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3. Tonic diaphragmatic activity in critically ill children with and without ventilatory support

Author

Guillaume Emeriaud, Gabrielle Constantin, Christer Sinderby, Alexandrine Larouche, Erika Massicotte, Jennifer Beck, Sandrine Essouri, and Laurence Ducharme-Crevier

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, Pediatric intensive care unit, business.industry, medicine.medical_treatment, Diaphragmatic breathing, Tonic (physiology), Interquartile range, Anesthesia, Pediatrics, Perinatology and Child Health, Medicine, Lung volumes, Expiration, business, Positive end-expiratory pressure
Abstract

SummaryBackground Infants have to actively maintain their end expiratory lung volume (EELV). In mechanically ventilated infants, the diaphragm stays activated until the end of expiration (tonic activity), contributing to EELV maintenance. It is unclear whether tonic activity compensates for the lack of laryngeal braking due to intubation or if it is normally present. Objective To determine if tonic diaphragm activity remains after extubation in infants, and if it can be observed in older children. Methods Prospective observational study of pediatric patients ventilated for >24 hr. Diaphragm electrical activity (EAdi) was recorded using a specific nasogastric catheter during four periods: (i) the acute phase, (ii) pre-extubation, (iii) post-extubation, and (iv) at PICU discharge. Tonic EAdi was defined as the EAdi in the last quartile of expiration. Results Fifty-five patients, median age 10 months (Interquartile range: 1–48) were studied. In infants (

Published
2015
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