Respiratory Muscle Failure

Rochester, Dudley F.; Arora, Narinder S.

doi:10.1016/s0025-7125(16)31190-7

Cited by 196 publications

(95 citation statements)

References 44 publications

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“…KOULOURIS et al [20] and TULLY et al [21] reported that maximal respiratory pressures depend much on the type of mouthpiece being used. The tube mouthpiece used by RINGQVIST [19], by BLACK and HYATT [4] and by ROCHESTER and ARORA [22] showed higher values than the flanged mouthpiece used by WILSON et al [8], by LEECH et al [17] and by VINCKEN et al [7]. COOK et al [16] suggested that higher expiratory pressures would be obtained using a tube-type mouthpiece, because it prevented air leakage around the mouthpiece, whereas KOULOURIS et al [20] claimed that the manner in which the mouthpiece is used is important.…”

Section: Discussionmentioning

confidence: 99%

Face mask spirometry and respiratory pressures in normal subjects

Wohlgemuth¹,

Kooi²,

Hendriks³

et al. 2003

Eur Respir J

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Spirometry and maximal respiratory pressures are pulmonary function parameters commonly used to evaluate respiratory function. Prediction values are available for conventional lung function devices using a standard tube or flanged type of mouthpiece connection. This equipment is not suitable for patients with facial or buccal muscle weakness, because of air leakage around the mouthpiece. A face mask was used for the portable lung function devices used in the neuromuscular department.The aim of this study was to compare the face mask and the conventional mouthpiece for the measurement of spirometry and of respiratory pressures in 22 healthy subjects.Values obtained with the conventional mouthpiece differed significantly from values obtained with the face mask. With the mask, forced vital capacity and forced expiratory volume in one second were 200 mL lower, and maximal expiratory pressure was 3.2 kPa lower than with the mouthpiece. Subsequently, new prediction values for face mask spirometry and maximal respiratory pressures were obtained from 252 other healthy subjects, from which new prediction equations were derived.It was concluded that the face mask connection to the lung function device is a valid alternative, is easy to use and is most useful to monitor changes in patients. This study confirms the importance of appropriate prediction equations, depending on subjectinstrument interfaces. Measurement of vital capacity (VC) and maximal respiratory pressures is commonly used to evaluate respiratory function and respiratory muscle strength in patients with chronic obstructive pulmonary disease or neuromuscular diseases [1][2][3]. Portable devices are useful for rapid and simple assessment of respiratory function in the office and at the bedside. Prediction values of spirometry and maximal respiratory pressures are available for portable and nonportable devices with a standard tube or a flanged type of mouthpiece connection [4][5][6][7][8]. This equipment is only suitable for subjects capable of making a good seal with their lips around the mouthpiece. However, patients with neuromuscular diseases characterised by facial or bulbar muscle weakness, e.g. amyotrophic lateral sclerosis, myasthenia gravis, myotonic dystrophy and facioscapulohumeral muscular dystrophy, often cannot effectively seal the lips around the mouthpiece, especially during forced manoeuvres such as spirometric and maximal respiratory pressure measurements [9,10]. In these cases, the conventional equipment with a tube or flanged type of mouthpiece is not adequate to evaluate respiratory muscle function. Therefore, a face mask adjusted to a portable spirometer and manometer was used to minimise air leakage in neuromuscular patients.The objective of this study was two-fold. First, possible differences in measurements between the original devices with the conventional mouthpiece and the face mask-adjusted devices were studied in healthy subjects. Secondly, a study to render new prediction equations for face mask spirometry and maximal re...

