TY - JOUR
T1 - Simultaneous measurement of diaphragm activity, chest impedance, and ECG using three standard cardiorespiratory monitoring electrodes
AU - Scholten, Anouk W.J.
AU - van Leuteren, Ruud W.
AU - de Jongh, Frans H.
AU - van Kaam, Anton H.
AU - Hutten, Gerard J.
N1 - Publisher Copyright:
© 2022 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.
PY - 2022/11
Y1 - 2022/11
N2 - Introduction: Current cardiorespiratory monitoring in neonates with electrocardiogram (ECG) and chest impedance (CI) has limitations. Adding transcutaneous electromyography of the diaphragm (dEMG) may improve respiratory monitoring, but requires additional hardware. We aimed to determine the feasibility of measuring dEMG and ECG/CI simultaneously using the standard ECG/CI hardware, with its three electrodes repositioned to dEMG electrode locations. Methods: Thirty infants (median postmenstrual age 30.4 weeks) were included. First, we assessed the feasibility of extracting dEMG from the ECG-signal. If successful, the agreement between dEMG-based respiratory rate (RR), using three different ECG-leads, and a respiratory reference signal was assessed using the Bland-Altman analysis and the intraclass correlation coefficient (ICC). Furthermore, we studied the agreement between CI-based RR and the reference signal with the electrodes placed at the standard and dEMG position. Finally, we explored the quality of the ECG-signal at the different electrode positions. Results: In 15 infants, feasibility of measuring dEMG with the monitoring electrodes was confirmed. In the next 15 infants, comparing dEMG-based RR to the reference signal resulted in a mean difference and limits of agreement for ECG-lead I, II and III of 4.2 [−8.2 to 16.6], 4.3 [−10.7 to 19.3] and 5.0 [–14.2 to 24.2] breaths/min, respectively. ICC analysis showed a moderate agreement for all ECG-leads. CI-based RR agreement was similar at the standard and dEMG electrode position. An exploratory analysis suggested similar quality of the ECG-signal at both electrode positions. Conclusion: Measuring dEMG using the ECG/CI hardware with its electrodes on the diaphragm is feasible, leaving ECG/CI monitoring unaffected.
AB - Introduction: Current cardiorespiratory monitoring in neonates with electrocardiogram (ECG) and chest impedance (CI) has limitations. Adding transcutaneous electromyography of the diaphragm (dEMG) may improve respiratory monitoring, but requires additional hardware. We aimed to determine the feasibility of measuring dEMG and ECG/CI simultaneously using the standard ECG/CI hardware, with its three electrodes repositioned to dEMG electrode locations. Methods: Thirty infants (median postmenstrual age 30.4 weeks) were included. First, we assessed the feasibility of extracting dEMG from the ECG-signal. If successful, the agreement between dEMG-based respiratory rate (RR), using three different ECG-leads, and a respiratory reference signal was assessed using the Bland-Altman analysis and the intraclass correlation coefficient (ICC). Furthermore, we studied the agreement between CI-based RR and the reference signal with the electrodes placed at the standard and dEMG position. Finally, we explored the quality of the ECG-signal at the different electrode positions. Results: In 15 infants, feasibility of measuring dEMG with the monitoring electrodes was confirmed. In the next 15 infants, comparing dEMG-based RR to the reference signal resulted in a mean difference and limits of agreement for ECG-lead I, II and III of 4.2 [−8.2 to 16.6], 4.3 [−10.7 to 19.3] and 5.0 [–14.2 to 24.2] breaths/min, respectively. ICC analysis showed a moderate agreement for all ECG-leads. CI-based RR agreement was similar at the standard and dEMG electrode position. An exploratory analysis suggested similar quality of the ECG-signal at both electrode positions. Conclusion: Measuring dEMG using the ECG/CI hardware with its electrodes on the diaphragm is feasible, leaving ECG/CI monitoring unaffected.
KW - neonates
KW - respiration
KW - transcutaneous electromyography
UR - http://www.scopus.com/inward/record.url?scp=85135884485&partnerID=8YFLogxK
U2 - 10.1002/ppul.26096
DO - 10.1002/ppul.26096
M3 - Article
C2 - 35938231
AN - SCOPUS:85135884485
VL - 57
SP - 2754
EP - 2762
JO - Pediatric pulmonology
JF - Pediatric pulmonology
SN - 8755-6863
IS - 11
ER -