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- Beck, J., et al.
(författare)
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Diaphragmatic function in advanced Duchenne muscular dystrophy
- 2006
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Ingår i: Neuromuscul Disord.. ; 16:3
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess diaphragm electrical activation and diaphragm strength in patients with advanced Duchenne muscular dystrophy during resting conditions. Eight patients with advanced Duchenne muscular dystrophy (age of 25+/-2 years) were studied during tidal breathing, maximal inspiratory capacity, maximal sniff inhalations, and magnetic stimulation of the phrenic nerves. Six patients were prescribed home mechanical ventilation (five non-invasive and one tracheotomy). Transdiaphragmatic pressure and diaphragm electrical activation were measured using an esophageal catheter. During tidal breathing (tidal volume 198+/-83ml, breathing frequency 25+/-7), inspiratory diaphragm electrical activation was clearly detectable in seven out of eight patients and was 12+/-7 times above the noise level, and represented 45+/-19% of the maximum diaphragm electrical activation. Mean inspiratory transdiaphragmatic pressure during tidal breathing was 1.5+/-1.2cmH(2)O, and during maximal sniff was 7.6+/-3.6cmH(2)O. Twitch transdiaphragmatic pressure deflections could not be detected. This study shows that despite near complete loss of diaphragm strength in advanced Duchenne muscular dystrophy, diaphragm electrical activation measured with an esophageal electrode array remains clearly detectable in all but one patient.
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| 3. |
- Jalde, FC, et al.
(författare)
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Neurally adjusted ventilatory assist and pressure support ventilation in small species and the impact of instrumental dead space
- 2010
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Ingår i: Neonatology. - : S. Karger AG. - 1661-7819 .- 1661-7800. ; 97:3, s. 279-285
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Neurally adjusted ventilatory assist (NAVA) is a pneumatically-independent mode of mechanical ventilation controlled by diaphragm electrical activity (EAdi), and has not yet been implemented in very small species. <i>Objectives:</i> The aims of the study were to evaluate the feasibility of applying NAVA in very small species and to compare this to pressure support ventilation (PSV) in terms of ventilatory efficiency and breathing pattern, and evaluate the impact of instrumental dead space on breathing pattern during both modes. <i>Methods:</i> Nine healthy rats (mean weight 385 ± 4 g) were studied while breathing on PSV or NAVA, at baseline or with added dead space. <i>Results:</i> A clear difference in breathing pattern between NAVA and PSV was observed during both baseline and dead space, where PSV – despite similar EAdi and tidal volume as during NAVA – caused shortened inspiratory time (p < 0.05) and increased the respiratory rate (p < 0.05). A higher minute ventilation (p < 0.05) in order to reach the same arterial CO<sub>2</sub> was observed. Ineffective inspiratory efforts occurred only during PSV and decreased with the dead space. <i>Conclusion:</i> This study demonstrates, in a small group of animals, that NAVA can deliver assist in very small species with a higher efficiency than PSV in terms of eliminating CO<sub>2</sub> for a given minute ventilation.
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