ABSTRACT
BACKGROUND: Thoracoabdominal asynchrony is the nonparallel motion of the ribcage and abdomen. It is estimated by using respiratory inductive plethysmography and, recently, using optoelectronic plethysmography; however the agreement of measurements between these 2 techniques is unknown. Therefore, the present study compared respiratory inductive plethysmography with optoelectronic plethysmography for measuring thoracoabdominal asynchrony to see if the measurements were similar or different. METHODS: 27 individuals (9 healthy subjects, 9 patients with interstitial lung disease, and 9 with chronic obstructive pulmonary disease performed 2 cycle ergometer tests with respiratory inductive plethysmography or optoelectronic plethysmography in a random order. Thoracoabdominal asynchrony was evaluated at rest, and at 50% and 75% of maximal workload between the superior ribcage and abdomen using a phase angle. RESULTS: Thoracoabdominal asynchrony values were very similar in both approaches not only at rest but also with exercise, with no statistical difference. There was a good correlation between the methods and the Phase angle values were within the limits of agreement in the Bland-Altman analysis. CONCLUSION: Thoracoabdominal asynchrony measured by optoelectronic plethysmography and respiratory inductive plethysmography results in similar values and has a satisfactory agreement at rest and even for different exercise intensities in these groups.
Subject(s)
Abdomen/physiopathology , Lung Diseases, Interstitial/physiopathology , Pulmonary Disease, Chronic Obstructive/physiopathology , Thorax/physiopathology , Adult , Cross-Sectional Studies , Female , Healthy Volunteers , Humans , Male , Middle Aged , Plethysmography , Respiratory MechanicsABSTRACT
Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength.
Subject(s)
Muscle Strength/physiology , Neuromuscular Diseases/diagnosis , Respiratory Function Tests/methods , Respiratory Muscles/physiopathology , Exhalation/physiology , Humans , Inhalation/physiology , Inspiratory Capacity , Mouth , PressureABSTRACT
Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength.
O acometimento da musculatura ventilatória (inspiratória e expiratória) é um achado clínico frequente, não somente nos pacientes com doenças neuromusculares, mas também nos pacientes com doenças primárias do parênquima pulmonar ou das vias aéreas. Embora esse acometimento seja frequente, seu reconhecimento costuma ser demorado porque seus sinais e sintomas são inespecíficos e tardios. Esse reconhecimento tardio, ou mesmo a falta de reconhecimento, é acentuado porque os exames diagnósticos usados para a avaliação da musculatura respiratória não são plenamente conhecidos e disponíveis. Usando diferentes métodos, a avaliação da força muscular ventilatória é feita para a fase inspiratória e expiratória. Os métodos usados dividem-se em volitivos (que exigem compreensão e colaboração do paciente) e não volitivos. Os volitivos, como a medida da pressão inspiratória e expiratória máximas, são os mais empregados por serem facilmente disponíveis. Os não volitivos dependem da estimulação magnética do nervo frênico associada a medida da pressão inspiratória na boca, no esôfago ou transdiafragmática. Finalmente, outro método que vem se tornando frequente é a ultrassonografia diafragmática. Acreditamos que o pneumologista envolvido nos cuidados a pacientes com doenças respiratórias deve conhecer os exames usados na avaliação da musculatura ventilatória. Por isso, o objetivo do presente artigo é descrever as vantagens, desvantagens, procedimentos de mensuração e aplicabilidade clínica dos principais exames utilizados para avaliação da força muscular ventilatória.
