1
|
Warnaar RSP, Cornet AD, Beishuizen A, Moore CM, Donker DW, Oppersma E. Advanced waveform analysis of diaphragm surface EMG allows for continuous non-invasive assessment of respiratory effort in critically ill patients at different PEEP levels. Crit Care 2024; 28:195. [PMID: 38851709 PMCID: PMC11162564 DOI: 10.1186/s13054-024-04978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Respiratory 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. METHODS NMCdi 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. RESULTS 593 manoeuvres were obtained from 42 PEEP trials in 17 ICU patients. Waveform exclusion was primarily based on low sEAdi signal-to-noise ratio (Ntolerant = 155, 37%, Nstrict = 241, 51% waveforms excluded), irregular or abrupt cessation of Pocc (Ntolerant = 145, 35%, Nstrict = 145, 31%), and high sEAdi area under the baseline (Ntolerant = 94, 23%, Nstrict = 79, 17%). Strict automated assessment allowed to reduce CoV of NMCdi to 15% from 37% for basic quality assessment. As PEEP was increased, NMCdi decreased significantly by 4.9 percentage point per cmH2O. CONCLUSION Advanced 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.
Collapse
Affiliation(s)
- R S P Warnaar
- Cardiovascular and Respiratory Physiology, Technical Medical Centre, University of Twente, Technohal 3184, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - A D Cornet
- Intensive Care Centre, Medisch Spectrum Twente, Enschede, The Netherlands
| | - A Beishuizen
- Intensive Care Centre, Medisch Spectrum Twente, Enschede, The Netherlands
| | - C M Moore
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - D W Donker
- Cardiovascular and Respiratory Physiology, Technical Medical Centre, University of Twente, Technohal 3184, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Intensive Care Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, Technical Medical Centre, University of Twente, Technohal 3184, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| |
Collapse
|
2
|
Korkmaz Dayican D, Keser I, Celiker Tosun O, Yavuz O, Tosun G, Kurt S, Baser Secer M. Exercise Position to Improve Synergy Between the Diaphragm and Pelvic Floor Muscles in Women With Pelvic Floor Dysfunction: A Cross Sectional Study. J Manipulative Physiol Ther 2024:S0161-4754(24)00005-8. [PMID: 38520441 DOI: 10.1016/j.jmpt.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE This study aimed to investigate the synergy between the diaphragm and pelvic floor muscles (PFM) according to different exercise positions in women with pelvic floor dysfunction. Our secondary aim was to determine the short-term effects of single-week pelvic floor muscle training (PFMT) program on diaphragmatic function. METHODS The cross-sectional study included 64 women with pelvic floor dysfunction. The participants' diaphragm and abdominal muscle functions during voluntary PFM contraction and relaxation were assessed by surface electromyography and ultrasonography. The surface electromyography assessments were performed in supine (P1), crawling (P2) and sitting (P3) positions. A single week-PFMT was conducted on women who agreed to determine the short-term responses of the diaphragm function. The muscle functions according to exercise positions were compared with Friedman Analysis of Variance, and the short-term effects of single-week PFMT on diaphragm function was analyzed with Wilcoxon Signed-Ranks Test. RESULTS The diaphragm activity during voluntary PFM contraction was highest in P2 before and after single-week PFMT (P < .001). Positive significant correlations were found between the activities diaphragm and abdominal muscles in different exercise positions (P < .05). After single-week PFMT, diaphragm thickness increased (P = .030) in P1, but diaphragm activity did not change in all 3 exercise positions (P > .05). CONCLUSION The synergy between the diaphragm and PFM was greater in the crawling position in women with pelvic floor dysfunction. The abdominal muscles seemed to contribute to maintaining this synergy. Therefore, PFMT combined with diaphragmatic breathing exercises in the crawling position should be considered. In addition, single-week PFMT may positively affect diaphragm function in the short-term.
