Brunger, A.F. (Anne Floor) (2015) De spierspanning van het diafragma bij acuut benauwde kinderen op de spoedpoli voor en na de behandeling met Salbutamol in vergelijking met de spierspanning van het diafragma van gezonde leeftijdsgenoten. thesis, Medicine.
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Abstract
Background: Dyspnea in children is a common problem. In young children estimating the severity of breathlessness and assessing the effectiveness of therapy with Salbutamol is guided by clinical features such as respiratory rate, wheezing, retractions and observed dyspnea. These observations, however, are subjective. An objective measurement to evaluate the degree of dyspnea in young children, and to evaluate the effect of therapy has not been found. Respiratory surface electromyographic(EMG) may be a way to determine objectively the degree of dyspnea and the effect of therapy. Earlier research showed that measuring the degree of airway obstruction during histamine provocation tests in children with asthma is possible using EMG. The possibility to use the EMG method to determine the severity of dyspnea and assessing the effect of therapy has never been investigated Aim: To determine: 1. the difference of surface EMG activity of the diaphragm in healthy children compared to children with dyspnea; 2. the effect of Salbutamol on surface EMG activity of the diaphragm in dyspnoeic children; 3. the correlation between the decrease of surface EMG activity of the diaphragm and the decrease of Clinical Asthma Score (CAS) after treatment with Salbutamol; 4. whether parents are capable to estimate the degree of breathlessness of their child well on a 10-point Borg scale compared to the Borgscore by nurses and the CAS. Design: prospective study Methods: 28 healthy children and 27 children with acute dyspnea were enrolled in this study. The mean age of the healthy children is 35±23 months and of the children with dyspnea is 35±20 months. Dyspnoeic children had an EMG measurement before and after the treatment with Salbutamol. CAS score by the investigator, Borg score by both parents and nurse were assessed before and after treatment. In healthy children a single EMG measurement was carried out, and the Borg and CAS score were determined. The parents of both groups were asked to fill in an ISAAC questionnaire. We used the logarithm of the EMG-Activity-Ratio (LogEMGAR; ratio of current mean peak to bottom value to that at baseline) as EMG parameter. Results: The LogEMGAR of the diaphragm in children with dyspnea (mean 0,12±0,50) was significantly higher compared to healthy children (mean -0,01±0,58) of the same age (p < 0,05). In dyspnoeic children (mean 0,02±0,32) the LogEMGAR was found to decrease significantly (p<0,01) after treatment with Salbutamol. No correlation is seen between the decrease of LogEMGAR of the diaphragm and the decrease of CAS score in the children with dyspnea after treatment with Salbutamol. The Borg score given by the parents correlates before and after treatment with Salbutamol with both the Borg score of the nurses (p<0,01; r=0,57 respectively p<0,01; r=0,66) and the CAS score (p=0,05; r=0,68 respectively p<0,01; r= 0,53). Conclusion: We found a significant difference in EMG activity of the diaphragm between healthy and dyspnoeic children. Measuring the EMG activity of the diaphragm seems to be an objective method to determine the effect of therapy with Salbutamol by patients. No correlation is found between the decrease in EMG activity of the diaphragm and the decrease in CAS score after treatment with Salbutamol. Parents were able to estimate the degree of dyspnea of their child well on a 10-point Borg score compared with nurses and the CAS score.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Vrijlandt, Dr. E.J.L.E. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1865 |
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