Invasive and non invasive ventilatory support is a life-saving therapy in the Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU). The management of mechanical ventilation remains a challenge due to a complex relationship between the ventilatory support and the patient.
As a preamble, we will explore the specificities of pediatric and neonatal respiratroy physiology in order to better understand the challenges of mechanical ventilation in this population, while focusing on the importance of patient's work of breathing. Our particular interest will be on the electrical activity of the diaphragm, after presenting all the main tools that can be used for this monitoring.
Our research work begins with a bench test, which aims to answer the question of whether the imposed work of breathing is influenced by the type of device and settings. We will then focus on the electrical activity of the diaphragm, which serves as an indirect indicator of the work of breathing, to determine if one of the three commonly used flow-variable CPAP in neonatalogy is superior to the others. Furthermore, we will explore how the diaphragmatic signal can also be useful in optimizing the respiratory assistance when used as a trigger for proportional respiratory support in a specific mode (Neurally Adjuted Ventilatory Assist), in terms of patient-ventilator interaction and respiratory variability maintenance. We will also present examples of clinical cases where the monitoring of electrical activity of the diaphragm, as well as transcutaneous electromyography (tc-EMG) of the respiratory muscles, help to optimize ventilatory management in clinical practice.
Finally, we will discuss future perspectives as we will 1) evaluate the correlation between diaphragmatic trans-cutaneous and trans-esophageal EMG, aiming to find a less invasive tool for the WOB’s monitoring in these patients, 2) explore patient-ventilator interactions in patients with acute respiratory failure associated to acute bronchiolitis, in order to optimize respiratory assistance, by comparing two types of support: NIV-NAVA and BIPAP with turbine driven ventilator. Lastly, for the quality improvement, we will implement a simulation program in our PICU to share knowledge of mechanical ventilation to the healthcare team.