Collapse
Affiliation(s)
- Damla Korkmaz Dayican
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Tınaztepe University, İzmir, Turkey
| | - Irem Keser
- Department of Physiotherapy and Rehabilitation, Faculty of Physiotherapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Ozge Celiker Tosun
- Department of Physiotherapy and Rehabilitation, Faculty of Physiotherapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Onur Yavuz
- Department of Obstetrics and Gynecology, Dokuz Eylül University, İzmir, Turkey
| | - Gokhan Tosun
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Sefa Kurt
- Department of Obstetrics and Gynecology, Dokuz Eylül University, İzmir, Turkey
| | - Melda Baser Secer
- Manisa Celal Bayar University, Vocational School of Health Services, Manisa, Turkey.
| |
Collapse
|
3
|
Chen Y, Li J, Zhu Z, Lyu G. Lung Ultrasound Assessment of Lung Hyperinflation in Patients with Stable COPD: An Effective Diagnostic Tool. Int J Chron Obstruct Pulmon Dis 2024; 19:319-330. [PMID: 38298918 PMCID: PMC10829508 DOI: 10.2147/copd.s441374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose To evaluate the degree of lung hyperinflation (LH) in patients with stable chronic obstructive pulmonary disease (COPD) by lung ultrasound score (LUS) and assess its value. Patients and Methods We conducted a study of 149 patients with stable COPD and 100 healthy controls recruited by the Second Affiliated Hospital of Fujian Medical University. The pleural sliding displacement (PSD) was measured, the sliding of the pleura in different areas was observed, and LUS was calculated from both of them. The diaphragm excursion (DE), residual capacity (RV), total lung capacity (TLC), inspiratory capacity (IC) and functional residual capacity (FRC) were measured. We described the correlation between ultrasound indicators and pulmonary function indicators reflecting LH. Multiple linear regression analysis was used. The ROC curves of LUS and DE were drawn to evaluate their diagnostic efficacy, and De Long method was used for comparison. Results (1) The LUS of patients with stable COPD were positively correlated with RV, TLC, RV/TLC and FRC and negatively correlated with IC and IC/TLC (r1=0.72, r2=0.41, r3=0.72, r4=0.70, r5=-0.56, r6=-0.65, P < 0.001). The correlation was stronger than that between DE at maximal deep inspiration and the corresponding pulmonary function indices (r1=-0.41, r2=-0.26, r3=-0.40, r4=-0.43, r5=0.30, r6=0.37, P < 0.001). (2) Multiple linear regression analysis showed that LUS were significantly correlated with IC/TLC and RV/TLC. (3) With IC/TLC<25% and RV/TLC>60% as the diagnostic criterion of severe LH, the areas under the ROC curves of LUS and DE at maximal deep inspiration for diagnosing severe LH were 0.914 and 0.385, 0.845 and 0.543, respectively (P < 0.001). Conclusion The lung ultrasound score is an important parameter for evaluating LH. LUS is better than DE at maximal deep inspiration for diagnosing severe LH and is expected to become an effective auxiliary tool for evaluating LH.
Collapse
Affiliation(s)
- Yongjian Chen
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
| | - Jingyun Li
- School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, People’s Republic of China
| | - Zhixing Zhu
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
| | - Guorong Lyu
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
- School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, People’s Republic of China
| |
Collapse
|
4
|
Aljohani H, Russell D, Kim YI, Bassler J, Lowman J. The Neuromechanics of Inspiratory Muscles in Mechanical Ventilation Liberation Success and Failure. Cureus 2024; 16:e51570. [PMID: 38313921 PMCID: PMC10835747 DOI: 10.7759/cureus.51570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Assessing the neuromechanical coupling of inspiratory muscles during mechanical ventilation (MV) could reveal the physiological mechanism of MV failure. This study examined the respiratory neuromechanical characteristics between MV liberation success and failure. METHODS This is an observational prospective study that included patients during their ventilator liberation process. Assessment of surface electromyography (sEMG) of inspiratory muscles, including the diaphragm and extra-diaphragmatic (scalene, sternocleidomastoid, and parasternal) muscles, was performed 15 minutes after the initiation of spontaneous breathing trials. Neuromechanical efficiency of the diaphragm (NMEDia) and extra-diaphragmatic muscles (NMEExtra) were compared in patients who were successfully liberated from MV with those who failed MV liberation within 72 hours after extubation. RESULTS A total of 45 patients were enrolled and 28 were female (67%). The sample median age was 63 (IQR 47, 69) years old. One-third of patients failed MV liberation within 72 hours of their spontaneous breathing trials (SBTs). NMEDia was significantly lower in patients who failed MV liberation with a root mean square of (M 0.27), (IQR 0.21, 0.37) compared with (M 0.371), (IQR 0.3, 0.631) for the success group (p=0.0222). The area under the curve for NMEDia was lower in the failure group (M 0.270), (IQR 0.160, 0.370) and (M 0.485), (IQR 0.280, 0.683) for the success group (p=0.024). However, NMEExtra was not statistically different between the two groups. CONCLUSION Reduced NMEDia is a predictor of MV liberation failure. NMEExtra was not a major contributor to MV liberation outcomes. Further studies should assess the performance of inspiratory muscles NME indices to predict MV liberation outcomes.
