Publications

Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.

JTD Keywords: Acute respiratory failure, Artificial ventilation, Asthmatic-children, Breathing muscle, Clinical monitoring, Clinical practice, Clinical research, Consensus development, Data interpretation, Disease exacerbation, Drive, Electrode positioning, Electrode removal, Electromyography, Force, Home care, Human, Human diaphragm, Humans, Information processing, Inspiratory muscle training, Inspiratory muscles, Intensive care unit, Knowledge gap, Long term care, Mechanical ventilation, Medical procedures, Muscle contraction, Muscle fatigue, Muscle function, Muscle training, Muscle, skeletal, Muscle-activity, Noninvasive ventilation, Patient monitoring, Patient-ventilator asynchrony, Physiology, Prognosis, Quality of life, Reporting and data system, Respiratory failure, Respiratory muscles, Review, Severe exacerbations, Signal processing, Skeletal muscle, Standardization, Surface electromyography, Time factor

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This study aims to investigate noninvasive indices of neuromechanical coupling (NMC) and mechanical efficiency (MEff) of parasternal intercostal muscles. Gold standard assessment of diaphragm NMC requires using invasive techniques, limiting the utility of this procedure. Nonin-vasive NMC indices of parasternal intercostal muscles can be calculated using surface mechano-myography (sMMGpara) and electromyography (sEMGpara). However, the use of sMMGpara as an in-spiratory muscle mechanical output measure, and the relationships between sMMGpara, sEMGpara, and simultaneous invasive and noninvasive pressure measurements have not previously been eval-uated. sEMGpara, sMMGpara, and both invasive and noninvasive measurements of pressures were recorded in twelve healthy subjects during an inspiratory loading protocol. The ratios of sMMGpara to sEMGpara, which provided muscle-specific noninvasive NMC indices of parasternal intercostal muscles, showed nonsignificant changes with increasing load, since the relationships between sMMGpara and sEMGpara were linear (R2 = 0.85 (0.75–0.9)). The ratios of mouth pressure (Pmo) to sEMGpara and sMMGpara were also proposed as noninvasive indices of parasternal intercostal muscle NMC and MEff, respectively. These indices, similar to the analogous indices calculated using invasive transdiaphragmatic and esophageal pressures, showed nonsignificant changes during threshold loading, since the relationships between Pmo and both sEMGpara (R2 = 0.84 (0.77–0.93)) and sMMGpara (R2 = 0.89 (0.85–0.91)) were linear. The proposed noninvasive NMC and MEff indices of parasternal intercostal muscles may be of potential clinical value, particularly for the regular assessment of patients with disordered respiratory mechanics using noninvasive wearable and wireless devices.

JTD Keywords: inspiratory threshold loading, neuromechanical coupling, parasternal intercostal muscles, respiratory pressure, surface electromyography, surface mechanomyography, Inspiratory threshold loading, Neuromechanical coupling, Parasternal intercostal mus-cles, Respiratory pressure, Surface electromyography, Surface mechanomyography

© 1964-2012 IEEE. Surface electromyography (sEMG) can be used for the evaluation of respiratory muscle activity. Recording sEMG involves the use of surface electrodes in a bipolar configuration. However, electrocardiographic (ECG) interference and electrode orientation represent considerable drawbacks to bipolar acquisition. As an alternative, concentric ring electrodes (CREs) can be used for sEMG acquisition and offer great potential for the evaluation of respiratory muscle activity due to their enhanced spatial resolution and simple placement protocol, which does not depend on muscle fiber orientation. The aim of this work was to analyze the performance of CREs during respiratory sEMG acquisitions. Respiratory muscle sEMG was applied to the diaphragm and sternocleidomastoid muscles using a bipolar and a CRE configuration. Thirty-two subjects underwent four inspiratory load spontaneous breathing tests which was repeated after interchanging the electrode positions. We calculated parameters such as (1) spectral power and (2) median frequency during inspiration, and power ratios of inspiratory sEMG without ECG in relation to (3) basal sEMG without ECG (Rins/noise), (4) basal sEMG with ECG (Rins/cardio) and (5) expiratory sEMG without ECG (Rins/exp). Spectral power, Rins/noise and Rins/cardio increased with the inspiratory load. Significantly higher values (p < 0.05) of Rins/cardio and significantly higher median frequencies were obtained for CREs. Rins/noise and Rins/exp were higher for the bipolar configuration only in diaphragm sEMG recordings, whereas no significant differences were found in the sternocleidomastoid recordings. Our results suggest that the evaluation of respiratory muscle activity by means of sEMG can benefit from the remarkably reduced influence of cardiac activity, the enhanced detection of the shift in frequency content and the axial isotropy of CREs which facilitates its placement.

JTD Keywords: atmospheric measurements, concentric ring electrodes, electrocardiography, electrodes, electromyography, laplacian potential, non-invasive respiratory monitoring, particle measurements, respiratory muscles, surface electromyography, Concentric ring electrodes, Laplacian potential, Muscles, Non-invasive respiratory monitoring, Respiratory muscles, Surface electromyography

Diaphragm electromyography (EMGdi) provides important information on diaphragm activity, to detect neuromuscular disorders of the most important muscle in the breathing inspiratory phase. EMGdi is habitually recorded using needles or esophageal catheters, with the implication of being invasive for patients. Surface electrodes offer an alternative for the non-invasive assessment of diaphragm activity. Ag/AgCl surface disc electrodes are used in monopolar or bipolar configuration to record EMGdi signals. On the other hand, Laplacian surface potential can be estimated by signal recording through active concentric ring electrodes. This kind of recording could reduce physiological interferences, increase the spatial selectivity and reduce orientation problems in the electrode location. The aim of this work is to compare EMGdi signals recorded simultaneously with disc electrodes in bipolar configuration and a Laplacian ring electrode over chest wall. EMGdi signal was recorded in one healthy subject during a breath hold maneuver and a static inspiratory maneuver based on Mueller’s technique. In order to estimate the covered frequency range and the degree of noise contamination in both bipolar and Laplacian EMGdi signals, the cumulative percentage of the power spectrum and the signal to noise ratio in sub-bands were determined. Furthermore, diaphragm fatigue was evaluated by means of amplitude and frequency parameters. Our findings suggest that Laplacian EMGdi recording covers a broader frequency range although with higher noise contamination compared to bipolar EMGdi recording. Finally, in Laplacian recording fatigue indexes showed a clearer trend for muscle fatigue detection and also a reduced cardiac interference, providing an alternative to bipolar recording for diaphragm fatigue studies.

JTD Keywords: Laplacian electrode, Diaphragm muscle, Fatigue, Surface electromyography