Manual Testing of Respiratory Muscles in Adults with Asthma: A Intra and Interrater Reliability and Validity Study

Background: Manual Muscle Testing (MMT) is a useful tool to evaluate ventilatory mechanics in adults with asthma. However, in the reviewed literature, there are few studies that report psychometric features of this test. Therefore, the present study aimed to evaluate MMT reliability and validity in respiratory muscles in adults with asthma.Methods: It was a cross-sectional study. Muscle strength (MMT and static respiratory pressures), sociodemographic and anthropometric variables related to the disease were evaluated. Measurements were carried out by two independent evaluators The reliability of MMT was analyzed with the weighted kappa and the convergent validity was evaluated by comparing the MTT and the respiratory pressure measurements using Pearson's correlation coefficient. The level of significance was p <0.05. Results: Twenty-six adults with stable asthma participated in the study. The intrarater reliability for MMT was between moderate and substantial (kappa=0.45-0.88) for all evaluated muscles while the interrater reliability was slight and fair for intercostal muscles (kappa=0.07-0.24), and fair and substantial (kappa=0.36-0.75) for other muscles. The convergent validity of MMT and respiratory pressures was low (r=0.20-0.48).Conclusions: MMT is a reliable measurement that can be used to evaluate respiratory muscle strength in adults with asthma. This study support MMT application for respiratory muscles at clinical settings when more objective measures such as MIP and MEP are not available. Considering that the MMT is a useful, practical, low-cost tool commonly used by physiotherapists, future studies could evaluate the convergent validity compared with dynamometry or electromyography of the respiratory muscles.

Semi-automated Detection of the Timing of Respiratory Muscle Activity: Validation and First Application

Background: Respiratory muscle electromyography (EMG) can identify whether a muscle is activated, its activation amplitude, and timing. Most studies have focused on the activation amplitude, while differences in timing and duration of activity have been less investigated. Detection of the timing of respiratory muscle activity is typically based on the visual inspection of the EMG signal. This method is time-consuming and prone to subjective interpretation.Aims: Our main objective was to develop and validate a method to assess the respective timing of different respiratory muscle activity in an objective and semi-automated manner.Method: Seven healthy adults performed an inspiratory threshold loading (ITL) test at 50% of their maximum inspiratory pressure until task failure. Surface EMG recordings of the costal diaphragm/intercostals, scalene, parasternal intercostals, and sternocleidomastoid were obtained during ITL. We developed a semi-automated algorithm to detect the onset (EMG, onset) and offset (EMG, offset) of each muscle’s EMG activity breath-by-breath with millisecond accuracy and compared its performance with manual evaluations from two independent assessors. For each muscle, the Intraclass Coefficient correlation (ICC) of the EMG, onset detection was determined between the two assessors and between the algorithm and each assessor. Additionally, we explored muscle differences in the EMG, onset, and EMG, offset timing, and duration of activity throughout the ITL.Results: More than 2000 EMG, onset s were analyzed for algorithm validation. ICCs ranged from 0.75–0.90 between assessor 1 and 2, 0.68–0.96 between assessor 1 and the algorithm, and 0.75–0.91 between assessor 2 and the algorithm (p &lt; 0.01 for all). The lowest ICC was shown for the diaphragm/intercostal and the highest for the parasternal intercostal (0.68 and 0.96, respectively). During ITL, diaphragm/intercostal EMG, onset occurred later during the inspiratory cycle and its activity duration was shorter than the scalene, parasternal intercostal, and sternocleidomastoid (p &lt; 0.01). EMG, offset occurred synchronously across all muscles (p ≥ 0.98). EMG, onset, and EMG, offset timing, and activity duration was consistent throughout the ITL for all muscles (p &gt; 0.63).Conclusion: We developed an algorithm to detect EMG, onset of several respiratory muscles with millisecond accuracy that is time-efficient and validated against manual measures. Compared to the inherent bias of manual measures, the algorithm enhances objectivity and provides a strong standard for determining the respiratory muscle EMG, onset.

Camrelizumab-Related Myocarditis and Myositis With Myasthenia Gravis: A Case Report and Literature Review

Immune checkpoint inhibitors (ICIs) have substantially changed the treatment of a variety of malignant tumors. With the increasing of their usage, the unique immune-mediated toxicity profile of ICIs has become apparent. We report a case of esophageal squamous cell carcinoma in a patient who received anti-programmed cell death protein 1 (PD-1) (camrelizumab) therapy and the occurrence of sequential immune-related adverse events (irAEs). Although many irAEs have been reported, severe myositis caused by camrelizumab with simultaneous involvement of multiple organs, including the myocardium, respiratory muscles, and skeletal muscles, has rarely been described in literature. This 69-year-old male patient developed a grade 4 camrelizumab-induced adverse reaction according to the Common Terminology Criteria for Adverse Events (CTCAE) and was successfully treated with methylprednisolone and immunoglobulins. The early identification of irAEs, immediate discontinuation of immunotherapy, use of steroids and/or immunosuppressants, and adjuvant supportive treatment are critical to the clinical prognosis of patients. It should be aware that autoimmune complications can occur even when ICI treatment is ceased.

