Evolution of inspiratory diaphragm activity in children over the course of the PICU stay
Purpose Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret...
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| Veröffentlicht in: | Intensive care medicine 2014-11, Vol.40 (11), p.1718-1726 |
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| creator | Emeriaud, Guillaume Larouche, Alexandrine Ducharme-Crevier, Laurence Massicotte, Erika Fléchelles, Olivier Pellerin-Leblanc, Amélie-Ann Morneau, Sylvain Beck, Jennifer Jouvet, Philippe |
| description | Purpose
Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.
Methods
This was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.
Results
Fifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdi
max
) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2–7.6] μV in the acute phase and 4.8 (IQR 2.0–10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdi
max
in spontaneous ventilation was 15.4 (IQR 7.4–20.7) μV shortly after extubation and 12.6 (IQR 8.1–21.3) μV before PICU discharge. The difference in EAdi
max
between mechanical ventilation and post-extubation periods was significant (
p
|
| doi_str_mv | 10.1007/s00134-014-3431-4 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1612979112</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A724296189</galeid><sourcerecordid>A724296189</sourcerecordid><originalsourceid>FETCH-LOGICAL-c656t-2a858d35a37b115f4cdd6bc3f2b95523e5d5b12368b61bc32acd19df3c62461d3</originalsourceid><addsrcrecordid>eNp1kU9r3DAQxUVJaTbbfoBeiiGXXpR69M_2MSxJEwi0hwZ6E7Ik7yrY1laSF_bbR2aTJilbdBCa-b3HjB5Cn6G8gLKsvsWyBMpwCQxTRgGzd2gBjBIMhNYnaFFSRjATjJyisxgfMl0JDh_QKeEAdS34Av2-2vl-Ss6Phe8KN8atCyr5sC-MU9tNUOuhUDq5nUv73C70xvUm2EzvbCjSxhbaTyHaWT2_ft6u7ouY1P4jet-pPtpPT_cS3V9f_Vrd4Lsf329Xl3dYCy4SJqrmtaFc0aoF4B3TxohW0460DeeEWm54m9cRdSsg14nSBhrTUS0IE2DoEn09-G6D_zPZmOTgorZ9r0brpyhBAGmqBrLHEp3_gz7k2cc83UwB44w18EKtVW-lGzufgtKzqbysCCONgLrJFD5Cre1og-r9aDuXy2_4iyN8PsYOTh8VwEGgg48x2E5ugxtU2Eso5Zy-PKQvc_pyTl-yrPnytODUDtb8VTzHnQFyAGJujWsbXv3Af10fAY_ttys</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1611454491</pqid></control><display><type>article</type><title>Evolution of inspiratory diaphragm activity in children over the course of the PICU stay</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Emeriaud, Guillaume ; Larouche, Alexandrine ; Ducharme-Crevier, Laurence ; Massicotte, Erika ; Fléchelles, Olivier ; Pellerin-Leblanc, Amélie-Ann ; Morneau, Sylvain ; Beck, Jennifer ; Jouvet, Philippe</creator><creatorcontrib>Emeriaud, Guillaume ; Larouche, Alexandrine ; Ducharme-Crevier, Laurence ; Massicotte, Erika ; Fléchelles, Olivier ; Pellerin-Leblanc, Amélie-Ann ; Morneau, Sylvain ; Beck, Jennifer ; Jouvet, Philippe</creatorcontrib><description>Purpose
Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.
Methods
This was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.
Results
Fifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdi
max
) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2–7.6] μV in the acute phase and 4.8 (IQR 2.0–10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdi
max
in spontaneous ventilation was 15.4 (IQR 7.4–20.7) μV shortly after extubation and 12.6 (IQR 8.1–21.3) μV before PICU discharge. The difference in EAdi
max
between mechanical ventilation and post-extubation periods was significant (
p
< 0.001). Patients intubated mainly because of a lung pathology exhibited higher EAdi (
p
< 0.01), with a similar temporal increase.
