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Intensive Care Medicine
Published in: Intensive Care Medicine 11/2003

01-11-2003 | Original

Measurement of diaphragm loading during pressure support ventilation

Authors: Brigitte Fauroux, Nicholas Hart, Yuan M. Luo, Stephanie MacNeill, John Moxham, Frédéric Lofaso, Michael I. Polkey

Published in: Intensive Care Medicine | Issue 11/2003

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Abstract

Objective

The diaphragmatic pressure-time product (PTPdi) has been used to quantify the loading and unloading of the diaphragm. The validity of the relationship between PTPdi and diaphragm electrical activity (EMGdi) during pressure-support ventilation (PSV) is unclear. We examined this relationship.

Design and setting

Physiological study in a physiology laboratory.

Subjects

Six healthy adults.

Interventions

Spontaneous breathing (SB) and two levels of PSV (6 and 12 cmH2O), breathing room air and incremental concentrations of carbon dioxide, sufficient to achieve an EMGdi signal of approximately 200% of baseline value.

Measurements and results

We measured the electrical (EMGdi) and mechanical (PTPdi) activity of the diaphragm using oesophageal electrode and oesophageal and gastric balloon catheters. The relationship between EMGdi and PTPdi during SB was linear in five subjects and curvilinear in one. However, with PSV 12 cmH2O we observed that the relationship between EMGdi and PTPdi was ‘left shifted’; specifically, for any given level of EMGdi the PTPdi was smaller with PSV 12 cmH2O than during SB. However, when PTPdi was converted to power (the product of pressure and flow) the tendency to left shift was largely reversed.

Conclusions

We conclude that when assessing of diaphragm unloading during PSV flow measurements are required. Where flow is constant, PTPdi is a valid measure of diaphragm unloading, but if not these data may be used to make an appropriate correction.
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Metadata
Title
Measurement of diaphragm loading during pressure support ventilation
Authors
Brigitte Fauroux
Nicholas Hart
Yuan M. Luo
Stephanie MacNeill
John Moxham
Frédéric Lofaso
Michael I. Polkey
Publication date
01-11-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 11/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1941-6

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