Lung function abnormalities and respiratory muscle weakness in children with juvenile chronic arthritis

Knook, Lidewij; Kleer, Ismé M. de; Ent, Cornelis K. van der; Net, Jan Jaap van der; Prakken, Berent J.; Kuis, Wietse

doi:10.1034/j.1399-3003.1999.14c09.x

Cited by 35 publications

(22 citation statements)

References 29 publications

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“…Furthermore, Pimax and Pemax were signiWcantly lower in JIA patients compared with controls. Knook et al [30] found that there was decrease in FVC, PEF, Pemax and Pimax, which were consistent with our results, but in contrast to ours, they found normal FEV1 and DLCO.…”

Section: Discussioncontrasting

confidence: 54%

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Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis

2010

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Juvenile idiopathic arthritis (JIA) is the most common rheumatologic disorder of childhood. It is a group of diseases characterized by chronic synovitis and associated with many extra-articular manifestations including cardiac and pulmonary involvement. Cardiac involvement as pericarditis, myocarditis and valvular disease is common in JIA. There are, however, few descriptions concerning systolic and diastolic functions of the left ventricle (LV) and the development of lung disease in children with JIA. The study was carried out to detect the cardiac and pulmonary involvement and to study the systolic and diastolic function of the left ventricle in a group of children with juvenile idiopathic arthritis. Forty-five children with JIA without any cardiac or pulmonary symptoms and 30 age- and sex-matched controls were included in the study. M-mode, two-dimensional and pulsed Doppler echocardiography (ECHO) was performed on 36 patients. Tissue Doppler ECHO examination was performed on 24 patients to assess systolic and diastolic functions of left ventricle. Pulmonary function tests: Forced vital capacity (FVC%), the predicted forced expiratory volume in the first second (FEV(1)%) and FEV(1)/FVC ratio and peak expiratory flow (PEF), total lung capacity (TLC) and residual volume (RV), carbon monoxide diffusing capacity of the lung (DLCO) and DLCO/alveolar volume (VA) were evaluated in 32 patients. Informed consent was obtained from all children's parents. The study protocol was approved by ethical committee of Faculty of Medicine, Assiut University. In this study, children with JIA had higher systolic and diastolic blood pressures, resting heart rate, left ventricle systolic size and volume (4.35 ± 0.68 vs. 3.92 ± 0.28, P value = 0.02). On Doppler and tissue Doppler analysis, the JIA group had lower peak early filling velocity (E, m/s), higher peak atrial filling velocity (A, m/s) and prolonged diastolic E and A waves deceleration times and isovolumic relaxation time (IRT) compared to control. Regarding pulmonary function tests, children with JIA showed significant decrease in FVC, PEF, Pimax, Pemax and DLCO compared to normal controls. This decrease was not related to age, height or weight of these patients. There was significant inverse correlation between lung function parameters and the rheumatoid factor titer, erythrosedimentation rate, disease duration and the duration of methotrexate use (P < 0.01). Despite of an asymptomatic cardiopulmonary status, significant systolic and diastolic functional abnormalities exist in children with JIA. Also, both restrictive and obstructive lung impairments were found.

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Section: Discussioncontrasting

confidence: 54%

“…An impairment of thoracic and/or spine mobility has been suggested to reduce thorax excursion, resulting in a tendency to develop lung function abnormalities [30][31][32]. But in our patients group, there was no impairment in thorax or spine mobility aVecting lung function.…”

Section: Discussionmentioning

confidence: 46%

Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis

2010

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“…Knook et al suggest that the reduced respiratory muscle strength in children with juvenile arthritis decreases their expiratory reserve volume, and, consequently, FVC, which indicates worsening chest wall mobility. 17 Similar to lung volumes, respiratory muscle strength was related to chest wall mobility in our study. The positive correlation between axillary cirtometry, thoracic cirtometry, and maximum inspiratory pressure (r ϭ 0.48, r ϭ 0.46, respectively) is expected, since the greater the inspiratory muscle strength, the greater the expansion of both the upper and the lower rib cage.…”

Section: Discussionsupporting

confidence: 50%

Chest Wall Mobility Is Related to Respiratory Muscle Strength and Lung Volumes in Healthy Subjects

