Intensive Care Medicine

, Volume 38, Issue 12, pp 2017–2025 | Cite as

Diaphragm electromyographic activity as a predictor of weaning failure

  • Martin Dres
  • Matthieu Schmidt
  • Alexis Ferre
  • Julien Mayaux
  • Thomas Similowski
  • Alexandre Demoule



To compare breathing pattern descriptors and diaphragm electromyographic activity (EAdi)-derived indices obtained from a neurally adjusted ventilatory assist catheter during a spontaneous breathing trial (SBT) in patients successfully and unsuccessfully separated from the ventilator and to assess their performance as a potential marker to discriminate these two categories of patients.


Fifty-seven ready-to-wean patients were included in a prospective observational study. During a 30-min SBT (pressure support 7 cmH2O, zero end expiratory pressure), tidal volume (V T) and respiratory rate (RR) were obtained from the flow signal at baseline and at 3, 10, 20 and 30 min during the SBT. EAdi-derived indices were simultaneously computed: maximum of the EAdi (EAdimax), area under the inspiratory curve of EAdi (EAdiAUC), the difference between EAdimax and EAdimin (∆EAdi), EAdimax/V T, EAdiAUC/V T and ∆EAdi/V T. Patients, successfully (success group; n = 35) and unsuccessfully (failure group; n = 22) separated from the ventilator were compared.


At baseline, the breathing pattern was similar in the two groups, whereas EAdimax and EAdiAUC were significantly lower in the success group (p < 0.05). In the failure group, RR and RR/V T increased significantly during the trial, V T decreased, whereas EAdimax and EAdiAUC did not change. At 3 min, the areas under the receiver operating characteristic-curve of RR/V T and the EAdi-derived indices to predict weaning outcome were 0.83 for the rapid shallow breathing index (RSBI), 0.84 for EAdimax/V T , 0.80 for EAdiAUC/V T (0.80) and 0.82 for ∆EAdi/V T. The coefficient of variation for V T decreased in the failure group while that for EAdimax remained unchanged.


EAdi-derived indices provide reliable and early predictors of weaning outcome. However, the performance of these indices is not better than the RR/V T.


Mechanical ventilation Patient–ventilator weaning Neurally adjusted ventilator assist 


Conflicts of interest

The Association pour le Développement et l’Organisation de la Recherche en Pneumologie et sur le sommeil, a non-profit structure that supports the research activities of the “Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière”, has received an unrestricted research grant from Maquet France SA, Orléans, France, to support pathophysiological research studies on NAVA.

Supplementary material

134_2012_2700_MOESM1_ESM.doc (102 kb)
Supplementary material 1 (DOC 102 kb)


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Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Martin Dres
    • 1
  • Matthieu Schmidt
    • 1
    • 2
  • Alexis Ferre
    • 1
  • Julien Mayaux
    • 1
  • Thomas Similowski
    • 1
    • 2
  • Alexandre Demoule
    • 1
    • 2
    • 3
  1. 1.Service de Pneumologie et Réanimation médicale, Groupe Hospitalier Pitié-SalpêtrièreAssistance Publique-Hôpitaux de ParisParis Cedex 13France
  2. 2.Université Paris 6-Pierre et Marie Curie, ER10ParisFrance
  3. 3.UMRS 974Institut National de la Santé et de la Recherche médicaleParisFrance

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