Muscle Impairment in Neuromuscular Disease Using an Expiratory/Inspiratory Pressure Ratio

Fregonezi, Guilherme; Azevedo, Ingrid Guerra; Resqueti, Vanessa; Andrade, Arméle Dornelas de; Gualdi, Lucien Peroni; Aliverti, Andréa; Dourado-Junior, Mário Et; Parreira, VF

doi:10.4187/respcare.03367

Cited by 21 publications

(18 citation statements)

References 13 publications

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“…In contrast, in the control group, MEP decreased to a greater extent than MIP did, after 8 weeks. This result coincides with findings obtained by a previous study, which reported that expiratory muscle strength decreases to a greater extent than inspiratory muscle strength in patients with NMD4, 13 ) .…”

Section: Discussionsupporting

confidence: 93%

“…MEP in MEP/MIP was reported to be greater than MIP in both the healthy control group and patients with NMD13 ) . In this study, MEP in MEP/MIP was also greater than MIP in both the experimental and control groups.…”

Section: Discussionmentioning

confidence: 96%

“…According to a study that investigated the correlation between cough capacity and respiratory muscle strength in patients with NMD, cough capacity is highly correlated with MIP and MEP13 ) . However, the degree of correlation between cough capacity and respiratory muscle strength varies as each disease exerts different influences on respiratory muscle weakness4 ) .…”

Section: Discussionmentioning

confidence: 99%

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The correlation of respiratory muscle strength and cough capacity in stroke patients

Kim

2016

J Phys Ther Sci

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[Purpose] The purpose of this study was to investigate the correlation between respiratory muscle strength and cough capacity in stroke patients. [Subjects and Methods] Forty-two stroke patients were assigned to 2 different groups (intervention group=21, control group=21). Both groups participated in a conventional stroke rehabilitation program, with the intervention group also receiving respiratory muscle training for 20 to 30 minutes a day, 3 times a week for 8 weeks. Respiratory muscle strength (maximal inspiratory pressure, maximal expiratory pressure), forced vital capacity, and cough capacity were measured. [Results] The intervention group showed significant increases in maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, and cough capacity. The change in maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity showed a significant correlation with cough capacity, with maximal expiratory pressure showing the highest correlation. [Conclusion] The present study showed that the increase in maximal expiratory pressure plays an important role in improving the cough capacity of stroke patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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The correlation of respiratory muscle strength and cough capacity in stroke patients

Kim

2016

J Phys Ther Sci

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“…The measurement of MIP and MEP is quick, non-invasive, and normal values have been established 5 . A recent study showed higher MEP values in comparison to MIP in patients with neuromuscular diseases; in this work, the MEP/MIP ratio was 1.33 ± 0.62 in patients with ALS and differed from those observed in other neuromuscular conditions 4 .…”

mentioning

confidence: 42%

“…furthermore, some ALS patients have significant upper motor neuron dysfunction, while others have little 4 . Severe weakness leads to breathlessness and ventilatory failure.…”

mentioning

confidence: 99%

Current issues in the respiratory care of patients with amyotrophic lateral sclerosis

Orsini

Lopes

Menezes

et al. 2015

Arq. Neuro-Psiquiatr.

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SHORT OVERVIEW OF ALSAmyotrophic lateral sclerosis (ALS) is characterized by progressive degeneration of both cortical and alpha motor neurons of the final common pathway. Despite being a progressive degenerative process which primarily affects motor systems, ALS is now recognized to involve several non-motor systems and in long survivors affects many subcortical structures. Many hypotheses have been formulated about what causes ALS, including chemical exposures, occupational exposure, military service, infectious agents, nutritional intake, physical activity, and trauma. Worldwide, ALS affects white males aged > 60 years more often than any other group 1 . In the past three decades new practice parameters to the clinical care in ALS were developed and several clinical trials were performed². As ALS remains as an incurable, progressive and fatal condition, the treatment strategies are focused in improving the quality of life 3 . The only effective pharmacological treatment is Riluzole, a putative glutamate release blocker linked to modestly prolonged survival 2 . Other therapeutic measures concerning respiratory support are outlined in this paper. PULMONARY FUNCTION IN ALS Respiratory muscle strengthProgressive weakness remains the foremost characteristic of ALS. However, while some ALS patients progress rapidly, others have slow progression of muscle weakness; ABSTRACTAmyotrophic lateral sclerosis is a progressive neuromuscular disease, resulting in respiratory muscle weakness, reduced pulmonary volumes, ineffective cough, secretion retention, and respiratory failure. Measures as vital capacity, maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressure, cough peak flow and pulse oximetry are recommended to monitor the respiratory function. The patients should be followed up by a multidisciplinary team, focused in improving the quality of life and deal with the respiratory symptoms. The respiratory care approach includes airway clearance techniques, mechanically assisted cough and noninvasive mechanical ventilation. Vaccination and respiratory pharmacological support are also recommended. To date, there is no enough evidence supporting the inspiratory muscle training and diaphragmatic pacing.Keywords: amyotrophic lateral sclerosis, respiratory function, rehabilitation. RESUMOEsclerose lateral amiotrófica é uma doença neuromuscular progressiva que resulta em fraqueza muscular, redução dos volumes pulmonares, tosse ineficaz, retenção de secreção e insuficiência respiratória. Medidas como a capacidade vital, pressão inspiratória e pressão expiratória máximas, pressão inspiratória máxima nasal, pico de fluxo de tosse e oximetria de pulso são recomendados para monitorar a função respiratória. Os pacientes devem ser acompanhados por uma equipe multidisciplinar, buscando melhorias na qualidade de vida e melhores estratégias para lidar com os sintomas respiratórios. A abordagem de cuidados respiratórios inclui técnicas de desobstrução das vias respiratórias, tosse assistida mecanicamente e ventilaç...

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Expiratory muscle dysfunction in critically ill patients: towards improved understanding

et al. 2019

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Introduction This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists. Results The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound. Conclusion The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.

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Muscle Impairment in Neuromuscular Disease Using an Expiratory/Inspiratory Pressure Ratio

Cited by 21 publications

References 13 publications

The correlation of respiratory muscle strength and cough capacity in stroke patients

The correlation of respiratory muscle strength and cough capacity in stroke patients

Current issues in the respiratory care of patients with amyotrophic lateral sclerosis

Expiratory muscle dysfunction in critically ill patients: towards improved understanding

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