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Valderrama P, Carugati R, Sardella A, Flórez S, de Carlos Back I, Fernández C, Abella IT, Grullón A, Ribeiro Turquetto AL, Fajardo A, Chiesa P, Cifra B, Garcia-Cuenllas L, Honicky M, Augustemak De Lima LR, Franco Moreno YM, Salinas ME, de Carvalho T, Hülle Catani L, Huertas-Quiñones M, Yáñez-Gutiérrez L. 2024 SIAC guidelines on cardiorespiratory rehabilitation in pediatric patients with congenital heart disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:680-689. [PMID: 38750931 DOI: 10.1016/j.rec.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 05/31/2024]
Abstract
The 2024 Interamerican Society of Cardiology (SIAC) guidelines on cardiorespiratory rehabilitation (CRR) in pediatric patients with congenital heart disease aim to gather and evaluate all relevant evidence available on the topic to unify criteria and promote the implementation of CRR programs in this population in Latin America and other parts of the world. Currently, there is no unified CRR model for the pediatric population. Consequently, our goal was to create these CRR guidelines adapted to the characteristics of congenital heart disease and the physiology of this population, as well as to the realities of Latin America. These guidelines are designed to serve as a support for health care workers involved in the care of this patient group who wish to implement a CRR program in their workplace. The guidelines include an easily reproducible program model that can be implemented in any center. The members of this Task Force were selected by the SIAC on behalf of health care workers dedicated to the care of pediatric patients with congenital heart disease. To draft the document, the selected experts performed a thorough review of the published evidence.
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Affiliation(s)
- Paulo Valderrama
- Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile.
| | - Romina Carugati
- División de Cardiología, Hospital de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Angela Sardella
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Sandra Flórez
- Servicio de Cardiología Pediátrica, Clínica Medical Duarte, Cúcuta, Colombia
| | | | - Carlos Fernández
- Centro Cardiovascular Pediátrico, Clínica Santa María, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Inés T Abella
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Angelica Grullón
- Departamento de Cardiología Pediátrica, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, República Dominicana
| | - Aida Luiza Ribeiro Turquetto
- Unidade de Cirurgia Cardíaca Pediátrica, Instituto de Coração, Hospital de Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Astrid Fajardo
- Departamento de Medicina Física y Rehabilitación, División de Rehabilitación Cardiaca, Fundación Cardio Infantil, LaCardio, Bogotá, Colombia
| | - Pedro Chiesa
- Facultad de Medicina, Centro Hospitalario Pereira Rossell, Instituto de Cardiología Integral, Montevideo, Uruguay
| | - Barbara Cifra
- Department of Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Luisa Garcia-Cuenllas
- Servicio de Pediatría, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Michele Honicky
- Programa de Pós-Graduação em Nutrição, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Yara María Franco Moreno
- Servicio de Pediatría, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - María Eugenia Salinas
- Instituto de Educação Física e Desporto da Universidade Federal de Alagoas, Maceio, Brazil
| | | | - Liane Hülle Catani
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Estatal de Santa Catarina, Florianópolis, Brazil
| | - Manuel Huertas-Quiñones
- Clínica Ambulatória de Medicina Esportiva para Crianças e Adolescentes, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucelli Yáñez-Gutiérrez
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología. Departamento de Pediatría, Universidad Nacional de Colombia y Universidad del Rosario, Bogotá, Colombia; Servicio de Cardiopatías Congénitas, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
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Deiwert DD, Dykstra B, Guilkey JP, Heidorn CE, Erichsen J, Kuszmaul D, Mahon AD. Oxygen uptake efficiency slope in 8- to 12-year-old boys and girls. J Sports Med Phys Fitness 2024; 64:624-630. [PMID: 38916085 DOI: 10.23736/s0022-4707.24.15597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Oxygen uptake efficiency slope (OUES) is an objective physiological measure that can be obtained from a standard graded exercise test. However, there is conflicting evidence regarding sex differences in OUES values in children. Therefore, this study investigated potential sex differences in absolute, ratio-scaled, and allometrically scaled OUES in 8.0- to 12.0-year-old children. METHODS Retrospective and prospective data of 18 boys and 22 girls were utilized. All participants had undergone familiarization before performing a maximal cycle ergometer test to determine OUES. These values were also ratio-scaled and allometrically scaled to mass and body surface area (BSA). Group differences were tested via independent sample t-tests (or Mann-Whitney U if not normally distributed). RESULTS Absolute OUES values (VO2 mL∙min-1/log10VE L∙min-1) were significantly higher in boys compared to girls (1860.8±359.3 vs. 1514.3±212.6). When scaled to mass (VO2 mL∙kg-1∙min-1/log10VE L∙kg-1∙min-1), OUES was no longer significantly different between groups, but when scaled to BSA (VO2 mL∙m-2∙min-1/log10VE L∙m-2∙min-1), OUES was significantly higher in the boys than the girls (1414.4±204.2 vs. 1268.9±134.6). When allometry was applied for mass (OUES/mass0.444) boys had significantly higher value than girls (350.8±46.7 vs. 305.0±31.5). CONCLUSIONS The present study demonstrated that boys had greater OUES values scaled to BSA and allometrically scaled to body mass. These findings provide further evidence of sex differences with OUES values in preadolescent children and implies the need for sex-specific reference values prior to using OUES for the assessment of cardiorespiratory pathology in children.
