***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We hypothesized that patients who fail weaning from mechanical ventilation  recruit their inspiratory rib cage muscles sooner than they recruit their expiratory muscles , and that rib cage muscle recruitment is accompanied by recruitment of sternomastoid muscles . Accordingly , we measured  sternomastoid electrical activity and changes in esophageal ( DeltaPes ) and gastric pressure ( DeltaPga ) in 11 weaning-failure and 8 weaning-success patients . At the start of trial , failure patients exhibited a higher DeltaPga-to-DeltaPes ratio than did success patients ( P = 0.05 ) , whereas expiratory rise in Pga was equivalent in the two groups . Between the start and end of the trial , failure patients developed additional increases in DeltaPga-to-DeltaPes ratio ( P < 0.0014 ) and the expiratory rise in Pga also increased ( P < 0.004 ) . At the start of trial , sternomastoid activity was present in 8 of 11 failure patients contrasted with 1 of 8 success patients . Over the course of the trial , sternomastoid activity increased by 53.0 + /- 9.3 % in the failure patients ( P = 0.0005 ) , whereas it did not change in the success patients . Failure patients recruited their respiratory muscles in a sequential manner . The sequence began with activity of diaphragm and greater-than-normal activity of inspiratory rib cage muscles ; recruitment of sternomastoids and rib cage muscles approached near maximum within 4 min of trial commencement ; expiratory muscles were recruited slowest of all . In conclusion , not only is activity of the inspiratory rib cage muscles increased during a failed weaning trial , but respiratory centers also recruit sternomastoid and expiratory muscles . Extradiaphragmatic muscle recruitment may be a mechanism for off setting the effects of increased load on a weak diaphragm Purpose : Respiratory muscle dysfunction is a key component of weaning failure . Balancing respiratory muscle loading and unloading by applying different ventilation modes along with spontaneous breathing episodes are established weaning strategies . However , the effects of body positioning on the respiratory muscles during weaning remains unclear . Material s and methods : This study aim ed at assessing respiratory drive by surface electromyography ( EMG ) of the diaphragm ( EMGdia ) and parasternal muscles ( EMGpara )  in tracheotomized patients during prolonged weaning in 3 r and omized body positions  — supine , 30 ° semirecumbent , and 80 ° sitting — during mechanical ventilation and spontaneous breathing . Results : Nine patients were included for analysis . Cardiorespiratory parameters ( heart rate , blood pressure , arterial oxygen saturation , dyspnea ) did not change under each condition ( all P > .05 ) . EMGpara and EMGdia did not change under mechanical ventilation ( both P > .05 ) . EMGdia changed under spontaneous breathing from supine to sitting ( 0.45 ± 0.26 vs 0.32 ± 0.19 ; P = .012 ) and between semirecumbent to sitting ( 0.41 ± 0.23 vs 0.32 ± 0.19 ; P = .039 ) , whereas EMGpara did not change . Conclusions : This is the first study to show that body positioning influences respiratory drive to the diaphragm in tracheotomized patients with prolonged weaning from mechanical ventilation during unassisted breathing . Sitting position reduces respiratory drive compared with semirecumbent and supine positioning and might therefore be favored during spontaneous breathing trials . HighlightsThis work highlights the effects of simple physical strategies that impose effects on the respiratory drive in difficult to wean patients . Current treatment strategies often include placing a weaning patient in an upright position , to ease unassisted breathing ; however , scientific evidence for doing so was lacking so far . This study assessed the activation of the diaphragm and parasternal muscles in patients with prolonged weaning in 3 body positions — supine , semirecumbent , and sitting — during either mechanical ventilation or unassisted breathing . Interestingly , parasternal and diaphragmatic EMG did not change under mechanical ventilation , but the sitting position leads to a decrease of the neuromuscular drive to the diaphragm . Therefore , the sitting position might be favored during