastoid muscles were recorded. Respiratory cycles were sampled for off-line analysis. The Pmus/EAdi index (PEI) was calculated by relying on EAdi and surface EAdi (surface PEI) from an airway pressure drop during end-expiratory occlusions performed every minute. RESULTS: surface EAdi well correlated with EAdi and Pmus, in particular, after averaging breaths into deciles (R = 0.92 and R = 0.84). When surface PEI was used with surface EAdi, it provided a reliable estimation of Pmus (R = 0.94 in comparison with measured Pmus). CONCLUSIONS: During assisted mechanical ventilation, EAdi can be reliably monitored by both EAdi and surface EMG. The measurement of Pmus based on the calibration of EAdi was also feasible by the use of surface EMG.

KW - electrical activity of the diaphragm

KW - esophageal pressure

KW - mechanical ventilation

KW - pressure-support ventilation

KW - surface electromyography

UR - http://www.scopus.com/inward/record.url?scp=85056074899&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056074899&partnerID=8YFLogxK

U2 - 10.4187/respcare.06176

DO - 10.4187/respcare.06176

M3 - Article

C2 - 30389829

AN - SCOPUS:85056074899

VL - 63

SP - 1341

EP - 1349

JO - Respiratory Care

JF - Respiratory Care

SN - 0020-1324

IS - 11

ER -