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Affiliation(s)
- Donald D Deiwert
- Department of Kinesiology, Indiana University Indianapolis, Indianapolis, IN, USA -
- Department of Kinesiology, Laboratory of Human Performance, Ball State University, Muncie, IN, USA -
| | - Brandon Dykstra
- Department of Kinesiology, Laboratory of Human Performance, Ball State University, Muncie, IN, USA
| | - Justin P Guilkey
- Department of Kinesiology, Laboratory of Human Performance, Ball State University, Muncie, IN, USA
| | - C Eric Heidorn
- Department of Kinesiology, Laboratory of Human Performance, Ball State University, Muncie, IN, USA
| | - Jennifer Erichsen
- Department of Kinesiology, Laboratory of Human Performance, Ball State University, Muncie, IN, USA
| | - Dillon Kuszmaul
- Department of Kinesiology, Laboratory of Human Performance, Ball State University, Muncie, IN, USA
| | - Anthony D Mahon
- Department of Kinesiology, Laboratory of Human Performance, Ball State University, Muncie, IN, USA
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Kuo FH, Elliott RA, Watkins SC, Shieh HF, Smithers CJ, Jennings RW, Munoz-San Julian C. Negative pressure suction test: An intraoperative airway maneuver to assess effectiveness of surgical correction of tracheobronchomalacia. Paediatr Anaesth 2024; 34:289-292. [PMID: 38130114 DOI: 10.1111/pan.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/15/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Surgical correction of tracheobronchomalacia (TBM) has evolved greatly over the past decade, with select pediatric institutions establishing dedicated surgery and anesthesia teams to navigate the complexities and challenges of surgical airway repairs. Although anesthetic techniques have evolved internally over many years to improve patient safety and outcomes, many of these methods remain undescribed in literature. TECHNIQUE In this article, we describe the intraoperative negative pressure suction test. This simulates the negative pressure seen in awake and spontaneously breathing patients, including the higher pressures seen during coughing which induce airway collapse in patients with TBM. Also known as the Munoz maneuver in surgical literature, this test has been performed on over 300 patients since 2015. DISCUSSION The negative pressure suction test allows for controlled intraoperative assessment of surgical airway repairs, replaces the need for risky intraoperative wake-up tests, increases the chances of a successful surgical repair, and improves anesthetic management for emergence and extubation. We provide a guide on how to perform the test and videos demonstrating its efficacy in intraoperative airway evaluation. CONCLUSIONS As surgeries to repair TBM become more prevalent in other pediatric institutions, we believe that pediatric patients and anesthesia providers will benefit from the insights and methods described here.
