RT Journal Article
SR Electronic
T1 Diaphragm electromyographic activity as a predictor of weaning failure
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 394
VO 40
IS Suppl 56
A1 Martin Dres
A1 Matthieu Scmidt
A1 Alexis Ferre
A1 Julien Mayaux
A1 Thomas Similowski
A1 Alexandre Demoule
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/394.abstract
AB Purpose:To compare breathing pattern descriptors and diaphragm electromyographic activity (EAdi)-derived indices obtained from a Neurally Adjusted Ventilatory Assist (NAVA) catheter during a spontaneous breathing trial (SBT) in patients successfully (SP) and unsuccessfully (UP) separated from the ventilator and to assess their performance to discriminate these two categories of patients.Methods:57 ready-to-wean patients were included in a prospective observational study (35 SP and 22 UP separated from the ventilator). During a 30 minutes SBT (pressure support 7 cmH2O, zero end expiratory pressure), tidal volume (VT) and respiratory rate (RR) were obtained from the flow signal at 3, 10, 20 and 30 minutes. EAdi-derived indices were simultaneously computed: maximum of the EAdi (EAdimax), area under the inspiratory curve of EAdi (EAdiAUC), the difference between EAdimax and EAdimin (ΔEAdi), EAdimax/VT, EAdiAUC/VT and ΔEAdi/VT.Results:At baseline, breathing pattern was similar in the two groups whereas EAdimax and EAdiAUC were significantly lower in the success group (p<0.05). In the failure group, RR and RR/VT increased significantly during the trial, VT decreased, whereas EAdimax and EAdiAUC did not change. At 3 minutes, the areas under the receiver operating characteristic-curve of RR/VT and EAdi-derived indices to predict weaning outcome were: RSBI (0.83), EAdimax/VT (0.84), EAdiAUC/VT (0.80) and ΔEAdi/VT (0.82). During the SBT, the coefficient of variation of VT decreased in the failure group while the one of EAdimax remained unchanged.Conclusion:EAdi-derived indices provide reliable and early predictors of weaning outcome. However, the performance of these indices is not better than the RR/VT.