Sniff nasal inspiratory pressure in children

Rafferty, Gerrard F.; Leech, Susan; Knight, L C; Moxham, John; Greenough, Anne

doi:10.1002/(sici)1099-0496(200006)29:6<468::aid-ppul9>3.0.co;2-2

Cited by 43 publications

(29 citation statements)

References 21 publications

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“…Indeed, inspiratory muscle strength may be better reflected by SNIP than by PI,max [22], which is more difficult to perform, particularly in children [10]. During the sniff manoeuvre, the nasal valve located in the first 2.5 cm from the external orifice collapses when a critical trans-nasal pressure of 10-15 cmH 2 O is reached [12,23].…”

Section: Discussionmentioning

confidence: 99%

“…As sniff is a natural manoeuvre that many children find easier to perform than static efforts, sniff nasal inspiratory pressure (SNIP) has been proposed as an alternative, or complementary, test to PI,max [7][8][9][10]. The SNIP manoeuvre consists of measuring nasal pressure in an occluded nostril during a maximal sniff performed through the controlateral nostril from functional residual capacity [11].…”

mentioning

confidence: 99%

“…Transmission of the oesophageal pressure during a maximal sniff manoeuvre (Poes) to the nose is obtained, considering that a trans-nasal pressure of 10-15 cmH 2 O is necessary to obtain a collapse of the unplugged nostril valve in adults [12]. Normal values for the SNIP have been established for children as for adults [7][8][9][10]. Values in healthy children aged 6-17 yrs are similar to those measured in adults, with an SNIP of 99-117 cmH 2 O in young males and 92-97 cmH 2 O in young females [8].…”

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confidence: 99%

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Sniff nasal inspiratory pressure in children with muscular, chest wall or lung disease

Fauroux¹,

Aubertin²,

Cohen³

et al. 2008

Eur Respir J

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Sniff nasal inspiratory pressure is proposed as a noninvasive test of inspiratory muscle strength. During this manoeuvre, the nasal pressure is supposed to reflect oesophageal pressure.The aim of the present study was to compare the nasal pressure with the oesophageal pressure during a maximal sniff in children with neuromuscular disease (NM, n578), thoracic scoliosis (n512) and cystic fibrosis (CF, n523).A significant correlation was observed between the sniff nasal and oesophageal pressure. The ratio of the sniff nasal/oesophageal pressure was lower in patients with CF (0.72¡0.13) than in NM patients (0.83¡0.17) or patients with thoracic scoliosis (0.86¡0.10). In patients with CF and NM disease, this ratio was not correlated to age or spirometric data. The difference between the sniff oesophageal and nasal pressure exceeded 15 cmH 2 O in 17, 33 and 87% of the NM, thoracic scoliosis and CF patients, respectively.Sniff nasal pressure often underestimates the strength of inspiratory muscles in cystic fibrosis. Such an underestimation occurs more rarely in neuromuscular disease disorders and thoracic scoliosis. A normal value excludes inspiratory muscle weakness but a low value requires the measurement of the oesophageal pressure.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Sniff nasal inspiratory pressure in children with muscular, chest wall or lung disease

Fauroux¹,

Aubertin²,

Cohen³

et al. 2008

Eur Respir J

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“…Tests such as the vital capacity or maximum mouth pressures are unlikely to be well performed in children v6 yrs. Even the sniff, which is a more natural manoeuvre that children find easier to perform, is unreliable v4 yrs [124]. Hence, the ability to assess respiratory muscle strength nonvolitionally is an attractive option.…”