Collapse
Affiliation(s)
- Hassan Aljohani
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Derek Russell
- Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Young-Il Kim
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - John Bassler
- Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - John Lowman
- Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|
5
|
Castillo-Allendes A, Delgado-Bravo M, Ponce AR, Hunter EJ. Muscle Activity and Aerodynamic Voice Changes at Different Body Postures: A Pilot Study. J Voice 2022:S0892-1997(22)00300-9. [PMID: 36273960 PMCID: PMC10924224 DOI: 10.1016/j.jvoice.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Body posture is a commonly discussed component of voice training and therapy. However, body postures, postural changes, related posturing muscle monitoring, and the potential changes in voice production (eg, glottal aerodynamic changes, acoustic differences) have been inconsistently described in the literature, leaving room for free interpretation and possible misunderstandings. The primary purpose of this pilot study was to compare the magnitude of electromyographical activation of muscles involved in phonation-breathing functions and their changes due to four standardized body postures in experienced singers. Secondly, to identify which body posture produces greater changes in aerodynamic parameters, vocal pitch, and loudness. METHODS Eight healthy adults with experience in singing voice performed a vocal task during different body postures commonly used in both voice training and therapy. A 3D-capture system was used to control and quantify the alignment of each posture. During the performances, surface electromyography (sEMG) was used to measure the muscular activity involved in the breathing/phonation and posture processes. A nonparametric Kruskal-Wallis test was used to compare the sEMG activity of phonatory muscles and aerodynamic voice variables between postures. RESULTS Our study did not reveal significant differences in sEMG activity, aerodynamic parameters, vocal pitch, and loudness among body postures during vocal task productions. However, the vocal pitch (in semitones) revealed significant differences in the unstable surface when compared to the upright posture, modified upright, and leaning postures. CONCLUSION The body postures selected did not generate voice aerodynamic modifications of the voice nor in the levels of activation of muscles involved in the phonation-breathing process in individuals with experience in singing voice. Modifications of body posture as a tool for voice therapy should be further investigated, considering the population with voice problems and no voice training experience.
Collapse
Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Mauricio Delgado-Bravo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Alvaro Reyes Ponce
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Chile
| | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| |
Collapse
|
6
|
Lozano-Garcia M, Estrada-Petrocelli L, Blanco-Almazan D, Tas B, Cho PSP, Moxham J, Rafferty GF, Torres A, Jane R, Jolley CJ. Noninvasive Assessment of Neuromechanical and Neuroventilatory Coupling in COPD. IEEE J Biomed Health Inform 2022; 26:3385-3396. [PMID: 35404825 DOI: 10.1109/jbhi.2022.3166255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study explored the use of parasternal second intercostal space and lower intercostal space surface electromyogram (sEMG) and surface mechanomyogram (sMMG) recordings (sEMGpara and sMMGpara, and sEMGlic and sMMGlic, respectively) to assess neural respiratory drive (NRD), neuromechanical (NMC) and neuroventilatory (NVC) coupling, and mechanical efficiency (MEff) noninvasively in healthy subjects and chronic obstructive pulmonary disease (COPD) patients. sEMGpara, sMMGpara, sEMGlic, sMMGlic, mouth pressure (Pmo), and volume (Vi) were measured at rest, and during an inspiratory loading protocol, in 16 COPD patients (8 moderate and 8 severe) and 9 healthy subjects. Myographic signals were analyzed using fixed sample entropy and normalized to their largest values (fSEsEMGpara%max, fSEsMMGpara%max, fSEsEMGlic%max, and fSEsMMGlic%max). fSEsMMGpara%max, fSEsEMGpara%max, and fSEsEMGlic%max were significantly higher in COPD than in healthy participants at rest. Parasternal intercostal muscle NMC was significantly higher in healthy than in COPD participants at rest, but not during threshold loading. Pmo-derived NMC and MEff ratios were lower in severe patients than in mild patients or healthy subjects during threshold loading, but differences were not consistently significant. During resting breathing and threshold loading, Vi-derived NVC and MEff ratios were significantly lower in severe patients than in mild patients or healthy subjects. sMMG is a potential noninvasive alternative to sEMG for assessing NRD in COPD. The ratios of Pmo and Vi to sMMG and sEMG measurements provide wholly noninvasive NMC, NVC, and MEff indices that are sensitive to impaired respiratory mechanics in COPD and are therefore of potential value to assess disease severity in clinical practice.