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Affiliation(s)
- Frederick H Kuo
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Richard A Elliott
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Scott C Watkins
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Charles J Smithers
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Russell W Jennings
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Carlos Munoz-San Julian
- Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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Manzak Dursun AS, Ozyilmaz S, Ucgun H, Elmadag NM. The effect of Pilates-based exercise applied with hybrid telerehabilitation method in children with adolescent idiopathic scoliosis: A randomized clinical trial. Eur J Pediatr 2024; 183:759-767. [PMID: 37993666 DOI: 10.1007/s00431-023-05340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
This study aimed to investigate the effect of Pilates-based exercise training applied with hybrid telerehabilitation on Cobb angle, respiratory function, respiratory muscle strength, and functional capacity in patients with adolescent idiopathic scoliosis (AIS). This is an evaluator-blinded, randomized, controlled trial. For the study, 32 patients were randomly allocated into two groups: a hybrid telerehabilitation group (training group), provided with modified Pilates-based exercises with synchronous sessions; and a home-based group (control group), doing the same exercises in their home. The Pilates-based exercise program consists of stretching and strengthening exercises combined with postural corrections and breathing exercises modified according to the curve type and localization of the patients, done every day of the week for 12 weeks. Analyses were made based on the comparison between the angle of trunk rotation, Cobb angle, spirometry, maximal inspiratory (MIP) and expiratory pressures (MEP), and incremental shuttle walk tests done at the beginning and end of the study. The training group showed statistically significant improvements in Cobb angle, PEF%, MIP, and MEP values compared with the control group (p < 0.05). CONCLUSION Pilates-based exercises applied with the hybrid telerehabilitation method can improve Cobb angle and respiratory muscle strength in patients with AIS. The hybrid telerehabilitation method can be used as an alternative to home-based programs, especially in locations and times where there may be limited access to supervised training. Also, the nature of the disease that requires long-term follow-up is another factor where hybrid telerehabilitation may be an advantage. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05761236. WHAT IS KNOWN • Exercise training is one of the main approaches to treating scoliosis. WHAT IS NEW • Application of exercises via telerehabilitation method may contribute more to the improvement of scoliosis-related parameters than home-based programs. • Telerehabilitation may be a preferable alternative exercise method in scoliosis, considering the advantages of accessibility and long-term follow-up.
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Affiliation(s)
- Ayse Sena Manzak Dursun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, 34050, Istanbul, Turkey
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Semiramis Ozyilmaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, 34050, Istanbul, Turkey.
| | - Hikmet Ucgun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Nuh Mehmet Elmadag
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Pradi N, Rocha Vieira DS, Ramalho O, Lemes ÍR, Cordeiro EC, Arpini M, Hulzebos E, Lanza F, Montemezzo D. Normal values for maximal respiratory pressures in children and adolescents: A systematic review with meta-analysis. Braz J Phys Ther 2024; 28:100587. [PMID: 38277805 PMCID: PMC10839618 DOI: 10.1016/j.bjpt.2023.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND The non-invasive assessment of maximal respiratory pressures (MRP) reflects the strength of the respiratory muscles. OBJECTIVE To evaluate the studies which have established normative values for MRP in healthy children and adolescents and to synthesize these values through a meta-analysis. METHODS The searches were conducted until October 2023 in the following databases: ScienceDirect, MEDLINE, CINAHL, SciELO, and Web of Science. Articles that determined normative values and/or reference equations for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in children and adolescents published in English, Portuguese, or Spanish regardless of the year of publication were included. Two reviewers selected titles and abstracts, in case of conflict, a third reviewer was consulted. Articles that presented sufficient data were included to conduct the meta-analysis. RESULTS Initially, 252 studies were identified, 28 studies were included in the systematic review and 19 in the meta-analysis. The sample consisted of 5798 individuals, and the MIP and MEP values were stratified by sex and age groups of 4-11 and 12-19 years. Values from females 4-11 years were: 65.8 cmH2O for MIP and 72.8 cmH2O for MEP, and for males, 75.4 cmH2O for MIP and 84.0 cmH2O for MEP. In the 12-19 age group, values for females were 82.1 cmH2O for MIP and 90.0 cmH2O for MEP, and for males, they were 95.0 cmH2O for MIP and 105.7 cmH2O for MEP. CONCLUSIONS This meta-analysis suggests normative values for MIP and MEP in children and adolescents based on 19 studies.
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Affiliation(s)
- Nicole Pradi
- Graduate Program in Physical Therapy, Department of Physical Therapy, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Danielle Soares Rocha Vieira
- Graduate Program in Rehabilitation Sciences, Department of Health Sciences, Universidade Federal de Santa Catarina (UFSC), Araranguá, SC, Brazil
| | - Olívia Ramalho
- Graduate Program in Physical Therapy, Department of Physical Therapy, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Ítalo Ribeiro Lemes
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
| | - Emanuella Cristina Cordeiro
- Graduate Program in Physical Therapy, Department of Physical Therapy, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Maiqueli Arpini
- Graduate Program in Rehabilitation Sciences, Department of Health Sciences, Universidade Federal de Santa Catarina (UFSC), Araranguá, SC, Brazil
| | - Erik Hulzebos
- University Medical Center Utrecht, Department of Child Development and Exercise Center, the Netherlands
| | - Fernanda Lanza
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Dayane Montemezzo
- Graduate Program in Physical Therapy, Department of Physical Therapy, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil.
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Mucha FC, Gonçalves Wamosy RM, Scalco JC, Almeida ACDS, Itaborahy BDH, Cardoso J, Mayer AF, Santos Schivinski CI. Comparison of the modified shuttle walk test in children with cystic fibrosis and healthy controls. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2052. [PMID: 37818756 DOI: 10.1002/pri.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls. METHODS A cross-sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann-Whitney and independent t-tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation. RESULTS Sixty-two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure. CONCLUSIONS There was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG.
