Sniff nasal inspiratory pressure in patients with chronic obstructive pulmonary disease

Uldry, Christophe; Janssens, J.-P.; Muralt, B de; Jw, Fitting

doi:10.1183/09031936.97.10061292

Cited by 64 publications

(50 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Different ratios can be used to characterise inspiratory effort during exercise. Oesophageal pressure/maximal inspiratory pressure (Peso/Pim) ratio (43), and tidal volume/vital capacity ratio (V T /VC) as a respiratory neuromechanical index can be used (18,25). In special cases, gas exchange abnormalities lead to critical arterial hypoxaemia and hypercapnia, which are in a direct or indirect way causing dyspnoea during exercise (28).…”

Section: Intensity Of Dyspnoeamentioning

confidence: 99%

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

View full text Add to dashboard Cite

Expiratory flow limitation can develop in parallel with the progression of COPD, and as a consequence, dynamic hyperinflation and lung mechanical abnormalities can develop. Dynamic hyperinflation can cause increased breathlessness and reduction in exercise tolerance. Achievement of critical inspiratory reserve volume is one of the main factors in exercise intolerance. Obesity has specific lung mechanical effects. There is also a difference concerning gender and dyspnoea. Increased nerve activity is characteristic in hyperinflation. Bronchodilator therapy, lung volume reduction surgery, endurance training at submaximal intensity, and heliox or oxygen breathing can decrease the degree of dynamic hyperinflation.Keywords: COPD, dyspnoea, expiratory flow limitation, dynamic hyperinflation, lung mechanics, exercise toleranceOne of the main symptoms in chronic obstructive pulmonary disease (COPD) is dyspnoea, and initially it is manifested during exercise and later at rest with the progression of the disease. Dyspnoea leads to exercise intolerance in parallel with physical inactivity, and as a consequence, disability may develop (28). The main causes of exercise intolerance may be lung mechanical abnormalities and patient's deconditioning (28). Dyspnoea is characterised by an increase in the following factors: respiratory work/ effort ratio, breathing load, end-expiratory lung volume (EELV) related dynamic hyperinflation, intrinsic positive end-expiratory pressure (PEEP) related elastic effort, and neurological sensation (Fig. 1) (28). Dyspnoea manifestation is often associated with dynamic hyperinflation (DH) in patients with COPD from moderate to severe obstruction (26,28,29,35,42). The discrepancy between respiratory centre induced respiratory muscle work and muscle load, and capacity related lung volume changes lead to neuromechanical dissociation (Fig. 2). The consequence of this process is the development of dynamic hyperinflation as a cause of chronic and exertional dyspnoea (28).

show abstract

Section: Intensity Of Dyspnoeamentioning

confidence: 99%

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

View full text Add to dashboard Cite

show abstract

“…A recent alternative noninvasive method consists of performing a short maximal sniff through one nostril while measuring nasal pressure through a plug occluding the contralateral nostril (sniff nasal inspiratory pressure (SNIP)) [3][4][5]. This natural manoeuvre is easier and less unpleasant than the static effort of MIP, but nevertheless depends on volitional muscle contraction.…”

mentioning

confidence: 99%

“…However, in addition to being closely dependent on subject collaboration, this manoeuvre is demanding and unpleasant. Thus, whilst high values of MIP exclude inspiratory muscle weakness, lower values are frequently difficult to interpret, reflecting either a true muscle weakness or a lack of motivation and co-ordination [2].A recent alternative noninvasive method consists of performing a short maximal sniff through one nostril while measuring nasal pressure through a plug occluding the contralateral nostril (sniff nasal inspiratory pressure (SNIP)) [3][4][5]. This natural manoeuvre is easier and less unpleasant than the static effort of MIP, but nevertheless depends on volitional muscle contraction.…”

mentioning

confidence: 99%

Reproducibility of twitch mouth pressure, sniff nasal inspiratory pressure, and maximal inspiratory pressure

