Respiratory failure & ventilation
Advanced waveform analysis of diaphragm surface EMG allows for continuous non-invasive assessment of respiratory effort in critically ill patients at different PEEP levels
Authors' conclusion
Advanced signal analysis of both Pocc and sEAdi greatly facilitates automated and well-defined identification of high-quality waveforms. In the critically ill, this approach allowed to demonstrate a dynamic NMCdi (Pocc/sEAdi) decrease upon PEEP increments, emphasising that sEAdi-based assessment of respiratory effort should be related to PEEP dependent diaphragm function.
Study context
- Population
- Stable ICU patients on pressure support ventilation593 manoeuvres
- Participants
- 17 patients · 42 PEEP trials
- Comparison
- Strict automated advanced vs basic manual waveform quality assessment; four incremental PEEP levels
- Outcome
- Coefficient of variation of non-invasive diaphragm neuromuscular coupling (NMCdi = Pocc/sEAdi) after basic manual vs automated advanced quality assessment, and effect of incremental PEEP on NMCdi
Methodological detailsincremental PEEP trial, automated advanced signal analysis
- Incremental PEEP trial
- Automated advanced signal analysis
Main finding
As reported in the abstract
Coefficient of variations (CoV) of NMCdi, strict automated assessment
15%
CoV of NMCdi, basic quality assessment
37%
NMCdi decrease per cmH2O PEEP increase (significant)
4.9 percentage point
Further findings
Waveform exclusion reasons (tolerant / strict criteria)
- Low sEAdi signal-to-noise ratio, tolerant
- 155, 37%
- Low sEAdi signal-to-noise ratio, strict
- 241, 51%
- Irregular or abrupt cessation of Pocc, tolerant
- 145, 35%
- Irregular or abrupt cessation of Pocc, strict
- 145, 31%
- High sEAdi area under the baseline, tolerant
- 94, 23%
- High sEAdi area under the baseline, strict
- 79, 17%
Original publication
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