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Section: Discussionmentioning

confidence: 99%

Face mask spirometry and respiratory pressures in normal subjects

Wohlgemuth¹,

Kooi²,

Hendriks³

et al. 2003

Eur Respir J

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“…60 Nevertheless, impressive differences are observed between the normal values reported in the literature. 52,53,[61][62][63][64][65][66] In all models of maximal inspiratory and expiratory pressures, the explained variance is low, reflecting large inter-individual differences even when age, sex, and anthropometric values are taken into account. Therefore, a low P Imax should always be interpreted with caution.…”

Section: Airway Pressure and Flowmentioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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The majority of patients admitted to the ICU require mechanical ventilation as a part of their process of care. However, mechanical ventilation itself or the underlying disease can lead to dysfunction of the diaphragm, a condition that may contribute to the failure of weaning from mechanical ventilation. However, extended time on the ventilator increases health-care costs and greatly increases patient morbidity and mortality. Nevertheless, symptoms and signs of muscle disease in a bedridden (or bed rest-only) ICU patient are often difficult to assess because of concomitant confounding factors. Conventional assessment of diaphragm function lacks specific, noninvasive, time-saving, and easily performed bedside tools or requires patient cooperation. Recently, the use of ultrasound has raised great interest as a simple, noninvasive method of quantification of diaphragm contractile activity. In this review, we discuss the physiology and the relevant pathophysiology of diaphragm function, and we summarize the recent findings concerning the evaluation of its (dys)function in critically ill patients, with a special focus on the role of ultrasounds. We describe how to assess diaphragm excursion and diaphragm thickening during breathing and the meaning of these measurements under spontaneous or mechanical ventilation as well as the reference values in health and disease. The spread of ultrasonographic assessment of diaphragm function may possibly result in timely identification of patients with diaphragm dysfunction and to a potential improvement in the assessment of recovery from diaphragm weakness.

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“…In the second group (the nNIPPV group) maximal static inspiratory (MIP) and expiratory mouth pressures were measured according to technique of ROCHESTER and ARORA [10] and their prediction equations were also applied.…”

Section: Pulmonary Function Measurementsmentioning

confidence: 99%

Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation?

Buyse¹,

Meersseman²,

Demedts³

2003

Eur Respir J

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Patients with kyphoscoliosis and chronic respiratory insufficiency are treated either with home oxygen therapy or ventilation. Kyphoscoliotic patients demonstrate impaired ventilatory mechanics, consequently ventilation seems to be the treatment of choice. Yet, no randomised controlled trials (CRT) exist to prove it.Most investigators find it difficult to ethically justify a CRT. Therefore, the current authors performed the following retrospective study: survival and pulmonary function were analysed in all consecutive kyphoscoliotic patients who started long-term oxygen therapy (LTO group; n=15, aged 62¡11 yrs (mean¡SD)) or LTO plus nocturnal nasal intermittent positive pressure ventilation (nNIPPV group; n=18, aged 61¡7 yrs) in the Dept of Pulmonology (University Hospital Gasthuisberg, Leuven) between 1990-2002.Prior to treatment partial pressure of oxygen (PO 2 ) was lower, partial pressure of carbon dioxide (PCO 2 ) tended to be higher and vital capacity (VC) tended to be lower in the nNIPPV group than in the LTO group (PO 2 5.9¡1 versus 6.7¡0.9 kPa (44¡8 versus 50¡7 mmHg), PCO 2 8¡1 versus 7.3¡0.9 kPa (60¡8 versus 55¡7 mmHg), VC 32¡12 versus 40¡16% predicted, or 645¡244 versus 970¡387 mL). In the nNIPPV group the 1-yr survival was higher (100% versus 66%). nNIPPV patients demonstrated an improvement in PO 2 (breathing air) z54%, PCO 2 (breathing air) -21%, VC z47% and maximal static inspiratory mouth pressurez33%; these improvements were absent in the LTO group.In conclusion, nocturnal nasal intermittent positive pressure ventilation, plus longterm oxygen therapy results in more favourable survival and changes in blood gases and respiratory function than long-term oxygen therapy alone. Eur Respir J 2003; 22: 525-528.

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Respiratory Muscle Failure

Cited by 196 publications

References 44 publications

Face mask spirometry and respiratory pressures in normal subjects

Face mask spirometry and respiratory pressures in normal subjects

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation?

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