ArticleCritical care (London, England)2024
Advanced waveform analysis of diaphragm surface EMG allows for continuous non-invasive assessment of respiratory effort in critically ill patients at different PEEP levels.
Article in Critical care (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Acquisition of respiratory surface EMG: a systematic literature review of electrode configurations and methodological reporting.Critical care (London, England) · 2025Pooled it
- Noninvasive monitoring of inspiratory effort in mechanical ventilation: a dual-database bibliometric analysis from 1990 to 2025.Frontiers in medicine · 2025Pooled it
- Diaphragm ultrasound and surface electromyography as predictors of clinical deterioration in acute exacerbations of COPD: a prospective observational study.ERJ open research · 2026Article
- Continuous and noninvasive respiratory effort monitoring: a narrative review of emerging techniques.Journal of intensive care · 2026Review
- Automatic Detection of Onset and Offset of Respiratory Electromyographic Activity in Severe COPD Patients on Non-Invasive Mechanical Ventilation.IEEE journal of translational engineering in health and medicine · 2026Article
- ReSurfEMG: A Python Package for Comprehensive Analysis of Respiratory Surface EMG.Sensors (Basel, Switzerland) · 2025Article
- Assessing inspiratory drive and effort in critically ill patients at the bedside.Critical care (London, England) · 2025Review
- Advanced serial analysis of the diaphragm surface EMG: insights into the effect of pressure support on the neuro-ventilatory response during the ICU stay.Critical care (London, England) · 2025Article
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6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundRespiratory effort should be closely monitored in mechanically ventilated ICU patients to avoid both overassistance and underassistance. Surface electromyography of the diaphragm (sEMGdi) offers a continuous and non-invasive modality to assess respiratory effort based on neuromuscular coupling (NMCdi). The sEMGdi derived electrical activity of the diaphragm (sEAdi) is prone to distortion by crosstalk from other muscles including the heart, hindering its widespread use in clinical practice. We developed an advanced analysis as well as quality criteria for sEAdi waveforms and investigated the effects of clinically relevant levels of PEEP on non-invasive NMCdi.
methodsNMCdi was derived by dividing end-expiratory occlusion pressure (Pocc) by sEAdi, based on three consecutive Pocc manoeuvres at four incremental (+ 2 cmH2O/step) PEEP levels in stable ICU patients on pressure support ventilation. Pocc and sEAdi quality was assessed by applying a novel, automated advanced signal analysis, based on tolerant and strict cut-off criteria, and excluding inadequate waveforms. The coefficient of variations (CoV) of NMCdi after basic manual and automated advanced quality assessment were evaluated, as well as the effect of an incremental PEEP trial on NMCdi.
results593 manoeuvres were obtained from 42 PEEP trials in 17 ICU patients. Waveform exclusion was primarily based on low sEAdi signal-to-noise ratio (N
conclusionAdvanced signal analysis of both Pocc and sEAdi greatly facilitates automated and well-defined identification of high-quality waveforms. In the critically ill, this approach allowed to demonstrate a dynamic NMCdi (Pocc/sEAdi) decrease upon PEEP increments, emphasising that sEAdi-based assessment of respiratory effort should be related to PEEP dependent diaphragm function. This novel, non-invasive methodology forms an important methodological foundation for more robust, continuous, and comprehensive assessment of respiratory effort at the bedside.
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