Cut-off Values of the Respiratory Muscle Power and Peak Cough Flow in Post-Stroke Dysphagia

Abstract

Background and objectives: This study aimed to determine the cut-off values of the following three respiratory pressure meters; the voluntary peak cough flow (PCF), maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP); associated with post-stroke dysphagia and assess which of these parameters show good diagnostic properties associated with post-stroke dysphagia. Materials and Methods: Retrospective analysis of a prospectively maintained database. Records of patients with first-ever diagnosed dysphagia attributable to cerebrovascular disease, who had performed spirometry measurements for the PCF, MIP and MEP. Results: From a total of 237 stroke patients, 163 patients were diagnosed with dysphagia. Those with dysphagia had significantly lower PCF values than those without dysphagia (116.3 ± 75.3 vs. 219.4 ± 91.8 L/min, p < 0.001). In addition, the former group also had lower MIP (30.5 ± 24.7 vs. 41.6 ± 25.7 cmH2O, p = 0.0002) and MEP (41.0 ± 27.9 vs. 62.8 ± 32.3 cmH2O, p < 0.001) values than the latter group. The receiver operating characteristic curve analysis showed that the PCF cut-off value of 151 L/min (area under the receiver operating characteristic curve [AUC] 0.81; sensitivity 72%; specificity 78.8%) was associated with post-stroke dysphagia. The optimum MEP and MIP cut-off were 38 cmH2O (AUC 0.70, sensitivity 58%; specificity 77.7%) and 20 cmH2O (AUC 0.65, sensitivity 49%; specificity 84%). PCF showed the highest AUC results. Results from the univariate analysis indicated that PCF values of ≤151 L/min increased risk of dysphagia by 9.51-fold (4.96–18.23). Multivariable analysis showed that after controlling of other clinical factor, the PCFs at this cut-off value still showed increased risk of by 4.19 (2.02–83.69) but this was not observed with the MIPs or MEPs. Conclusions: Our study has provided cut-off values that are associated with increased risk of dysphagia. Among the three parameters, PCF showed increased association with post-stroke dysphagia.

The Implementation of Inspiratory Muscle Training to Enhance Weaning from Mechanical Ventilation: A Systematic Literature Review

“…This is related to the previous study that ventilation mechanics increase in strength within two weeks of IMT (Bissett et al, 2016). The increase in respiratory muscle strength can be caused by the effects of exercise such as IMT and the MIP (Maximal Inspiration Pressure) test manoeuvre (Cabrita et al, 2021;Han et al, 2020;Tanriverdi et al, 2021) However, atrophy may occur quickly in ICU patients, especially in skeletal muscle and respiratory muscles (Spiesshoefer et al, 2020), if the patient is attached to a mechanical ventilator for more than five days. With an adequate training stimulus, the possibility of atrophy in the respiratory muscles will decrease in a relatively short period of time, so that it will help the ventilator weaning process.…”

The Effect of Respiratory Muscle Training on Swallowing Function in Patients With Stroke: A Systematic Review and Meta-Analysis

“…26,48 The difference in IEMT and EMT effects may be related to the strengthening of inspiratory muscle strength after training, which has been shown to be beneficial for their lung volume at the onset of cough. 16 Furthermore, the cough peak flow, an index of voluntary cough strength, is well correlated with maximal inspiratory pressure, in addition to maximal expiratory pressure and forced vital capacity. 49 Thus, IEMT may be more beneficial in avoiding aspiration and pneumonia.…”

“…15 Strengthening the inspiratory muscles of stroke survivors has been proven to be beneficial for their lung volume at the beginning of cough; meanwhile, the improvement of expiratory muscle strength also contributes to increased intrathoracic pressure. 16 Coughing and swallowing are highly sophisticated and interconnected re-flexive behaviors that serve to protect the airways during swallowing. Currently, positive results have been observed using IEMT in improving cough effectiveness and airway protection in neurological patients.…”

Cut-Off Value of Voluntary Peak Cough Flow in Patients with Parkinson’s Disease and Its Association with Severe Dysphagia: A Retrospective Pilot Study

“…The PCF cut-off value of 153 derived in this study was similar to the standard value of 160 for decannulation after tracheotomy [ 31 ]. Previous studies on patients with strokes have also revealed that dysphagia is associated with PCF, and a study by Han et al suggested a cut-off value of 151 [ 32 , 33 ]. The cut-off value of 153 in this study was similar to the PCF reference values of previous studies, suggesting clinical significance.…”