Neural respiratory drive assessment and its correlation with inspiratory muscle strength in patients undergoing open-heart surgery: A cross-sectional study.

Abstract

Pulmonary dysfunction and inspiratory muscle weakness are frequently observed after cardiac surgery. Understanding the load on and capacity of respiratory muscles can provide valuable insights into the overall respiratory mechanics and neural regulation of breathing. This study aimed to assess the extent of neural respiratory drive (NRD) and determine whether admission-to-discharge differences in NRD were associated with inspiratory muscle strength changes among patients undergoing open-heart surgery. This cross-sectional study was conducted on 45 patients scheduled for coronary artery bypass graft or heart valve surgery. NRD was measured using a surface parasternal intercostal electromyogram during resting breathing (sEMGpara tidal) and maximal inspiratory effort (sEMGpara max). Maximal inspiratory pressure (MIP) was used to determine inspiratory muscle strength. Evaluations were performed on the day of admission and discharge. There was a significant increase in sEMGpara tidal (6.9±3.6μV, p<0.001), sEMGpara %max (13.7±11.2%, p=0.008), and neural respiratory drive index (NRDI, the product of EMGpara %max and respiratory rate) (337.7±286.8%.breaths/min, p<0.001), while sEMGpara max (-43.6±20.4μV, p<0.01) and MIP (-24.4±10.7, p<0.001) significantly decreased during the discharge period. Differences in sEMGpara tidal (r=-0.369, p=0.045), sEMGpara %max (r=-0.646, p=0.001), and NRDI (r=-0.639, p=0.001) were significantly associated with a reduction in MIP. The findings indicate that NRD increases after open-heart surgery, which corresponds to a decrease in inspiratory muscle strength.