Analysis of expiratory muscle strength and spontaneous breathing of individuals on mechanical ventilation
a cross-sectional study
DOI:
https://doi.org/10.1590/1809-2950/17011525032018Keywords:
Abdominal Muscles, Muscle Weakness, Ventilator Weaning, Physical Therapy Modalities, Critical CareAbstract
The expiratory muscles have functions throughout the respiratory cycle, but they are not often evaluated in the weaning from mechanical ventilation. Thus, reviews and consensus do not mention the maximal expiratory pressure (MEP) and the expiratory training. The aim of this study was to investigate the relationship of expiratory muscle strength with the spontaneous breathing of individuals on mechanical ventilation. This is a cross-sectional study with participants aged between 18 and 79 years. The groups satisfactory MEP (SMEPG) and low MEP (LMEPG) were formed according to the cut-off point of 55 cmH2 O and compared to weaning parameters. The SMEPG (n=9) had better performance than LMEPG (n=21) in the rapid shallow breathing index (RSBI) (40.6±17.6 bpm/L and 75.3±44.1 bpm/L, respectively; p=0.022) and in the respiratory rate (RR) (19.1±6.2 bpm and 26.1±9.4 bpm; p=0.044). Prevalence of satisfactory MEP was low, as observed in the size of groups. In addition, although the MEP percentage of the predicted value was lower in LMEPG, as expected (67.2±15.4% vs. 45.8±14.7%; p=0.001), the percentage for maximal inspiratory pressure was not significantly different (82.4±21.8% vs. 67.8±18.4%; p=0.077). The MEP was moderately correlated with the RSBI (r=−0.406; p=0.026) and with the RR (r=−0.426; p=0.017). It was concluded that MEP≥55 cmH2 O was associated with better values in RSBI and RR and that the reduction of expiratory muscle strength was more prevalent and severe than that of inspiratory muscle strength.
Downloads
References
Abe T, Kusuhara N, Yoshimura N, Tomita T, Easton PA. Differential
respiratory activity of four abdominal muscles in humans. J Appl
Physiol. 1996;80(4):1379-89. doi: 10.1152/jappl.1996.80.4.1379
Reid WD, Dechman G. Considerations when testing and
training the respiratory muscles. Phys Ther. 1995;75(11):971-82.
doi: 10.1093/ptj/75.11.971
Kim E, Lee H. The effects of deep abdominal muscle
strengthening exercises on respiratory function and lumbar
stability. J Phys Ther Sci. 2013;25(6):663-5. doi: 10.1589/
jpts.25.663
Silva KM, Sayers BM, Sears TA, Stagg DT. The changes in
configuration of the rib cage and abdomen during breathing
in the anaesthetized cat. J Physiol. 1977;266(2):499-521.
doi: 10.1113/jphysiol.1977.sp011779
Gollee H, Hunt KJ, Fraser MH, McLean AN. Abdominal
stimulation for respiratory support in tetraplegia: a tutorial
review. J Automatic Contr. 2008;18(2):85-92. doi: 10.2298/
JAC0802085G
Cuello AF, Aquim EL, Cuello GA. Músculos ventilatórios:
biomotores da ventilação: avaliação e tratamento. São Paulo:
Andreoli; 2013.
Taylor BJ, Romer LM. Effect of expiratory muscle fatigue on
exercise tolerance and locomotor muscle fatigue in healthy
humans. J Appl Physiol. 2008;104(5):1442-51. doi: 10.1152/
japplphysiol.00428.2007
Suárez AA, Pessolano FA, Monteiro SG, Ferreyra G,
Capria ME, Mesa L, et al. Peak flow and peak cough
flow in the evaluation of expiratory muscle weakness
and bulbar impairment in patients with neuromuscular
disease. Am J Phys Med Rehabil. 2002;81(7):506-11.
doi: 10.1097/00002060-200207000-00007
McCaughey EJ, Berry HR, McLean AN, Allan DB, Gollee H.
Abdominal functional electrical stimulation to assist ventilator
weaning in acute tetraplegia: a cohort study. PLoS One.
;10(6):e0128589. doi: 10.1371/journal.pone.0128589
Boles JM, Bion J, Cannors A, Herridge M, Marsh B, Melot C,
et al. Weaning from mechanical ventilation. Eur Respir J.
;29:1033-56. doi: 10.1183/09031936.00010206
Appleton R, Kinsella J. Intensive care unit: acquired weakness.
