Document Detail

Estimation of Patient's Inspiratory Effort From the Electrical Activity of the Diaphragm.
MedLine Citation:
PMID:  23478659     Owner:  NLM     Status:  Publisher    
OBJECTIVES:: To calculate an index (termed Pmusc/Eadi index) relating the pressure generated by the respiratory muscles (Pmusc) to the electrical activity of the diaphragm (Eadi), during assisted mechanical ventilation and to assess if the Pmusc/Eadi index is affected by the type and level of ventilator assistance. The Pmusc/Eadi index was also used to measure the patient's inspiratory effort from Eadi without esophageal pressure. DESIGN:: Crossover study. SETTING:: One general ICU. PATIENTS:: Ten patients undergoing assisted ventilation. INTERVENTION:: Pressure support and neurally adjusted ventilator assist delivered, each, at three levels of ventilatory assistance. MEASUREMENT AND MAIN RESULTS:: Airways flow and pressure, esophageal pressure, and Eadi were continuously recorded. Sixty tidal volumes for each ventilator settings were analyzed off-line, at three time points during inspiration. For each time point, Pmusc/Eadi index was calculated. Pmusc/Eadi index was also calculated from airway pressure drop during end-expiratory occlusions. Pmusc/Eadi index was very variable among patients, but within one patient it was not affected by type and level of ventilator assistance. Pmusc/Eadi index decreased during the inspiration. Pmusc/Eadi index obtained during an occlusion from airway pressure swing was tightly correlated with that derived from esophageal pressure during tidal ventilation and allowed to estimate pressure time product. CONCLUSIONS:: Pmusc is tightly related to Eadi, by a proportionality coefficient that we termed Pmusc/Eadi index, stable within each patient under different conditions of ventilator assistance. The derivation of the Pmusc/Eadi index from Eadi and airway pressure during an expiratory occlusion enables a continuous estimate of patient's inspiratory effort.
Giacomo Bellani; Tommaso Mauri; Andrea Coppadoro; Giacomo Grasselli; Nicolò Patroniti; Savino Spadaro; Vittoria Sala; Giuseppe Foti; Antonio Pesenti
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-3-8
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-3-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Experimental Medicine, University of Milan-Bicocca, Monza, Italy. 2Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
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