Respiratory Muscle Weakness and Respiratory Failure in Pediatric Neuromuscular Disorders: The Value of Noninvasive Determined Tension-Time Index

2016 ◽  
Vol 47 (06) ◽  
pp. 374-379 ◽  
Author(s):  
Katharina Alfen ◽  
Christian Dohna-Schwake ◽  
Uwe Mellies ◽  
Florian Stehling
Keyword(s):  
Respiratory Failure ◽  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Neuromuscular Disorders ◽  
Respiratory Muscle Weakness ◽  
Time Index ◽  
Tension Time

Respiratory problems in neuromuscular disease

2007 ◽  
pp. 237-240
Keyword(s):  
Muscle Weakness ◽  
Neuromuscular Disease ◽  
Respiratory Muscle ◽  
Neuromuscular Disorders ◽  
Respiratory Muscle Weakness ◽  
Respiratory Problems ◽  
Alveolar Hypoventilation ◽  
Ventilatory Failure ◽  
End Stage

Introduction 238 Assessment 239 Treatment 240 A variety of neuromuscular disorders may affect the ventilatory pump at different sites (Table 37.1). Most of these disorders result in respiratory muscle weakness, which results in alveolar hypoventilation and impaired cough. Patients with known neuromuscular disease may present acutely with a presentation related to their underlying neuromuscular disease (such as infection) or occasionally in end-stage ventilatory failure....

Noninvasive measurement of the tension-time index in children with neuromuscular disease

2003 ◽  
Vol 95 (3) ◽  
pp. 931-937 ◽  
Author(s):  
Laura T. Mulreany ◽  
Daniel J. Weiner ◽  
Joseph M. McDonough ◽  
Howard B. Panitch ◽  
Julian L. Allen
Keyword(s):  
Respiratory Failure ◽  
Muscle Fatigue ◽  
Neuromuscular Disease ◽  
Respiratory Muscle ◽  
Forced Expiratory Volume ◽  
Inspiratory Pressure ◽  
Maximal Inspiratory Pressure ◽  
Respiratory Muscle Fatigue ◽  
Time Index ◽  
Tension Time

Respiratory muscle weakness is common in children with neuromuscular disease (NMD). We hypothesized that weakness puts them at risk for respiratory muscle fatigue, a harbinger of chronic respiratory failure. We therefore measured a noninvasive index of respiratory muscle fatigue, the tension-time index of the respiratory muscles (TTmus), in 11 children with NMD and 13 control subjects. Spirometric flow rates and maximal inspiratory pressure were significantly lower in the NMD group than in controls (43 ± 23 vs. 99 ± 21 cmH2O, P < 0.001). The mean TTmus was significantly higher in the NMD group than in controls (0.205 ± 0.117 vs. 0.054 ± 0.021, P < 0.001). The increase in TTmus was primarily due to an increase in the ratio of average mean inspiratory pressure to maximal inspiratory pressure, indicating decreased respiratory muscle strength reserve. We found a significant correlation between TTmus and the residual volume-to-total lung capacity ratio ( r = 0.504, P = 0.03) and a negative correlation between TTmus and forced expiratory volume in 1 s ( r = -0.704, P < 0.001). In conclusion, children with NMD are prone to respiratory muscle fatigue. TTmus may be useful in assessing tolerance during weaning from mechanical ventilation, identifying impending respiratory failure, and aiding in the decision to institute therapies.

scholarly journals Volitional assessment of respiratory muscle strength

2015 ◽  
Vol 77 (1) ◽  
Author(s):  
J.W. Fitting
Keyword(s):  
Muscle Strength ◽  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Neuromuscular Disorders ◽  
Ventilatory Support ◽  
Neuromuscular Diseases ◽  
Respiratory Muscle Strength ◽  
Respiratory Muscle Weakness ◽  
Complete Evaluation ◽  
Non Invasive

Respiratory muscle weakness may induce dyspnoea, secretion retention and respiratory failure. Assessing respiratory muscle strength is mandatory in neuromuscular diseases and in case of unexplained dyspnoea. A step by step approach is recommended, starting with simple volitional tests. Using spirometry, respiratory muscle weakness may be suspected on the basis of an abnormal flowvolume loop or a fall of supine vital capacity. When normal, maximal inspiratory and expiratory pressures against a near complete occlusion exclude significant muscle weakness, but low values are more difficult to interpret. Sniff nasal inspiratory pressure is a useful alternative because it is easy and it eliminates the problem of air leaks around the mouthpiece in patients with neuromuscular disorders. The strength available for coughing is easily assessed by measuring peak cough flow. In most cases, these simple non invasive tests are sufficient to confirm or to eliminate significant respiratory muscle weakness and help the timely introduction of ventilatory support or assisted cough techniques. In a minority of patients, a more complete evaluation is necessary using non volitional tests like cervical magnetic stimulation of phrenic nerves.

