Normal range of values for contractility and relaxation parameters of inspiratory muscles in healthy children: An exploratory study

Lira, Maria; Fregonezi, Guilherme; Marcelino, Ana Aline; Sarmento, António; Resqueti, Vanessa

doi:10.1002/ppul.24779

Cited by 1 publication

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“…Definitions based on ΔPaw twitch obtained after maximal magnetic stimulation have been proposed in adults [ 10 , 20 , 21 , 25 , 36 ], but this method is challenging in infants and thus most pediatric studies of diaphragm strength are based on variables comparable to ΔPaw max described here. In a recent study aiming to define normal value ranges in non-intubated healthy children aged 6–11 years old, maximum inspiratory pressure was 85 ± 30 cmH 2 O [ 51 ]. In 22 infants and children, ΔPaw max was 31 cmH 2 O after 4.4 days of MV [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Evolution of inspiratory muscle function in children during mechanical ventilation

et al. 2021

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Background There is no universally accepted method to assess the pressure-generating capacity of inspiratory muscles in children on mechanical ventilation (MV), and no study describing its evolution over time in this population. Methods In this prospective observational study, we have assessed the function of the inspiratory muscles in children on various modes of MV. During brief airway occlusion maneuvers, we simultaneously recorded airway pressure depression at the endotracheal tube (ΔPaw, force generation) and electrical activity of the diaphragm (EAdi, central respiratory drive) over five consecutive inspiratory efforts. The neuro-mechanical efficiency ratio (NME, ΔPaw/EAdimax) was also computed. The evolution over time of these indices in a group of children in the pediatric intensive care unit (PICU) was primarily described. As a secondary objective, we compared these values to those measured in a group of children in the operating room (OR). Results In the PICU group, although median NMEoccl decreased over time during MV (regression coefficient − 0.016, p = 0.03), maximum ΔPawmax remained unchanged (regression coefficient 0.109, p = 0.50). Median NMEoccl at the first measurement in the PICU group (after 21 h of MV) was significantly lower than at the only measurement in the OR group (1.8 cmH2O/µV, Q1–Q3 1.3–2.4 vs. 3.7 cmH2O/µV, Q1–Q3 3.5–4.2; p = 0.015). Maximum ΔPawmax in the PICU group was, however, not significantly different from the OR group (35.1 cmH2O, Q1–Q3 21–58 vs. 31.3 cmH2O, Q1–Q3 28.5–35.5; p = 0.982). Conclusions The function of inspiratory muscles can be monitored at the bedside of children on MV using brief airway occlusions. Inspiratory muscle efficiency was significantly lower in critically ill children than in children undergoing elective surgery, and it decreased over time during MV in critically ill children. This suggests that both critical illness and MV may have an impact on inspiratory muscle efficiency.

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