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Monitoring Respiratory Muscle Function

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Cardiopulmonary Monitoring

Abstract

Activity of the respiratory muscles is disturbed by virtually every respiratory disorder. Clinical manifestations of respiratory muscle involvement are subtle and commonly missed. The critical step in diagnosing problems is for a clinician to suspect a muscle problem when the presentation is camouflaged by obscuring features. This chapter provides a detailed discussion of methods to detect and monitor respiratory muscle function. Screening tools consist of physical examination, pulmonary function testing, and recordings of inspiratory and expiratory pressures. Precise quantification of diaphragmatic contractility is provided by recordings of transdiaphragmatic pressure in response to phrenic-nerve stimulation. Mechanical load on the respiratory muscles is best captured by computation of work of breathing and its subfractions. Electromyographic recordings of electrical activity of the diaphragm help in assessing neuromuscular coupling. Burgeoning reports on ultrasound and airway pressure recordings reflect a craving for easy-to-use noninvasive tools, but the techniques are beset by poor reproducibility and failure to validate proposed threshold values. The greatest challenge for improving patient care remains physician understanding of the basic physiology that underpins methods used to diagnose and monitor respiratory muscle pathology.

Supported by grants from the Veterans Administration Research Service.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Hines Veterans Administration Hospital, Hines, IL, USA

    Franco Laghi & Martin J. Tobin

  2. Loyola University of Chicago Stritch School of Medicine, Maywood, IL, USA

    Franco Laghi

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  1. Royal Victoria Hospital (McGill University Health Centre), Departments of Critical Care and Physiology McGill University, Montreal, QC, Canada

    Sheldon Magder

  2. UC San Diego, Department of Medicine, La Jolla, CA, USA

    Atul Malhotra

  3. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Kathryn A. Hibbert

  4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Charles Corey Hardin

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Laghi, F., Tobin, M.J. (2021). Monitoring Respiratory Muscle Function. In: Magder, S., Malhotra, A., Hibbert, K.A., Hardin, C.C. (eds) Cardiopulmonary Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-73387-2_36

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