Conclusions
This is the first systematic description of EAdi evolution in children during their stay in the PICU. In our patient cohort, diaphragm activity was frequently low in conventional ventilation, suggesting that overassistance or oversedation is common in clinical practice. EAdi monitoring appears to be a helpful tool to detect such situations.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-014-3431-4</identifier><identifier>PMID: 25118865</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Airway Extubation ; Anesthesia ; Anesthesiology ; Catheters ; Child, Preschool ; Children ; Clinical medicine ; Critical Care Medicine ; Critical Illness ; Diaphragm - physiopathology ; Emergency Medicine ; Extubation ; Female ; Humans ; Infant ; Intensive ; Intensive care ; Intensive Care Units, Pediatric ; Longitudinal Studies ; Male ; Medicine ; Medicine & Public Health ; Observational studies ; Pain Medicine ; Pediatric intensive care ; Pediatric Original ; Pediatrics ; Pneumology/Respiratory System ; Prospective Studies ; Respiration, Artificial ; Ventilators ; Weaning</subject><ispartof>Intensive care medicine, 2014-11, Vol.40 (11), p.1718-1726</ispartof><rights>Springer-Verlag Berlin Heidelberg and ESICM 2014</rights><rights>COPYRIGHT 2014 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c656t-2a858d35a37b115f4cdd6bc3f2b95523e5d5b12368b61bc32acd19df3c62461d3</citedby><cites>FETCH-LOGICAL-c656t-2a858d35a37b115f4cdd6bc3f2b95523e5d5b12368b61bc32acd19df3c62461d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-014-3431-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-014-3431-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25118865$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Emeriaud, Guillaume</creatorcontrib><creatorcontrib>Larouche, Alexandrine</creatorcontrib><creatorcontrib>Ducharme-Crevier, Laurence</creatorcontrib><creatorcontrib>Massicotte, Erika</creatorcontrib><creatorcontrib>Fléchelles, Olivier</creatorcontrib><creatorcontrib>Pellerin-Leblanc, Amélie-Ann</creatorcontrib><creatorcontrib>Morneau, Sylvain</creatorcontrib><creatorcontrib>Beck, Jennifer</creatorcontrib><creatorcontrib>Jouvet, Philippe</creatorcontrib><title>Evolution of inspiratory diaphragm activity in children over the course of the PICU stay</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.
Methods
This was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.
Results
Fifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdi
max
) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2–7.6] μV in the acute phase and 4.8 (IQR 2.0–10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdi
max
in spontaneous ventilation was 15.4 (IQR 7.4–20.7) μV shortly after extubation and 12.6 (IQR 8.1–21.3) μV before PICU discharge. The difference in EAdi
max
between mechanical ventilation and post-extubation periods was significant (
p
< 0.001). Patients intubated mainly because of a lung pathology exhibited higher EAdi (
p
< 0.01), with a similar temporal increase.
Conclusions
This is the first systematic description of EAdi evolution in children during their stay in the PICU. In our patient cohort, diaphragm activity was frequently low in conventional ventilation, suggesting that overassistance or oversedation is common in clinical practice. EAdi monitoring appears to be a helpful tool to detect such situations.</description><subject>Airway Extubation</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Catheters</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Clinical medicine</subject><subject>Critical Care Medicine</subject><subject>Critical Illness</subject><subject>Diaphragm - physiopathology</subject><subject>Emergency Medicine</subject><subject>Extubation</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive Care Units, Pediatric</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Observational studies</subject><subject>Pain Medicine</subject><subject>Pediatric intensive care</subject><subject>Pediatric Original</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial</subject><subject>Ventilators</subject><subject>Weaning</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU9r3DAQxUVJaTbbfoBeiiGXXpR69M_2MSxJEwi0hwZ6E7Ik7yrY1laSF_bbR2aTJilbdBCa-b3HjB5Cn6G8gLKsvsWyBMpwCQxTRgGzd2gBjBIMhNYnaFFSRjATjJyisxgfMl0JDh_QKeEAdS34Av2-2vl-Ss6Phe8KN8atCyr5sC-MU9tNUOuhUDq5nUv73C70xvUm2EzvbCjSxhbaTyHaWT2_ft6u7ouY1P4jet-pPtpPT_cS3V9f_Vrd4Lsf329Xl3dYCy4SJqrmtaFc0aoF4B3TxohW0460DeeEWm54m9cRdSsg14nSBhrTUS0IE2DoEn09-G6D_zPZmOTgorZ9r0brpyhBAGmqBrLHEp3_gz7k2cc83UwB44w18EKtVW-lGzufgtKzqbysCCONgLrJFD5Cre1og-r9aDuXy2_4iyN8PsYOTh8VwEGgg48x2E5ugxtU2Eso5Zy-PKQvc_pyTl-yrPnytODUDtb8VTzHnQFyAGJujWsbXv3Af10fAY_ttys</recordid><startdate>20141101</startdate><enddate>20141101</enddate><creator>Emeriaud, Guillaume</creator><creator>Larouche, Alexandrine</creator><creator>Ducharme-Crevier, Laurence</creator><creator>Massicotte, Erika</creator><creator>Fléchelles, Olivier</creator><creator>Pellerin-Leblanc, Amélie-Ann</creator><creator>Morneau, Sylvain</creator><creator>Beck, Jennifer</creator><creator>Jouvet, Philippe</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20141101</creationdate><title>Evolution