ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2021 March;87(3):319-24

DOI: 10.23736/S0375-9393.20.14543-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

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

Matteo DI NARDO ¹, Margherita LONERO ¹ ✉, Francesco STAFFIERI ², Rosa DI MUSSI ³, Francesco MURGOLO ³, Pantaleo LORUSSO ³, Tai PHAM ⁴, Sergio G. PICARDO ¹, Daniela PERROTTA ¹, Corrado CECCHETTI ¹, Lucilla RAVÀ ⁵, Salvatore GRASSO ³

¹ Department of Pediatric Anesthesia and Critical Care Medicine, Bambino Gesù Children’s Hospital, Rome, Italy; ² Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University of Bari, Bari, Italy; ³ Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation, Aldo Moro University of Bari, Bari, Italy; ⁴ Bicêtre Hospital, Paris, France; ⁵ Unit of Epidemiology and Biostatistics, Bambino Gesù Children’s Hospital, Rome, Italy

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 s, 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.

KEY WORDS: Ventilator-induced lung injury; Diaphragm; Child; Physicians