Respiratory failure & ventilation
Monitoring diaphragmatic effort during diaphragm neurostimulation-assisted ventilation
Authors' conclusion
ΔPTPaw is a reliable, non-invasive surrogate for monitoring diaphragm loading during DNAV under assist-controlled volume-controlled mode and may guide neurostimulation titration in mechanically ventilated patients.
Study context
- Population
- Passively mechanically ventilated patients receiving diaphragm neurostimulation-assisted ventilation (DNAV) in assist control volume-controlled mode494 respiratory cycles analysed
- Participants
- 12 participants
- Comparison
- ΔPTPaw vs PTPdi and PTPmus (esophageal/gastric pressure-derived) across four neurostimulation levels at two PEEP levels
Methodological details494 high-quality respiratory cycles (63% of recorded cycles)
- 494 high-quality respiratory cycles (63% of recorded cycles)
Primary result
As reported in the abstract
Agreement and discrimination of ΔPTPaw
- Correlation of ΔPTPaw with PTPdi (R²)
- 0.82
- Correlation of ΔPTPaw with PTPmus (R²)
- 0.92
- Bland-Altman limits of agreement, ΔPTPaw vs PTPdi (cm H₂O·s/min)
- - 4 to 44
- Bland-Altman limits of agreement, ΔPTPaw vs PTPmus (cm H₂O·s/min)
- - 5 to 39
- AUROC of ΔPTPaw for inadequate diaphragmatic effort
- ≥ 0.94
- AUROC of ΔPTPaw for excessive diaphragmatic effort
- ≥ 0.86
Further findings
Effort and airway pressure with increasing neurostimulation
- Increasing neurostimulation associated with higher PTPdi and PTPmus and a corresponding reduction in PTPaw
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Monitoring diaphragmatic effort during diaphragm neurostimulation-assisted ventilation. Crit Care. Published 23 December 2025. doi:10.
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