Clinimetric properties of breath‐stacking technique for assessment of inspiratory capacity

Feitosa, Larissa Andrade de Sá; Barbosa, Paula Antas; Pessoa, Maíra Floretino; Rodrigues‐Machado, Maria da Glória; Andrade, Armèle Dornelas de

doi:10.1002/pri.512

Cited by 6 publications

(11 citation statements)

References 18 publications

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“…Ineffective IBS may reflect very shallow breathing and significant weakness, and thus a need for supported breath stacking which is technically more demanding. Finally, volumes achieved by IBS are reproducible, and offer a way to estimate vital capacity in adults . We believe that the use of IBS may also prove useful for the assessment of respiratory function in uncooperative children with NMD.…”

Section: Discussionmentioning

confidence: 87%

Breath stacking in children with neuromuscular disorders

Jenkins

Stocki

Kriellaars

et al. 2013

Pediatric Pulmonology

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Respiratory muscle weakness in neuromuscular disorders (NMD) can lead to shallow breathing and respiratory insufficiency over time. Children with NMD often cannot perform maneuvers to recruit lung volume. In adults, breath stacking with a mask and one-way valve can achieve significantly increased lung volumes. To evaluate involuntary breath stacking (IBS) in NMD, we studied 23 children of whom 15 were cognitively aware and able to communicate verbally. For IBS, a one-way valve and pneumotachograph were attached to a face mask. Tidal volumes (V t) and minute ventilation (V E ) were calculated from airflow over 30 sec before and after 15 sec of expiratory valve closure. Six cooperative male subjects with Duchenne muscular dystrophy (DMD) participated in a subsequent comparison of IBS with voluntary breath stacking (VBS) and supported breath stacking (SBS). The average V t in those studied with IBS was 277 ml (range 29-598 ml). The average increase in volume by stacking was 599 ml (range À140 to 2,916 ml) above V t . The average number of stacked breaths was 4.5 (range 0-17). V E increased on average by 18% after stacking (P < 0.05, paired t-test). Oxygen saturation did not change after stacking. Four of the 23 children did not breath stack. Compared to IBS, VBS achieved similar volumes in the six subjects with DMD but SBS was more successful in those with greatest muscle weakness. IBS may achieve breath volumes of approximately three times V t and may be particularly useful in noncooperative subjects with milder degrees of respiratory muscle weakness. Pediatr Pulmonol.

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Section: Discussionmentioning

confidence: 87%

Breath stacking in children with neuromuscular disorders

Jenkins

Stocki

Kriellaars

et al. 2013

Pediatric Pulmonology

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“…(17) Outro estudo já havia aventado a hipótese de que os volumes pulmonares induzidos pela técnica de BS são maiores que os induzidos pela espirometria de incentivo, pois a válvula unidirecional permite que os músculos inspiratórios relaxem, sem perder a expansão pulmonar. (35) Além disso, já se sugeriu que a respiração cumulativa permite o apoio da pressão intrapulmonar, a redistribuição do volume por forças interdependentes e a abertura de áreas hipoventiladas por meio de ventilação colateral nas bases pulmonares e regiões periféricas, mais predispostas a complicações no pós-operatório. (35) Observamos melhoria da PImáx e da PEmáx após o BS, ambas as quais são indicadores de força muscular respiratória.…”

Section: Discussionunclassified

“…(35) Além disso, já se sugeriu que a respiração cumulativa permite o apoio da pressão intrapulmonar, a redistribuição do volume por forças interdependentes e a abertura de áreas hipoventiladas por meio de ventilação colateral nas bases pulmonares e regiões periféricas, mais predispostas a complicações no pós-operatório. (35) Observamos melhoria da PImáx e da PEmáx após o BS, ambas as quais são indicadores de força muscular respiratória. (33) Esse achado pode ser explicado, pelo menos em parte, pelo tempo inspiratório prolongado (hiperinsuflação) somado às pausas entre os esforços inspiratórios durante as manobras de BS, que permitem o relaxamento fásico dos músculos inspiratórios, principalmente do diafragma, reduzindo a carga sobre esse músculo e otimizando seu desempenho.…”

Section: Discussionunclassified

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Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial

et al. 2022

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Objective: To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety. Methods: This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions. Results: Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed. Conclusions: BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.

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“…Cough augmentation techniques, such as 'lung volume recruitment' or 'assisted cough', are suggested to prevent respiratory complications associated with chronic conditions like neuromuscular disease (6). With 'lung volume recruitment', also known as 'air stacking' or 'breath stacking', multiple successive insufflations result in a maximum long volume potentially improving the strength of a natural cough (7,8). With 'assisted cough techniques', like 'mechanical in-exsufflation' or 'cough assist' not only the tidal volume is increased, but also an inspiratory hold and a quick maximal release of air is performed, provoking an artificial cough.…”

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confidence: 99%

Preventing mucus plugging in invasively ventilated intensive care unit patients—routine or personalized care and ‘primum non nocere’

2018

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Clinimetric properties of breath‐stacking technique for assessment of inspiratory capacity

Abstract: Data from both the intra-examiner and inter-examiner analyses suggest that the BS technique is reproducible. This technique mobilizes greater lung volumes than conventional spirometry.

Cited by 6 publications

References 18 publications

Breath stacking in children with neuromuscular disorders

Breath stacking in children with neuromuscular disorders

Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial

Preventing mucus plugging in invasively ventilated intensive care unit patients—routine or personalized care and ‘primum non nocere’

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