Assessment of Diaphragm Function with A Newly Designed Multi-function Esophageal Electrode Catheter and Bilateral Anterolateral Magnetic Stimulation of Phrenic Nerves in Patients Underwent Mechanical Ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WangYinyan , LinZhimin , ChenSibei , HuangYongbo , MaoPu , HeWeiqun , LiuXiaoqing ,  LiYimin

Intensive Care Unit, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical university, Guangzhou, Guangdong, 510120, China;

Corresponding?author：

LiYimin, Email: dryiminli@vip.163.com

Keywords：

Mechanical ventilation; Diaphragm function; Bilateral anterolateral magnetic stimulation of the phrenic nerves; Phrenic nerve conduction time; Diaphragm compound muscle action potential; Twitch transdiaphragmatic pressure

DOI：

10.7507/1671-6205.2014085

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Objective To monitor the diaphragm function of mechanical ventilated patients in the intensive care unit. Methods A prospective study was conducted on mechanical ventilation patients who had been evaluated by ventilation weaning screening test and planning to underwent spontaneous breathing trial between May 2013 and November 2013. A newly designed multi-function esophageal electrode was used to record the phrenic nerve conduction time (PNCT),diaphragm compound muscle action potential (CMAP) and twitch transdiaphragmatic pressure (TwPdi) elicited by bilateral anterolateral magnetic phrenic nerve stimulation. Results 14 patients were recruited in this study. 1 case exited because of intolerance of repetitive magnetic stimulation,2 cases had no diaphragmatic electromyographic signals nor twitch signals,1 case had diaphragmatic electromyographic signal but could not be elicited by magnetic stimulation,1 case had no available TwPdi value with PNCT of 7.2 ms and CMAP of 1.26 mV. In the rest 9 cases,the PNCT,CMAP and TwPdi were (8.5±1.5)ms,(1.01±0.35)mV,(11.2±4.7)cm H₂O,respectively. Conclusion Newly designed multi-function esophageal electrode catheter combined with bilateral anterolateral magnetic phrenic nerve stimulation can be used for non-volitional comprehensive assessment of diaphragm in critically ill patients,but not suitable for all subjects.

Citation： WangYinyan, LinZhimin, ChenSibei, HuangYongbo, MaoPu, HeWeiqun, LiuXiaoqing, LiYimin. Assessment of Diaphragm Function with A Newly Designed Multi-function Esophageal Electrode Catheter and Bilateral Anterolateral Magnetic Stimulation of Phrenic Nerves in Patients Underwent Mechanical Ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(4): 348-352. doi: 10.7507/1671-6205.2014085 Copy

1.	Doorduin J,van Hees HW,van der Hoeven JG,et al. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med,2013,187:20-27.
2.	Mead J,Loring SH.Analysis of volume displacement and length changes of the diaphragm during breathing. J Appl Physiol Respir Environ Exerc Physiol,1982,53:750-755.
3.	Man WD,Moxham J,Polkey MI.Magnetic stimulation for the measurement of respiratory and skeletal muscle function. Eur Respir J,2004,24:846-860.
4.	NHLBI Workshop summary. Respiratory muscle fatigue. Report of the Respiratory Muscle Fatigue Workshop Group. Am Rev Respir Dis,1990,142:474-480.
5.	Mador MJ,Khan S,Kufel TJ.Bilateral anterolateral magnetic stimulation of the phrenic nerves can detect diaphragmatic fatigue. Chest,2002,121:452-458.
6.	ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med,2002,166:518-624.
7.	鄭則廣.兩種測量膈神經傳導時間和動作電位幅度方法的比較. 中國呼吸與危重監護雜志,2002,1:36-39.
8.	鄭則廣.電刺激和磁波刺激法評價膈肌功能的比較. 中國呼吸與危重監護雜志,2004,3:117-119.
9.	Luo YM,Moxham J,Polkey MI.Diaphragm electromyography using an oesophageal catheter:current concepts. Clin Sci(London,England:1979),2008,115:233-244.
10.	Watson AC,Hughes PD,Louise Harris M,et al.Measurement of twitch transdiaphragmatic,esophageal,and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med,2001,29:1325-1331.
11.	Hermans G,Agten A,Testelmans D,et al.Increased duration of mechanical ventilation is associated with decreased diaphragmatic force:a prospective observational study. Crit Care,2010,14:R127.
12.	Cattapan SE,Laghi F,Tobin MJ.Can diaphragmatic contractility be assessed by airway twitch pressure in mechanically ventilated patients? Thorax,2003,58:58-62.
13.	Demoule A,Jung B,Prodanovic H,et al.Diaphragm dysfunction on admission to the intensive care unit. Prevalence,risk factors,and prognostic impact-a prospective study. Am J Respir Crit Care Med,2013,188:213-219.
14.	Luo YM,Li RF,Jolley C,et al.Neural respiratory drive in patients with COPD during exercise tests. Respiration,2011,81:294-301.
15.	中華醫學會重癥醫學分會.機械通氣臨床應用指南(2006). 中國危重病急救醫學,2007,19:65-72.
16.	羅遠明,陳榮昌,鐘南山.磁刺激誘發的膈肌復合動作電位的多導食道電極記錄及其在重癥監護室患者中的應用. 中華結核和呼吸雜志,2005,28:505-508.
17.	Wragg S,Hamnegard C,Road J,et al.Potentiation of diaphragmatic twitch after voluntary contraction in normal subjects. Thorax,1994,49:1234-1237.
18.	Luo YM,Lyall RA,Harris ML,et al.Effect of lung volume on the oesophageal diaphragm EMG assessed by magnetic phrenic nerve stimulation. Euro Respir J,2000,15:1033-1038.
19.	Man WDC,Luo YM,Mustfa N,et al.Postprandial effects on twitch transdiaphragmatic pressure. Euro Respir J,2002,20:577-580.
20.	Mier A,Brophy C,Moxham J,et al.Influence of lung volume and rib cage configuration on transdiaphragmatic pressure during phrenic nerve stimulation in man. Respir Physiol,1990,80:193-202.
21.	Chen R,Collins S,Remtulla H,et al.Phrenic nerve conduction study in normal subjects. Muscle Nerve,1995,18:330-335.
22.	Luo YM,Hart N,Mustfa N,et al.Reproducibility of twitch and sniff transdiaphragmatic pressures. Respir Physiol Neurobiol,2002,132:301-306.
23.	Luo YM,Lyall RA,Lou Harris M,et al.Quantification of the esophageal diaphragm electromyogram with magnetic phrenic nerve stimulation. Am J Respir Crit Care Med,1999,160:1629-1634.

