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Deshmukh MP, Baxi G, Wadhokar OC, Palekar TJ, Pokle S. Determining the Optimal Position of Surface Electrodes for Diaphragm Electromyography: A Cross-Sectional Study. Cureus 2024; 16:e55176. [PMID: 38558640 PMCID: PMC10980579 DOI: 10.7759/cureus.55176] [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: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Placing electrodes on different aspects of the chest determines the motor firing from the diaphragm. The electrode placement close to the extent of the muscle gave promising readings as compared to the ones that were placed away. The position with the maximum amplitude and least duration was chosen. Positions of the electrodes were decided as per the extent of the muscle. The aim is to determine the appropriate position of surface electrodes for surface diaphragm electromyography (EMG). MATERIAL AND METHODOLOGY Thirty healthy individuals of age ranging from 21 to 45 years were included in the study. Participants were made to lie down in a supine position and different positions like G1 (recording electrode) 5 cm superior to the tip of the xiphoid process and G2 (reference) 16 cm along the costal margin from G1, G1 over the xiphoid tip and G2 at the seventh intercostal space at the costochondral junction and G1 over the xiphoid tip and G2 at the eight intercostal space at the costochondral junction were used for assessing maximum amplitudes and durations were observed by using a Octopus New Wave EMG machine (Octopus Medical Technologies, Vadodara, IND). After observing all the positions, an optimum position for maximum amplitude and least duration was analyzed. RESULTS As per the study, out of the four positions, the electrode placements on the tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space showed maximum amplitude and the least duration with maximum mean amplitude and less mean duration of 232.35 and 7.316. On the seventh intercostal space it was 199.15 and 7.887 and on the eighth intercostal space was 176.055 and 8.639. The tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space is chosen as the appropriate position for electrode placement for EMG of the diaphragm. CONCLUSION We conclude that the best electrode position was when the electrodes were placed 5 cm superior to the xiphoid process, i.e., G1, and 16 cm away from the recording electrode on the costochondral junction, i.e., G2, at the sixth intercostal space. Ground electrode placement is the nearest bony prominence, i.e., xiphisternum.
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Affiliation(s)
- Mayura P Deshmukh
- Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Gaurang Baxi
- Cardiorespiratory Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Om C Wadhokar
- Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
- Musculoskeletal Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Tushar J Palekar
- Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Siddhi Pokle
- Cardiorespiratory Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
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Jonkman AH, Warnaar RSP, Baccinelli W, Carbon NM, D'Cruz RF, Doorduin J, van Doorn JLM, Elshof J, Estrada-Petrocelli L, Graßhoff J, Heunks LMA, Koopman AA, Langer D, Moore CM, Nunez Silveira JM, Petersen E, Poddighe D, Ramsay M, Rodrigues A, Roesthuis LH, Rossel A, Torres A, Duiverman ML, Oppersma E. Analysis and applications of respiratory surface EMG: report of a round table meeting. Crit Care 2024; 28:2. [PMID: 38166968 PMCID: PMC10759550 DOI: 10.1186/s13054-023-04779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.
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Affiliation(s)
- A H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R S P Warnaar
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - W Baccinelli
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - N M Carbon
- Department of Anesthesiology, Friedrich Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Erlangen, Germany
| | - R F D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Elshof
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Estrada-Petrocelli
- Facultad de Ingeniería and Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) - Sistema Nacional de Investigación (SNI), Universidad Latina de Panamá (ULATINA), Panama, Panama
| | - J Graßhoff
- Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - L M A Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A Koopman
- Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - D Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - C M Moore
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - J M Nunez Silveira
- Hospital Italiano de Buenos Aires, Unidad de Terapia Intensiva, Ciudad de Buenos Aires, Argentina
| | - E Petersen
- Technical University of Denmark (DTU), DTU Compute, 2800, Kgs. Lyngby, Denmark
| | - D Poddighe
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - M Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Rodrigues
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - L H Roesthuis
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rossel
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - A Torres
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona Institute of Science and Technology (BIST) and Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands.
