Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit

Watson, Anna C.; Hughes, Philip D.; Harris, Mark; Hart, Nicholas; Ware, R.; Wendon, Julia; Green, Malcolm; Moxham, John

doi:10.1097/00003246-200107000-00005

Cited by 188 publications

(149 citation statements)

References 23 publications

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“…[20][21][22] The decrease in diaphragm contractility is time-dependent, and it worsens as mechanical ventilation is prolonged. The effects of critical illness on respiratory muscle function are often part of a more generalized phenomenon, known as ICU-acquired weakness.…”

Section: Ventilator-induced Diaphragm Dysfunctionmentioning

confidence: 99%

“…In the last decade, the understanding of the molecular and cellular mechanisms underlying respiratory muscle weakness in the critically ill has been the subject of extensive research. 23 Muscle atrophy can result from decreased protein synthesis, increased protein degradation, or both 21 ; fiber remodeling with change from slow to fast fibers may reduce the endurance of the diaphragm, because fewer slow, fatigue-resistant fibers are available. 24 Moreover, oxidative stress and structural injury are implicated as potential mechanisms of ventilatorinduced diaphragm dysfunction.…”

Section: Ventilator-induced Diaphragm Dysfunctionmentioning

confidence: 99%

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Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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The majority of patients admitted to the ICU require mechanical ventilation as a part of their process of care. However, mechanical ventilation itself or the underlying disease can lead to dysfunction of the diaphragm, a condition that may contribute to the failure of weaning from mechanical ventilation. However, extended time on the ventilator increases health-care costs and greatly increases patient morbidity and mortality. Nevertheless, symptoms and signs of muscle disease in a bedridden (or bed rest-only) ICU patient are often difficult to assess because of concomitant confounding factors. Conventional assessment of diaphragm function lacks specific, noninvasive, time-saving, and easily performed bedside tools or requires patient cooperation. Recently, the use of ultrasound has raised great interest as a simple, noninvasive method of quantification of diaphragm contractile activity. In this review, we discuss the physiology and the relevant pathophysiology of diaphragm function, and we summarize the recent findings concerning the evaluation of its (dys)function in critically ill patients, with a special focus on the role of ultrasounds. We describe how to assess diaphragm excursion and diaphragm thickening during breathing and the meaning of these measurements under spontaneous or mechanical ventilation as well as the reference values in health and disease. The spread of ultrasonographic assessment of diaphragm function may possibly result in timely identification of patients with diaphragm dysfunction and to a potential improvement in the assessment of recovery from diaphragm weakness.

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Section: Ventilator-induced Diaphragm Dysfunctionmentioning

confidence: 99%

Section: Ventilator-induced Diaphragm Dysfunctionmentioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

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“…This is probably because BAMPS results in less co-activation of extradiaphragmatic muscles, demonstrated by the similar oesophageal and gastric pressure contributions to Pdi,tw observed with BAMPS and electrical stimulation [54]. Other advantages are that the technique can be applied in the supine subject, and over obstructing objects, such as neck catheters, yet still ensuring a supramaximal response [56]. In the clinical setting, BAMPS is usually the magnetic stimulation technique of choice when studying diaphragm contractility, although normal values have been principally obtained from studies of small numbers of young healthy male individuals [57].…”

Section: Unilateral/bilateral Anterolateral Magnetic Phrenic Nerve Stmentioning

confidence: 99%

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Man¹

2004

European Respiratory Journal

116

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Respiratory and skeletal muscle function is of interest in many areas of pulmonary and critical care medicine. The capacity of the respiratory muscle pump to respond to the load imposed by disease is the basis of an understanding of ventilatory failure. Over the last four decades, considerable progress has been made in quantifying the capacity of the respiratory muscles, in terms of strength, endurance and fatigue. With the development of magnetic stimulation, it has recently become possible to nonvolitionally assess the respiratory muscles in a clinically acceptable way. This is of particular interest in the investigation of patients receiving critical care, those with neuromuscular disease, and in children where volitional efforts are either not possible or likely to be sub-maximal. Furthermore, the adaptation of these techniques to quantify the strength of peripheral muscles, such as the quadriceps, has allowed the effects of muscle training or rehabilitation, uninfluenced by learning effect, to be assessed. This article focuses on the physiological basis of magnetic nerve stimulation, and reviews how the technique has been applied to measure muscle strength and fatigue, with particular emphasis upon the diaphragm. The translation of magnetic stimulation into a clinical tool is described, and how it may be of diagnostic, prognostic and therapeutic value in several areas of pulmonary medicine. In particular, the use of magnetic stimulation in neuromuscular disease, the intensive care setting, chronic obstructive pulmonary disease and paediatrics will be discussed. The nonvolitional assessment of skeletal musclesFor routine muscle strength measurements, the force generated from a maximum voluntary contraction (MVC) is often used. However volitional, effort-dependent manoeuvres for measuring strength are not always suitable for patients as the ability to perform a true MVC relies upon subject motivation and cooperation. This is particularly so in patients on intensive care units (ICU), children, patients with cognitive difficulties, and those patients prevented from performing a true MVC by pain (for example, following surgery). However, even in well-motivated subjects, sub-maximal muscle activation is common in routine clinical practice [1]. As volitional manoeuvres are influenced by a learning effect, the value of MVC is also limited in studies of training or rehabilitation. Consequently, there has been a need for nonvolitional methods to assess muscle strength. Skeletal muscle physiologySkeletal muscle is controlled by electrical impulses conducted by motor neurones that lead to the release of acetylcholine from the motor end plate, thus depolarising the muscle cell membrane. The force generated by muscle contraction is dependent upon a number of factors, including the number of muscle fibres stimulated, muscle length at the time of stimulation and the frequency of stimulation. The force-frequency curve of a muscle is of particular relevance in the understanding of nonvolitional techniques to asse...

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“…This evidence is not surprising and is possibly explained by the fact that direct measurement of pressures at the trachea most likely resembles maximal oesophageal [35,36] or cough gastric pressures measured by means of oesophageal and gastric balloons. In particular, clinical situations in which standard measurement of respiratory pressures is difficult or scarcely reliable, such as in patients with facial muscle weakness or bulbar dysfunction [37,38], maximal sniff manoeuvre and cough pressures, are considered accurate and reproducible estimates of respectively inspiratory and expiratory muscle strength.…”

Section: Discussionmentioning

confidence: 90%

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients

Vitacca

Paneroni

Bianchi

et al. 2006

European Respiratory Journal

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The present study compared four different sites and conditions for the measurement of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in 38 spontaneous breathing tracheotomised patients. Of the patients, 28 had chronic obstructive pulmonary disease (COPD).The four different conditions were: 1) through a cuff inflated cannula (condition A); 2) through the mouth with a deflated cannula (condition B); 3) through the mouth with a phonetic uncuffed cannula (condition C); and 4) through the mouth after stoma closure (condition D). Five trials in each condition were performed using a standardised method.The measurement of both MIP and MEP differed significantly depending on the condition of measurement. MIP taken in condition A was significantly higher when compared with conditions B, C and D. MEP in condition A was significantly higher when compared with condition B and D. In condition A the highest frequency of the best measurement of MIP and MEP was observed at the fourth and fifth effort, respectively. The same results were obtained after the selection of only COPD patients.In conclusion, respiratory muscle assessment differs significantly depending on measurement condition. Measurement through inflated cannula tracheotomy yields higher values of both maximal inspiratory and maximal expiratory pressure.

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Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit

Cited by 188 publications

References 23 publications

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients

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