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01.08.2013 | Original

Dyspnea and surface inspiratory electromyograms in mechanically ventilated patients

verfasst von: Matthieu Schmidt, Félix Kindler, Stewart B. Gottfried, Mathieu Raux, Francois Hug, Thomas Similowski, Alexandre Demoule

Erschienen in: Intensive Care Medicine | Ausgabe 8/2013

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Abstract

Context

Pressure support ventilation (PSV) must be tailored to the load capacity balance of the respiratory system. While "over assistance" generated hyperinflation and ineffective efforts, "under assistance" increased respiratory drive and causes dyspnea. Surface electromyograms (sEMGs) of extradiaphragmatic inspiratory muscles were responsive to respiratory loading/unloading.

Objectives

To determine if sEMGs of extradiaphragmatic inspiratory muscles vary with PSV settings and relate to the degree of discomfort and the intensity of dyspnea in acutely ill patients.

Design

Pathophysiological study, prospective inclusions of 12 intubated adult patients.

Interventions

Two PSV levels (high and low) and two expiratory trigger (ET) levels (high and low).

Measurements

Surface electromyograms of the scalene, parasternal, and Alae Nasi muscles (peak, EMG_max; area under the curve, EMG_AUC); dyspnea visual analogue scale (VAS); prevalence of ineffective triggering efforts.

Main results

For the three recorded muscles, EMG_max and EMG_AUC were significantly greater with low PS than high PS. The influence of ET was less important. A strong correlation was found between dyspnea and EMG_max. A significant inverse correlation was found between the prevalence of ineffective efforts and both dyspnea-VAS and EMG_min.

Conclusions

Surface electromyograms of extradiaphragmatic inspiratory muscles provides a simple, reliable and non-invasive indicator of respiratory muscle loading/unloading in mechanically ventilated patients. Because this EMG activity is strongly correlated to the intensity of dyspnea, it could be used as a surrogate of respiratory sensations in mechanically ventilated patients, and might, therefore, provide a monitoring tool in patients in whom detection and quantification of dyspnea is complex if not impossible.

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Titel: Dyspnea and surface inspiratory electromyograms in mechanically ventilated patients
verfasst von: Matthieu Schmidt
Félix Kindler
Stewart B. Gottfried
Mathieu Raux
Francois Hug
Thomas Similowski
Alexandre Demoule
Publikationsdatum: 01.08.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 8/2013
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2910-3

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Dyspnea and surface inspiratory electromyograms in mechanically ventilated patients

Abstract

Context

Objectives

Design

Interventions

Measurements

Main results

Conclusions

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Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

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Springer Medizin

Abstract

Context

Objectives

Design

Interventions

Measurements

Main results

Conclusions

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