The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study

Background Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes. Methods This work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death. Results One hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93–0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively). Conclusions MEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone. Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015

Relationship between respiratory muscle strength and grip strength in institutionalized and community-dwelling older adults

OBJECTIVE: To evaluate the relationship between respiratory muscle strength and grip strength in institutionalized and community-dwelling older adults. METHODS: This cross-sectional study had 64 voluntary participants, and 33 were institutionalized and 31 lived in the community. Maximal inspiratory pressure, maximal expiratory pressure, peak expiratory flow, grip strength, anthropometric data, and physical activity level were assessed. RESULTS: In the institutionalized group, there was no correlation between respiratory variables and grip strength, but maximal expiratory pressure was the respiratory predictor most strongly associated with grip strength (p = 0.04). In the community-dwelling group, there was a correlation between maximal inspiratory pressure and grip strength (r = 0.54), maximal expiratory pressure and grip strength (r = 0.62), and peak expiratory flow and grip strength (r = 0.64); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). In a joint group analysis, there was an association between maximal inspiratory pressure and grip strength (r = 0.40), maximal expiratory pressure and grip strength (r = 0.57), and peak expiratory flow and grip strength (r = 0.57); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). CONCLUSIONS: Peak expiratory flow and maximal expiratory pressure seem to be good predictors of grip strength in community-dwelling older adults, but this relationship does not seem to be maintained in institutionalized patients, possibly because of a greater loss of respiratory function.

Effects of Three-Dimension Schroth Exercises and Kinesio Taping on General Mobility of Vertebrae, Angle of Trunk Rotation, Muscle Strength and Endurance of Trunk, and Inspiratory and Expiratory Muscle Strength in Children with Idiopathic Scoliosis

This study aimed to compare the effects of 3-dimension Schroth exercises and Kinesio taping (KT) on several variables in children with idiopathic scoliosis. Female volunteers aged 10 - 18 years with an angle trunk rotation > 7 degrees participated in the study. The 16 volunteers were divided into 2 groups: ‘Three-dimension Schroth exercises’ (Con) and ‘Kinesio tape with Schroth exercises’ (KT). The training program comprised 2 sessions per week with 2 h per session for 6 consecutive weeks. Significant increases of maximal inspiratory pressure (Con; p = 0.046), maximal expiratory pressure (Con; p = 0.046, KT; p = 0.047), and back muscle endurance (Con; p = 0.028, KT; p = 0.028) were recorded. Significant decreases of angle trunk rotation at the thoracic level (Con; p = 0.046, KT; p = 0.017) and the lumbar level (Con; p = 0.042, KT; p = 0.041) were recorded. In conclusion, 3-dimension Schroth exercises and KT with Schroth exercises can increase maximal expiratory pressure, back muscle endurance, and angle of trunk rotation at the thoracic and the lumbar level.