Subject(s)
Humans , Muscle Strength/physiology , Neuromuscular Diseases/diagnosis , Respiratory Function Tests/methods , Respiratory Muscles/physiopathology , Exhalation/physiology , Inspiratory Capacity , Inhalation/physiology , Mouth , PressureABSTRACT
OBJETIVO: Verificar os efeitos da manobra de hiperinsuflação manual associada à pressão positiva expiratória final em pacientes submetidos à cirurgia de revascularização do miocárdio. MÉTODOS: Ensaio clínico randomizado realizado entre agosto de 2007 e julho de 2008 na unidade de terapia intensiva do Hospital Luterano (ULBRA). Os pacientes foram divididos em grupo intervenção, no qual foi aplicada a manobra de hiperinsuflação manual associada à pressão positiva expiratória final, e grupo controle. As variáveis ventilatórias foram mensuradas em dois momentos: pré-manobra e pós-manobra. Foram utilizados os testes t de Student para amostras independentes e pareadas, bem como os testes exato de Fisher e o qui-quadrado de McNemar. RESULTADOS: Foram incluídos 18 pacientes durante o período de estudo, com idade média de 64±11 anos, sendo que houve predomínio do sexo feminino (55,6 por cento). O volume corrente inspirado foi de 594± 112 ml no grupo intervenção e 487± 51 ml no grupo controle (p=0,024) e o volume corrente expirado de 598± 105 ml no grupo intervenção e 490± 58 ml no grupo controle (p=0,02). A média da complacência pulmonar estática no grupo intervenção pré-manobra foi de 41,6± 12,1 ml/cmH2O e pós-manobra de 47,4± 16,6 ml/cmH2O (p=0,03). Não houve diferença significativa entre os grupos nas seguintes variáveis: saturação periférica de oxigênio, pressão arterial de oxigênio, tempo de extubação e alterações radiológicas. CONCLUSÃO: Os resultados demonstram uma tendência da manobra de hiperinsuflação manual associada à pressão positiva expiratória final promover aumento dos volumes pulmonares e da complacência estática, entretanto estes achados necessitam confirmação.
OBJECTIVE: To verify the effects of manual hyperinflation maneuver associated with positive end expiratory pressure in coronary artery bypass grafting patients. METHODS: This was a randomized trial, conducted from August 2007 to July 2008 in the intensive care unit of the Hospital Luterano (ULBRA). The patients were divided in the groups intervention - with manual hyperinflation plus positive end expiratory pressure - and controlThe ventilatory variables were measured before and after the manual hyperinflation. The t Student's test was used for independent and paired samples as well as Fisher's exact test and McNemar's Chi-square test with 0.05 significance level. RESULTS: Eighteen patients were included. The mean age was 64± 11 years and 55.6 percent were female. The inspired tidal volume was 594± 112ml in the intervention group and 487± 51ml in the control group (p=0.024) and the expired tidal volume was 598± 105ml in the intervention group and 490± 58ml in the control group (p=0.02). The mean pre-maneuver static pulmonary compliance in the intervention group was 41.6± 12.1 ml/cmH2O and post maneuver it was 47.4± 16.6 ml/cmH2O (p=0.03). There was no significant between groups difference in the following variables: oxygen peripheral saturation, oxygen arterial pressure, extubation time and radiological changes. CONCLUSION: The results show that the manual hyperinflation associated with positive end expiratory pressure maneuver trends to promote increased lung volumes and static compliance, however these findings require further confirmation.
ABSTRACT
OBJECTIVE: To verify the effects of manual hyperinflation maneuver associated with positive end expiratory pressure in coronary artery bypass grafting patients. METHODS: This was a randomized trial, conducted from August 2007 to July 2008 in the intensive care unit of the Hospital Luterano (ULBRA). The patients were divided in the groups intervention - with manual hyperinflation plus positive end expiratory pressure - and controlThe ventilatory variables were measured before and after the manual hyperinflation. The t Student's test was used for independent and paired samples as well as Fisher's exact test and McNemar's Chi-square test with 0.05 significance level. RESULTS: Eighteen patients were included. The mean age was 64± 11 years and 55.6% were female. The inspired tidal volume was 594± 112ml in the intervention group and 487± 51ml in the control group (p=0.024) and the expired tidal volume was 598± 105ml in the intervention group and 490± 58ml in the control group (p=0.02). The mean pre-maneuver static pulmonary compliance in the intervention group was 41.6± 12.1 ml/cmH2O and post maneuver it was 47.4± 16.6 ml/cmH2O (p=0.03). There was no significant between groups difference in the following variables: oxygen peripheral saturation, oxygen arterial pressure, extubation time and radiological changes. CONCLUSION: The results show that the manual hyperinflation associated with positive end expiratory pressure maneuver trends to promote increased lung volumes and static compliance, however these findings require further confirmation.
