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Minerva Anestesiologica 2020 Aug 04

DOI: 10.23736/S0375-9393.20.14543-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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 sec, 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; Neurally adjust ventilatory assist; Asynchronies; Pediatric

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