A brief airway occlusion is sufficient to measure the patient’s inspiratory effort/electrical activity of the diaphragm index (PEI)

  • Andrea CoppadoroEmail author
  • Roberto Rona
  • Giacomo Bellani
  • Giuseppe Foti
Original Research


Pressure generated by patient’s inspiratory muscles (Pmus) during assisted mechanical ventilation is of significant relevance. However, Pmus is not commonly measured since an esophageal balloon catheter is required. We have previously shown that Pmus can be estimated by measuring the electrical activity of the diaphragm (EAdi) through the Pmus/EAdi index (PEI). We investigated whether PEI could be reliably measured by a brief end-expiratory occlusion maneuver to propose an automated PEI measurement performed by the ventilator. Pmus, EAdi, airway pressure (Paw), and flow waveforms of 12 critically ill patients undergoing assisted mechanical ventilation were recorded. Repeated end-expiratory occlusion maneuvers were performed. PEI was measured at 100 ms (PEI0.1) and 200 ms (PEI0.2) from the start of the occlusion and compared to the PEI measured at the maximum Paw deflection (PEIoccl, reference). PEI0.1 and PEI0.2 tightly correlated with PEIoccl, (p < 0.001, R2 = 0.843 and 0.847). At a patient-level analysis, the highest percentage error was -64% and 50% for PEI0.1 and PEI0.2, respectively, suggesting that PEI0.2 might be a more reliable measurement. After correcting the error bias, the PEI0.2 percentage error was lower than ± 30% in all but one subjects (range − 39 to + 29%). It is possible to calculate PEI over a brief airway occlusion of 200 ms at inspiratory onset without the need for a full patient's inspiratory effort. Automated and repeated brief airway occlusions performed by the ventilator can provide a real time measurement of PEI; combining the automatically measured PEI with the EAdi trace could be used to continuously display the Pmus waveform at the bedside without the need of an esophageal balloon catheter.


Pressure generated by inspiratory muscles over electrical activity of the diaphragm index Patient spontaneous breathing effort Diaphragm neuromuscular efficiency Patient inspiratory effort 



Departmental funds, University of Milan-Bicocca.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study, according to the Institutional Ethical Committee recommendations.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10877_2020_459_MOESM1_ESM.pdf (304 kb)
Supplementary file1 (PDF 303 kb)


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Copyright information

© Springer Nature B.V. 2020

Authors and Affiliations

  1. 1.Department of Emergency and Intensive CareSan Gerardo HospitalMonzaItaly
  2. 2.Department of Medicine and SurgeryUniversity of Milan-BicoccaMonzaItaly

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