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A. Lista-Paz1, S. Souto Camba1, L. González Doniz1, A. Quintela del Río1, A. Arbillaga Etxarri2, R. Torres-Castro3, A.B. Varas de la Fuente4, C. Serrano Veguillas4, P. Bravo Cortés5, E. García Delgado6, C. Martín Cortijo6, E. Gimeno-Santos7, J. Vilaró8, C. González Montáñez9, J.L. Valera Felices10, E. Giménez Moolhuijzen11, Y. Sanesteban Hermida12, B. Herrero Cortina13, M. Francín Gallego13, G. Fregonezi14, R. Martín Valero15, A.T. Ríos Cortés16, J. Álvarez Rivas17
1The University of A Coruña, Faculty of Physiotherapy, A Coruña, Spain, 2The University of Deusto, Donosti, Spain, 3The University of Chile, Faculty of Medicine, Department of Physical Therapy, Santiago de Chile, Chile, 4ONCE University School of Physiotherapy, Madrid, Spain, 5Paraplegics National Hospital of Toledo, Toledo, Spain, 6Doce de Octubre University Hospital, Madrid, Spain, 7Hospital Clínic Barcelona, Department of Pulmonary Medicine, Barcelona, Spain, 8Universitat Ramon Llull, Facultad Ciencias de la Salud Blanquerna, Barcelona, Spain, 9Canarias University Hospital - Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain, 10Son Espases University Hospital, Palma de Mallorca, Spain, 11A Coruña University Hospital, A Coruña, Spain, 12Coruña University Hospital, A Coruña, Spain, 13Universidad San Jorge -Zaragoza, Zaragoza, Spain, 14Universidade Federal do Río Grande do Norte, Natal, Brazil, 15University of Málaga, Málaga, Spain, 16Santa Lucía´s University Hospital, Cartagena, Spain, 17University of Córdoba, Córdoba, Spain
Background: The measurement of maximal respiratory pressures is commonly used to assess respiratory muscle strength. Maximal inspiratory pressure (PiMax) and maximal expiratory pressure (PeMax) are defined as the maximum pressure sustained for 1 second. Internationally, the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines (Laveneziana P et al., 2019) establish that ideally, PiMax and PeMax must be maintained for at least 1.5 seconds. On the other hand, the protocol endorsed by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) (Calaf N., 2004) sets up the total duration of both manoeuvres in 3-5 seconds.
Purpose: We aimed to analyse, which is the ideal duration of the PiMax and PeMax manoeuvres in healthy adults to assess the maximal respiratory pressures accurately.
Methods: A multicenter cross-sectional study was carried out in 14 centres of Spain. Healthy non-smokers people aged 20-80 years old and without ventilatory pattern alterations were recruited. PiMax and PeMax were measured following the SEPAR protocol using a digital manometer MicroRPM® Carefusion connected to the software PUMA®. We asked participants to sustain pressures for 3 to 5 seconds. We performed a minimum of 6 acceptable repetitions, defined as manoeuvres without air leaks and with the graph showing a trend to a plateau (10 maximum), to measure PiMax and PeMax; with, 3 of them with variability <5% (repeatability criteria). We chose the highest reading of the three reproducible manoeuvres. The time from which PiMax and PeMax were reached in each manoeuvre was calculated. Continuous variables are presented as mean±SD.
Results: A total of 239 subjects (108 males; 46±17 years) were included. PiMax in women was 100±25cmH2O (achieved after 1±0.7sec) and 125±26cmH2O in males (measured after 0.8±0.5sec). PeMax was 147±33cmH2O in women (after 1.6±0.9sec) and 196±47cmH2O in males (after 1.8±1.1sec). Considering both sexes, PiMax (111±28cmH2O) was reached after 1±0.6sec, and 50% of the sample reached it after 0.7sec. PeMax (169±47cmH2O) was reached after 1.7±1sec, and 50% of the participants achieved it after 1.5sec.
Conclusion(s): This study shows that the maximal respiratory pressures, especially PeMax, are not always reached before 1.5 seconds in healthy adults. Thus, this time may not be always enough to identify the maximum effort in the assessment of maximal respiratory pressures according to the international protocol. Future studies are needed to analyse, which is the ideal duration of this manoeuvres in people with chronic respiratory and neuromuscular diseases.
Implications: According to our results, it would be advisable to review the protocols for measuring maximal respiratory pressures, especially regarding the duration of the manoeuvre, since it is decisive in the accuracy of the maximal respiratory pressure results.
Funding, acknowledgements: The Spanish Society of Pneumology and Thoracic Surgery (SEPAR) and the Chartered Society of Physiotherapists in Galicia.
Keywords: Respiratory Muscles, Maximal Respiratory Pressures, Respiratory Function Tests
Topic: Cardiorespiratory
Did this work require ethics approval? Yes
Institution: The University of A Coruña
Committee: Ethics Committee of The University of A Coruña
Ethics number: UDC2018-05
All authors, affiliations and abstracts have been published as submitted.
