The Diaphragmatic Electrical Activity During Spontaneous Breathing Trial in Patients with Mechanical Ventilation: Physiological Description and Potential Clinical Utility

Overview

Journal BMC Pulm Med

Publisher Biomed Central

Specialty Pulmonary Medicine

Date 2024 May 30

PMID 38816810

Authors

Shitong Diao

Shan Li

Run Dong

Wei Jiang

Chunyao Wang

Yan Chen

Jingyi Wang

Shuhua He

Yifan Wang

Bin Du

Li Weng

Affiliations

Soon will be listed here.

Abstract

Backgrounds: Increased respiratory drive has been demonstrated to correlate with weaning failure, which could be quantified by electrical activity of the diaphragm (EAdi). We described the physiological process of EAdi-based parameters during the spontaneous breathing trial (SBT) and evaluated the change of EAdi-based parameters as potential predictors of weaning failure.

Methods: We conducted a prospective study in 35 mechanically ventilated patients who underwent a 2-hour SBT. EAdi and ventilatory parameters were continuously measured during the SBT. Diaphragm ultrasound was performed before the SBT and at the 30 min of the SBT. Three EAdi-based parameters were calculated: neuro-ventilatory efficiency, neuro-excursion efficiency and neuro-discharge per min.

Results: Of the thirty 35 patients studied, 25 patients were defined as SBT success, including 22 patients weaning successfully and 3 patients reintubated. Before the SBT, neuro-excursion efficiency differed significantly between two groups and had the highest predictive value for SBT failure (AUROC 0.875, p < 0.01). Early increases in EAdi were observed in SBT, which are more prominent in SBT failure group. One minute, changes in EAdi and neuro-discharge per min also predicted weaning outcome (AUROCs 0.944 and 0.918, respectively).

Conclusions: EAdi-based parameters, especially neuro-excursion efficiency and changes in neuro-discharge per min, may detect impending weaning failure earlier than conventional indices. EAdi monitoring provides physiological insights and a more tailored approach to facilitate successful weaning. Further research should validate these findings and explore the utility of combined EAdi and diaphragm ultrasound assessment in weaning ICU patients from mechanical ventilation.

Trial Registration: Registered at ClinicalTrials.gov on 20 September 2022 (Identifier: NCT05632822).

Citing Articles

Optimizing ICU weaning: globalizing personalized weaning strategies.

Liang C, Zhou C, Pan J Intensive Care Med. 2024; 51(2):446-447.

PMID: 39570403 DOI: 10.1007/s00134-024-07728-6.

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