An evidence-based approach in the management of fatigue due to heart failure: breathing exercises

Fatigue is one of the common symptoms that adversely affect the quality of life of patients with heart failure. It has been reported that fatigue seen in heart failure is caused by conditions such as deterioration of peripheral circulation due to decrease in oxygen delivery, autonomic nervous system abnormalities and deterioration in the strength of the respiratory muscles. Breathing exercises are one of the integrative applications that can increase oxygen delivery due to the functional connection of the heart and lungs providing relief from fatigue. In the literature, breathing exercises have a wide range of breathing techniques that create changes in breathing form and rate. Many studies have found that breathing exercises reduce fatigue, and can have significant effects on patient care and clinical outcomes. Nurses have a major impact on patient outcomes such as reducing fatigue in heart failure patients and improving health-related quality of life. For this reason, it is very important to include breathing exercises in nursing practices. In this regard, the importance of breathing exercises in the management of fatigue due to heart failure has been addressed in this review.

Relationship of Nutritional Status to Incidency Symptom Respiratory on Online Ojek Drivers in Malang City, East Java, Indonesia

Backgrounds/Aims: Respiratory disease is one of occupational disease that increasing and becoming the biggest three diseases that contribute more than three-quarters of total work-related deaths with circulations disease and neoplasm. Exposure to dust, allergens and toxins are some of the risk factors for respiratory diseases. One of the jobs with a high risk of exposure to air pollution is online motorcycle taxi drivers, they inhale pollution from the transportation sector and pollutant gases in the air which can cause respiratory problems. In addition, nutrition and respiratory disorders have an important relationship. In the recovery process, nutritional status has an important impact in the process of breaking down proteins contained in muscles including respiratory muscles in the catabolism process. Methods: This study was an analytic observation and the data was collected retrospectively in online motorcycle taxi drivers in Malang City with inclusion criteria on April 2021. Results: 108 online motorcycle taxi drivers in Malang, aged 15-55 years, 96.3% men, respiratory disorders 76.9% respondents with 93.6% underweight. Respiratory symptom more having common cold 66,7%, cough 42,6% and phlegm 38,9%. The relationship between nutritional status and the incidence of respiratory symptoms was 8.1 times (95% CI (1.9-16.4) p = 0.017). Conclusions: There is a significant relationship between nutritional status and symptoms of respiratory disorders in online motorcycle taxi drivers in Malang City with 8 times. Keywords: acute ischemic, stroke, platelet lymphocyte ratio, poor outcome.

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases

The postmortem diagnosis of drowning death and understanding the mechanisms leading to drowning require a comprehensive judgment based on numerous morphological findings in order to determine the pathogenesis and epidemiological characteristics of the findings. Effortful breathing during the drowning process can result in intramuscular hemorrhage in respiratory and accessory respiratory muscles. However, the characteristics of this phenomenon have not been investigated. We analyzed the epidemiological characteristics of 145 cases diagnosed as drowning, in which hemorrhage, not due to trauma, was found in the respiratory muscles and accessory respiratory muscles. Hemorrhage was observed in 31.7% of these cases, and the incidence did not differ by gender or drowning location. The frequency of hemorrhage was significantly higher in months with a mean temperature below 20°C than in months above 20°C, suggesting a relationship between the occurrence of hemorrhage and low environmental temperature. Moreover, the frequency of hemorrhage was significantly higher in the elderly (aged ≥65 years) compared to those <65 years old. In the elderly, the weakening of muscles due to aging may contribute to the susceptibility for intramuscular hemorrhage. Moreover, these intramuscular hemorrhages do not need to be considered in cases of a potential bleeding tendency due to disease such as cirrhosis or medication such as anticoagulants. Our results indicate that intramuscular hemorrhage in respiratory and accessory respiratory muscles can serve as an additional criterion to differentiate between fatal drowning and other causes of death, as long as no cutaneous or subcutaneous hematomas above the muscles with hemorrhages are observed. In addition, the epidemiological features that such intramuscular hemorrhage is more common in cold environments and in the elderly may provide useful information for the differentiation.