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Affiliation(s)
- Francieli Camila Mucha
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Renata Maba Gonçalves Wamosy
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Janaina Cristina Scalco
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Ana Carolina da Silva Almeida
- Physiotherapy, Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Juliana Cardoso
- Physiotherapy, Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Anamaria Fleig Mayer
- Undergraduate and Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Undergraduate and Graduate Program in Human Movement Sciences, Center for Health and Sports Sciences, University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Camila Isabel Santos Schivinski
- Undergraduate and Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Kant-Smits K, Hulzebos EHJ, Habets LE, Asselman FL, Veldhoen ES, van Eijk RPA, de Groot JF, van der Pol WL, Bartels B. Respiratory muscle fatigability in patients with spinal muscular atrophy. Pediatr Pulmonol 2022; 57:3050-3059. [PMID: 36039838 PMCID: PMC9826393 DOI: 10.1002/ppul.26133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Respiratory failure is a major cause of morbidity and mortality in patients with Spinal Muscular Atrophy (SMA). Lack of endurance, or "fatigability," is an important symptom of SMA. In addition to respiratory muscle weakness, respiratory function in SMA may be affected by Respiratory Muscle Fatigability (RMF). AIM The purpose of this study was to explore RMF in patients with SMA. METHODS We assessed a Respiratory Endurance Test (RET) in 19 children (median age [years]: 11) and 36 adults (median age [years]: 34) with SMA types 2 and 3. Participants were instructed to breath against an inspiratory threshold load at either 20%, 35%, 45%, 55%, or 70% of their individual maximal inspiratory mouth pressure (PImax). RMF was defined as the inability to complete 60 consecutive breaths. Respiratory fatigability response was determined by change in maximal inspiratory mouth pressure (ΔPImax) and perceived fatigue (∆perceived fatigue). RESULTS The probability of RMF during the RET increased by 59%-69% over 60 breaths with every 10% increase in inspiratory threshold load (%PImax). Fatigability response was characterized by a large variability in ΔPImax (-21% to +16%) and a small increase in perceived fatigue (p = 0.041, range 0 to +3). CONCLUSION AND KEY FINDINGS Patients with SMA demonstrate a dose-dependent increase in RMF without severe increase in exercise-induced muscle weakness or perceived fatigue. Inspiratory muscle loading in patients with SMA seems feasible and its potential to stabilize or improve respiratory function in patients with SMA needs to be determined in further research.
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Affiliation(s)
- Kim Kant-Smits
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik H J Hulzebos
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura E Habets
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fay-Lynn Asselman
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatric Intensive Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- University Medical Center Utrecht, Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands and University Medical Center Utrecht, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Janke F de Groot
- Research Group Lifestyle and Health, HU University of Applied Health Sciences Utrecht, Utrecht, The Netherlands
| | - W Ludo van der Pol
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Dirks S, Kramer P, Schleiger A, Speck HM, Wolfarth B, Thouet T, Berger F, Sallmon H, Ovroutski S. Home-Based Long-Term Physical Endurance and Inspiratory Muscle Training for Children and Adults With Fontan Circulation—Initial Results From a Prospective Study. Front Cardiovasc Med 2022; 8:784648. [PMID: 35198605 PMCID: PMC8858796 DOI: 10.3389/fcvm.2021.784648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with congenital heart disease (CHD)—including those after Fontan operation—are encouraged to be physically active.AimTo prospectively determine the effects of an individually adapted, home-based cycle ergometer endurance training in combination with inspiratory muscle training (IMT) in pediatric and adult Fontan patients. We, herein, report the results of the initial 10-months follow-up (phase 1).Methods18 patients (median age 16.5 years; range 10-43 years) completed baseline check-ups, and 4 and 10 months follow-up visits, which each included cardiopulmonary exercise testing (CPET), bodyplethysmography (including measurement of respiratory muscle strength), and a quality of life questionnaire (PedsQL™). The training program consisted of a home-based cycle ergometer endurance training on a “Magbike® AM-5i/3i” (DKN Technology®, Clermont-Ferrand, France) and IMT with a handheld “POWERbreathe® Medic plus” device. Patients performed 90 min of endurance training per week in addition to IMT (30 breaths per day, 6-7 times per week). After the first 4 months, patients underwent additional interval training.ResultsAfter 10 months of training, we observed significant increases in maximum relative workload (W/kg, p = 0.003) and in maximum inspiratory (MIP, p = 0.002) and expiratory (MEP, p = 0.008) pressures. Peak VO2 values did not increase significantly as compared to baseline (p = 0.12) in the entire cohort (n = 18), but reached statistical significance in a subgroup analysis of teenage/adult patients (n = 14; p = 0.03). Patients' subjective quality of life did not show any significant changes after 10 months of training.DiscussionIn Fontan patients, an individually adapted home-based training is safe and associated with improvements in some CPET variables. However, these improvements did not translate into an improved QoL after 10 months. With an unclear, but most likely negative, impact of the COVID-19 pandemic, improvements in QoL may become evident during further follow-up (phase 2 of the study).