Disorders of the thoracic cage and diaphragm

2010 ◽  
pp. 3504-3513
Author(s):  
John M. Shneerson
Keyword(s):  
Respiratory Failure ◽  
Pulmonary Tuberculosis ◽  
Muscle Weakness ◽  
Early Onset ◽  
Respiratory Muscle ◽  
Vital Capacity ◽  
Thoracic Cage ◽  
Respiratory Muscle Weakness ◽  
Tuberculous Osteomyelitis

Disorders of the thoracic skeleton—these can lead to a severe restrictive ventilatory defect, the risk of respiratory failure being highest with (1) scoliosis—particularly if the following characteristics are present: early onset, severe angulation, high in the thorax, respiratory muscle weakness, low vital capacity; (2) kyphosis—but only if of very sharp angulation (gibbus), most commonly seen following tuberculous osteomyelitis; and (3) after thoracoplasty—historically performed as treatment for pulmonary tuberculosis....

scholarly journals Respiratory Muscle Weakness as a Risk Factor for Pneumonia in Older People

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Tatsuma Okazaki ◽  
Yoshimi Suzukamo ◽  
Midori Miyatake ◽  
Riyo Komatsu ◽  
Masahiro Yaekashiwa ◽  
...  
Keyword(s):  
Risk Factor ◽  
Muscle Strength ◽  
Older People ◽  
Serum Albumin ◽  
Muscle Mass ◽  
Muscle Weakness ◽  
Fat Mass ◽  
Respiratory Muscle ◽  
Respiratory Muscle Strength ◽  
Respiratory Muscle Weakness

Introduction: The respiratory muscle strength regulates the effectiveness of coughing, which clears the airways and protects people from pneumonia. Sarcopenia is an aging-related loss of muscle mass and function, the worsening of which is associated with malnutrition. The loss of respiratory and swallowing muscle strength occurs with aging, but its effect on pneumonia is unclear. This study aimed to determine the risks of respiratory muscle weakness on the onset and relapse of pneumonia in older people in conjunction with other muscle-related factors such as malnutrition. Methods: We conducted a longitudinal study with 47 pneumonia inpatients and 35 non-pneumonia controls aged 70 years and older. We evaluated the strength of respiratory and swallowing muscles, muscle mass, and malnutrition (assessed by serum albumin levels and somatic fat) during admission and confirmed pneumonia relapse within 6 months. The maximal inspiratory and expiratory pressures determined the respiratory muscle strength. Swallowing muscle strength was evaluated by tongue pressure. Bioelectrical impedance analysis was used to evaluate the muscle and fat mass. Results: The respiratory muscle strength, body trunk muscle mass, serum albumin level, somatic fat mass, and tongue pressure were significantly lower in pneumonia patients than in controls. Risk factors for the onset of pneumonia were low inspiratory respiratory muscle strength (odds ratio [OR], 6.85; 95% confidence interval [CI], 1.56–30.11), low body trunk muscle mass divided by height2 (OR, 6.86; 95% CI, 1.49–31.65), and low serum albumin level (OR, 5.46; 95% CI, 1.51–19.79). For the relapse of pneumonia, low somatic fat mass divided by height2 was a risk factor (OR, 20.10; 95% CI, 2.10–192.42). Discussion/Conclusions: Respiratory muscle weakness, lower body trunk muscle mass, and malnutrition were risk factors for the onset of pneumonia in older people. For the relapse of pneumonia, malnutrition was a risk factor.

Lambert Eaton Syndrome: A Unique Presentation of the Disease With Isolated Respiratory Muscle Weakness

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 326A
Author(s):  
Urooj Fatima ◽  
Tasneem Shah ◽  
Paras Dedhia ◽  
Muhammad Ebrahim Khan ◽  
Sean Devine
Keyword(s):  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Respiratory Muscle Weakness
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