Diaphragmatic contraction during assisted mechanical ventilation.

Abstract:

:Indirect evidence from airway pressure recordings in mechanically ventilated patients suggests that the diaphragm exhibits contractile activity beyond that required to trigger a ventilator-assisted breath. We used the diaphragmatic EMG to provide direct evidence of persistent contractile activity and studied the effects of alterations in ventilator-delivered flow rate and tidal volume on the duration of diaphragmatic contraction. The duration of contraction was expressed in terms of inspired volume. During a single breath, diaphragmatic force generation ceases at the point of peak electromyographic activity; hence, the inspired volume at peak EMG is the volume at the diaphragmatic off-switch (Voff). Ventilator-delivered flow rate and tidal volume were varied during assisted (patient-initiated) and controlled (ventilator-initiated) breaths while diaphragmatic EMG and inspired volume were recorded simultaneously in ten patients with a variety of illnesses requiring mechanical ventilation. Spontaneous ventilator-unassisted breaths were also recorded for comparison. We found that (1) during assisted breaths, diaphragmatic activity continued after the ventilator was triggered, (2) Voff was usually close to spontaneous tidal volume, (3) Voff increased significantly as ventilator-delivered flow rate increased, and (4) controlled breaths may also be associated with phasic electromyographic activity. The data have implications for resting patients on assisted ventilation.

journal_name

Chest

journal_title

Chest

authors

Flick GR,Bellamy PE,Simmons DH

doi

10.1378/chest.96.1.130

subject

Has Abstract

pub_date

1989-07-01 00:00:00

pages

130-5

issue

1

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)45755-1

journal_volume

96

pub_type

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