Can visual inspection of the electrical activity of the diaphragm improve the detection of patient-ventilator asynchronies by pediatric critical care physicians?

BacKgroUND: Patient-ventilator asynchronies are challenging during pediatric mechanical ventilation. We hypoth-esized that monitoring the electrical activity of the diaphragm (eadi) together with the "standard" airway opening pres-sure (Pao) and flow-time waveforms during pressure support ventilation would improve the ability of a cohort of critical care physicians to detect asynchronies in ventilated children. METHODS: We recorded the flow, Pao and EAdi waveforms in ten consecutive patients. The recordings were split in periods of 15 s, each reproducing a ventilator screenshot. From this pool, a team of four experts selected the most repre-sentative screenshots including at least one of the three most common asynchronies (missed efforts, auto-triggering and double triggering) and split them into two versions, respectively showing or not the eadi waveforms. the screenshots were shown in random order in a questionnaire to sixty experienced pediatric intensivists that were asked to identify any episode of patient-ventilator asynchrony. resUlts: Among the ten patients included in the study, only eight had eadi tracings without artifacts and were ana-lyzed. When the eadi waveform was shown, the auto-triggering detection improved from 13% to 67% (P<0.0001) and the missed efforts detection improved from 43% to 95% (P<0.0001). the detection of double triggering, instead, did not improve (85% with the eadi vs. 78% without the eadi waveform; P=0.52). coNclUsioNs: This single center study suggests that the eadi waveform may improve the ability of pediatric inten-sivists to detect missed efforts and auto-triggering asynchronies. Further studies are required to determine the clinical implications of these findings.