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Transcutaneous monitoring of diaphragm activity as a measure of work of breathing in preterm infants
Author(s) -
Leuteren Ruud W.,
Waal Cornelia G.,
Hutten Gerard J.,
Jongh Frans H.,
Kaam Anton H.
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25284
Subject(s) - medicine , diaphragm (acoustics) , work of breathing , anesthesia , continuous positive airway pressure , functional residual capacity , gestational age , interquartile range , lung volumes , tidal volume , diaphragmatic breathing , respiratory system , mechanical ventilation , lung , pregnancy , obstructive sleep apnea , physics , alternative medicine , pathology , biology , acoustics , loudspeaker , genetics
Objective Monitoring work of breathing (WOB) is important to assess the pulmonary condition and adjust respiratory support in preterm infants. Conventional WOB measurement (esophageal pressure, tidal volume) is invasive and we hypothesized that monitoring diaphragm activity could be a noninvasive alternative to estimate WOB. The objective was to determine the correlation between conventional WOB measures and diaphragm activity, in preterm infants. Methods WOB and diaphragm activity, measured with transcutaneous electromyography (dEMG), were simultaneously recorded at different nasal continuous positive airway pressure (nCPAP) levels. During a 30‐s recording at each nCPAP level, dEMG parameters, inspiratory WOB (WOB i ), and pressure time product (PTP in ) were calculated per breath. The correlation coefficient between WOB‐ and dEMG‐measures was calculated using single breaths and after aggregating all breaths into deciles of incremental WOB i . Results Fifteen preterm infants were included (median gestational age, 28 weeks). Single‐breath analysis showed a poor median correlation of 0.27 (interquartile range [IQR], 0.03 to 0.33) and 0.08 (IQR, −0.03 to 0.28), respectively, for WOB i and PTP in with peak diaphragmatic activity (dEMG peak ). A modest median correlation coefficient of 0.65 (IQR, 0.13 to 0.79) and 0.43 (IQR, −0.33 to 0.69) was found for, respectively, WOB i and PTP in with dEMG peak in the aggregated analysis. Conclusion Diaphragm activity showed a modest correlation with WOB i and PTP in in an aggregated analysis. This finding warrants further studies in infants with more significant lung disease.