Use of twitch pressures to assess diaphragmatic function and central drive.

Transdiaphragmatic pressures generated by phrenic nerve twitches have been proposed as a means to assess diaphragmatic function and central drive, but their validity and reliability have not been determined. We evaluated diaphragmatic twitch and twitch occlusion measurements in a rabbit model of diaphragmatic contractile dysfunction and diaphragmatic fatigue to determine whether 1) diaphragmatic twitch pressures accurately assess changes in low- and high-frequency diaphragm trains during the development of, and recovery from, contractile fatigue; 2) twitch occlusion measurements accurately quantify the intensity of central drive to the diaphragm; and 3) twitch measurements are affected by thoracoabdominal binding or twitch potentiation. Single-twitch and 20-Hz double- and triple-twitch pressures accurately reflected changes in low-frequency diaphragm train pressures, whereas only 80-Hz triple-twitch pressures accurately reflected changes in high-frequency trains. Twitch occlusion measurements of central drive closely mirrored central drive as reflected by phrenic nerve recordings and only slightly underestimated the absolute intensity of central drive. Thoracoabdominal binding increased twitch and train pressures, and repetitive electrical stimulations further potentiated twitch pressure. However, twitch potentiation and a lack of thoracoabdominal binding had no effect on twitch measurements of diaphragmatic function during the induction and recovery from fatigue or on twitch occlusion measurements of intensity of central drive. Thus, twitch measurements can be used to accurately assess diaphragmatic low- and high-frequency fatigue and to quantify the intensity of central drive to the diaphragm.