Section: Childrenmentioning

confidence: 99%

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Man¹

2004

Eur Respir J

118

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Respiratory and skeletal muscle function is of interest in many areas of pulmonary and critical care medicine. The capacity of the respiratory muscle pump to respond to the load imposed by disease is the basis of an understanding of ventilatory failure. Over the last four decades, considerable progress has been made in quantifying the capacity of the respiratory muscles, in terms of strength, endurance and fatigue. With the development of magnetic stimulation, it has recently become possible to nonvolitionally assess the respiratory muscles in a clinically acceptable way. This is of particular interest in the investigation of patients receiving critical care, those with neuromuscular disease, and in children where volitional efforts are either not possible or likely to be sub-maximal. Furthermore, the adaptation of these techniques to quantify the strength of peripheral muscles, such as the quadriceps, has allowed the effects of muscle training or rehabilitation, uninfluenced by learning effect, to be assessed. This article focuses on the physiological basis of magnetic nerve stimulation, and reviews how the technique has been applied to measure muscle strength and fatigue, with particular emphasis upon the diaphragm. The translation of magnetic stimulation into a clinical tool is described, and how it may be of diagnostic, prognostic and therapeutic value in several areas of pulmonary medicine. In particular, the use of magnetic stimulation in neuromuscular disease, the intensive care setting, chronic obstructive pulmonary disease and paediatrics will be discussed. The nonvolitional assessment of skeletal musclesFor routine muscle strength measurements, the force generated from a maximum voluntary contraction (MVC) is often used. However volitional, effort-dependent manoeuvres for measuring strength are not always suitable for patients as the ability to perform a true MVC relies upon subject motivation and cooperation. This is particularly so in patients on intensive care units (ICU), children, patients with cognitive difficulties, and those patients prevented from performing a true MVC by pain (for example, following surgery). However, even in well-motivated subjects, sub-maximal muscle activation is common in routine clinical practice [1]. As volitional manoeuvres are influenced by a learning effect, the value of MVC is also limited in studies of training or rehabilitation. Consequently, there has been a need for nonvolitional methods to assess muscle strength. Skeletal muscle physiologySkeletal muscle is controlled by electrical impulses conducted by motor neurones that lead to the release of acetylcholine from the motor end plate, thus depolarising the muscle cell membrane. The force generated by muscle contraction is dependent upon a number of factors, including the number of muscle fibres stimulated, muscle length at the time of stimulation and the frequency of stimulation. The force-frequency curve of a muscle is of particular relevance in the understanding of nonvolitional techniques to asse...

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“…Ao se avaliar a pressão inspiratória nasal em crianças e comparar os valores obtidos com os de PImáx, Rafferty et al (34) encontraram correlação entre os valores de PImáx com idade, peso e altura. Trata-se de achado frequente, mesmo em estudos com populações distintas e em diversas faixas etárias (35) .…”

Section: Discussionunclassified

Equações preditivas e valores de normalidade para pressões respiratórias máximas na infância e adolescência

Freitas¹,

Borja²,

Ferreira

et al. 2011

Rev. paul. pediatr.

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OBJETIVO: Pesquisar equações preditivas e valores de normalidade para pressões respiratórias máximas disponíveis na literatura para a faixa etária compreendida entre a infância e a adolescência. FONTES DE DADOS: Estudos publicados em inglês e em português no período entre 1980 e 2009. As bases de dados eletrônicas Lilacs e Medline foram consultadas utilizando-se as palavras-chave "capacidade respiratória máxima", "músculos respiratórios", "valores de referência", "adolescente" e "criança". SÍNTESE DOS DADOS: Foram incluídos oito artigos na revisão, totalizando 1.463 crianças e adolescentes avaliados. A faixa etária da população estudada variou de sete a 18 anos. Geralmente o indivíduo é avaliado na posição sentada e com um clipe nasal. Os esforços máximos são realizados a partir do volume residual e da capacidade pulmonar total e sustentados por um a três segundos. Valores de normalidade e equações de predição foram propostos em oito e dois estudos, respectivamente. Nestes, demonstra-se incremento nas pressões respiratórias máximas desde a infância à adolescência e a ocorrência de maiores valores de pressão expiratória máxima quando comparados à pressão inspiratória máxima em crianças e adolescentes de ambos os sexos. CONCLUSÕES: As pressões respiratórias máximas constituem um meio efetivo para avaliar a força muscular respiratória e diversos fatores contribuem para a grande variedade de equações preditivas e de valores de normalidade disponíveis. É preciso buscar um consenso para normatizar os métodos requeridos ao avaliar a força muscular respiratória em crianças e adolescentes.

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Sniff nasal inspiratory pressure in children

Cited by 43 publications

References 21 publications

Sniff nasal inspiratory pressure in children with muscular, chest wall or lung disease

Sniff nasal inspiratory pressure in children with muscular, chest wall or lung disease

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Equações preditivas e valores de normalidade para pressões respiratórias máximas na infância e adolescência

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