University of Twente Student Theses


Optimizing Pressure Settings in Mechanically Ventilated Infants Utilizing Forced Oscillation Technique and Transcutaneous Diaphragmatic Electromyography

Poelgeest, Jorrit van (2022) Optimizing Pressure Settings in Mechanically Ventilated Infants Utilizing Forced Oscillation Technique and Transcutaneous Diaphragmatic Electromyography.

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Abstract:Rationale: Due to underdevelopment of the respiratory system, preterm infants may need mechanical ventilation (MV) to facilitate gas exchange. Nowadays, the titration of MV is done based on peripheral oxygen saturation (SpO2), oxygen demand (FiO2) and transcutaneous carbon dioxide (tcCO2). However, a dedicated lung function measurement, which is not influenced by the circulatory condition, is currently lacking. In this research the Forced Oscillation Technique (FOT) and the use of transcutaneous electromyography of the diaphragm (dEMG) are investigated as candidate techniques to fill this gap. FOT measuresreactance (Xrs) providing information about lung mechanics while dEMG can expressthe respiratory effort of the patient. Incorporating this information in practice might aid optimization of MV settings. Methods: First, exploratory research was done about the added value of three different variability analyses on dEMG data: Poincaré, detrended fluctuation- and entropy analysis. If one showed promising results, it was applied in the main research. Next, a clinical pilot (FOT study) was initiated to compare optimal pressure as determined by FOT measurements (PFOT) and by clinicians (PCLIN) during lung recruitment manoeuvres. In the main research (Gemini study), dEMG and FOT measurements were performed regularly during the period of MV, to acquire knowledge on development of these parameters over time. SpO2, FiO2 and tcCO2 values were noted for correlation analysis between clinical parameters and the FOT and dEMG parameters. Lastly, correlation analysis was done between Xrs and dEMG to investigate whether these techniques might be complementary. Results: Poincaré seemed to be the most useful variability analysis on dEMG data and was used in subsequent analyses. Eight infants were included in the FOT study which showed that PFOT and PCLIN are correlated. However, PFOT was lower than PCLIN for some patients. The Gemini study included six infants so far and showed various correlations between the two techniques and clinical parameters (e.g. correlation Xrs vs tonic diaphragm activity: r =-0.63, p=0.03). Inclusion is ongoing to increase the power of the analysis. Conclusion: Our study shows that both FOT and dEMG can provide interesting information on the lung function of ventilated preterm infants. The FOT study suggests that lower pressure settings might be sufficient as well, while the Gemini study is the first study combining techniques striving for a combination of techniques to get a full picture of the patient’s condition. The studies are ongoing and more data on these outcomes is required to draw firm conclusions
Item Type:Essay (Master)
Academisch Medisch Centrum, Amsterdam, Nederland
Academisch Medisch Centrum, Amsterdam, Nederland
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
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