Can visual inspection of the electrical activity of the diaphragm improve the detection of patient-ventilator asynchronies by pediatric critical care physicians?

Abstract:

BACKGROUND:Patient-ventilator asynchronies are challenging during pediatric mechanical ventilation. We hypothesized that monitoring the electrical activity of the diaphragm (EAdi) together with the "standard" airway opening pressure (Pao) and flow-time waveforms during pressure support ventilation would improve the ability of a cohort of critical care physicians to detect asynchronies in ventilated children. METHODS:We recorded the flow, Pao and EAdi waveforms in ten consecutive patients. The recordings were split in periods of 15 sec, each reproducing a ventilator screenshot. From this pool, a team of four experts selected the most representative screenshots including at least one of the three most common asynchronies (missed efforts, auto-triggering and double triggering) and split them into two versions, respectively showing or not the EAdi waveforms. The screenshots were shown in random order in a questionnaire to sixty experienced pediatric intensivists that were asked to identify any episode of patient-ventilator asynchrony. RESULTS:Among the ten patients included in the study, only eight had EAdi tracings without artifacts and were analyzed. When the Eadi waveform was shown, the auto-triggering detection improved from 13% to 67% (p <0.0001) and the missed efforts detection improved from 43% to 95% (p <0.0001). The detection of double triggering, instead, did not improve (85 % with the EAdi vs 78% without the EAdi waveform; p = 0.52). CONCLUSIONS:This single center study suggests that the EAdi waveform may improve the ability of pediatric intensivists to detect missed efforts and auto-triggering asynchronies. Further studies are required to determine the clinical implications of these findings.

journal_name

Minerva Anestesiol

journal_title

Minerva anestesiologica

authors

Di Nardo M,Lonero M,Staffieri F,Di Mussi R,Murgolo F,Lorusso P,Pham T,Picardo SG,Perrotta D,Cecchetti C,Ravà L,Grasso S

doi

10.23736/S0375-9393.20.14543-7

subject

Has Abstract

pub_date

2020-08-04 00:00:00

eissn

0375-9393

issn

1827-1596

pii

S0375-9393.20.14543-7

pub_type

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