4.4 Article

Tonic Diaphragmatic Activity in Critically Ill Children With and Without Ventilatory Support

期刊

PEDIATRIC PULMONOLOGY
卷 50, 期 12, 页码 1304-1312

出版社

WILEY-BLACKWELL
DOI: 10.1002/ppul.23182

关键词

mechanical ventilation; pediatric intensive care unit; diaphragm function; expiration; end expiratory lung volume; positive end expiratory pressure

资金

  1. Respiratory Health Network of the Fonds de la Recherche du Quebec Sante [24470]
  2. CHU Sainte-Justine and Sainte-Justine Research Center

向作者/读者索取更多资源

Background: Infants have to actively maintain their end expiratory lung volume (EELV). In mechanically ventilated infants, the diaphragm stays activated until the end of expiration (tonic activity), contributing to EELV maintenance. It is unclear whether tonic activity compensates for the lack of laryngeal braking due to intubation or if it is normally present. Objective: To determine if tonic diaphragm activity remains after extubation in infants, and if it can be observed in older children. Methods: Prospective observational study of pediatric patients ventilated for >24 hr. Diaphragm electrical activity (EAdi) was recorded using a specific nasogastric catheter during four periods: (i) the acute phase, (ii) pre-extubation, (iii) post-extubation, and (iv) at PICU discharge. Tonic EAdi was defined as the EAdi in the last quartile of expiration. Results: Fifty-five patients, median age 10 months (Interquartile range: 1-48) were studied. In infants (< 1 year, n = 28), tonic EAdi was always present, and represented 33% (22-43) of inspiratory EAdi at PICU discharge. No significant change was observed between pre- and post-extubation periods. In older patients (n = 27), tonic activity was negligible as a whole, but 10 patients exhibited significant tonic EAdi at one time-point during PICU stay. Bronchiolitis was the only independent factor associated with tonic EAdi. Conclusions: In infants, tonic EAdi remains involved in ventilatory control after extubation and restoration of laryngeal braking. Tonic EAdi may play a pathophysiological role in bronchiolitis and it can be reactivated in older patients. The interest of tonic EAdi as a tool to titrate mechanical ventilation warrants further evaluation. (C) 2015 Wiley Periodicals, Inc.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.4
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据