1. Transcutaneous monitoring of diaphragm activity as a measure of work of breathing in preterm infants
- Author
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Ruud W. van Leuteren, Frans H. de Jongh, Gerard J. Hutten, Anton H. van Kaam, Cornelia G. de Waal, Graduate School, ARD - Amsterdam Reproduction and Development, General Paediatrics, and Neonatology
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,diaphragm activity ,medicine.medical_treatment ,Diaphragm ,Diaphragmatic breathing ,Electromyography ,Neonatal Lung Disease ,preterm infant ,03 medical and health sciences ,Work of breathing ,0302 clinical medicine ,Interquartile range ,030225 pediatrics ,Internal medicine ,work of breathing ,medicine ,Humans ,Continuous positive airway pressure ,Tidal volume ,medicine.diagnostic_test ,Continuous Positive Airway Pressure ,business.industry ,Respiration ,Infant, Newborn ,Gestational age ,Infant ,Diaphragm (structural system) ,monitoring ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Cardiology ,esophageal pressure ,Original Article ,ORIGINAL ARTICLES ,business ,Infant, Premature - Abstract
Objective Monitoring work of breathing (WOB) is important to assess the pulmonary condition and adjust respiratory support in preterm infants. Conventional WOB measurement (esophageal pressure, tidal volume) is invasive and we hypothesized that monitoring diaphragm activity could be a noninvasive alternative to estimate WOB. The objective was to determine the correlation between conventional WOB measures and diaphragm activity, in preterm infants. Methods WOB and diaphragm activity, measured with transcutaneous electromyography (dEMG), were simultaneously recorded at different nasal continuous positive airway pressure (nCPAP) levels. During a 30-s recording at each nCPAP level, dEMG parameters, inspiratory WOB (WOBi ), and pressure time product (PTPin ) were calculated per breath. The correlation coefficient between WOB- and dEMG-measures was calculated using single breaths and after aggregating all breaths into deciles of incremental WOBi . Results Fifteen preterm infants were included (median gestational age, 28 weeks). Single-breath analysis showed a poor median correlation of 0.27 (interquartile range [IQR], 0.03 to 0.33) and 0.08 (IQR, -0.03 to 0.28), respectively, for WOBi and PTPin with peak diaphragmatic activity (dEMGpeak ). A modest median correlation coefficient of 0.65 (IQR, 0.13 to 0.79) and 0.43 (IQR, -0.33 to 0.69) was found for, respectively, WOBi and PTPin with dEMGpeak in the aggregated analysis. Conclusion Diaphragm activity showed a modest correlation with WOBi and PTPin in an aggregated analysis. This finding warrants further studies in infants with more significant lung disease.
- Published
- 2021