Maillard¹,

Burdet²,

Melle³

et al. 1998

Eur Respir J

View full text Add to dashboard Cite

The measurement of mouth pressure during a maximal inspiratory effort against a quasi occlusion (maximal inspiratory pressure (MIP)) is classically established as the standard for assessment of inspiratory muscle strength [1]. However, in addition to being closely dependent on subject collaboration, this manoeuvre is demanding and unpleasant. Thus, whilst high values of MIP exclude inspiratory muscle weakness, lower values are frequently difficult to interpret, reflecting either a true muscle weakness or a lack of motivation and co-ordination [2].A recent alternative noninvasive method consists of performing a short maximal sniff through one nostril while measuring nasal pressure through a plug occluding the contralateral nostril (sniff nasal inspiratory pressure (SNIP)) [3][4][5]. This natural manoeuvre is easier and less unpleasant than the static effort of MIP, but nevertheless depends on volitional muscle contraction. The need for a nonvolitional test, especially in situations where collaboration is totally lacking, has led to the development of phrenic nerve stimulation. Because it is better tolerated and easier to apply, cervical magnetic stimulation has now largely replaced electrical stimulation [6,7]. The measurement of twitch mouth pressure (Pmo,tw) during magnetic stimulation was recently reported as a reliable assessment of diaphragm strength [8].Thus, several noninvasive techniques are now available for assessing inspiratory muscle strength, based on volitional and nonvolitional manoeuvres. In order to use these new methods in clinical settings, it is necessary to characterize them in comparison with the established reference method. The aim of this study was to determine the reproducibility of SNIP and Pmo,tw during cervical magnetic stimulation and to compare them to classical MIP in a group of normal subjects. Materials and methods Study subjectsTen healthy volunteers (nine males, one female) were studied. Their characteristics were (mean±SD): age 28±7 Ten healthy subjects were studied at functional residual capacity in semirecumbent position. Cervical magnetic phrenic nerve stimulation was performed during gentle expiration against an occlusion incorporating a small leak. Constancy of stimulation was controlled by recording diaphragmatic electromyogram. Within and betweensession reproducibility of pressure were studied for Pmo,tw, SNIP, and MIP. The subjects were studied during a session of 10 manoeuvres repeated after 1 day and 1 month.The mean values were 16 cmH 2 O for Pmo,tw, 118 cmH 2 O for SNIP, and 115 cmH 2 O for MIP. For the three tests, the within subject variation was small in relation to between-subject variation, with the intraclass correlation coefficient ranging 0. We conclude that the within session reproducibility of the new tests twitch mouth pressure and sniff nasal inspiratory pressure is sufficient to be clinically useful. For sniff nasal inspiratory pressure, the between session reproducibility established after 1 day was maintained after 1 month. For twitch mouth pressure,...

show abstract

“…İnspi-ratuvar kas gücü ölçümünde kullanılan noninvaziv bir yöntemdir (33,34). MIP yöntemine göre daha basit ve hasta uyumu daha fazladır (21).…”

Section: Nazal Inspiratuvar Basınç öLçümü (Snip)unclassified

“…Bu test burun deliği içine yerleştirilen basınç ölçerli bir kateter taşıyan bir tıkaç ve burundan havayı içe çekme sıra-sında oluşan negatif basıncın inspiratuvar kas gücü değeri olarak cmH 2 O cinsinden ölçülmesi esasına dayanır (33,34). SNIP test ağır hava yolu obstrüksi-yonu olan hastalar dışında genellikle Sniff özefagus testine yakın sonuçlar verir (34)(35)(36) dan yapılması gereklidir. Bu grup testlerin başlıcaları; "Sniff esophageal pressure (Sniff Pe)", "Sniff transdiaphragmatic pressure (Sniff Pdi)" ve "gastric pressure"dır.…”