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Affiliation(s)
- Stefan Dirks
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Peter Kramer
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Anastasia Schleiger
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Hans-Martin Speck
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Thouet
- Department of Sports Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Pediatric Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Hannes Sallmon
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Pediatric Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- *Correspondence: Stanislav Ovroutski
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Effects of core stabilization exercises on pulmonary function, respiratory muscle strength, peripheral muscle strength, functional capacity and perceived appearance in children with adolescent idiopathic scoliosis. Am J Phys Med Rehabil 2022; 101:719-725. [DOI: 10.1097/phm.0000000000001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Schivinski CIS, Wamosy RMG, Parazzi PLF, Morcillo AM. Distribuição padrão e percentuais dos valores de pressão respiratória máxima de crianças saudáveis de 7 a 10 anos de idade. REVISTA PAULISTA DE PEDIATRIA 2022. [DOI: 10.1590/1984-0462/2022/40/2021007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Objetivo: Apresentar distribuição normal para os valores das pressões respiratórias máximas de escolares saudáveis, de acordo com o gênero. Métodos: Estudo transversal envolvendo crianças saudáveis de 7 a 10 anos. Foram avaliados os dados de massa corporal e estatura, para o cálculo do índice de massa corporal (IMC). Os valores de volume expiratório forçado no primeiro segundo (VEF1) e pressão expiratória máxima foram avaliados de acordo com a American Thoracic Society. Os dados de pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) obtidos no estudo deram origem à distribuição normal, cuja construção foi elaborada pelo método the Lambda-Mu-Sigma (LMS), bem como os percentis 3, 10, 25, 50, 75, 90 e 97 de PImáx e PImáx de cada sexo. Resultados: Os dados de PImáx e PImáx foram coletados de 399 escolares. Todos os escolares da amostra apresentavam VEF1 e índice de massa corporal adequados. O estudo mostrou aumento dos valores de pressão respiratória com o avançar da idade. Os valores de PImáx e PImáx das meninas foram de 53,49±11,07 e 61,80±12,51cmH2O, respectivamente; e os meninos de 59,96±13,66 e 69,68±15,72 cmH2O, respectivamente. Conclusões: Foram desenvolvidas curvas e percentis normais para os valores de PImáx e PImáx de escolares saudáveis o que poderia auxiliar no acompanhamento clínico e terapêutico de diferentes populações pediátricas.
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Schivinski CIS, Wamosy RMG, Parazzi PLF, Morcillo AM. Standard reference and percentiles of maximum respiratory pressures values of healthy children aged 7–10 years. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2021007. [PMID: 35648985 PMCID: PMC9150902 DOI: 10.1590/1984-0462/2022/40/2021007in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/29/2021] [Indexed: 11/25/2022]
Abstract
Objective: This study aims to present standard reference for values of maximum respiratory pressures of healthy schoolchildren, according to gender. Methods: This is a cross-sectional study involving healthy children aged 7–10 years. Data of body mass and height were evaluated to calculate body mass index (BMI). In addition, forced expiratory volume in 1 second (FEV1) and maximal expiratory pressure values were evaluated according to the American Thoracic Society. The maximal inspiratory pressure (MIP) and data of maximal expiratory pressure (MEP) obtained in the study showed normal distribution and curves were built by the Lambda–Mu–Sigma (LMS) method, as well as the values of MIP and MEP percentiles 3, 10, 25, 50, 75, 90, and 97 for each gender. Results: MIP and MEP data were collected from 399 schoolchildren. All schoolchildren in the sample had adequate FEV1 and BMI. The study showed an increase in respiratory pressure values with age progression. The MIP and MEP values of girls were of 53.4±11.0 and 61.8±12.5cmH2O, respectively, and those of boys were 59.9±13.6 and 69.6±15.7cmH2O, respectively. Conclusions: Normal curves and percentiles were developed for MIP and MEP values of healthy schoolchildren. The extreme percentiles (3rd and 97th) were determined, and a specific graph was elaborated for each group. These graphs may help clinical follow-up and therapeutic monitoring of different pediatric populations.