Collapse
|
7
|
Relationship of electromyography (EMG) masticatory variables with sensory texture and instrumental texture parameters of different textured foods. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2022. [DOI: 10.1007/s11694-021-01168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Features of electromyography threshold of the respiratory muscles during incremental exercise test. Respir Physiol Neurobiol 2021; 295:103785. [PMID: 34508868 DOI: 10.1016/j.resp.2021.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Abstract
In this study, we aimed to examine the electromyography threshold (EMGT) of the respiratory muscle and accessory respiratory muscles. Sixteen healthy men underwent an incremental exercise test at 15 W/minute to the end point. Expired gases and electromyograms of the respiratory and lower limb muscles were measured. The breakpoints for the EMG and expired gas data were analyzed using a segmented regression model. EMGT of the sternocleidomastoid and diaphragm was significantly more delayed than the ventilation threshold (VT) (287.94 s, 288.15 s vs. 185.5 s, p = 0.028 and 0.044, respectively). The EMGT of respiratory muscles and VT were not related, though EMGT of rectus femoris and vastus lateralis correlated with VT (r = 0.854, p < 0.001; r = 0.657, p = 0.011, respectively). EMGT of respiratory muscles may be influenced by multiple factors, such as central command and afferent input of mechanical stimulation from muscles, in addition to VT-induced changes in metabolic dynamics.
Collapse
|
9
|
Noninvasive Assessment of Neuromechanical Coupling and Mechanical Efficiency of Parasternal Intercostal Muscle during Inspiratory Threshold Loading. SENSORS 2021; 21:s21051781. [PMID: 33806463 PMCID: PMC7961675 DOI: 10.3390/s21051781] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022]
Abstract
This study aims to investigate noninvasive indices of neuromechanical coupling (NMC) and mechanical efficiency (MEff) of parasternal intercostal muscles. Gold standard assessment of diaphragm NMC requires using invasive techniques, limiting the utility of this procedure. Noninvasive NMC indices of parasternal intercostal muscles can be calculated using surface mechanomyography (sMMGpara) and electromyography (sEMGpara). However, the use of sMMGpara as an inspiratory muscle mechanical output measure, and the relationships between sMMGpara, sEMGpara, and simultaneous invasive and noninvasive pressure measurements have not previously been evaluated. sEMGpara, sMMGpara, and both invasive and noninvasive measurements of pressures were recorded in twelve healthy subjects during an inspiratory loading protocol. The ratios of sMMGpara to sEMGpara, which provided muscle-specific noninvasive NMC indices of parasternal intercostal muscles, showed nonsignificant changes with increasing load, since the relationships between sMMGpara and sEMGpara were linear (R2 = 0.85 (0.75-0.9)). The ratios of mouth pressure (Pmo) to sEMGpara and sMMGpara were also proposed as noninvasive indices of parasternal intercostal muscle NMC and MEff, respectively. These indices, similar to the analogous indices calculated using invasive transdiaphragmatic and esophageal pressures, showed nonsignificant changes during threshold loading, since the relationships between Pmo and both sEMGpara (R2 = 0.84 (0.77-0.93)) and sMMGpara (R2 = 0.89 (0.85-0.91)) were linear. The proposed noninvasive NMC and MEff indices of parasternal intercostal muscles may be of potential clinical value, particularly for the regular assessment of patients with disordered respiratory mechanics using noninvasive wearable and wireless devices.
