Observational studyIntensive care medicine2014
Evolution of inspiratory diaphragm activity in children over the course of the PICU stay.
Observational study in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 53 citations in OpenAlex.
- Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).Intensive care medicine · 2017Guideline
- Neurally adjusted ventilatory assist (NAVA) allows patient-ventilator synchrony during pediatric noninvasive ventilation: a crossover physiological study.Critical care (London, England) · 2015Trial
- An overview of patient-ventilator asynchrony in children.Expert review of respiratory medicine · 2025Review
- Ventilation distribution in mechanically ventilated children in response to positioning: An exploratory study.The Southern African journal of critical care : the official journal of the Critical Care Society · 2025Article
- Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study.BMC pediatrics · 2024Article
- An algorithm for discontinuing mechanical ventilation in boys with x-linked myotubular myopathy after positive response to gene therapy: the ASPIRO experience.Respiratory research · 2024Article
- Diaphragmatic electromyography in infants: an overview of possible clinical applications.Pediatric research · 2024Review
- Fundamental concepts and the latest evidence for esophageal pressure monitoring.Journal of intensive care · 2023Review
- Neurally-Adjusted Ventilatory Assist (NAVA) versus Pneumatically Synchronized Ventilation Modes in Children Admitted to PICU.Journal of clinical medicine · 2021Review
- Evolution of inspiratory muscle function in children during mechanical ventilation.Critical care (London, England) · 2021Observational
- Real-Time Effort Driven Ventilator Management: A Pilot Study.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020Article
- Ventilator Liberation in the Pediatric ICU.Respiratory care · 2020Article
- A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and risk factors.BMC pediatrics · 2020Observational
- High Breath-by-Breath Variability Is Associated With Extubation Failure in Children.Critical care medicine · 2020Article
- The role of computer-based clinical decision support systems to deliver protective mechanical ventilation.Current opinion in critical care · 2020Review
- A Phase II randomized controlled trial for lung and diaphragm protective ventilation (Real-time Effort Driven VENTilator management).Contemporary clinical trials · 2020Article
- Mechanical ventilation causes diaphragm dysfunction in newborn lambs.Critical care (London, England) · 2019Article
- [Advances in respiratory assessment and treatment in children undergoing invasive mechanical ventilation].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2019Review
- Transcutaneous electromyographic respiratory muscle recordings to quantify patient-ventilator interaction in mechanically ventilated children.Annals of intensive care · 2018Article
- Patient-ventilator asynchrony during conventional mechanical ventilation in children.Annals of intensive care · 2017Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDiaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.
methodsThis was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.
resultsFifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdimax) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2-7.6] μV in the acute phase and 4.8 (IQR 2.0-10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdimax in spontaneous ventilation was 15.4 (IQR 7.4-20.7) μV shortly after extubation and 12.6 (IQR 8.1-21.3) μV before PICU discharge. The difference in EAdimax between mechanical ventilation and post-extubation periods was significant (p < 0.001). Patients intubated mainly because of a lung pathology exhibited higher EAdi (p < 0.01), with a similar temporal increase.
conclusionsThis is the first systematic description of EAdi evolution in children during their stay in the PICU. In our patient cohort, diaphragm activity was frequently low in conventional ventilation, suggesting that overassistance or oversedation is common in clinical practice. EAdi monitoring appears to be a helpful tool to detect such situations.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.