Original Articles
Determination of Maximal Diaphragm Strength in Chronic Obstructive Pulmonary Disease: Cervical Magnetic Stimulation Versus Traditional Sniff Maneuver
Juana Martínez-Llorensa,1,
, Carlos Coronella, Alba Ramírez-Sarmientoa, Mauricio Orozco-Levia, Josep M. Espadalerb, Juan Bautista Gáldizc, Joaquim Geaa, on behalf of the ENIGMA COPD study group
Corresponding author
jmartinezl@imas.imim.es
Correspondence: Dra. J. Martínez-Llorens. Servei de Medicina Respiratòria. Hospital del Mar. Pg. Martítim, 27.08003 Barcelona, España
Correspondence: Dra. J. Martínez-Llorens. Servei de Medicina Respiratòria. Hospital del Mar. Pg. Martítim, 27.08003 Barcelona, España
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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Espadaler, Juan Bautista Gáldiz, Joaquim Gea" "autores" => array:8 [ 0 => array:5 [ "preGrado" => "Dra." "nombre" => "Juana" "apellidos" => "Martínez-Llorens" "email" => array:1 [ 0 => "jmartinezl@imas.imim.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Carlos" "apellidos" => "Coronell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Alba" "apellidos" => "Ramírez-Sarmiento" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Mauricio" "apellidos" => "Orozco-Levi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Josep M." 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J. Martínez-Llorens. Servei de Medicina Respiratòria. Hospital del Mar. Pg. Martítim, 27.08003 Barcelona, España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-08-31" "fechaAceptado" => "2006-02-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154189" "palabras" => array:4 [ 0 => "Respiratory muscles" 1 => "Pulmonary disease" 2 => "Transdiaphragmatic pressure" 3 => "Muscle stimulation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154190" "palabras" => array:4 [ 0 => "Músculos respiratorios" 1 => "Enfermedad pulmonar" 2 => "Presión transdiafragmática" 3 => "Estimulación muscular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">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).</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">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 H<span class="elsevierStyleInf">2</span>O vs 97 [27] cm H<span class="elsevierStyleInf">2</span>O, 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%).</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. It is particularly indicated in patients with limited capacity for understanding instructions or those unable to cooperate.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">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 (<span class="elsevierStyleItalic">sniff</span>) en un grupo de pacientes con enfermedad pulmonar obstructive crónica (EPOC).</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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 cmH<span class="elsevierStyleInf">2</span>O, 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%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara">Dr J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 3 | 8 |
| 2024 October | 35 | 26 | 61 |
| 2024 September | 46 | 32 | 78 |
| 2024 August | 72 | 46 | 118 |
| 2024 July | 34 | 28 | 62 |
| 2024 June | 39 | 24 | 63 |
| 2024 May | 43 | 31 | 74 |
| 2024 April | 29 | 27 | 56 |
| 2024 March | 19 | 16 | 35 |
| 2024 February | 21 | 24 | 45 |
| 2023 March | 3 | 0 | 3 |
