Proposal Intensity Adequacy of Expiratory Effort and Heart Rate Behavior During the Valsalva Maneuver in Preadolescents

Abstract

Background When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

Maximal expiratory pressure and Valsalva manoeuvre do not produce similar cardiovascular responses in healthy men

“…Although some authors speculate that the MEP measure produces similar cardiovascular responses to the VM (American Thoracic Society/European Respiratory Society, ; Paschoal et al . ), there were no studies that evaluated this hypothesis. In the present study, the percentage of changes in the CO were similar between the manoeuvres and can be explained by the decrease in the SV during the strain.…”

“…) and to cardiovascular changes similar to those of the Valsalva manoeuvre (VM) (American Thoracic Society/European Respiratory Society, ; Paschoal et al . ), e.g. decreased cardiac output (CO), venous return, pulmonary circulation and coronary flow (Looga, ; Liang & Liu, ).…”

“…Maximal expiratory pressure values reflect the action of the muscles of the abdominal wall (Black & Hyatt, 1969;Gibson, 1995;American Thoracic Society/European Respiratory Society, 2002) and the ability to cough and expectorate in patients with neuromuscular disease (Chiara et al 2006). However, although the MEP measure is widely used in clinical practice, it has some absolute and relative contraindications (Fiz & Morera, 2000;American Thoracic Society/European Respiratory Society, 2002), in particular owing to increased intrathoracic and abdominal pressure during MEP (Gibson, 1995;Steier et al 2007) and to cardiovascular changes similar to those of the Valsalva manoeuvre (VM) (American Thoracic Society/European Respiratory Society, 2002;Paschoal et al 2014), e.g. decreased cardiac output (CO), venous return, pulmonary circulation and coronary flow (Looga, 2005;Liang & Liu, 2006).…”

Predictive effect of the difference of brachial artery peak velocity during the valsalva maneuver in different positions on supine hypotension syndrome of parturient after spinal anesthesia

“…The Valsalva maneuver pressure monitoring device was composed of a whistle, connecting pipe, TE2000 type pressure gauge and so on. To conduct the Valsalva maneuver training after monitoring [5] : prescribing the parturient to start to bite the whistle and breathe out in a calm breathing state, maintaining pressure 30 mmHg(1mmHg = 0.133 kPa), releasing rapidly after 15 s and then breathing smoothly. To begin the study after the training standard.…”