SBTs Context Pressure support ventilation ( PSV ) must be tailored to the load capacity balance of the respiratory system . While " over assistance " generated hyperinflation and ineffective efforts , " under assistance " increased respiratory drive and causes dyspnea . Surface electromyograms ( sEMGs ) of extradiaphragmatic inspiratory muscles were responsive to respiratory loading/unloading . Objectives To determine if sEMGs of extradiaphragmatic inspiratory muscles vary with PSV setting s and relate to the degree of discomfort and the intensity of dyspnea in acutely ill patients . Design Pathophysiological study , prospect i ve inclusion s of 12 intubated adult patients . Interventions Two PSV levels ( high and low ) and two expiratory trigger ( ET ) levels ( high and low ) . Measurements Surface electromyograms of the scalene , parasternal , and Alae Nasi muscles ( peak , EMGmax ; area under the curve , EMGAUC ) ; dyspnea visual analogue scale ( VAS ) ; prevalence of ineffective triggering efforts . Main results For the three recorded muscles , EMGmax and EMGAUC were significantly greater with low PS than high PS . The influence of ET was less important . A strong correlation was found between dyspnea and EMGmax . A significant inverse correlation was found between the prevalence of ineffective efforts and both dyspnea-VAS and EMGmin . Conclusions Surface electromyograms of extradiaphragmatic inspiratory muscles provides a simple , reliable and non-invasive indicator of respiratory muscle loading/unloading in mechanically ventilated patients . Because this EMG activity is strongly correlated to the intensity of dyspnea , it could be used as a surrogate of respiratory sensations in mechanically ventilated patients , and might , therefore , provide a monitoring tool in patients in whom detection and quantification of dyspnea is complex if not impossible Purpose 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 . Methods Fifty-seven ready-to-wean patients were included in a prospect i ve observational study . During a 30-min SBT ( pressure support 7 cmH2O , zero end expiratory pressure ) , tidal volume ( VT ) 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/VT , EAdiAUC/VT and ∆EAdi/VT . Patients , successfully ( success group ; n = 35 ) and unsuccessfully ( failure group ; n = 22 ) separated from the ventilator were compared . Results 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/VT increased significantly during the trial , VT decreased , whereas EAdimax and EAdiAUC did not change . At 3 min , the areas under the receiver operating characteristic-curve of RR/VT and the EAdi-derived indices to predict weaning outcome were 0.83 for the rapid shallow breathing index ( RSBI ) , 0.84 for EAdimax/VT , 0.80 for EAdiAUC/VT ( 0.80 ) and 0.82 for ∆EAdi/VT . The coefficient of variation for VT decreased in the failure group while that for EAdimax remained unchanged . Conclusions EAdi-derived indices provide reliable and early predictors of weaning outcome . However , the performance of these indices is not better than the RR/VT Objective To compare the effects of adaptive support ventilation ( ASV ) and synchronized intermittent m and atory ventilation plus pressure support ( SIMV-PS ) on patient-ventilator interactions in patients undergoing partial ventilatory support . Design Prospect i ve , crossover interventional study . Setting Medical intensive care unit , university tertiary care center . Patients Ten patients , intubated and mechanically ventilated for acute respiratory failure of diverse causes , in the early weaning period , ventilated with SIMV-PS and clinical ly detectable sternocleidomastoid activity suggesting increased inspiratory load and patient-ventilator dyssynchrony . Interventions Measurement of respiratory mechanics , P0.1 , sternocleidomastoid electromyographic activity , arterial blood gases , and systemic hemodynamics in three conditions : 1 ) after 45 mins with SIMV-PS ( SIMV-PS 1 ) ; 2 ) after 45 mins with ASV , set to deliver the same minute-ventilation as during SIMV-PS ; 3 ) 45 mins after return to SIMV-PS ( SIMV-PS 2 ) , with setting s identical to those of the first SIMV-PS period . Main Results The same minute ventilation was observed during ASV ( 11.4 ± 3.1 l/min [ mean ± sd ] ) as