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Arboleda A, Amado L, Rodriguez J, Naranjo F, Giraldo BF. A new protocol to compare successful versus failed patients using the electromyographic diaphragm signal in extubation process. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5646-5649. [PMID: 34892403 DOI: 10.1109/embc46164.2021.9629815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In clinical practice, when a patient is undergoing mechanical ventilation, it is important to identify the optimal moment for extubation, minimizing the risk of failure. However, this prediction remains a challenge in the clinical process. In this work, we propose a new protocol to study the extubation process, including the electromyographic diaphragm signal (diaEMG) recorded through 5-channels with surface electrodes around the diaphragm muscle. First channel corresponds to the electrode on the right. A total of 40 patients in process of withdrawal of mechanical ventilation, undergoing spontaneous breathing tests (SBT), were studied. According to the outcome of the SBT, the patients were classified into two groups: successful (SG: 19 patients) and failure (FG: 21 patients) groups. Parameters extracted from the envelope of each channel of diaEMG in time and frequency domain were studied. After analyzing all channels, the second presented maximum differences when comparing the two groups of patients, with parameters related to root mean square (p = 0.005), moving average (p = 0.001), and upward slope (p = 0.017). The third channel also presented maximum differences in parameters as the time between maximum peak (p = 0.004), and the skewness (p = 0.027). These results suggest that diaphragm EMG signal could contribute to increase the knowledge of the behaviour of respiratory system in these patients and improve the extubation process.Clinical Relevance-This establishes the characterization of success and failure patients in the extubation process.
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Dres M, Similowski T, Goligher EC, Pham T, Sergenyuk L, Telias I, Grieco DL, Ouechani W, Junhasavasdikul D, Sklar MC, Damiani LF, Melo L, Santis C, Degravi L, Decavèle M, Brochard L, Demoule A. Dyspnea and respiratory muscles ultrasound to predict extubation failure. Eur Respir J 2021; 58:13993003.00002-2021. [PMID: 33875492 DOI: 10.1183/13993003.00002-2021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/30/2021] [Indexed: 11/05/2022]
Abstract
This study investigated dyspnea intensity and respiratory muscles ultrasound early after extubation to predict extubation failure.It was conducted prospectively in two intensive care units in France and Canada. Patients intubated for at least 48 h were studied within 2 h after an extubation following a successful spontaneous breathing trial. Dyspnea was evaluated by the Dyspnea-Visual Analog Scale from 0 to 10 cm (VAS) and the Intensive Care - Respiratory Distress Observational Scale (range 0-10). The ultrasound thickening fraction of the parasternal intercostal and the diaphragm were measured; limb muscle strength was evaluated using the Medical Research Council score (MRC) (range 0-60).Extubation failure occurred in 21 of the 122 enrolled patients (17%). Dyspnea-VAS and Intensive Care - Respiratory Distress Observational scale were higher in patients with extubation failure versus success: 7 (5-9) cm versus 3 (1-5) cm respectively (p<0.001) and 4.4 (2.5-6.5) versus 2.4 (2.1-2.8) respectively (p<0.001). The ratio of intercostal muscle to diaphragm thickening fraction was significantly higher and MRC was lower in patients with failure (0.9 [0.4-3.0] versus 0.3 [0.2-0.5], p<0.001, and 45 [36-50] versus 52 [44-60], p=0.012). The thickening fraction of the intercostal and its ratio to diaphragm thickening showed the highest area under the receiver operating characteristic curves for an early prediction of extubation failure (0.81). Areas under the receiver operating characteristic curves of Dyspnea-VAS and Intensive Care - Respiratory Distress Observational scale reached 0.78 and 0.74 respectively.Respiratory muscle ultrasound and dyspnea measured within 2 h after extubation predict subsequent extubation failure.
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Affiliation(s)
- Martin Dres
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive Réanimation (Département R3S), Paris, France .,Sorbonne Université, INSERM, UMRS_1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.,St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Thomas Similowski
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive Réanimation (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS_1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - Tai Pham
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Hôpital Bicêtre, Service de Médecine Intensive - Réanimation, Hôpitaux universitaires Paris-Saclay, Le Kremlin-Bicêtre, France.,Équipe d'Épidémiologie Respiratoire Intégrative, Center for Epidemiology and Population Health (CESP), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Villejuif, France
| | - Liliya Sergenyuk
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive Réanimation (Département R3S), Paris, France
| | - Irene Telias
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - Domenico Luca Grieco
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
| | - Wissale Ouechani
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive Réanimation (Département R3S), Paris, France
| | - Detajin Junhasavasdikul
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Michael C Sklar
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - L Felipe Damiani
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Departamento Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luana Melo
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada
| | - Cesar Santis
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Departamento de Medicina Interna, Universidad de Chile, Campus Sur, San Miguel, Chile.,Unidad de Pacientes Críticos, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Lauriane Degravi
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive Réanimation (Département R3S), Paris, France
| | - Maxens Decavèle
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive Réanimation (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS_1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Laurent Brochard
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Alexandre Demoule
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive Réanimation (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS_1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
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