Acute Crit Care.  2022 Nov;37(4):592-600. 10.4266/acc.2022.00325.

Agreement between two methods for assessment of maximal inspiratory pressure in patients weaning from mechanical ventilation

• Ribeiro EOS
• Gosselink R
• Moura LEdS
• Correia RF
• Leite WS
• Araújo MdGRd
• Andrade ADd
• Brandão DC
• Campos SL

• KMID: 2540147
• DOI: http://doi.org/10.4266/acc.2022.00325

Abstract

Background
Respiratory muscle strength in patients with an artificial airway is commonly assessed as the maximal inspiratory pressure (MIP) and is measured using analogue or digital manometers. Recently, new electronic loading devices have been proposed to measure respiratory muscle strength. This study evaluates the agreement between the MIPs measured by a digital manometer and those according to an electronic loading device in patients being weaned from mechanical ventilation. Methods: In this prospective study, the standard MIP was obtained using a protocol adapted from Marini, in which repetitive inspiratory efforts were performed against an occluded airway with a one-way valve and were recorded with a digital manometer for 40 seconds (MIPDM). The MIP measured using the electronic loading device (MIPELD) was obtained from repetitively tapered flow resistive inspirations sustained for at least 2 seconds during a 40-second test. The agreement between the results was verified by a Bland-Altman analysis. Results: A total of 39 subjects (17 men, 55.4±17.7 years) was enrolled. Although a strong correlation between MIPDM and MIPELD (R=0.73, P<0.001) was observed, the Bland-Altman analysis showed a high bias of –47.4 (standard deviation, 22.3 cm H2O; 95% confidence interval, –54.7 to –40.2 cm H2O). Conclusions: The protocol of repetitively tapering flow resistive inspirations to measure the MIP with the electronic loading device is not in agreement with the standard protocol using one-way valve inspiratory occlusion when applied in poorly cooperative patients being weaned from mechanical ventilation.

Keyword

agreement; biomedical technology assessment; mechanical ventilation; respiratory muscles; respiratory system diagnostic technique

Figure

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  Figure 1. Recording of maximal inspiratory pressure by maximal inspiratory pressure by electronic loading device (MIPELD) and digital manometer (MIPDM). (A) Recording of MIPELD. This recording was performed using POWERBreathe Breathe-Link 1.0 software (POWERBreathe Holdings, Southam, UK). (B) Recording of MIPDM. The arrow indicates the peak MIP value at approximately 40 seconds. This recording was performed using MVD300 digital manometer software version 1.5 (Microhard System; Globalmed, Porto Alegre, Brazil). The numerical data are shown on the device's display and the equipment's software screen.

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  Figure 2. Flowchart of subjects. MIP: maximal inspiratory pressure; MIPELD: maximal inspiratory pressure by electronic loading device.

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  Figure 3. Main results of the study. (A) Linear correlation between maximal inspiratory pressure by digital manometer (MIPDM) and maximal inspiratory pressure by electronic loading device (MIPELD). (B) Bland-Altman diagram between MIPDM and MIPELD variables plotted for the whole sample and measured in cm H2O. SD: standard deviation.

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  Figure 4. Characteristics of the digital manometer and electronic loading device used to measure maximal inspiratory pressure in this study.

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