Contin Educ Anaesth Crit Care Pain. 2012:12(2):62-6.
doi: 10.1093/bjaceaccp/mkr057
Associação de Medicina Intensiva Brasileira, Sociedade
Brasileira de Pneumologia e Tisiologia. Diretrizes brasileiras
de ventilação mecânica. São Paulo: AMIB, SBPT; 2013.
American Thoracic Society, European Respiratory Society.
ATS/ERS statement on respiratory muscle testing. Am J Respir
Crit Care Med. 2002;166(4):518-624. doi: 10.1164/rccm.166.4.518
Caruso P, Carnieli DS, Kagohara KH, Anciães A, Segarra
JS, Deheinzelin D. Trend of maximal inspiratory pressure
in mechanically ventilated patients: predictors. Clinics.
;63(1):33-8. doi: 10.1590/S1807-59322008000100007
Daniel Martin A, Smith BK, Davenport PD, Harman E,
Gonzalez-Rothi RJ, Baz M, et al. Inspiratory muscle strength
training improves weaning outcome in failure to wean patients:
a randomized trial. Crit Care. 2011;15(2):R84. doi: 10.1186/
cc10081
Condessa RL, Brauner JS, Saul AL, Baptista M, Silva ACT, Vieira
SRR. Inspiratory muscle training did not accelerate weaning
from mechanical ventilation but did improve tidal volume and
maximal respiratory pressures: a randomised trial. J Physiother.
;59(2):101-7. doi: 10.1016/S1836-9553(13)70162-0
Nemer SN, Barbas CSV. Parâmetros preditivos para o desmame
da ventilação mecânica. J Bras Pneumol. 2011;37(5):669-79.
doi: 10.1590/S1806-37132011000500016
Lai CC, Chen CM, Chiang SR, Liu WL, Weng SF, Sung MI, et al.
Establishing predictors for successfully planned endotracheal
extubation. Medicine (Baltimore). 2016;95(41):e4852.
doi: 10.1097/MD.0000000000004852
Duan J, Liu J, Xiao M, Yang X, Wu J, Zhou L. Voluntary is better
than involuntary cough peak flow for predicting re-intubation
after scheduled extubation in cooperative subjects. Respir
Care. 2014;59(11):1643-51. doi: 10.4187/respcare.03045
Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values
for lung function tests II: maximal respiratory pressures and
voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719-27.
doi: 10.1590/S0100-879X1999000600007
Hamilton VA, Grap MJ. The role of the endotracheal tube cuff
in microaspiration. Heart Lung. 2012;41(2):167-72. doi: 10.1016/j.
hrtlng.2011.09.001
Guimarães FS, Alves FF, Constantino SS, Dias CM, Menezes
SLS. Maximal inspiratory pressure evaluation among noncooperative critical patients: comparison between two
methods. Rev Bras Fisioter (São Carlos). 2007;11(3):233-8.
doi: 10.1590/S1413-35552007000300010
Truwit JD, Marini JJ. Validation of a technique to assess maximal
inspiratory pressure in poorly cooperative patients. Chest.
;102(4):1216-9. doi: 10.1378/chest.102.4.1216
Yang KL, Tobin MJ. A prospective study of indexes
predicting the outcome of trials of weaning from mechanical
ventilation. N Engl J Med. 1991;324(21):1445-50. doi: 10.1056/
NEJM199105233242101
Marini JJ, Rodriguez RM, Lamb VJ. Involuntary breath-stacking:
an alternative method for vital capacity estimation in poorly
cooperative subjects. Am Rev Respir Dis. 1986;134(4):694-8.
doi: 10.1164/arrd.1986.134.4.694
Bjelica D, Popović S, Kezunović M, Petković J, Jurak G,
Grasgruber P. Body height and its estimation utilising arm span
measurements in Montenegrin adults. Anthropol Notebooks.
;18(2):69-83.
Acute Respiratory Distress Syndrome Network. Ventilation
with lower tidal volumes as compared with traditional tidal
volumes for acute lung injury and the acute respiratory distress
syndrome. N Engl J Med. 2000;342(18):1301-8. doi: 10.1056/
NEJM200005043421801
Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues
P, Cerf C, et al. Respiratory weakness is associated with
limb weakness and delayed weaning in critical illness.
Crit Care Med. 2007;35(9):2007-15. doi: 10.1097/01.
ccm.0000281450.01881.d8
Confer J, Wolcott J, Hayes R. Critical illness polyneuromyopathy.
Am J Health Syst Pharm. 2012;69(14):1199-205. doi: 10.2146/
ajhp110343
Sugiura H, Sako S, Oshida Y. Effect of expiratory muscle fatigue
on the respiratory response during exercise. J. Phys Ther Sci.
