Predictive Value Of Electromyography Of Diaphragmatic Muscles In Patients With Nerve-Assisted Ventilation

OBJECTIVE: To investigate the difference of the electromyographic activity of the diaphragm in patients with nerve-assisted ventilation and to evaluate the prognostic value of the patients with nerve-assisted ventilation.Methods: From June 2013 to December 2016,the First Affiliated Hospital of Guangxi Medical University,Department of Ophthalmology,Second Affiliated Hospital of Neurosurgery,assisted the use of neurological ventilation to carry out retrospective analysis of patients,according to the weaning results are divided into weaning success group and withdrawal Machine failure group.(Sex,age,body mass index,artificial airway,cause of mechanical ventilation,ICU time before weaning),respiratory mechanics(using mechanical ventilation time before weaning,Before the weaning use NAVA time,before the weaning of the diaphragm muscle activity,respiratory rate,tidal volume,shallow breathing index,minute ventilation,positive end expiratory pressure,oxygen concentration,airway pressure,mean airway pressure),Cyclic mechanics(before and after weaning 2 hours after the heart rate,mean arterial pressure),blood gas analysis(before and after weaning 2 hours after the acidity,oxygen partial pressure,carbon dioxide partial pressure,bicarbonate,blood oxygen Saturation,lactic acid,oxygenation index,hemoglobin),and to evaluate the predictive value of each index.Results:(1)the general situation: the application of 20 cases of NAVA patients,excluding the need for the disease did not implement 4 cases of patients with weaning,in line with the inclusion of standard patients in 16 cases,which weaning patients in 9 cases(9/16),7 cases of weaning failure patients(P <0.05).There was no significant difference between the two groups(P> 0.05).There was no significant difference between the two groups(P> 0.05).There was no significant difference between the two groups in age,sex,BMI,artificial airway,leading to mechanical ventilation,ICU time before weaning 2)Respiratory mechanics: Edi,Ve and P mean were significantly higher in patients with failure of weaning group than 6.5(4.5 ~ 9.1)VS 3.1(2.3 ~ 3.8)(P = 0.005),9.8(7.7 ~ 13.1(P = 0.004),9.0(8.0 ~ 10.0)VS 7.0(4.5 ~ 7.4)(P = 0.019),the difference was statistically significant;(3)Circulation mechanics and blood gas analysis:(P> 0.05).(4)Bivariate correlation analysis showed that Edi and NAVA were used before weaning(r =-0.596),and there was no significant difference between the two groups(P> 0.05)(P = 0.015),P mean(r = 0.695,P = 0.003),and there was a significant positive correlation with Ve(r = 0.600,P = 0.014),P mean(r = 0.695,P = 0.003);(5)single factor logistic regression(6)ROC curve analysis showed that the AUC of Edi was 0.921(P = 0.005),and the relative risk(OR)was 2.436(P = 0.04)The optimal cutoff value for the failure of the machine is Edi = 3.65 uV with a sensitivity of 1.000 and a specificity of 0.778.Conclusion: The diaphragmatic electromyography has a good predictive value for the failure of patients with neuromodulation-assisted ventilation.