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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Magnetic stimulation of the diaphragm allows its strength to be assessed&#46; The clinical applications of this technique are becoming more widespread given that the patient&#39;s cooperation is not required&#46; The aim of the present study was to compare this inhalation technique with traditional voluntary forced inspiration &#40;sniff test&#41; in a group of patients with chronic obstructive pulmonary disease &#40;COPD&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Sixteen men with moderate-to-severe COPD were studied &#40;mean &#91;SD&#93; forced expiratory volume in 1 second&#44; 35&#37; &#91;15&#37;&#93; of the reference value&#41;&#46; For all patients&#44; the maximal transdiaphragmatic pressure &#40;a measure of the contractility of the muscle&#41; was determined at peak inspiration and during cervical magnetic stimulation&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A moderate correlation between measurements with the 2 techniques was observed&#46; The value obtained with stimulation was approximately 20&#37; of that obtained with voluntary inhalation &#40;22 &#91;7&#93; cm H<span class="elsevierStyleInf">2</span>O vs 97 &#91;27&#93; cm H<span class="elsevierStyleInf">2</span>O&#44; respectively&#41;&#46; The stimulation technique yielded an intraindividual coefficient of variation of 12&#37; &#40;7&#37;&#41; and an interindividual one of 33&#37; &#40;6&#37;&#41;&#46; Very similar values for these coefficients were obtained with forced inhalation&#46; Qualitative analysis of the stimulation technique showed it to have a high sensitivity &#40;89&#37;&#41; for diagnosing muscle weakness&#44; with few fake negatives&#46; In contrast&#44; specificity was very low &#40;43&#37;&#41;&#44; and false positives for muscle weakness were relatively common&#46; The overall effectiveness of the prediction was acceptable &#40;69&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Cervical magnetic stimulation appears to be a good clinical option for ruling out diaphragm weakness&#46; It is particularly indicated in patients with limited capacity for understanding instructions or those unable to cooperate&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La estimulaci&#243;n magn&#233;tica del diafragma es una t&#233;cnica que permite evaluar la fuerza de este m&#250;sculo&#46; Dado que obvia la necesidad de colaboraci&#243;n del paciente&#44; va extendiendo progresivamente su aplicaci&#243;n clinica&#46; El objetiyo del presente estudio ha sido comparar esta t&#233;cnica de estimulaci&#243;n con la cl&#225;sica de inhalaci&#243;n voluntaria forzada &#40;<span class="elsevierStyleItalic">sniff</span>&#41; en un grupo de pacientes con enfermedad pulmonar obstructive cr&#243;nica &#40;EPOC&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 16 pacientes varones con EPOC de moderada a grave &#40;valor medio &#177; desviaci&#243;n est&#225;ndar del volumen espiratorio forzado en el primer segundo del 35 &#177; 15&#37; del valor de referencia&#41;&#46; En todos ellos se obtuvo la presi&#243;n m&#225;xima del diafragma &#40;expresi&#243;n de la fuerza contr&#225;ctil del m&#250;sculo&#41; por maniobras de inhalaci&#243;n voluntaria m&#225;xima y de estimulaci&#243;n cervical magn&#233;tica&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; una relaci&#243;n moderada entre ambas t&#233;cnicas&#44; siendo los valores obtenidos con estimulaci&#243;n de aproximadamente un 20&#37; de los obtenidos con la maniobra voluntaria &#40;97 &#177; 27 y 22 &#177; 7 cmH<span class="elsevierStyleInf">2</span>O&#44; respectivamente&#41;&#46; La t&#233;cnica de estimulaci&#243;n mostr&#243; unos coeficientes de variabilidad intraindividual del 12 &#177; 7&#37;&#44; e interindividual del 33 &#177; 6&#37;&#44; muy similares a los del m&#233;todo de inhalaci&#243;n&#46; El an&#225;lisis cualitativo de la t&#233;cnica de estimulaci&#243;n para el diagn&#243;stico de debilidad muscular mostr&#243; una elevada sensibilidad &#40;89&#37;&#41;&#44; con escasos falsos negativos&#46; Por el contrario&#44; su especificidad fue muy baja &#40;43&#37;&#41;&#44; con una tasa relativamente elevada de sobrediagn&#243;sticos&#46; La eficacia de la predicci&#243;n result&#243; globalmente aceptable &#40;69&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La t&#233;cnica de estimulaci&#243;n magn&#233;tica cervical se muestra como una buena opci&#243;n cl&#237;nica para descartar debilidad del diafragma&#44; con indicati&#243;n sobre todo en pacientes con poca capacidad de comprensi&#243;n o incapacidad de colaboraci&#243;n&#46;</p>"
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Vol. 42. Issue 10.
Pages 509-515 (October 2006)
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Vol. 42. Issue 10.
Pages 509-515 (October 2006)
Original Articles
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Determination of Maximal Diaphragm Strength in Chronic Obstructive Pulmonary Disease: Cervical Magnetic Stimulation Versus Traditional Sniff Maneuver
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Juana Martínez-Llorensa,1,
Corresponding author
jmartinezl@imas.imim.es

