Quantitative Comparison of Pes and Respiratory Muscle Surface EMG Derived Inspiratory Effort

J. Graßhoff (Lübeck, Germany), E. Petersen (Copenhagen, Denmark), F. Farquharson (Konstanz, Germany), M. Kustermann (Konstanz, Germany), H. Kabitz (Konstanz, Germany), P. Rostalski (Lübeck, Germany), S. Walterspacher (Witten, Germany)

Source: Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation - Mechanical ventilation in the acute setting - Health-related quality of life in mechanical ventilation - Long-term noninvasive ventilation: Diagnosis and outcome - Long-term noninvasive ventilation: Outcome - Acute respiratory failure: Physiology

Session: Acute respiratory failure: Physiology
Session type: Oral poster discussion
Number: 135

Abstract

Background: Assessment of inspiratory effort under mechanical ventilation often requires invasive techniques like esophageal pressure (P_es) measurements and derived indices like respiratory muscle pressure (P_mus). Respiratory muscle surface electromyography (sEMG) is as a promising, noninvasive technique of monitoring patient activity. This study observed the correlation of P_mus and sEMG-derived inspiratory effort under mechanical ventilation.

Methods: This prospective observational study was conducted with patients for elective intubation bronchoscopy. Four pressure levels were applied and airway flow/pressure, esophageal pressure, as well as diaphragmatic/intercostal sEMG were recorded. Patient efforts were quantified via the Pmus-time product (PTP_mus) and EMG-time product (ETP). The neuromechanical conversion factor (K_EMG) was used to evaluate correlation between ETP and PTP_mus.

Results: In 43 patients, ETP of both sEMG channels correlated well with PTP_mus (diaphragm: r=0.79±0.25; intercostal: r=0.84±0.16). An automated channel selection method for optimizing the sEMG signal-to-noise ratio improved correlation with PTP_mus (r=0.87±0.09). The proportionality factor K_EMG between ETP and PTP_mus varied widely between patients (K_EMG=4.32±3.73 cmH2O/µV) and was highly correlated with K_EMG determined during intermittent airway occlusions (r=0.95, p<0.001). The occlusion-based method for deriving PTP_mus from ETP showed a breath-wise deviation to PTP_mus of 0.43±1.73 cmH2Os.

Conclusion: These results show that sEMG is a promising alternative for monitoring breath-by-breath inspiratory effort during mechanical ventilation. Calculation of K_EMG allowed a concise prediction of sEMG-based inspiratory effort.

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Citations should be made in the following way:
J. Graßhoff (Lübeck, Germany), E. Petersen (Copenhagen, Denmark), F. Farquharson (Konstanz, Germany), M. Kustermann (Konstanz, Germany), H. Kabitz (Konstanz, Germany), P. Rostalski (Lübeck, Germany), S. Walterspacher (Witten, Germany). Quantitative Comparison of Pes and Respiratory Muscle Surface EMG Derived Inspiratory Effort. Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation - Mechanical ventilation in the acute setting - Health-related quality of life in mechanical ventilation - Long-term noninvasive ventilation: Diagnosis and outcome - Long-term noninvasive ventilation: Outcome - Acute respiratory failure: Physiology

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