Warnaar R S P, Cornet A D, Beishuizen A, Donker D W, Oppersma E
Cardiovascular and Respiratory Physiology, Technical Medical Centre, University of Twente, Technohal 3184, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
Intensive Care Center, Medisch Spectrum Twente, Enschede, The Netherlands.
Crit Care. 2025 Jun 23;29(1):258. doi: 10.1186/s13054-025-05424-5.
Ventilatory support levels in ICU patients should be tailored to both optimal gas exchange and respiratory muscle loading, as over- and underassistance may cause diaphragm dysfunction. The diaphragm's capacity to overcome mechanical load and deliver ventilatory output is reflected by the patient's neural respiratory drive (NRD), tidal volume (TV) and respiratory rate (RR). Surface electromyography of the diaphragm (sEMGdi) offers a continuous, non-invasive measure of NRD. We investigated the effect of pressure support (PS) level on the coupling of diaphragm electrical activity (sEAdi) and ventilatory output during the ICU stay.
In clinically stable ICU patients (N = 17), four PS-levels were applied on alternate days, based on the clinical value (- 3, + 0, + 3, and + 6 cmHO). sEAdi time-product (ETPdi) was calculated from high-quality sEAdi waveforms, using a novel, advanced signal analysis approach. The breath-by-breath correlation between ETPdi and TV was defined as neuro-ventilatory coupling (NVC), enabling quantification of the neuro-ventilatory response.
On group level (13 patients, 26 PS-trials), ETPdi and RR increased with decreasing PS-levels (2.4 and 1.6 percentage point (pp)/cmHO), whereas TV decreased (2.5 pp/cmHO). Longitudinal analysis (4 patients, 14 PS-trials) showed strengthened coupling between ETPdi and TV during weaning, reflected by an increase in median NVC from 3.4% (IQR 2.9) to 26.3% (IQR 21.7) between the first and last PS-trial.
Advanced sEMGdi analysis allows for non-invasive quantification of NVC, reflecting the diaphragm's capacity to overcome mechanical load. In patients approaching liberation from MV, increasing NVC indicates the shift from near-passive to active breathing. This study demonstrates the potential of NVC to inform tailoring of ventilatory support levels.
Dutch Trial Register NL9654. Registered August 05, 2021.
重症监护病房（ICU）患者的通气支持水平应根据最佳气体交换和呼吸肌负荷进行调整，因为过度或不足的辅助可能会导致膈肌功能障碍。患者的神经呼吸驱动（NRD）、潮气量（TV）和呼吸频率（RR）反映了膈肌克服机械负荷并产生通气输出的能力。膈肌表面肌电图（sEMGdi）提供了一种连续、无创的NRD测量方法。我们研究了压力支持（PS）水平对ICU住院期间膈肌电活动（sEAdi）与通气输出耦合的影响。
在临床稳定的ICU患者（N = 17）中，根据临床值（-3、+0、+3和+6 cmH₂O）每隔一天应用四种PS水平。使用一种新颖的高级信号分析方法，从高质量的sEAdi波形计算sEAdi时间乘积（ETPdi）。ETPdi与TV之间的逐次呼吸相关性被定义为神经通气耦合（NVC），从而能够量化神经通气反应。
在组水平（13名患者，26次PS试验）上，ETPdi和RR随着PS水平的降低而增加（分别为2.4和1.6个百分点（pp）/cmH₂O），而TV则降低（2.5 pp/cmH₂O）。纵向分析（4名患者，14次PS试验）显示，在撤机过程中ETPdi与TV之间的耦合增强，第一次和最后一次PS试验之间的中位NVC从3.4%（四分位间距2.9）增加到26.3%（四分位间距21.7）即可体现。
先进的sEMGdi分析允许对NVC进行无创量化，反映膈肌克服机械负荷的能力。在接近脱离机械通气的患者中，NVC增加表明从近乎被动呼吸向主动呼吸的转变。本研究证明了NVC在指导通气支持水平调整方面的潜力。
荷兰试验注册编号NL9654。于2021年8月5日注册。
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