of inspiratory diaphragm activity in children over the course of the PICU stay</title><author>Emeriaud, Guillaume ; Larouche, Alexandrine ; Ducharme-Crevier, Laurence ; Massicotte, Erika ; Fléchelles, Olivier ; Pellerin-Leblanc, Amélie-Ann ; Morneau, Sylvain ; Beck, Jennifer ; Jouvet, Philippe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c656t-2a858d35a37b115f4cdd6bc3f2b95523e5d5b12368b61bc32acd19df3c62461d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Airway Extubation</topic><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Catheters</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Clinical medicine</topic><topic>Critical Care Medicine</topic><topic>Critical Illness</topic><topic>Diaphragm - physiopathology</topic><topic>Emergency Medicine</topic><topic>Extubation</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive Care Units, Pediatric</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Observational studies</topic><topic>Pain Medicine</topic><topic>Pediatric intensive care</topic><topic>Pediatric Original</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial</topic><topic>Ventilators</topic><topic>Weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Emeriaud, Guillaume</creatorcontrib><creatorcontrib>Larouche, Alexandrine</creatorcontrib><creatorcontrib>Ducharme-Crevier, Laurence</creatorcontrib><creatorcontrib>Massicotte, Erika</creatorcontrib><creatorcontrib>Fléchelles, Olivier</creatorcontrib><creatorcontrib>Pellerin-Leblanc, Amélie-Ann</creatorcontrib><creatorcontrib>Morneau, Sylvain</creatorcontrib><creatorcontrib>Beck, Jennifer</creatorcontrib><creatorcontrib>Jouvet, Philippe</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Emeriaud, Guillaume</au><au>Larouche, Alexandrine</au><au>Ducharme-Crevier, Laurence</au><au>Massicotte, Erika</au><au>Fléchelles, Olivier</au><au>Pellerin-Leblanc, Amélie-Ann</au><au>Morneau, Sylvain</au><au>Beck, Jennifer</au><au>Jouvet, Philippe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evolution of inspiratory diaphragm activity in children over the course of the PICU stay</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2014-11-01</date><risdate>2014</risdate><volume>40</volume><issue>11</issue><spage>1718</spage><epage>1726</epage><pages>1718-1726</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><abstract>Purpose
Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.
Methods
This was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.
Results
Fifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdi
max
) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2–7.6] μV in the acute phase and 4.8 (IQR 2.0–10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdi
max
in spontaneous ventilation was 15.4 (IQR 7.4–20.7) μV shortly after extubation and 12.6 (IQR 8.1–21.3) μV before PICU discharge. The difference in EAdi
max
between mechanical ventilation and post-extubation periods was significant (
p
< 0.001). Patients intubated mainly because of a lung pathology exhibited higher EAdi (
p
< 0.01), with a similar temporal increase.
Conclusions
This is the first systematic description of EAdi evolution in children during their stay in the PICU. In our patient cohort, diaphragm activity was frequently low in conventional ventilation, suggesting that overassistance or oversedation is common in clinical practice. EAdi monitoring appears to be a helpful tool to detect such situations.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25118865</pmid><doi>10.1007/s00134-014-3431-4</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2014-11, Vol.40 (11), p.1718-1726 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1612979112 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Airway Extubation Anesthesia Anesthesiology Catheters Child, Preschool Children Clinical medicine Critical Care Medicine Critical Illness Diaphragm - physiopathology Emergency Medicine Extubation Female Humans Infant Intensive Intensive care Intensive Care Units, Pediatric Longitudinal Studies Male Medicine Medicine & Public Health Observational studies Pain Medicine Pediatric intensive care Pediatric Original Pediatrics Pneumology/Respiratory System Prospective Studies Respiration, Artificial Ventilators Weaning |
| title | Evolution of inspiratory diaphragm activity in children over the course of the PICU stay |
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