Obstructive Sleep Apnea (OSA), Overview and Treatment Options: A Review

There are different forms of sleep apnea, each with different causes. Fortunately, they are all treatable. 1] Obstructive sleep apnea (OSA) occurs when the muscles and soft tissues in the upper airways relax and become blocked during sleep. It is often accompanied by loud snoring or snorting. OSA is the most common form of sleep apnea, 2] Central sleep apnea (CSA) occurs when the brain stops sending signals to the respiratory muscles while sleeping. Although the airways remain open, breathing stops. CSA is less common than OSA, 3] Mixed sleep apnea is a combination of central and obstructive sleep apnea, and Common to all of these disorders is the occurrence of apneas and hypopneas. Apnea is when the muscles and soft tissues in the upper airways slacken and collapse to the point that they are completely blocked for 10 seconds or more. Hypopnea is a partial blockage of the airways that decreases airflow by more than 50% for 10 seconds or more.

Surface EMG-based Quantification of Inspiratory Effort: A Quantitative Comparison with Pes

Background Inspiratory patient effort under assisted mechanical ventilation is an important quantity for assessing patient-ventilator interaction and recognizing over and under assistance. An established clinical standard is respiratory muscle pressure Pmus, derived from esophageal pressure (Pes), which requires the correct placement and calibration of an esophageal balloon catheter. Surface electromyography (sEMG) of the respiratory muscles represents a promising and straightforward alternative technique, enabling non-invasive monitoring of patient activity. Methods A prospective observational study was conducted with patients under assisted mechanical ventilation, who were scheduled for elective bronchoscopy. Airway flow and pressure, esophageal/gastric pressures and sEMG of the diaphragm and intercostal muscles were recorded at four levels of pressure support ventilation. Patient efforts were quantified via the Pmus–time product (PTPmus), the transdiaphragmatic pressure–time product (PTPdi) and the EMG–time products (ETP) of the two sEMG channels. To improve the signal-to-noise ratio, a method for automatically selecting the more informative of the sEMG channels was investigated. Correlation between ETP and PTPmus was assessed by determining a neuromechanical conversion factor KEMG between the two quantities. Moreover, it was investigated whether this scalar can be reliably determined from airway pressure during occlusion maneuvers, thus allowing to quantify inspiratory effort based solely on sEMG measurements. Results In total, 62 patients with heterogeneous pulmonary diseases were enrolled in the study, 43 of wich were included in the data analysis. The ETP of the two sEMG channels was well correlated with PTPmus (r=0.79±0.25 and r=0.84±0.16 for diaphragm and intercostal recordings, respectively). The proposed automatic channel selection method improved correlation with PTPmus (r=0.87±0.09). The neuromechanical conversion factor obtained by fitting ETP to PTPmus varied widely between patients (KEMG=4.32±3.73 cmH2O/μV) and was highly correlated with the scalar determined during occlusions (r=0.95, p<.001). The occlusion-based method for deriving PTPmus from ETP showed a breath-wise deviation to PTPmus of 0.43±1.73 cmH2Os across all datasets. Conclusion These results support the use of surface electromyography as a reliable non-invasive alternative for monitoring breath-by-breath inspiratory effort of patients under assisted mechanical ventilation.

FUNCTIONAL LIMITATIONS ARISING FROM CHANGES IN RESPIRATORY MECHANICS IN CHRONIC OBSTRUCTIVE PULMONARY DYSFUNCTION

(INTRODUCTION) chronic obstructive pulmonary disease is a common preventable and treatable disease where an obstruction leads to various respiratory changes such as impaired airflow, leading to several changes occurring in the mechanics of the respiratory muscles, alters the conformation of the chest and diaphragm, mainly causing dyspnea and limitations as limitations. This research aims to correlate limitations according to changes in respiratory mechanics. (MATERIALS AND METHODS) the present is an integrative literature review, for the search for articles were used as databases PUBMED and SCIELO, studies were included without distinction of language and year, published and indexed in the databases free of charge and in full, studies that associated COPD with other respiratory diseases were excluded, studies where the reserves had undergone lung surgery, and studies that did not bring complete results. (RESULTS) 52 studies were found in total, 15 duplicates were excluded, in the first selection stage 19 studies were excluded, in the second stage 10 studies were excluded, thus the review sample of 9 studies, of the clinical trial type. (CONCLUDING REMARKS) Among the most prevalent limitations we saw low tolerance and resistance to physical exercises, limitations to perform activities of daily living, leading to dyspnea and dysfunction of the respiratory muscles, affecting the happy quality of life.