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12
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Pawar S, Narayan A, Karnad SD, Alaparthi GK, Bairapareddy KC. Respiratory Muscle Strength in Healthy Indian Children of Age 7-17 Years: A Cross-Sectional Study. Int J Gen Med 2021; 14:4413-4422. [PMID: 34408480 PMCID: PMC8366788 DOI: 10.2147/ijgm.s315626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose As the values of respiratory muscle strength vary according to race, ethnicity, and geographical area, there is a wide-ranging difference among different populations. Thus, the available reference values may not have an application for use in the Indian paediatric population, creating a need for generating values which will be appropriate for the Indian paediatric context. Materials and Methods Assessment of respiratory muscle strength was carried out by assessing maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and synthesising predictive formulas using anthropometric variables like height, gender and age, which will be suitable for Indian children. Results We calculated MIP and MEP of 320 (boys=160 and girls= 160) children in the age range of 7 years to 17 years of Mangaluru city, India. Results stated that mean MIP and MEP for boys were 72.5±32.8 cm H2O and 73±33.2 cm H2O, while for the girls it was 67±30.2 cm H2O and 68±30.1 cm H2O, respectively. Conclusion This study concluded that there is a difference in respiratory pressure values of Indian children with respect to those of other countries. Age, gender, height and BMI have a significant role in determining respiratory muscle strength. Boys demonstrated higher MIP and MEP. As age, height, weight and BMI increases, so does MIP and MEP.
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Affiliation(s)
- Saloni Pawar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Amitesh Narayan
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shreekanth D Karnad
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Assessment of Dysphonia in Children with Pompe Disease Using Auditory-Perceptual and Acoustic/Physiologic Methods. J Clin Med 2021; 10:jcm10163617. [PMID: 34441913 PMCID: PMC8396833 DOI: 10.3390/jcm10163617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Bulbar and respiratory weakness occur commonly in children with Pompe disease and frequently lead to dysarthria. However, changes in vocal quality associated with this motor speech disorder are poorly described. The goal of this study was to characterize the vocal function of children with Pompe disease using auditory-perceptual and physiologic/acoustic methods. High-quality voice recordings were collected from 21 children with Pompe disease. The Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale was used to assess voice quality and ratings were compared to physiologic/acoustic measurements collected during sustained phonation tasks, reading of a standard passage, and repetition of a short phrase at maximal volume. Based on ratings of grade, dysphonia was present in 90% of participants and was most commonly rated as mild or moderate in severity. Duration of sustained phonation tasks was reduced and shimmer was increased in comparison to published reference values for children without dysphonia. Specific measures of loudness were found to have statistically significant relationships with perceptual ratings of grade, breathiness, asthenia, and strain. Our data suggest that dysphonia is common in children with Pompe disease and primarily reflects impairments in respiratory and laryngeal function; however, the primary cause of dysphonia remains unclear. Future studies should seek to quantify the relative contribution of deficits in individual speech subsystems on voice quality and motor speech performance more broadly.