Correspondence: Dra. J. Martínez-Llorens. Servei de Medicina Respiratòria. Hospital del Mar. Pg. Martítim, 27.08003 Barcelona, España
, Carlos Coronella, Alba Ramírez-Sarmientoa, Mauricio Orozco-Levia, Josep M. Espadalerb, Juan Bautista Gáldizc, Joaquim Geaa, on behalf of the ENIGMA COPD study group
a Servei de Medicina Respiratòria, Unitat de Recerca en Múscul i Aparell Respiratori (URMAR), Hospital del Mar-IMIM, Departament CEXS, Universital Pompeu Fabra, Barcelona, Spain
b Secció de Neurofisiologia, Unitat de Recerca en Múscul i Aparell Respiratori (URMAR), Hospital del Mar-IMIM, Departament CEXS, Universitat Pompeu Fabra, Barcelona, Spain
c cServicio de Neumología, Hospital de Cruces, Barakaldo, Vizcaya, Spain, Study supported by UE QLRT-2001, RTIC C03/11 (Red RespiralSCIII) and SOCAP 2002 and 2003 grants
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Objective

Magnetic stimulation of the diaphragm allows its strength to be assessed. The clinical applications of this technique are becoming more widespread given that the patient's cooperation is not required. The aim of the present study was to compare this inhalation technique with traditional voluntary forced inspiration (sniff test) in a group of patients with chronic obstructive pulmonary disease (COPD).

Patients and methods

Sixteen men with moderate-to-severe COPD were studied (mean [SD] forced expiratory volume in 1 second, 35% [15%] of the reference value). For all patients, the maximal transdiaphragmatic pressure (a measure of the contractility of the muscle) was determined at peak inspiration and during cervical magnetic stimulation.

Results

A moderate correlation between measurements with the 2 techniques was observed. The value obtained with stimulation was approximately 20% of that obtained with voluntary inhalation (22 [7] cm H2O vs 97 [27] cm H2O, respectively). The stimulation technique yielded an intraindividual coefficient of variation of 12% (7%) and an interindividual one of 33% (6%). Very similar values for these coefficients were obtained with forced inhalation. Qualitative analysis of the stimulation technique showed it to have a high sensitivity (89%) for diagnosing muscle weakness, with few fake negatives. In contrast, specificity was very low (43%), and false positives for muscle weakness were relatively common. The overall effectiveness of the prediction was acceptable (69%).

Conclusions

Cervical magnetic stimulation appears to be a good clinical option for ruling out diaphragm weakness. It is particularly indicated in patients with limited capacity for understanding instructions or those unable to cooperate.

Key words:
Respiratory muscles
Pulmonary disease
Transdiaphragmatic pressure
Muscle stimulation
Objetivo

La estimulación magnética del diafragma es una técnica que permite evaluar la fuerza de este músculo. Dado que obvia la necesidad de colaboración del paciente, va extendiendo progresivamente su aplicación clinica. El objetiyo del presente estudio ha sido comparar esta técnica de estimulación con la clásica de inhalación voluntaria forzada (sniff) en un grupo de pacientes con enfermedad pulmonar obstructive crónica (EPOC).

Pacientes y métodos

Se estudió a 16 pacientes varones con EPOC de moderada a grave (valor medio ± desviación estándar del volumen espiratorio forzado en el primer segundo del 35 ± 15% del valor de referencia). En todos ellos se obtuvo la presión máxima del diafragma (expresión de la fuerza contráctil del músculo) por maniobras de inhalación voluntaria máxima y de estimulación cervical magnética.

Resultados

Se observó una relación moderada entre ambas técnicas, siendo los valores obtenidos con estimulación de aproximadamente un 20% de los obtenidos con la maniobra voluntaria (97 ± 27 y 22 ± 7 cmH2O, respectivamente). La técnica de estimulación mostró unos coeficientes de variabilidad intraindividual del 12 ± 7%, e interindividual del 33 ± 6%, muy similares a los del método de inhalación. El análisis cualitativo de la técnica de estimulación para el diagnóstico de debilidad muscular mostró una elevada sensibilidad (89%), con escasos falsos negativos. Por el contrario, su especificidad fue muy baja (43%), con una tasa relativamente elevada de sobrediagnósticos. La eficacia de la predicción resultó globalmente aceptable (69%).

Conclusiones

La técnica de estimulación magnética cervical se muestra como una buena opción clínica para descartar debilidad del diafragma, con indicatión sobre todo en pacientes con poca capacidad de comprensión o incapacidad de colaboración.

Palabras clave:
Músculos respiratorios
Enfermedad pulmonar
Presión transdiafragmática
Estimulación muscular
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Dr J. Martínez-Llorens received the SEPAR 2002 grant during the study period.

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