et al. 2013

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BACKGROUND: Chest wall mobility is often measured in clinical practice, but the correlations between chest wall mobility and respiratory muscle strength and lung volumes are unknown. We investigate the associations between chest wall mobility, axillary and thoracic cirtometry values, respiratory muscle strength (maximum inspiratory pressure and maximum expiratory pressure), and lung volumes (expiratory reserve volume, FEV 1 , inspiratory capacity, FEV 1 /FVC), and the determinants of chest mobility in healthy subjects. METHODS: In 64 healthy subjects we measured inspiratory capacity, FVC, FEV 1 , expiratory reserve volume, maximum inspiratory pressure, and maximum expiratory pressure, and chest wall mobility via axillary and thoracic cirtometry. We used linear regression to evaluate the influence of the measured variables on chest wall mobility. RESULTS: The subjects' mean ؎ SD values were: age 24 ؎ 3 years, axillary cirtometry 6.3 ؎ 2.0 cm, thoracic cirtometry 7.5 ؎ 2.3 cm; maximum inspiratory pressure 90.4 ؎ 10.6% of predicted, maximum expiratory pressure 92.8 ؎ 13.5% of predicted, inspiratory capacity 99.7 ؎ 8.6% of predicted, FVC 101.9 ؎ 10.6% of predicted, FEV 1 98.2 ؎ 10.3% of predicted, expiratory reserve volume 90.9 ؎ 19.9% of predicted. There were significant correlations between axillary cirtometry and FVC (r ‫؍‬ 0.32), FEV 1 (r ‫؍‬ 0.30), maximum inspiratory pressure (r ‫؍‬ 0.48), maximum expiratory pressure (r ‫؍‬ 0.25), and inspiratory capacity (r ‫؍‬ 0.24), and between thoracic cirtometry and FVC (r ‫؍‬ 0.50), FEV 1 (r ‫؍‬ 0.48), maximum inspiratory pressure (r ‫؍‬ 0.46), maximum expiratory pressure (r ‫؍‬ 0.37), inspiratory capacity (r ‫؍‬ 0.39), and expiratory reserve volume (r ‫؍‬ 0.47). In multiple regression analysis the variable that best explained the axillary cirtometry variation was maximum inspiratory pressure (R 2 0.23), and for thoracic cirtometry it was FVC and maximum inspiratory pressure (R 2 0.32). CONCLUSIONS: Chest mobility in healthy subjects is related to respiratory muscle strength and lung function; the higher the axillary cirtometry and thoracic cirtometry values, the greater the maximum inspiratory pressure, maximum expiratory pressure, and lung volumes in healthy subjects.

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“…In the current study, the change in the Pi/PI max term was due to a decrease in PI max indicating a decrease in functional inspiratory muscle strength and a greater inspiratory demand in relation to inspiratory reserve. Atrophy and remodeling from inactivity (28); injury from overuse (29); sepsis (30); medications such as aminoglycosides, steroids, or neuromuscular blockers (31); malnutrition; and chronic illnesses (32,33) can also detrimentally affect respiratory muscle strength. In addition the degree of consciousness, respiratory drive, and lung volume can also affect measurement of PI max (34).…”

Section: Discussionmentioning

confidence: 99%

Tension–Time Index as a Predictor of Extubation Outcome in Ventilated Children

Harikumar¹,

Egberongbe²,

Nadel³

et al. 2009

Am J Respir Crit Care Med

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Rationale: Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. Objectives: To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children. Methods: Eighty children (median [range] age 2.1 yr [0.15-16]) admitted to pediatric intensive care units at King's College and St Mary's Hospitals who required mechanical ventilation for more than 24 hours were studied. Measurements and Main Results: TTmus, maximal inspiratory pressure, respiratory drive, respiratory system mechanics, and functional residual capacity using a helium dilution technique, the rapid shallow breathing and CROP indices (compliance, rate, oxygenation, and pressure) indexed for body weight were measured and standard clinical data recorded in all patients. TTdi was measured in 28 of the 80 children using balloon catheters. Eight children (three in the TTdi group) failed extubation. TTmus (0.199 vs. 0.09) and TTdi (0.157 vs. 0.07) were significantly higher in children who failed extubation. TTmus greater than 0.18 (n 5 80) and TTdi greater than 0.15 (n 5 28) had sensitivities and specificities of 100% in predicting extubation failure. The other predictors performed less well. Conclusions: Invasive and noninvasive measurements of TTI may provide accurate prediction of extubation outcome in mechanically ventilated children.Keywords: diaphragm; respiratory muscles; pediatric critical care; weaningPatients are extubated when assessed to be capable of sustaining spontaneous ventilation without respiratory support. Premature extubation leading to cardiorespiratory compromise necessitates reintubation and reinstitution of mechanical ventilation and increases mortality and morbidity (1), whereas prolonged ventilatory support exposes the child to increased risk of nosocomial infection and lung injury (2). Extubation failure has been reported to occur in 4 to 10% of children (3, 4), hence an accurate predictor of extubation outcome would be of significant clinical value (1).Univariate indices that examine a single aspect of physiological function often have poor predictive power probably because they do not fully reflect all the pathophysiological processes affecting extubation outcome (5). Accurate prediction is more likely using multivariate indices that integrate a number of physiological functions (6). Studies of multivariate indices in children, such as the rapid-shallow breathing index (RSB) (respiratory rate [RR] divided by tidal volume [VT]) (5) and the CROP index (compliance, RR, oxygenation, and inspiratory pressure [PI]), however, have been limited and yielded contradictory results. We (7) and others (8, 9) have shown that the predictive power of those indices in children is poor, whereas Baumeister and colleagues (10), demonstrated that the CROP index discriminated strongly between successful an...

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Lung function abnormalities and respiratory muscle weakness in children with juvenile chronic arthritis

Cited by 35 publications

References 29 publications

Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis

Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis

Chest Wall Mobility Is Related to Respiratory Muscle Strength and Lung Volumes in Healthy Subjects

Tension–Time Index as a Predictor of Extubation Outcome in Ventilated Children

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