Department of Anesthesiology, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Passeig Maritim 25, 08003, Barcelona, Spain.
Department of Respiratory Medicine, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES (ISC III), Barcelona, Spain.
Respir Res. 2018 Oct 1;19(1):191. doi: 10.1186/s12931-018-0897-6.
Cough pressure, an expression of expiratory muscle strength, is usually measured with esophageal or gastric balloons, but these invasive catheters can be uncomfortable for the patient or their placement impractical. Because pressure in the thorax and abdomen are expected to be similar during a cough, we hypothesized that measurement at other thoracic or abdominal locations might also be similar as well as useful in clinical scenarios. This study aimed to compare cough pressures measured at thoracic and abdominal sites that could serve as alternatives to esophageal pressures (P).
Nine patients scheduled for laparotomy were asked to cough as forcefully as possible from total lung capacity in supine position. Three cough maneuvers were performed while P (the gold standard) as well as gastric, central venous, bladder and rectal pressures (P, P, P, and P, respectively) were measured simultaneously. The intraclass correlation coefficient (ICC) was used to evaluate the repeatability of the measurements in each patient at each site and evaluate agreement between alternative sites (P, P, P, and P) and P. Bland-Altman plots were used to compare P and the measurements at the other sites.
Median (first quartile, third quartile) maximum pressures were as follows: P 112 (89,148), P 105 (92,156), P 102 (91,149), P 118 (93,157), and P 103 (88,150) cmHO. The ICCs showed excellent within-site repeatability of the measurements (p < 0.001) and excellent agreement between alternative sites and P (p < 0.004). The Bland-Altman plots showed minimal differences between P, P, P, and P. However, P was higher than the other pressures in most patients, and the difference between P and P was slightly larger.
Cough pressure can be measured in the esophagus, stomach, superior vena cava or rectum, since their values are similar. It can also be measured in the bladder, although the value will be slightly higher. These results potentially facilitate the assessment of dynamic expiratory muscle strength with fewer invasive catheter placements in most hospitalized patients, thus providing an option that will be particularly useful in those undergoing thoracic or abdominal surgery.
NCT02957045 registered at November 7, 2016. Retrospectively registered.
咳嗽压力是呼气肌力量的一种表现，通常通过食管或胃气球进行测量，但这些有创导管可能会使患者感到不适，或者其放置不切实际。由于在咳嗽过程中胸腔和腹部的压力预计相似，我们假设在其他胸腔或腹部位置进行测量也可能相似并且在临床情况下也很有用。本研究旨在比较可以替代食管压力（P）的胸腔和腹部位置测量的咳嗽压力。
9 名计划接受剖腹手术的患者被要求在仰卧位从肺总量中尽可能用力地咳嗽。同时测量了 3 次咳嗽动作，同时测量了 P（金标准）以及胃、中心静脉、膀胱和直肠压力（P、P、P 和 P）。使用组内相关系数（ICC）评估每位患者在每个部位测量的重复性，并评估替代部位（P、P、P 和 P）与 P 的一致性。使用 Bland-Altman 图比较 P 和其他部位的测量值。
中位（第一四分位数，第三四分位数）最大压力如下：P 112（89，148）、P 105（92，156）、P 102（91，149）、P 118（93，157）和 P 103（88，150）cmH2O。ICC 显示测量值在同一部位的重复性极好（p < 0.001），替代部位与 P 之间的一致性也极好（p < 0.004）。Bland-Altman 图显示 P、P、P 和 P 之间差异最小。然而，在大多数患者中，P 高于其他压力，P 和 P 之间的差异略大。
可以在食管、胃、上腔静脉或直肠中测量咳嗽压力，因为它们的值相似。也可以在膀胱中测量，尽管值会略高。这些结果可能会在大多数住院患者中通过减少有创导管放置来评估动态呼气肌力量，从而提供一种在接受胸部或腹部手术的患者中特别有用的选择。
NCT02957045 于 2016 年 11 月 7 日在 ClinicalTrials.gov 注册。回顾性注册。
