title: Evolution of inspiratory diaphragm activity in children over the course of the PICU stay.
abstract: OBJECTIVE
  Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.
  
  
  METHODS
  This was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.
  
  
  RESULTS
  Fifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdimax) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2-7.6] μV in the acute phase and 4.8 (IQR 2.0-10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdimax in spontaneous ventilation was 15.4 (IQR 7.4-20.7) μV shortly after extubation and 12.6 (IQR 8.1-21.3) μV before PICU discharge. The difference in EAdimax between mechanical ventilation and post-extubation periods was significant (p < 0.001). Patients intubated mainly because of a lung pathology exhibited higher EAdi (p < 0.01), with a similar temporal increase.
  
  
  CONCLUSIONS
  This is the first systematic description of EAdi evolution in children during their stay in the PICU. In our patient cohort, diaphragm activity was frequently low in conventional ventilation, suggesting that overassistance or oversedation is common in clinical practice. EAdi monitoring appears to be a helpful tool to detect such situations.
authors.affiliation: Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada, guillaume.emeriaud@umontreal.ca.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Emeriaud
authors.forename: Alexandrine
authors.initials: A
authors.lastname: Larouche
authors.forename: Laurence
authors.initials: L
authors.lastname: Ducharme-Crevier
authors.forename: Erika
authors.initials: E
authors.lastname: Massicotte
authors.forename: Olivier
authors.initials: O
authors.lastname: Fléchelles
authors.forename: Amélie-Ann
authors.initials: AA
authors.lastname: Pellerin-Leblanc
authors.forename: Sylvain
authors.initials: S
authors.lastname: Morneau
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beck
authors.forename: Philippe
authors.initials: P
authors.lastname: Jouvet
mesh_terms: D060666:Airway Extubation; D002675:Child, Preschool; D016638:Critical Illness; D003964:Diaphragm / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial