jlrqac8u

Property	Value
?:abstract	INTRODUCTION: Pressure support ventilation (PSV) should allow spontaneous breathing with a “normal” neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12 h the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of “Low” and/or “High” neuro-ventilatory drive during clinical application of PSV. METHOD: In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdi(PEAK)), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTP(DI/b) and PTP(DI/min), respectively), breathing pattern and major asynchronies were continuously monitored for 12 h (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdi(PEAK) 5–15 μV), “Low” (EAdi(PEAK) < 5 μV) and “High” (EAdi(PEAK) > 15 μV) neuro-ventilatory drive. RESULTS: Within all the analyzed breaths (177.117), the neuro-ventilatory drive, as expressed by the EAdi(PEAK), was “Low” in 50.116 breath (28%), “Normal” in 88.419 breaths (50%) and “High” in 38.582 breaths (22%). The average times spent in “Low”, “Normal” and “High” class were 1.37, 3.67 and 0.55 h, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than 1 h, median 6.1 [3.9–8.5] h and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2–7.8] h. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts. CONCLUSIONS: We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12 h of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.
is ?:annotates of	<https://research.tib.eu/covid-19/entity/jlrqac8u_hasAnnotation_C0013404> <https://research.tib.eu/covid-19/entity/jlrqac8u_hasAnnotation_C0036601> <https://research.tib.eu/covid-19/entity/jlrqac8u_hasAnnotation_C1417167>
?:creator	<https://research.tib.eu/covid-19/entity/Di_mussi%2C_Rosa%3B_Spadaro%2C_Savino%3B_Volta%2C_Carlo_Alberto%3B_Bartolomeo%2C_Nicola%3B_Trerotoli%2C_Paolo%3B_Staffieri%2C_Francesco%3B_Pisani%2C_Luigi%3B_Iannuzziello%2C_Rachele%3B_Dalfino%2C_Lidia%3B_Murgolo%2C_Francesco%3B_Grasso%2C_Salvatore>
?:doi	10.1186/s13054-020-03357-9
?:doi	<https://research.tib.eu/covid-19/entity/10.1186/s13054-020-03357-9>
?:externalLink	<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677450/>
?:journal	Crit_Care
?:license	cc-by
?:pdf_json_files	document_parses/pdf_json/67231f00f4118f08512bdf5cd7028a5048ee159c.json
?:pmc_json_files	document_parses/pmc_json/PMC7677450.xml.json
?:pmcid	<https://research.tib.eu/covid-19/entity/PMC7677450>
?:pmid	<https://research.tib.eu/covid-19/entity/33218354>
?:pmid	33218354
?:publication_isRelatedTo_Disease	<https://research.tib.eu/covid-19/entity/COVID-19>
?:sha_id	<https://research.tib.eu/covid-19/entity/67231f00f4118f08512bdf5cd7028a5048ee159c>
?:source	PMC
?:title	Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients
?:type	<https://research.tib.eu/covid-19/vocab/Publication>
?:year	2020-11-20

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?:abstract

INTRODUCTION: Pressure support ventilation (PSV) should allow spontaneous breathing with a “normal” neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12 h the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of “Low” and/or “High” neuro-ventilatory drive during clinical application of PSV. METHOD: In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdi(PEAK)), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTP(DI/b) and PTP(DI/min), respectively), breathing pattern and major asynchronies were continuously monitored for 12 h (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdi(PEAK) 5–15 μV), “Low” (EAdi(PEAK) < 5 μV) and “High” (EAdi(PEAK) > 15 μV) neuro-ventilatory drive. RESULTS: Within all the analyzed breaths (177.117), the neuro-ventilatory drive, as expressed by the EAdi(PEAK), was “Low” in 50.116 breath (28%), “Normal” in 88.419 breaths (50%) and “High” in 38.582 breaths (22%). The average times spent in “Low”, “Normal” and “High” class were 1.37, 3.67 and 0.55 h, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than 1 h, median 6.1 [3.9–8.5] h and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2–7.8] h. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts. CONCLUSIONS: We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12 h of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.

is ?:annotates of