Collapse
|
10
|
Estrada-Petrocelli L, Torres A, Sarlabous L, Rafols-de-Urquia M, Ye-Lin Y, Prats-Boluda G, Jane R, Garcia-Casado J. Evaluation of Respiratory Muscle Activity by Means of Concentric Ring Electrodes. IEEE Trans Biomed Eng 2020; 68:1005-1014. [PMID: 32746073 DOI: 10.1109/tbme.2020.3012385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Surface electromyography (sEMG) can be used for the evaluation of respiratory muscle activity. Recording sEMG involves the use of surface electrodes in a bipolar configuration. However, electrocardiographic (ECG) interference and electrode orientation represent considerable drawbacks to bipolar acquisition. As an alternative, concentric ring electrodes (CREs) can be used for sEMG acquisition and offer great potential for the evaluation of respiratory muscle activity due to their enhanced spatial resolution and simple placement protocol, which does not depend on muscle fiber orientation. The aim of this work was to analyze the performance of CREs during respiratory sEMG acquisitions. Respiratory muscle sEMG was applied to the diaphragm and sternocleidomastoid muscles using a bipolar and a CRE configuration. Thirty-two subjects underwent four inspiratory load spontaneous breathing tests which was repeated after interchanging the electrode positions. We calculated parameters such as (1) spectral power and (2) median frequency during inspiration, and power ratios of inspiratory sEMG without ECG in relation to (3) basal sEMG without ECG (Rins/noise), (4) basal sEMG with ECG (Rins/cardio) and (5) expiratory sEMG without ECG (Rins/exp). Spectral power, Rins/noise and Rins/cardio increased with the inspiratory load. Significantly higher values (p < 0.05) of Rins/cardio and significantly higher median frequencies were obtained for CREs. Rins/noise and Rins/exp were higher for the bipolar configuration only in diaphragm sEMG recordings, whereas no significant differences were found in the sternocleidomastoid recordings. Our results suggest that the evaluation of respiratory muscle activity by means of sEMG can benefit from the remarkably reduced influence of cardiac activity, the enhanced detection of the shift in frequency content and the axial isotropy of CREs which facilitates its placement.
Collapse
|
11
|
Estrada-Petrocelli L, Jane R, Torres A. Neural Respiratory Drive Estimation in Respiratory sEMG with Cardiac Arrhythmias. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2748-2751. [PMID: 33018575 DOI: 10.1109/embc44109.2020.9176377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neural respiratory drive as measured by the electromyography allows the study of the imbalance between the load on respiratory muscles and its capacity. Surface respiratory electromyography (sEMG) is a non-invasive tool used for indirectly assessment of NRD. It also provides a way to evaluate the level and pattern of respiratory muscle activation. The prevalence of electrocardiographic activity (ECG) in respiratory sEMG signals hinders its proper evaluation. Moreover, the occurrence of abnormal heartbeats or cardiac arrhythmias in respiratory sEMG measures can make even more challenging the NRD estimation. Respiratory sEMG can be evaluated using the fixed sample entropy (fSampEn), a technique which is less affected by cardiac artefacts. The aim of this work was to investigate the performance of the fSampEn, the root mean square (RMS) and the average rectified value (ARV) on respiratory sEMG signals with supraventricular arrhythmias (SVA) for NRD estimation. fSampEn, ARV and RMS parameters increased as the inspiratory load increased during the test. fSampEn was less influenced by ECG with SVAs for the NRD estimation showing a greater response to respiratory sEMG, reflected with a higher percentage increase with increasing load (228 % total increase, compared to 142 % and 135 % for ARV and RMS, respectively).
Collapse
|
12
|
AbuNurah HY, Russell DW, Lowman JD. The validity of surface EMG of extra-diaphragmatic muscles in assessing respiratory responses during mechanical ventilation: A systematic review. Pulmonology 2020; 26:378-385. [PMID: 32247711 PMCID: PMC8085814 DOI: 10.1016/j.pulmoe.2020.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/22/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Evidence supporting the utilization of surface EMG (sEMG) of extra-diaphragmatic muscles for monitoring of mechanical ventilation (MV) assistance is unclear. The purpose of this review was to assess the quality of literature available on using extra-diaphragmatic sEMG as an assessment technique of respiratory responses during MV. METHODS Studies using sEMG of extra-diaphragmatic respiratory muscles during MV were selected by two independent researchers after performing a database search of PubMed, CINAHL, GOOGLE SCHOLAR. Exclusion criteria were studies of patients with neuromuscular disorders, receiving neuromuscular blocking agents, receiving non-invasive MV, using needle EMG, and studies written in languages other than English. Quality of identified studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). This study is registered with PROSPERO, number (CRD42018081341). RESULTS 596 references were identified. Of the identified studies, 7 studies were included in the review. Findings demonstrate that sEMG of extra-diaphragmatic muscle activity is a valid and applicable tool to evaluate mechanical loading/unloading of respiratory muscles and respiratory drive or sensation. However, the quality of literature supporting sEMG as monitoring tool of respiratory responses were characterized by a high and unclear risk of bias. CONCLUSIONS Although it appears to be a valid and applicable tool, there is a scarcity of literature that directly demonstrates the diagnostic accuracy of sEMG of extra-diaphragmatic muscles in monitoring respiratory mechanics and respiratory drive or sensation during MV assistance across wide populations and conditions.
