University of Twente Student Theses


Triggering the Ventilator during Non-Invasive Ventilation in Infants using Transcutaneous Electromyography of the Diaphragm : A proof of principle study

Elburg, Amber van (2022) Triggering the Ventilator during Non-Invasive Ventilation in Infants using Transcutaneous Electromyography of the Diaphragm : A proof of principle study.

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Abstract:Introduction. Delivering respiratory support to preterm infants is often life-saving due to a premature respiratory system. Non-invasive respiratory support is preferred, as invasive mechanical ventilation is associated with long-term detrimental outcome. The most advanced form of non-invasive support is nasal intermittent positive pressure ventilation (nIPPV). However, the inflations from nIPPV are often not synchronized with the infants own inspiration, because a technique which is both non-invasive and reliable is unavailable. Recently, transcutaneous diaphragm electromyography (tc-dEMG) has been suggested as a novel method to establish reliable and non-invasive inspiratory triggering, which was further investigated in this study. Method. A triggering algorithm based on tc-dEMG was developed in Simulink. The algorithm was designed to reduce noise and detect inspiratory efforts in real-time. After simulation testing, the algorithm was integrated into a hardware prototype, which was used in a bench set-up that converted the triggers into inflations by a custom-made ventilator. To determine the algorithm performance, the results were compared with a reference study using non-synchronized nIPPV. The amount of matching and extra triggers, and the amount of unsupported inspirations were compared between the two settings. Lastly, the quality of the matched triggers was assessed by determining the amount of synchronous, early and late triggers and calculating the trigger delay. Results. The algorithm was tested using 2-minute epochs from pre-recorded tc-dEMG measurements of 15 (preterm) subjects. The percentage of matching and extra triggers, and unsupported inspirations was respectively 93.4% (IQR 71.2 – 96.7), 6.6% (IQR 3.3 – 28.8) and 7.1% (IQR 2.1 – 9.7). All performance indicators were better compared to the reference study, which was only significant for the percentage of unsupported inspirations (7.1 % vs. 22%, p < 0.05). For all subjects, most matching triggers were categorized as late, 84.9% (IQR 70.5 – 92.8). The trigger delay was estimated at ~404 ms, which mostly consisted of the delay introduced by the time needed to detect an inspiratory effort based on the tc-dEMG signal, which was 341 ms (IQR 315 – 374). Once the inspiration was detected, the prototype was able to successfully trigger the ventilator in the bench set-up. Conclusion. This study showed for the first time that a dEMG-based triggering algorithm is capable of real-time extraction of inspiratory triggers and subsequent triggering of the ventilator. However, the inspiratory triggers were given relatively late. Future research should focus on further reduction of the trigger delay and testing of the algorithm in various bench and clinical settings.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
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