during SIMV-PS 1 ( 11.6 ± 3.5 L/min ) and SIMV-PS 2 ( 10.8 ± 3.4 L/min ) . No parameter was significantly different between SIMV-PS 1 and 2 , hence subsequent results refer to ASV vs. SIMV-PS 1 . During ASV , tidal volume increased ( 538 ± 91 vs. 671 ± 100 mL , p < .05 ) and total respiratory rate decreased ( 22 ± 7 vs. 17 ± 3 breaths/min , p < .05 ) vs. SIMV-PS . However , spontaneous respiratory rate increased in six patients , decreased in four , and remained unchanged in one . P0.1 decreased during ASV in all patients except three in whom no change was noted ( 1.8 ± 0.9 vs. 1.1 ± 1 cm H2O , p < .05 ) . During ASV , sternocleidomastoid electromyogram activity was markedly reduced ( electromyogram index , where SIMV-PS 1 = 100 , ASV 34 ± 41 , SIMV-PS 2 89 ± 36 , p < .02 ) as was palpable muscle activity . No changes were noted in arterial blood gases , pH , or mean systemic pressure during the trial . Conclusion In patients undergoing partial ventilatory support , with clinical and electromyographic signs of increased respiratory muscle loading , ASV provided levels of minute ventilation comparable to those of SIMV-PS . However , with ASV , central respiratory drive and sternocleidomastoid activity were markedly reduced , suggesting decreased inspiratory load and improved patient-ventilator interactions . These preliminary results warrant further testing of ASV for partial ventilatory support [ Purpose ] This study aim ed to determine the effects of different intensities of inspiratory muscle training on the relative respiratory muscle activity in healthy adults . [ Subjects and Methods ] Thirteen healthy male volunteers were instructed to perform inspiratory muscle training ( 0 % , 40 % , 60 % , and 80 % maximal inspiratory pressure ) on the basis of their individual intensities . The inspiratory muscle training was performed in r and om order of intensities .  Surface electromyography data  were collected from the right-side diaphragm , external intercostal , and sternocleidomastoid , and pulmonary functions ( forced expiratory volume in 1 s , forced vital capacity , and their ratio ; peak expiratory flow ; and maximal inspiratory pressure ) were measured . [ Results ] Comparison of the relative activity of the diaphragm showed significant differences between the 60 % and 80 % maximal inspiratory pressure intensities and baseline during inspiratory muscle training . Furthermore , significant differences were found in sternocleidomastoid relative activity between the 60 % and 80 % maximal inspiratory pressure intensities and baseline during inspiratory muscle training . [ Conclusion ] During inspiratory muscle training in the clinic , the patients were assisted ( verbally or through feedback ) by therapists to avoid overactivation of their accessory muscles ( sternocleidomastoid ) . This study recommends that inspiratory muscle training be performed at an accurate and appropriate intensity through the practice of proper deep breathing CONTEXT Infection is a major cause of morbidity and mortality in intensive care units ( ICUs ) worldwide . However , relatively little information is available about the global epidemiology of such infections . OBJECTIVE To provide an up-to- date , international picture of the extent and patterns of infection in ICUs . DESIGN , SETTING , AND PATIENTS The Extended Prevalence of Infection in Intensive Care ( EPIC II ) study , a 1-day , prospect i ve , point prevalence study with follow-up conducted on May 8 , 2007 . Demographic , physiological , bacteriological , therapeutic , and outcome data were collected for 14,414 patients in 1265 participating ICUs from 75 countries on the study day . Analyses focused on the data from the 13,796 adult ( > 18 years ) patients . RESULTS 
    Output:
    
Findings demonstrate that sEMG of extra-diaphragmatic muscle activity is a valid and applicable tool to evaluate mechanical loading/unloading of respiratory muscles and respiratory drive or sensation .
Although it appears to be a valid and applicable tool , there is a scarcity of literature that directly demonstrates the diagnostic accuracy of sEMG of extra-diaphragmatic muscles in monitoring respiratory mechanics and respiratory drive or sensation during MV assistance across wide population s and conditions