Acceleration sensors in abdominal wall position as a non-invasive approach to detect early breathing alterations induced by intolerance of increased airway resistance

Thomas Breuer,Norbert Zoremba,Henning Steffen,Rolf Rossaint,Christian S Bruells,Michael Czaplik,Catherine Disselhorst-Klug

doi:10.1186/s13019-017-0658-5

Thomas Breuer, Norbert Zoremba + Show 5 more

Open Access

https://doi.org/10.1186/s13019-017-0658-5

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Abstract

BackgroundEarly detection of respiratory overload is crucial to mechanically ventilated patients, especially during phases of spontaneous breathing. Although a diversity of methods and indices has been established, there is no highly specific approach to predict respiratory failure. This study aimed to evaluate acceleration sensors in abdominal and thoracic wall positions to detect alterations in breathing excursions in a setting of gradual increasing airway resistance.MethodsTwenty-nine healthy volunteers were committed to a standardized protocol of a two-minutes step-down spontaneous breathing on a 5 mm, 4 mm and then 3 mm orally placed endotracheal tube. Accelerator sensors in thoracic and abdominal wall position monitored breathing excursions. 15 participants passed the breathing protocol (“completed” group), 14 individuals cancelled the protocol due to subjective intolerance to the increasing airway resistance (“abandoned” group).ResultsGradual increased respiratory workload led to a significant decrease of acceleration in abdominal wall position in the “abandoned” group compared to the “completed” group (p < 0.001), while these gradual accelerating changes were not observed in thoracic wall position (p = 0.484). Thoracic acceleration sensors did not detect any time- and group-specific changes (p = 0.746).ConclusionsThe abdominal wall position of the acceleration sensors may be a non-invasive, economical and practical approach to detect early breathing alterations prior to respiratory failure.Trial registrationEK 309–15; by the Ethics Committee of the Faculty of Medicine, RWTH Aachen, Aachen, Germany. Retrospectively registered 28th of December 2015.

Highlights

Detection of respiratory overload is crucial to mechanically ventilated patients, especially during phases of spontaneous breathing
Respiratory failure manifesting as inadequate gas exchange is raised by a variety of pathophysiological alterations like airway obstruction, chest wall pathologies, muscular or innervation insufficiency, disturbance of alveolar-capillary units or cerebral pathologies
Measurements of breathing excursion Gradual increased respiratory workload led to a significant decrease of acceleration in abdominal wall position in the “abandoned” group compared to the “completed” group (p < 0.001), while these gradual accelerating changes were not observed in thoracic wall position (p = 0.484) (Fig. 4)

Summary

Introduction

Detection of respiratory overload is crucial to mechanically ventilated patients, especially during phases of spontaneous breathing. The resulting pathological breathing patterns are influenced by the workload of the respiratory system, leading to respiratory muscle dysfunction. This well-described phenomenon is determined by the duty cycle of the inspiratory muscle and the ratio of inspiratory pressure to its maximal capacity (P/Pmax) [3, 4]. Due to the fact that the resulting force of respiratory muscles is inaccessible to direct measurements, several indirect methods have been established to predict respiratory muscle work like trans-diaphragmatic pressures, diaphragmatic sonography or the rapid shallow breathing index (RSBI) [5,6,7]

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