1. Doorduin J,van Hees HW,van der Hoeven JG,et al. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med,2013,187:20-27.
2. Mead J,Loring SH.Analysis of volume displacement and length changes of the diaphragm during breathing. J Appl Physiol Respir Environ Exerc Physiol,1982,53:750-755.
3. Man WD,Moxham J,Polkey MI.Magnetic stimulation for the measurement of respiratory and skeletal muscle function. Eur Respir J,2004,24:846-860.
4. NHLBI Workshop summary. Respiratory muscle fatigue. Report of the Respiratory Muscle Fatigue Workshop Group. Am Rev Respir Dis,1990,142:474-480.
5. Mador MJ,Khan S,Kufel TJ.Bilateral anterolateral magnetic stimulation of the phrenic nerves can detect diaphragmatic fatigue. Chest,2002,121:452-458.
6. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med,2002,166:518-624.
7. 鄭則廣.兩種測量膈神經傳導時間和動作電位幅度方法的比較. 中國呼吸與危重監護雜志,2002,1:36-39.
8. 鄭則廣.電刺激和磁波刺激法評價膈肌功能的比較. 中國呼吸與危重監護雜志,2004,3:117-119.
9. Luo YM,Moxham J,Polkey MI.Diaphragm electromyography using an oesophageal catheter:current concepts. Clin Sci(London,England:1979),2008,115:233-244.
10. Watson AC,Hughes PD,Louise Harris M,et al.Measurement of twitch transdiaphragmatic,esophageal,and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med,2001,29:1325-1331.
11. Hermans G,Agten A,Testelmans D,et al.Increased duration of mechanical ventilation is associated with decreased diaphragmatic force:a prospective observational study. Crit Care,2010,14:R127.
12. Cattapan SE,Laghi F,Tobin MJ.Can diaphragmatic contractility be assessed by airway twitch pressure in mechanically ventilated patients? Thorax,2003,58:58-62.
13. Demoule A,Jung B,Prodanovic H,et al.Diaphragm dysfunction on admission to the intensive care unit. Prevalence,risk factors,and prognostic impact-a prospective study. Am J Respir Crit Care Med,2013,188:213-219.
14. Luo YM,Li RF,Jolley C,et al.Neural respiratory drive in patients with COPD during exercise tests. Respiration,2011,81:294-301.
15. 中華醫學會重癥醫學分會.機械通氣臨床應用指南(2006). 中國危重病急救醫學,2007,19:65-72.
16. 羅遠明,陳榮昌,鐘南山.磁刺激誘發的膈肌復合動作電位的多導食道電極記錄及其在重癥監護室患者中的應用. 中華結核和呼吸雜志,2005,28:505-508.
17. Wragg S,Hamnegard C,Road J,et al.Potentiation of diaphragmatic twitch after voluntary contraction in normal subjects. Thorax,1994,49:1234-1237.
18. Luo YM,Lyall RA,Harris ML,et al.Effect of lung volume on the oesophageal diaphragm EMG assessed by magnetic phrenic nerve stimulation. Euro Respir J,2000,15:1033-1038.
19. Man WDC,Luo YM,Mustfa N,et al.Postprandial effects on twitch transdiaphragmatic pressure. Euro Respir J,2002,20:577-580.
20. Mier A,Brophy C,Moxham J,et al.Influence of lung volume and rib cage configuration on transdiaphragmatic pressure during phrenic nerve stimulation in man. Respir Physiol,1990,80:193-202.
21. Chen R,Collins S,Remtulla H,et al.Phrenic nerve conduction study in normal subjects. Muscle Nerve,1995,18:330-335.
22. Luo YM,Hart N,Mustfa N,et al.Reproducibility of twitch and sniff transdiaphragmatic pressures. Respir Physiol Neurobiol,2002,132:301-306.
23. Luo YM,Lyall RA,Lou Harris M,et al.Quantification of the esophageal diaphragm electromyogram with magnetic phrenic nerve stimulation. Am J Respir Crit Care Med,1999,160:1629-1634.

Chinese Journal of Respiratory and Critical Care Medicine

Assessment of Diaphragm Function with A Newly Designed Multi-function Esophageal Electrode Catheter and Bilateral Anterolateral Magnetic Stimulation of Phrenic Nerves in Patients Underwent Mechanical Ventilation

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