Monitoring diaphragmatic effort during diaphragm neurostimulation-assisted ventilation
Bibliographic record
Abstract
RATIONALE: Diaphragm neurostimulation-assisted ventilation (DNAV) can improve cardiopulmonary function during passive mechanical ventilation. However, this technique requires a reliable method to monitor and titrate diaphragmatic loading to avoid both insufficient and excessive diaphragmatic stimulation. OBJECTIVE: To establish whether the reduction in airway pressure-time product (ΔPTPaw) obtained during diaphragm neurostimulation in assist control volume-controlled mode accurately quantifies the magnitude of respiratory muscle effort elicited by neurostimulation. METHODS: This was a secondary analysis of the STIMULUS trial. Diaphragm neurostimulation was titrated across four levels targeting progressive occlusion pressures of 0, - 5, - 10, and - 15 cm H₂O at two PEEP levels. At each level, airway, esophageal, and gastric pressures were recorded to compute transdiaphragmatic pressure-time product (PTPdi), respiratory muscles pressure-time product (PTPmus), and ΔPTPaw, defined as the difference in airway pressure-time product between non-stimulated and stimulated breaths. Linear mixed-effects models, Bland-Altman analyses, and receiver operating characteristic (ROC) curves were used to assess agreement and discriminative ability. MEASUREMENTS AND MAIN RESULTS: Twelve patients contributed 494 high-quality respiratory cycles (63% of recorded cycles). Valid Pdi data were available in nine patients. Increasing neurostimulation was associated with higher PTPdi and PTPmus and a corresponding reduction in PTPaw. ΔPTPaw was correlated with both PTPdi (R² = 0.82) and PTPmus (R² = 0.92), with good agreement observed (limits: - 4 to 44 cm H₂O·s/min for PTPdi, and - 5 to 39 cm H₂O·s/min for PTPmus). ΔPTPaw demonstrated excellent discrimination for inadequate (area under receiver operating characteristic curve, AUROC ≥ 0.94) and excessive (AUROC ≥ 0.86) diaphragmatic effort. CONCLUSIONS: ΔPTPaw is a reliable, non-invasive surrogate for monitoring diaphragm loading during DNAV under assist-controlled volume-controlled mode and may guide neurostimulation titration in mechanically ventilated patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".