Giacomo Bellani1, Andrea Coppadoro2, Matteo Pozzi3, Alfio Bronco3, Daniela Albiero4, Nilde Eronia3, Valeria Meroni5, Giacomo Grasselli6, Antonio Pesenti3. 1. Department of Health Science, University of Milan-Bicocca, Monza, Italy. Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. giacomo.bellani1@unimib.it. 2. Department of Emergency and Intensive care, A. Manzoni Hospital, Lecco, Italy. 3. Department of Health Science, University of Milan-Bicocca, Monza, Italy. Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 4. Humanitas Research Hospital, Rozzano, Italy. 5. Department of Health Science, University of Milan-Bicocca, Monza, Italy. 6. Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
Abstract
BACKGROUND: We previously described an index, defined as the ratio between the inspiratory muscle pressure (Pmus) and the electrical activity of the diaphragm (EA(di)) (Pmus/EA(di) index). In the present work, we describe the trend of Pmus/EA(di) index over time, investigating whether it could be an indicator of muscular efficiency associated with risk factors for diaphragmatic injury and/or clinical outcomes. METHODS: This work is a retrospective analysis of subjects with measurements of Pmus/EA(di) index obtained, on different days, during assisted ventilation. Effects of Pmus/EA(di) index absolute value on clinical outcomes were investigated dividing subjects into those with Pmus/EA(di) index higher or lower than the median. Effects of Pmus/EA(di) index trend over time were analyzed, distinguishing between subjects with Pmus/EA(di) index increasing or decreasing. RESULTS: Mean Pmus/EA(di) index was 1.04 ± 0.67, and the median (interquartile range) was 1.00 (0.59-1.34), without a systematic trend over the days. Demographic, ventilator, or outcome data did not significantly differ between subjects with Pmus/EA(di) index higher or lower than the median. Similarly, we did not find relevant differences in subjects with Pmus/EA(di) index increasing or decreasing over time. CONCLUSIONS: The Pmus/EA(di) index value remained constant in each subject over time, although the inter-individual variability was high. Neither the Pmus/EA(di) index nor its trends appeared to be associated with ventilatory variables or clinical outcome.
BACKGROUND: We previously described an index, defined as the ratio between the inspiratory muscle pressure (Pmus) and the electrical activity of the diaphragm (EA(di)) (Pmus/EA(di) index). In the present work, we describe the trend of Pmus/EA(di) index over time, investigating whether it could be an indicator of muscular efficiency associated with risk factors for diaphragmatic injury and/or clinical outcomes. METHODS: This work is a retrospective analysis of subjects with measurements of Pmus/EA(di) index obtained, on different days, during assisted ventilation. Effects of Pmus/EA(di) index absolute value on clinical outcomes were investigated dividing subjects into those with Pmus/EA(di) index higher or lower than the median. Effects of Pmus/EA(di) index trend over time were analyzed, distinguishing between subjects with Pmus/EA(di) index increasing or decreasing. RESULTS: Mean Pmus/EA(di) index was 1.04 ± 0.67, and the median (interquartile range) was 1.00 (0.59-1.34), without a systematic trend over the days. Demographic, ventilator, or outcome data did not significantly differ between subjects with Pmus/EA(di) index higher or lower than the median. Similarly, we did not find relevant differences in subjects with Pmus/EA(di) index increasing or decreasing over time. CONCLUSIONS: The Pmus/EA(di) index value remained constant in each subject over time, although the inter-individual variability was high. Neither the Pmus/EA(di) index nor its trends appeared to be associated with ventilatory variables or clinical outcome.
Authors: Diana Jansen; Annemijn H Jonkman; Lisanne Roesthuis; Suvarna Gadgil; Johannes G van der Hoeven; Gert-Jan J Scheffer; Armand Girbes; Jonne Doorduin; Christer S Sinderby; Leo M A Heunks Journal: Crit Care Date: 2018-09-27 Impact factor: 9.097