| 2023 February | 18 | 24 | 42 |
| 2023 January | 17 | 30 | 47 |
| 2022 December | 21 | 28 | 49 |
| 2022 November | 26 | 20 | 46 |
| 2022 October | 34 | 34 | 68 |
| 2022 September | 22 | 32 | 54 |
| 2022 August | 25 | 42 | 67 |
| 2022 July | 27 | 41 | 68 |
| 2022 June | 31 | 40 | 71 |
| 2022 May | 18 | 42 | 60 |
| 2022 April | 26 | 27 | 53 |
| 2022 March | 20 | 40 | 60 |
| 2022 February | 19 | 23 | 42 |
| 2022 January | 14 | 26 | 40 |
| 2021 December | 13 | 50 | 63 |
| 2021 November | 17 | 59 | 76 |
| 2021 October | 18 | 43 | 61 |
| 2021 September | 21 | 65 | 86 |
| 2021 August | 12 | 24 | 36 |
| 2021 July | 14 | 28 | 42 |
| 2021 June | 12 | 41 | 53 |
| 2021 May | 12 | 23 | 35 |
| 2021 April | 25 | 47 | 72 |
| 2021 March | 23 | 24 | 47 |
| 2021 February | 11 | 18 | 29 |
| 2021 January | 5 | 19 | 24 |
| 2020 December | 10 | 13 | 23 |
| 2020 November | 8 | 15 | 23 |
| 2020 October | 4 | 16 | 20 |
| 2020 September | 10 | 5 | 15 |
| 2020 August | 10 | 12 | 22 |
| 2020 July | 20 | 17 | 37 |
| 2020 June | 7 | 3 | 10 |
| 2020 May | 17 | 24 | 41 |
| 2020 April | 14 | 22 | 36 |
| 2020 March | 9 | 13 | 22 |
| 2020 February | 23 | 18 | 41 |
| 2020 January | 17 | 19 | 36 |
| 2019 December | 17 | 18 | 35 |
| 2019 November | 11 | 19 | 30 |
| 2019 October | 8 | 5 | 13 |
| 2019 September | 25 | 10 | 35 |
| 2019 August | 11 | 13 | 24 |
| 2019 July | 10 | 20 | 30 |
| 2019 June | 7 | 7 | 14 |
| 2019 May | 14 | 10 | 24 |
| 2019 April | 29 | 39 | 68 |
| 2019 March | 13 | 19 | 32 |
| 2019 February | 10 | 13 | 23 |
| 2019 January | 8 | 13 | 21 |
| 2018 December | 9 | 12 | 21 |
| 2018 November | 13 | 7 | 20 |
| 2018 October | 17 | 16 | 33 |
| 2018 September | 14 | 11 | 25 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 5 | 6 | 11 |
| 2018 March | 4 | 2 | 6 |
| 2018 February | 10 | 13 | 23 |
| 2018 January | 2 | 6 | 8 |
| 2017 December | 7 | 13 | 20 |
| 2017 November | 3 | 9 | 12 |
| 2017 October | 1 | 13 | 14 |
| 2017 September | 6 | 8 | 14 |
| 2017 August | 8 | 27 | 35 |
| 2017 July | 0 | 6 | 6 |
| 2017 June | 10 | 19 | 29 |
| 2017 May | 5 | 16 | 21 |
| 2017 April | 5 | 15 | 20 |
| 2017 March | 2 | 20 | 22 |
| 2017 February | 1 | 4 | 5 |
| 2017 January | 5 | 4 | 9 |
| 2016 December | 14 | 6 | 20 |
| 2016 November | 22 | 11 | 33 |
| 2016 October | 16 | 13 | 29 |
| 2016 September | 10 | 7 | 17 |
| 2016 August | 9 | 7 | 16 |
| 2016 July | 11 | 14 | 25 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 50 | 18 | 68 |
| 2015 September | 63 | 7 | 70 |
| 2015 August | 48 | 13 | 61 |
| 2015 July | 58 | 4 | 62 |
| 2015 June | 33 | 9 | 42 |
| 2015 May | 63 | 14 | 77 |
| 2015 April | 47 | 5 | 52 |
| 2015 March | 44 | 7 | 51 |
| 2015 February | 38 | 2 | 40 |
| 2015 January | 44 | 8 | 52 |
| 2014 December | 47 | 6 | 53 |
| 2014 November | 51 | 10 | 61 |
| 2014 October | 76 | 8 | 84 |
| 2014 September | 69 | 6 | 75 |
| 2014 August | 54 | 8 | 62 |
| 2014 July | 66 | 6 | 72 |
| 2014 June | 67 | 5 | 72 |
| 2014 May | 129 | 10 | 139 |
| 2014 April | 72 | 6 | 78 |
| 2014 March | 73 | 9 | 82 |
| 2014 February | 67 | 12 | 79 |
| 2014 January | 51 | 8 | 59 |
| 2013 December | 49 | 10 | 59 |
| 2013 November | 51 | 4 | 55 |
| 2013 October | 45 | 9 | 54 |
| 2013 September | 44 | 9 | 53 |
| 2013 August | 48 | 8 | 56 |
| 2013 July | 62 | 18 | 80 |
| 2013 June | 54 | 6 | 60 |
| 2013 May | 47 | 5 | 52 |
| 2013 April | 15 | 7 | 22 |
| 2013 March | 6 | 1 | 7 |
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