;25(11):1491-5. doi: 10.1589/jpts.25.1491
Kim J, Davenport P, Sapienza C. Effect of expiratory muscle
strength training on elderly cough function. Arch Gerontol
Geriatr. 2009;48(3):361-6. doi: 10.1016/j.archger.2008.03.006
Liu L, Liu H, Yang Y, Huang Y, Liu S, Beck J, et al. Neuroventilatory
efficiency and extubation readiness in critically ill patients.
Crit Care. 2012;16(4):R143. doi: 10.1186/cc11451
Schellekens WJ, Van Hees HW, Doorduin J, Roesthuis LH,
Scheffer GJ, Van der Hoeven JG, et al. Strategies to optimize
respiratory muscle function in ICU patients. Crit Care.
;20(1):103. doi: 10.1186/s13054-016-1280-y
Vassilakopoulos T, Roussos C. Physiology and testing of
respiratory muscles. In: Albert R, Spiro S, Jett J, editors. Clinical
respiratory medicine. 3rd ed. Mosby Elsevier, Philadelphia:
Mosby Elsevier; 2008. p. 135-146.
Smina M, Salam A, Khamiees M, Gada P, Amoateng-Adjepong
Y, Manthous CA. Cough peak flows and extubation outcomes.
Chest. 2003;124(1):262-8. doi: 10.1378/chest.124.1.262
Hermans G, Jonghe B, Bruyninckx F, Van den Berghe G. Clinical
review: critical illness polyneuropathy and myopathy. Crit Care.
;12(6):238. doi: 10.1186/cc7100
Laghi F, Cattapan SE, Jubran A, Parthasarathy S, Warshawsky
P, Choi YSA, et al. Is weaning failure caused by low-frequency
fatigue of the diaphragm? Am J Respir Crit Care Med.
;167(2):120-7. doi: 10.1164/rccm.200210-1246OC
Hodges PW, Richardson CA. Inefficient muscular stabilization
of the lumbar spine associated with low back pain. Spine.
;21(22):2640-50. doi: 10.1097/00007632-199611150-00014
Rochester DF, Braun NMT. Determinants of maximal inspiratory
pressure in chronic obstructive pulmonary disease. Am Rev
Respir Dis. 1985;132(1):42-7. doi: 10.1164/arrd.1985.132.1.42
Gosselink R, Kovacs L, Ketelaer P, Carton H, Decramer
M. Respiratory muscle weakness and respiratory muscle
training in severely disabled multiple sclerosis patients.
Arch Phys Med Rehabil. 2000;81(6):747-51. doi: 10.1016/
S0003-9993(00)90105-9
Gounden P. Static respiratory pressures in patients with
post-traumatic tetraplegia. Spinal Cord. 1997;35(1):43-7.
doi: 10.1038/sj.sc.3100336
Zhou C, Wu L, Fenghimg N, Ji W, Wu J, Zhang H. Critical illness
polyneuropathy and myopathy: a systematic review. Neural
Regen Res. 2014;9(1):101-10. doi: 10.4103/1673-5374.125337
Tzanis G, Vasileiadis I, Zervakis D, Karatzanos E, Dimopoulos
S, Pitsolis T, et al. Maximum inspiratory pressure, a surrogate
parameter for the assessment of ICU-acquired weakness. BMC
Anesthesiology. 2011;11:14. doi: 10.1186/1471-2253-11-14
O’Neill S, McCarthy DS. Postural relief of dyspnoea in severe
chronic airflow limitation: relationship to respiratory muscle
strength. Thorax. 1983;38(8):595-600. doi: 10.1136/thx.38.8.595.
Campbell EJM, Green JH. The expiratory function of the
abdominal muscles in man: an electromyographic study. J
Physiol. 1953;120(3):409-18. doi: 10.1113/jphysiol.1953.sp004903
Larivière C, Gagnon, D, Oliveira JE Jr., Henry SM, Mecheri H,
Dumas JP. Reliability of ultrasound measures of the transversus
abdominis: effect of task and transducer position. PM R.
;5(2):104-13. doi: 10.1016/j.pmrj.2012.11.002
Hodges PW. Is there a role for transversus abdominis in
lumbo-pelvic stability? Man Ther. 1999;4(2):74-86. doi: 10.1054/
math.1999.0169
Downloads
Published
Issue
Section
License
Copyright (c) 2018 Fisioterapia e Pesquisa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.