Diaphragm electromyography post processing with Simulink as a means of guiding weaning from ventilation in preterm infants

Abstract

The problem of premature births is widespread throughout the world affecting 41000 newborns daily; the issues that follow, often related to breathing, require the use of mechanical ventilation to compensate for the poor compliance of the respiratory muscles of newborns. However, side effects associated with artificial ventilation, including atrophy, require a cyclic interruption of automatic ventilation so that infants can develop and train their respiratory muscles (the so-called weaning from ventilation).
However, the criteria for judging the readiness and progression of the detachment from ventilation are unsatisfactory since they rely on the subjective judgments of the clinicians.
As a consequence, a research project in collaboration between TU Delft, the DEMCON BV (a Dutch mechatronics engineering company) and the Erasmus Medical Center of Rotterdam was carried out to look for an objective measure, provided with visual feedback, to give indications of the respiratory fatigue of newborns to the clinicians, also referred as work of breathing (WOB). This research revealed that the analysis of the diaphragmatic electromyography (dEMG) is a non-invasive tool that can be used to measure the WOB. As a result, three WOB detection algorithms named peak-to-peak (P2P), differential-peak-to-peak (DP2P) and area-under-the-curve (AUC) were developed. The relevance of these algorithms consists in extracting the WOB information from the dEMG and giving direct visual feedback to the clinicians.
Moreover, since often weaning from ventilation is impaired by the advent of adverse events such as apnea and brachicardia, two algorithms were implemented to detect such complications as well. \newline\newline
Before starting the actual research, some background work was carried out for the DEMCON BV. DEMCON BV deals with the acquisition and processing of dEMG utilizing a Software called Polybench. The first part of the background work was to write a Simulink program which has the same functionality as Polybench. The relevance of this work consists in allowing better communication between DEMCON and any other professional who wants to collaborate with them since Simulink is a popular software while Polybench is not. The second part of the background work was to create a Simulink block-chain that given a raw dEMG signal can extract the breathing envelope from it.