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Boonjindasup W, Chang AB, Marchant JM, Irons JY, McElrea MS. How Many Maneuvers Should We Do for Maximal Inspiratory and Expiratory Muscle Pressure Testing in Children: A Retrospective Review in Children with Cystic Fibrosis. Lung 2021; 199:213-222. [PMID: 33590270 DOI: 10.1007/s00408-021-00422-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) could be useful clinical parameters in monitoring many conditions including cystic fibrosis (CF). However, current protocols for undertaking the measurements lack standardization including the number of repeated attempts to achieve best values. We aimed to (a) determine the optimum number of attempts to achieve best MIP/MEP values, and (b) evaluate if the number of attempts is consistent across two different test days. METHODS We analyzed data of a previous randomized controlled trial involving the effect of singing on respiratory muscle strength in 35 children with CF. On two different days (T1, T2) children performed MIP/MEP with at least ten attempts each to achieve < 10% repeatability. RESULTS All children achieved repeatable MIP/MEP values within 10-11 attempts with 24 (68.6%) and 26 (74.3%) of these achieving best values of MIP and MEP, respectively, at attempts 6-11. Median values of the pressures by three, five, eight and all attempts significantly increased with more attempts (all p < 0.05). At T2, 56% required fewer attempts to achieve best values, but 32% required more attempts, indicating that the number of attempts required was inconsistent between test days. CONCLUSION It is likely that at least ten attempts (best two within < 10% variability) is required to achieve best and reliable MIP/MEP in children with CF. A larger sample size in children with CF and various conditions is required to consolidate these findings.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. .,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia. .,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Cough, Asthma & Airways Research Group, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - J Yoon Irons
- Health and Social Care Research Centre, University of Derby, Derby, UK
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
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Turquetto ALR, Dos Santos MR, Agostinho DR, Sayegh ALC, de Souza FR, Amato LP, Barnabe MSR, de Oliveira PA, Liberato G, Binotto MA, Negrão CE, Canêo LF, Trindade E, Jatene FB, Jatene MB. Aerobic exercise and inspiratory muscle training increase functional capacity in patients with univentricular physiology after Fontan operation: A randomized controlled trial. Int J Cardiol 2021; 330:50-58. [PMID: 33571562 DOI: 10.1016/j.ijcard.2021.01.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/02/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effect of exercise training and its mechanisms on the functional capacity improvement in Fontan patients (FP) are virtually unknown. This trial evaluated four-month aerobic exercise training and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation. METHODS A randomized controlled clinical trial with 42 FP aged 12 to 30 years and, at least, five years of Fontan completion. Twenty-seven were referred to a four-months supervised and personalized aerobic exercise training (AET) or an inspiratory muscle training (IMT). A group of non-exercise (NET) was used as control. The effects of the exercise training in peak VO2; pulmonary volumes and capacities, maximal inspiratory pressure (MIP); muscle sympathetic nerve activity (MSNA); forearm blood flow (FBF); handgrip strength and cross-sectional area of the thigh were analyzed. RESULTS The AET decreased MSNA (p = 0.042), increased FBF (p = 0.012) and handgrip strength (p = 0.017). No significant changes in autonomic control were found in IMT and NET groups. Both AET and IMT increased peak VO2, but the increase was higher in the AET group compared to IMT (23% vs. 9%). No difference was found in the NET group. IMT group showed a 58% increase in MIP (p = 0.008) in forced vital capacity (p = 0.011) and forced expiratory volume in the first second (p = 0.011). No difference in pulmonary function was found in the AET group. CONCLUSIONS Both aerobic exercise and inspiratory muscle training improved functional capacity. The AET group developed autonomic control, and handgrip strength, and the IMT increased inspiratory muscle strength and spirometry. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02283255.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gabriela Liberato
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Carlos Eduardo Negrão
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil; School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Evelinda Trindade
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
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Spiesshoefer J, Henke C, Herkenrath S, Randerath W, Brix T, Young P, Boentert M. Assessment of Central Drive to the Diaphragm by Twitch Interpolation: Normal Values, Theoretical Considerations, and Future Directions. Respiration 2020; 98:283-293. [PMID: 31352459 DOI: 10.1159/000500726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/30/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The twitch interpolation technique is a promising tool for assessing central drive to the diaphragm. It is used to quantify the degree of voluntary diaphragm activation during predefined breathing maneuvers. OBJECTIVES This study was designed to (a) determine reference values for the level of voluntary activation of the diaphragm using the twitch occlusion technique in healthy adults and (b) explore the association between central drive to the diaphragm and volitional tests of respiratory muscle strength. METHODS Twenty-seven healthy volunteers aged 26 ± 14 years (18 male) were enrolled. Twitch transdiaphragmatic pressure (Pdi) was determined at relaxed functional residual capacity in response to cervical magnetic stimulation (CMS) of the phrenic nerves. The subjects were then instructed to gradually increase voluntary activation of the diaphragm, and the effects of superimposed magnetic stimuli on voluntary Pdi were assessed. RESULTS The twitch Pdi amplitude following CMS linearly decreased with increasing inspiratory effort. The resulting diaphragm voluntary activation index (DVAI) during maximal voluntary contraction was 75 ± 15% irrespective of gender or age. Twitch duration, half relaxation time, and area under the curve of superimposed Pdi deflections did not show a linear but an exponential association with increasing voluntary activation of the diaphragm. More than 2/3 of the decrease in the above values was evident after 1/3 of voluntary diaphragm contraction. Forced vital capacity (FVC) was inversely correlated with the DVAI. CONCLUSIONS Twitch interpolation allows for assessment of central drive to the diaphragm. The maximum DVAI is independent of gender or age, and significantly related to FVC but not to maximum inspiratory pressure or Pdi as direct measures of diaphragm strength.
