TY - JOUR
T1 - Diaphragmatic electromyography in preterm infants
T2 - The influence of electrode positioning
AU - van Leuteren, Ruud W.
AU - Bekhuis, Robin E.
AU - de Waal, Cornelia G.
AU - de Jongh, Frans H.
AU - van Kaam, Anton H.
AU - Hutten, Gerard J.
N1 - Wiley deal
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Objective: To determine the effect of changing electrode positions on vital signs and respiratory effort parameters measured with transcutaneous electromyography of the diaphragm (dEMG) in preterm infants. Methods: In this observational study, simultaneous dEMG measurements were performed at the standard position and at one alternative electrode position (randomly assigned to lateral, superior, medial, inferior to the standard placement, or dorsal). The activity of the diaphragm was measured for 1 hour at both positions. Main outcome measures were the agreement in heart rate (HR), respiratory rate (RR), and percentage difference in dEMG parameters of respiratory effort (peak and tonic activity, amplitude, area under the curve, and frequency content) between the standard and alternative electrode positions. Results: Thirty clinically stable preterm infants (gestational age 30.1 ± 3.0 weeks) with either no or noninvasive respiratory support were included. Agreement in HR was excellent at all positions (ICC > 0.95) while RR agreement showed more diversity (ICC range 0.40-0.86). Mixed modeling of dEMG parameters revealed that medial and inferior placement measured the weakest signals (median 75.5% and 64.5% lower dEMG amplitude). Lateral electrode placement showed the highest similarity to standard positioning (median 23.5% lower amplitude). Conclusion: Measuring HR showed high similarity at all positions. However, registration of RR and respiratory effort is clearly influenced by the electrode position. Electrodes in the same transversal plane as the diaphragm, and at sufficient distance from each other, provide the best agreement with the standard positioning.
AB - Objective: To determine the effect of changing electrode positions on vital signs and respiratory effort parameters measured with transcutaneous electromyography of the diaphragm (dEMG) in preterm infants. Methods: In this observational study, simultaneous dEMG measurements were performed at the standard position and at one alternative electrode position (randomly assigned to lateral, superior, medial, inferior to the standard placement, or dorsal). The activity of the diaphragm was measured for 1 hour at both positions. Main outcome measures were the agreement in heart rate (HR), respiratory rate (RR), and percentage difference in dEMG parameters of respiratory effort (peak and tonic activity, amplitude, area under the curve, and frequency content) between the standard and alternative electrode positions. Results: Thirty clinically stable preterm infants (gestational age 30.1 ± 3.0 weeks) with either no or noninvasive respiratory support were included. Agreement in HR was excellent at all positions (ICC > 0.95) while RR agreement showed more diversity (ICC range 0.40-0.86). Mixed modeling of dEMG parameters revealed that medial and inferior placement measured the weakest signals (median 75.5% and 64.5% lower dEMG amplitude). Lateral electrode placement showed the highest similarity to standard positioning (median 23.5% lower amplitude). Conclusion: Measuring HR showed high similarity at all positions. However, registration of RR and respiratory effort is clearly influenced by the electrode position. Electrodes in the same transversal plane as the diaphragm, and at sufficient distance from each other, provide the best agreement with the standard positioning.
KW - UT-Hybrid-D
KW - neonatal intensive care unit
KW - respiratory effort
KW - cardiorespiratory monitoring
UR - http://www.scopus.com/inward/record.url?scp=85075445333&partnerID=8YFLogxK
U2 - 10.1002/ppul.24585
DO - 10.1002/ppul.24585
M3 - Article
C2 - 31765520
AN - SCOPUS:85075445333
VL - 55
SP - 354
EP - 359
JO - Pediatric pulmonology
JF - Pediatric pulmonology
SN - 8755-6863
IS - 2
ER -