Section: Nazal Inspiratuvar Basınç öLçümü (Snip)unclassified

Solunum Kas Fi̇zyoloji̇si̇ Ve Kas Gücü Ölçümü

Ulubay¹

2017

Bulletin of Thoracic Surgery

View full text Add to dashboard Cite

Respiratory muscle strength can be assessed noninvasively by measuring the forced vital capacity (FVC), vital capacity (VC), maximal inspiratory pressure (MIP or PImax), the maximal expiratory pressure (MEP or PEmax) and maximal sniff nasal inspiratory pressure (SNIP) tests. The MIP and SNIP reflect the strength of the diaphragm and other inspiratory muscles, while the MEP reflects the strength of the expiratory muscles including abdominal muscles and other expiratory muscles. Respiratory muscle strength can also be assessed invasively by Sniff esophageal pressure (Sniff Pe), Sniff transdiaphragmatic pressure (Sniff Pdi), gastric pressure measurement methods. Common indications for measurement of the MIP, MEP, and SNIP include clinically suspected respiratory muscle weakness, lung function consistent with respiratory muscle weakness (e.g., unexplained restrictive pattern, low vital capacity), and evaluation of whether respiratory muscle weakness has improved, remained stable, or worsened. In this topic, the anatomy, physiology of respiratory muscles, and the methods for the evaluation of muscle strength by invasive and noninvasive methods will be reviewed. Keywords: Respiratory muscles, respiratory function tests, muscle weakness ÖzetSolunum kas gücü, zorlu vital kapasite (FVC), vital kapasite (VC), maksimal inspiratuvar basınç (MIP ya da PImax), maksimal ekspiratuvar basınç (MEP ya da PEmax) ve maksimal sniff nazal inspiratuvar basınç (SNIP) testleri ile invaziv olmayan şekilde ölçülebilir. MIP ve SNIP testler, diyafragma ve diğer inspiratuvar kasların gü-cünü yansıtırken, MEP karın ve diğer ekspiratuvar kasların gücünü yansıtır. Solunum kas gücü ayrıca Sniff özefageal basınç (Sniff Pe), Sniff trans diyafragmatik basınç (Sniff Pdi) ve gastrik basınç öl-çüm yöntemleriyle invaziv olarak da ölçülebilir. MIP, MEP ve SNIP ölçümleri için en sık endikasyonlar, klinik olarak solunum kas güç-süzlüğü şüphesi, solunum kas güçsüzlüğü ile uyumlu solunum fonksiyon testi bulguları (örn. açıklanamayan restriktif patern, düşük vital kapasite gibi) ve solunum kas gücünde iyileşme, kö-tüleşme, stabil seyir durumlarının değerlendirmesidir. Bu bölüm-de, solunum kaslarının anatomisi, fizyolojisi ve invaziv, noninvaziv yöntemlerle solunum kaslarının değerlendirilme yöntemleri göz-den geçirilecektir.Anahtar kelimeler: Solunum kasları, solunum fonksiyon testleri, kas güçsüzlüğü SOLUNUM KASLARININ ANATOMİSİSolunum yolları burun ile başlar ve arka arkaya birbirini takip ederek burun boşlukları, farenks, larenks, trakea ve bronşlarla devam eder. Bronşlar akciğer içinde giderek incelerek dallara ayrılır ve sonrasında solunumsal yüzeyi meydana getiren alveolleri oluşturarak sonlanır. Dinlenme durumunda inspirasyon; diyafragma, eksternal interkostal ve skalen kasların kasılmasıyla gerçekleştirilir. Sakin solunumda görev yapan bu kaslar, primer inspirasyon kasları olarak adlandırılır. Primer inspirasyon kaslarının kasılmasıyla toraks genişler ve hacmi artar (1). Üst Hava YollarıFarenks kavitesi üç kısımdan oluşur; 1. Nazofarenks: Buru...

show abstract

Sniff nasal inspiratory pressure in patients with chronic obstructive pulmonary disease

Cited by 64 publications

References 11 publications

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Reproducibility of twitch mouth pressure, sniff nasal inspiratory pressure, and maximal inspiratory pressure

Solunum Kas Fi̇zyoloji̇si̇ Ve Kas Gücü Ölçümü

Contact Info

Product

Resources

About