Collapse
Affiliation(s)
- H Y AbuNurah
- Department of Respiratory Therapy, King Saud bin Abdulaziz University for Health Sciences, KSA & the PhD in Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - D W Russell
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - J D Lowman
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
13
|
van Leuteren RW, Bekhuis RE, de Waal CG, de Jongh FH, van Kaam AH, Hutten GJ. Diaphragmatic electromyography in preterm infants: The influence of electrode positioning. Pediatr Pulmonol 2020; 55:354-359. [PMID: 31765520 PMCID: PMC7004062 DOI: 10.1002/ppul.24585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ruud W van Leuteren
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin E Bekhuis
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Cornelia G de Waal
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans H de Jongh
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gerard J Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Abstract
The diaphragm muscle is the most important contractile district used for breathing. Like other muscles in the human body, it is subject to ageing and sarcopenia. Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature. Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or unrelated to ageing. In the elderly population, transdiaphragmatic pressure (Pdi) decreases by 20-41%, with a decline in the overall strength of 30% (the strength of the expiratory muscles also decreases). The article discusses the adaptation of the diaphragm muscle to ageing and some other ailments and co-morbidities, such as back pain, emotional alterations, motor incoordination, and cognitive disorders, which are related to breathing.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Bruno Morabito
- Physical Medicine and Rehabilitation, School of Osteopathic Centre for Research and Studies, Milan, ITA
| | - Marta Simonelli
- Integrative/Complimentary Medicine, French-Italian School of Osteopathy, Pisa, ITA
| |
Collapse
|
15
|
Biagetti G, Carnielli VP, Crippa P, Falaschetti L, Scacchia V, Scalise L, Turchetti C. Dataset from spirometer and sEMG wireless sensor for diaphragmatic respiratory activity monitoring. Data Brief 2019; 25:104217. [PMID: 31440545 PMCID: PMC6698777 DOI: 10.1016/j.dib.2019.104217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022] Open
Abstract
We introduce a dataset to provide insights into the relationship between the diaphragm surface electromyographic (sEMG) signal and the respiratory air flow. The data presented had been originally collected for a research project jointly developed by the Department of Information Engineering and the Department of Industrial Enginering and Mathematical Sciences, Polytechnic University of Marche, Ancona, Italy. This article describes data recorded from 8 subjects, and includes 8 air flow and 8 surface electromyographic (sEMG) signals for diaphragmatic respiratory activity monitoring, measured with a sampling frequency of 2 kHz.
Collapse
Affiliation(s)
- Giorgio Biagetti
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| | - Virgilio Paolo Carnielli
- Maternal and Child Health Institute, Polytechnic University of Marche and Salesi Hospital, Ancona, Italy
| | - Paolo Crippa
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| | - Laura Falaschetti
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| | - Valentina Scacchia
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Lorenzo Scalise
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Claudio Turchetti
- Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
16
|
van Leuteren RW, Hutten GJ, de Waal CG, Dixon P, van Kaam AH, de Jongh FH. Processing transcutaneous electromyography measurements of respiratory muscles, a review of analysis techniques. J Electromyogr Kinesiol 2019; 48:176-186. [PMID: 31401341 DOI: 10.1016/j.jelekin.2019.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022] Open
Abstract
Transcutaneous electromyography (tc-EMG) has been used to measure the electrical activity of respiratory muscles during inspiration in various studies. Processing the raw tc-EMG signal of these inspiratory muscles has shown to be difficult as baseline noise, cardiac interference, cross-talk and motion artefacts can influence the signal quality. In this review we will discuss the most important sources of signal noise in tc-EMG of respiratory muscles and the various techniques described to suppress or reduce this signal noise. Furthermore, we will elaborate on the options available to develop or improve an algorithm that can be used to guide the approach for analysis of tc-EMG signals of inspiratory muscles in future research.
Collapse
Affiliation(s)
- R W van Leuteren
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - G J Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - C G de Waal
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - P Dixon
- Vyaire Medical, Basingstoke, United Kingdom
| | - A H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - F H de Jongh
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| |
Collapse
|