Comparison between maximum inspiratory pressure measured by a digital manometer and by an electronic inspiratory muscle training device
DOI:
https://doi.org/10.15448/1980-6108.2016.1.22678Keywords:
respiratory tract diseases, respiratory failure, intensive care unit, ventilator weaning.Abstract
Aims: To compare maximum inspiratory pressure (MIP) measured by a digital manometer and by an inspiratory muscle training (IMT) device and to evaluate hemodynamic changes after measurements.
Methods: The sample included male and female individuals older than 18 years admitted to an intensive care unit who were hemodynamically stable, not being treated with vasoactive drugs or sedated, intubated or tracheostomized, and who were in the process of being weaned from mechanical ventilation. MIP was measured by both devices on three different occasions, with an occlusion time of 20 seconds and a 5-minute interval between measurements. The following parameters were assessed: respiratory rate, mean arterial pressure, and respiratory rate before and after each measurement by each device. The statistical analysis was made in the Statistical Analysis System and the R Project for Statistical Computing V. 3.1.2 softwares, using the ANOVA and the Wilcoxon tests.
Results: Fifty-eight patients were included in the study. The mean value obtained for MIP was -46.22 centimeters of water (cmH2O) in the digital manometer and -13.15 cmH2O (p<0.001) in the IMT device. Heart rate showed a significant increase (p<0.0001) both before and after all measurements in both devices. Mean arterial pressure showed a statistically significant difference only before and after the first measurement by the digital manometer and before and after the second measurement by the IMT device (p<0.001). The respiratory rate oscillated significantly before and after the three measurements by both devices (p<0.0001). The hemodynamic parameters remained within reference values after MIP measurements.
Conclusions: The digital manometer recorded a higher MIP than that measured by the IMT device. The hemodynamic parameter values oscillated in both devices, but they remained within the normal range and were not clinically significant.Downloads
References
Parreira VF, França DC, Zampa CC, Fonseca MM, Tomich GM, Britto RR. Maximal respiratory pressures: actual and predicted valuesin healthy subjects. Rev Bras Fisioter. 2007;11(5):361-8. http://dx.doi.org/10.1590/S1413-35552007000500006
Passarelli RCV, Tonella RM, Souza HCD, Gastaldi AC. Evaluation of Inspiratory Muscular Force (Plmáx) during Weaning from Mechanical Ventilation in Neurological Patients in the Intensive Care Unit. Fisioter Pesq. 2011;18(1):48-53. http://dx.doi.org/10.1590/S1809-29502011000100009
Monteiro LS, Veloso CA, Araújo S, Figueiredo LC, Terzi RGG. Comparação de dois métodos de mensuração da pressão inspiratória máxima com o uso de uma válvula unidirecional. Rev Bras de Ter Intensiva. 2004;16:74-7.
Filho GRP, Reis HFC, Almeida MJ, Andrade WS, Rocha RLS, Leite PA. Comparison and effects of two different airway occlusion times during measurement of maximal inspiratory pressure in adult intensive care unit neurological patients. Rev Bras Ter Intensiva. 2010;22(1):33-9. http://dx.doi.org/10.1590/S0103-507X2010000100007
Souza C, Da Silva CT Jr, Lugon JR. Evaluation of the inspiratory pressure using a digital vacuometer in mechanically ventilated patients: analysis of the time to achieve the inspiratory peak. Respir Care. 2012 Feb;57(2):257-62. http://dx.doi.org/10.4187/respcare.01228
Black LF, Hyatt RE. Maximal Respiratory pressures: Normal Valus and Relationship To Age and Sex. Am Rev Respir Dis. 1969 May;99(5):696-702.
Ferreira JL, Nadja C, Oliveira Júnior M, Vasconcelos FH, Parreira V, Tierra-Criollo CJ. Medidor de pressões respiratórias máximas: calibração e cálculo da incerteza. SBA Controle & Automação. 2010;21(6):589-97.
Kulkarni SR, Fletcher E, McConnell AK, Poskitt KR, Whyman MR. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot study. Ann R Coll Surg Engl. 2010 Nov;92(8):700-7. http://dx.doi.org/10.1308/003588410X12771863936648
Marini JJ, Smith TC, Lamb V. Estimation of inspiratory muscle strength in mechanically ventilated patients: the measurement of maximal inspiratory pressure. J Crit Care. 1986 Mar;1(1):32-8. http://dx.doi.org/10.1016/S0883-9441(86)80114-9
Souza LC. Impact of using a digital vacuum gauge and check valve on respiratory indices predictors of weaning. Nitéroi: Universidade Federal Fluminense; 2011.
Silva BAK, Souza JKD, Pereira DM, Aydos RD, Carvalho PTC, Reis FA. Correlação entre pressão inspiratória máxima, ventilação pulmonar e tempo de ventilação em pacientes ventilados no modo de pressão de suporte. ConScientia e Saúde. 2008;7(3):379-84. http://dx.doi.org/10.5585/conssaude.v7i3.1370
Caruso P, Albuquerque LP, Santana PV, Cardenas LZ, Ferreira JG, Prina E. Métodos diagnósticos para avaliação da força muscular inspiratória e expiratória. J Bras Pneumol, 2015;41(2):110-23. http://dx.doi.org/10.1590/S1806-37132015000004474
Lima, L. P. Mensuração das pressões respiratórias máximas com equipamentos analógico e digital. In: 5º Amostra Acadêmica UNIMEP. Piracicaba; 2007.
Saad IAB, Santos BP, Paganini C, Guidetti EL, Silva YB, Toro IFC, Zambon L. Comparison between maximal respiratory pressures obtained from digital and analog manovacuometers in 120 Brasilian patients with lung disease. Eur Respir J. 2014;44(Suppl58):4284.
Clanton TL, Diaz PT. Clinical assessment of the respiratory muscles. Phys Ther. 1995 Nov;75(11):983-95.
Stiller K, Phillips A. Safety aspects of mobilising acutely ill in patients. Physiother Theory Pract. 2003;19(4):239-57. http://dx.doi.org/10.1080/09593980390246751
Stiller K, Philips AC, Lambert P. The safety of mobilisation and its effect on haemodynamic and respiratory status of intensive care patients. Physiother Theory Pract. 2004;20(3):175-85. http://dx.doi.org/10.1080/09593980490487474
Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007 Jan;23(1):35-53. http://dx.doi.org/10.1016/j.ccc.2006.11.005
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818-29. http://dx.doi.org/10.1097/00003246-198510000-00009
