Comparison of cervical magnetic stimulation and bilateral percutaneous electrical stimulation of the phrenic nerves in normal subjects

Wragg, S; Aquilina, R.; Moran, John M.; Ridding, M. C.; Hamnegärd, C H; Fearn, Tom; Green, M; Moxham, John

doi:10.1183/09031936.94.07101788

Cited by 106 publications

(78 citation statements)

References 11 publications

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“…It is associated with Pdi values higher than those obtained with BES, due to a larger Poes component ( [23], and this study). Because CMS provokes diaphragmatic contraction via stimulation of cervical roots rather than of the phrenic nerve itself, it implies co-contraction of various muscles innervated by the C 3 -C 6 roots [24], as well as muscles innervated by the XIth cranial nerve.…”

Section: Contribution To the Understanding Of The Differences Betweenmentioning

confidence: 78%

“…CMS is a noninvasive and easy-to-use nonvolitional test of diaphragmatic contraction [18,23]. It is associated with Pdi values higher than those obtained with BES, due to a larger Poes component ( [23], and this study).…”

Section: Contribution To the Understanding Of The Differences Betweenmentioning

confidence: 99%

“…Therefore, it has been postulated that the better "efficiency" of CMSinduced diaphragmatic contraction in terms of Poes was due to decreased rib cage distortability as a result of the prior action of extradiaphragmatic muscles (e.g. sternomastoid or scaleni muscles) [23,25].…”

Section: Contribution To the Understanding Of The Differences Betweenmentioning

confidence: 99%

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Assessment of the voluntary activation of the diaphragm using cervical and cortical magnetic stimulation

Similowski

Duguet²,

Straus³

et al. 1996

Eur Respir J

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The twitch occlusion technique is a promising tool for use in assessing central drive to the diaphragm and determining maximal transdiaphragmatic pressure (Pdi) from submaximal efforts. Its clinical use is limited by difficulties inherent to bilateral electrical stimulation (BES) of the phrenic nerves. This study was designed to revisit the technique using cervical magnetic stimulation (CMS). In addition, the effects of a voluntary contraction on diaphragm response to magnetic stimulation of the cortex (CxMS) were studied.Seven volunteers aged 23-33 yrs were studied. Pdi was determined at relaxed functional residual capacity (FRC) in response to BES (Pdi,p-ES) and CMS (Pdi,p-CMS), and the effects of an increasing voluntary contraction (Pdi,vol) were assessed. The same procedure was applied to CxMS.Pdi,p-CMS at relaxed FRC was 27.5±2.2 cmH 2 O (mean±SEM), about 20% higher than Pdi,p-ES, as reported previously. Pdi,p-CMS linearly decreased with Pdi,vol, and six out of seven subjects were capable of producing voluntary contractions sufficient to extinguish the twitch. More complex patterns were observed with CxMS.Cervical magnetic stimulation provides diaphragmatic twitch occlusion data very similar to bilateral electrical phrenic stimulation. Magnetic stimulation, be it cervical or cortical, could probably be helpful for the assessment of central and peripheral mechanisms of diaphragmatic dysfunction in the clinical setting.

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Section: Contribution To the Understanding Of The Differences Betweenmentioning

confidence: 78%

Section: Contribution To the Understanding Of The Differences Betweenmentioning

confidence: 99%

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Assessment of the voluntary activation of the diaphragm using cervical and cortical magnetic stimulation

Similowski

Duguet²,

Straus³

et al. 1996

Eur Respir J

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“…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].…”

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confidence: 99%

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

Maillard¹,

Burdet²,

Melle³

et al. 1998

Eur Respir J

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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,...

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“…Magnetic nerve stimulation exploits the principle, originally described by Michael Faraday, that a changing magnetic field creates an electrical current in objects placed within it. In cervical magnetic stimulation, a coil is discharged over the phrenic nerve roots and the brief powerful (>2 T) magnetic pulse produced depolarizes the phrenic nerves [12,13]. The resulting diaphragm contraction may be measured as P di .…”

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confidence: 99%

The diaphragm in chronic obstructive pulmonary disease: how useful is it?

Polkey

Moxham

1997

Eur J Clin Investigation

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The respiratory muscle pump should be considered an essential organ, and the diaphragm is normally the most important inspiratory muscle in man [1], accounting for approximately 70% of resting ventilation. Diaphragm dysfunction would reasonably be expected to impose limits on ventilatory performance and, in the extreme case of neuromuscular disease, this is easily demonstrated [2,3]. Probably the most common potential cause of diaphragm dysfunction in clinical medicine is that associated with chronic obstructive pulmonary disease (COPD). In COPD, the pressure-generating capacity of the diaphragm is affected by several factors, of which the most important is hyperinflation.When lung volume is increased acutely, the force that can be generated by the diaphragm (assessed as transdiaphragmatic pressure, P id ) is reduced [4]. Since the mid-nineteenth century, abnormal rib cage movement, attributed to diaphragm dysfunction, has been recognized as a clinical feature of advanced emphysema [5][6][7]. However, more recently, studies in emphysematous

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Comparison of cervical magnetic stimulation and bilateral percutaneous electrical stimulation of the phrenic nerves in normal subjects

Cited by 106 publications

References 11 publications

Assessment of the voluntary activation of the diaphragm using cervical and cortical magnetic stimulation

Assessment of the voluntary activation of the diaphragm using cervical and cortical magnetic stimulation

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

The diaphragm in chronic obstructive pulmonary disease: how useful is it?

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