title: Interest of monitoring diaphragmatic electrical activity in the pediatric intensive care unit.
abstract: The monitoring of electrical activity of the diaphragm (EAdi) is a new minimally invasive bedside technology that was developed for the neurally adjusted ventilatory assist (NAVA) mode of ventilation. In addition to its role in NAVA ventilation, this technology provides the clinician with previously unavailable and essential information on diaphragm activity. In this paper, we review the clinical interests of EAdi in the pediatric intensive care setting. Firstly, the monitoring of EAdi allows the clinician to tailor the ventilatory settings on an individual basis, avoiding frequent overassistance leading potentially to diaphragmatic atrophy. Increased inspiratory EAdi levels can also suggest insufficient support, while a strong tonic activity may reflect the patient efforts to increase its lung volume. EAdi monitoring also allows detection of patient-ventilator asynchrony. It can play a role in evaluation of extubation readiness. Finally, EAdi monitoring provides the clinician with better understanding of the ventilatory capacity of patients with acute neuromuscular disease. Further studies are warranted to evaluate the clinical impact of these potential benefits.
authors.affiliation: Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1C5.
authors.forename: Laurence
authors.initials: L
authors.lastname: Ducharme-Crevier
authors.forename: Geneviève
authors.initials: G
authors.lastname: Du Pont-Thibodeau
authors.forename: Guillaume
authors.initials: G
authors.lastname: Emeriaud