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Affiliation(s)
- Jens Spiesshoefer
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Münster, Münster, Germany,
| | - Carolin Henke
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Münster, Münster, Germany
| | - Simon Herkenrath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute of Pneumology, University of Cologne, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute of Pneumology, University of Cologne, Solingen, Germany
| | - Tobias Brix
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Bad Feilnbach, Germany
| | - Matthias Boentert
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Münster, Münster, Germany
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Spiesshoefer J, Henke C, Herkenrath SD, Randerath W, Brix T, Görlich D, Young P, Boentert M. Noninvasive Prediction of Twitch Transdiaphragmatic Pressure: Insights from Spirometry, Diaphragm Ultrasound, and Phrenic Nerve Stimulation Studies. Respiration 2019; 98:301-311. [PMID: 31387103 DOI: 10.1159/000501171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Twitch transdiaphragmatic pressure (twPdi) following magnetic stimulation (MS) of the phrenic nerves is the gold standard for non-volitional assessment of diaphragm strength. Expiratory muscle function can be investigated using MS of the abdominal muscles and measurement of twitch gastric pressure (twPgas). OBJECTIVES To investigate whether twitch pressures following MS of the phrenic and lower thoracic nerve roots can be predicted noninvasively by diaphragm ultrasound parameters and volitional tests of respiratory muscle strength. METHODS Sixty-three healthy subjects underwent standard spirometry, measurement of maximum inspiratory (PImax) and expiratory pressure (PEmax), and diaphragm ultrasound. TwPdi following cervical MS of the phrenic nerve roots and twPgas after lower thoracic MS (twPgas-Thor) were measured using esophageal and gastric balloon catheters inserted transnasally. Using surface electrodes, compound muscle action potentials (CMAP) were simultaneously recorded from the diaphragm or obliquus abdominis muscles, respectively. RESULTS Forced expiratory flow (FEF25-75) was significantly correlated with twPdi (r = 0.37; p = 0.003) and its components (twPgas and twitch esophageal pressure, twPes). Diaphragm excursion velocity during tidal breathing was correlated to twPes (r = 0.44; p = 0.02). No prediction of twitch pressures was possible from CMAP amplitude, forced vital capacity (FVC), or PImax. TwPgas-Thor was correlated with FEF25-75 (r = 0.46; p = 0.05) and diaphragm thickness at total lung capacity (r = 0.38; p = 0.04) but could not be predicted from CMAP amplitude, FVC, or PEmax. CONCLUSIONS TwPdi and twPgas-Thor cannot be predicted from volitional measures of respiratory muscle strength, diaphragm and abdominal CMAP, or diaphragm ultrasound. Invasive recording of esophageal and gastric pressures following MS remains indispensable for objective assessment of respiratory muscle strength.
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Affiliation(s)
- Jens Spiesshoefer
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany,
| | - Carolin Henke
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Simon Dominik Herkenrath
- Institute for Pneumology, University of Cologne, Solingen, Germany.,Bethanien Hospital gGmbH, Solingen, Germany
| | - Winfried Randerath
- Institute for Pneumology, University of Cologne, Solingen, Germany.,Bethanien Hospital gGmbH, Solingen, Germany
| | - Tobias Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Bad Feilnbach, Germany
| | - Matthias Boentert
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
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Zhang Z, Xue Y, Li HH, Li YM. [Research advances in validity of predictors for extubation outcome in children receiving invasive mechanical ventilation]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:730-734. [PMID: 31315777 PMCID: PMC7389097 DOI: 10.7499/j.issn.1008-8830.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/25/2019] [Indexed: 06/10/2023]
Abstract
The development of invasive mechanical ventilation technology provides effective respiratory support for critically ill children. However, respiratory support is not the end of treatment as the ultimate goal is successful extubation in children. At present, some evaluation indicators before extubation including rapid shallow breathing index, maximal inspiratory pressure, and work of breathing are of high clinical value in predicting adult extubation outcome, but their evidence of evidence-based medicine is not sufficient in the field of pediatric intensive care. This paper reviews the current research on the validity of predictors for extubation outcomes in children. It shows that there is still a lack of indicators with good sensitivity and specificity for assessment before extubation in children. The studies are still in a small-sample size and single-center stage. Therefore, how to optimize evaluation before extubation and improve the success rate of extubation is the direction of joint efforts of doctors in the pediatric intensive care unit and rehabilitation medicine department.
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Affiliation(s)
- Zhen Zhang
- Pediatric Intensive Care Unit, First Hospital of Jilin University, Changchun 130021, China.
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Wagdy E, Nasef SA. The interaction of sex and body mass index on ventilatory functions in school children. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_16_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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