• Giacomo Bellani, Alfio Bronco, Arrigoni Marocco Stefano S School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy, and Department of Emergency and Intensive Care, San Gerardo Hospital, Matteo Pozzi, Vittoria Sala, Nilde Eronia, Giulia Villa, Giuseppe Foti, Giovanni Tagliabue, Marcus Eger, and Antonio Pesenti.
• School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy, and Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. Giacomo.bellani1@unimib.it.
• Respir Care. 2018 Nov 1; 63 (11): 1341-1349.

BackgroundQuantification of patient effort during spontaneous breathing is important to tailor ventilatory assistance. Because a correlation between inspiratory muscle pressure (Pmus) and electrical activity of the diaphragm (EAdi) has been described, we aimed to assess the reliability of surface electromyography (EMG) of the respiratory muscles for monitoring diaphragm electrical activity and subject effort during assisted ventilation.MethodsAt a general ICU of a single university-affiliated hospital, we enrolled subjects who were intubated and on pressure support ventilation (PSV) and were on mechanical ventilation for > 48 h. The subjects were studied at 3 levels of pressure support. Airway flow and pressure; esophageal pressure; EAdi; and surface EMG of the diaphragm (surface EAdi), intercostal, and sternocleidomastoid muscles were recorded. Respiratory cycles were sampled for off-line analysis. The Pmus/EAdi index (PEI) was calculated by relying on EAdi and surface EAdi (surface PEI) from an airway pressure drop during end-expiratory occlusions performed every minute.Resultssurface EAdi well correlated with EAdi and Pmus, in particular, after averaging breaths into deciles (R = 0.92 and R = 0.84). When surface PEI was used with surface EAdi, it provided a reliable estimation of Pmus (R = 0.94 in comparison with measured Pmus).ConclusionsDuring assisted mechanical ventilation, EAdi can be reliably monitored by both EAdi and surface EMG. The measurement of Pmus based on the calibration of EAdi was also feasible by the use of surface EMG.Copyright © 2018 by Daedalus Enterprises.

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