Dyspnea and the electromyographic activity of inspiratory muscles during weaning from mechanical ventilation,Annals of Intensive Care

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Dyspnea and the electromyographic activity of inspiratory muscles during weaning from mechanical ventilation
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-06-10 , DOI: 10.1186/s13613-022-01025-5
Côme Bureau _{1,

2} , Martin Dres _{1,

2} , Elise Morawiec ₂ , Julien Mayaux ₂ , Julie Delemazure ₂ , Thomas Similowski _{1,

3} , Alexandre Demoule _{1,

2}

Affiliation

Rationale

Dyspnea, a key symptom of acute respiratory failure, is not among the criteria for spontaneous breathing trial (SBT) failure. Here, we sought (1) to determine whether dyspnea is a reliable failure criterion for SBT failure; (2) to quantify the relationship between dyspnea and the respective electromyographic activity of the diaphragm (EMGdi), the parasternal (EMGpa) and the Alae nasi (EMGan).

Methods

Mechanically ventilated patients undergoing an SBT were included. Dyspnea intensity was measured by the Dyspnea-Visual Analogic Scale (Dyspnea-VAS) at the initiation and end of the SBT. During the 30-min SBT or until SBT failure, the EMGdi was continuously measured with a multi-electrode nasogastric catheter and the EMGan and EMGpa with surface electrodes.

Results

Thirty-one patients were included, SAPS 2 (median [interquartile range]) 53 (37‒74), mechanically ventilated for 6 (3‒10) days. Seventeen patients (45%) failed the SBT. The increase in Dyspnea-VAS along the SBT was higher in patients who failed (6 [4‒8] cm) than in those who passed (0 [0‒1] cm, p = 0.01). The area under the receiver operating characteristics curve for Dyspnea-VAS was 0.909 (0.786–1.032). The increase in Dyspnea-VAS was significantly correlated to the increase in EMGan (Rho = 0.42 [0.04‒0.70], p < 0.05), but not to the increase in EMGpa (Rho = − 0.121 [− 0.495 to − 0.290], p = 0.555) and EMGdi (Rho = − 0.26 [− 0.68 to 0.28], p = 0.289).

Conclusion

Dyspnea is a reliable criterion of SBT failure, suggesting that Dyspnea-VAS could be used as a monitoring tool of the SBT. In addition, dyspnea seems to be more closely related to the electromyographic activity of the Alae nasi than of the diaphragm.

中文翻译：

机械通气撤机期间呼吸困难和吸气肌肌电活动

基本原理

呼吸困难是急性呼吸衰竭的一个关键症状，不属于自主呼吸试验 (SBT) 失败的标准。在这里，我们寻求 (1) 确定呼吸困难是否是 SBT 失败的可靠失败标准；(2) 量化呼吸困难与膈肌 (EMGdi)、胸骨旁 (EMGpa) 和鼻翼(EMGan) 各自的肌电活动之间的关系。

方法

接受 SBT 的机械通气患者也包括在内。在 SBT 开始和结束时，通过呼吸困难视觉模拟量表 (Dyspnea-VAS) 测量呼吸困难强度。在 30 分钟 SBT 期间或直到 SBT 失败，使用多电极鼻胃导管连续测量 EMGdi，使用表面电极连续测量 EMGan 和 EMGpa。

结果

纳入 31 名患者，SAPS 2（中位数 [四分位距]）53（37-74），机械通气 6（3-10）天。17 名患者 (45%) 未能通过 SBT。失败的患者（6 [4-8] cm）的呼吸困难-VAS 增加高于通过的患者（0 [0-1] cm，p = 0.01）。呼吸困难-VAS 的受试者工作特征曲线下面积为 0.909 (0.786–1.032)。呼吸困难-VAS 的增加与 EMGan 的增加显着相关（Rho = 0.42 [0.04-0.70]，p < 0.05），但与 EMGpa 的增加无关（Rho = - 0.121 [- 0.495 至 - 0.290]，p = 0.555）和 EMGdi（Rho = - 0.26 [- 0.68 至 0.28]，p = 0.289）。