title: Monitoring of Electrical Activity of the Diaphragm Shows Failure of T-Piece Trial Earlier than Protocol-Based Parameters in Prolonged Weaning in Non-communicative Neurological Patients.
abstract: BACKGROUND
  The weaning target in tracheotomised patients is not extubation, but spontaneous breathing without the support of a ventilator. Overloading the respiratory pump during such spontaneous breathing trials is unfavorable, prolongs weaning time, and increases morbidity and mortality. The goal of this study was to evaluate the electrical activity of the diaphragm during a t-piece trial in non-communicative neurological patients and the comparison to clinical parameters of exhaustion.
  
  
  METHODS
  During multiple t-piece trials, the electrical activity of the diaphragm was obtained before, during and after the end of the trial. T-piece trials were grouped based on the reason for stopping the trial (exhaustion or allotted time period).
  
  
  RESULTS
  Twenty-nine tracheotomised patients in prolonged weaning (29 ± 22 days ventilated at the start of the study) were included in a prospective observational study. T-piece trials (n = 152; 5 ± 2 per patient) were grouped based on the reason for stopping the trial (n = 91 because of exhaustion; n = 61 because of the allotted time period). We found that the electrical activity of the diaphragm exhibits an earlier increase than protocol-based clinical parameters in patients who failed the trial due to exhaustion. The electrical activity of the diaphragm shows no relevant difference during the t-piece trial in patients in whom the trial was stopped due to the allotted time period per protocol.
  
  
  CONCLUSIONS
  Monitoring the electrical activity of the diaphragm in non-communicative neurological patients in prolonged weaning allows earlier detection of exhaustion than protocol-based parameters.
authors.affiliation: Asklepios Schlossberg Clinic, Bad König, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Trapp
authors.affiliation: Clinic for Anaesthesiology and Operative Intensive Care Medicine, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Mascha
authors.initials: M
authors.lastname: Fiedler
authors.affiliation: Asklepios Schlossberg Clinic, Bad König, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hartwich
authors.affiliation: Passauer Wolf Rehabilitation Center, Neurology, Bad Gögging, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schorl
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Hospital Bergstrasse, Heppenheim, Germany. armin.kalenka@kkh-bergstrasse.de.|Medical Faculty Heidelberg, Heidelberg, Germany. armin.kalenka@kkh-bergstrasse.de.
authors.forename: Armin
authors.initials: A
authors.lastname: Kalenka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070642:Brain Injuries, Traumatic / Q000628:therapy; D002985:Clinical Protocols; D003964:Diaphragm / Q000502:physiology; D055724:Electrophysiological Phenomena; D002534:Hypoxia, Brain / Q000628:therapy; D008991:Monitoring, Physiologic / Q000379:methods; D020521:Stroke / Q000628:therapy; D014139:Tracheostomy; D015300:Ventilator Weaning / Q000379:methods
keywords: Brain-injured patients; Electrical activity of the diaphragm; Neurally adjusted ventilatory assist; T-piece trial; Tracheotomy; Weaning