ArticleCritical care (London, England)2016
Correlation of maximal inspiratory pressure to transdiaphragmatic twitch pressure in intensive care unit patients.
Article in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- ICU-acquired weakness.Intensive care medicine · 2020Pooled it
- A randomized controlled trial to determine whether beta-hydroxy-beta-methylbutyrate and/or eicosapentaenoic acid improves diaphragm and quadriceps strength in critically Ill mechanically ventilated patients.Critical care (London, England) · 2021Trial
- The contribution of mechanical ventilation to critical illness-associated diaphragm dysfunction: a critical appraisal.Critical care (London, England) · 2026Review
- Article
- Diaphragm Contraction Pressure Index: A New Forecasting Indicator for Weaning from Mechanical Ventilation.International journal of general medicine · 2025Article
- Risk Factors and Electromyographic Characteristics of Acquired Weakness in Critically Ill Patients: A Retrospective Study.Therapeutics and clinical risk management · 2024Article
- The metabolic cost of inspiratory muscle training in mechanically ventilated patients in critical care.Intensive care medicine experimental · 2023Article
- Intensive care unit-acquired weakness: A review from molecular mechanisms to its impact in COVID-2019.European journal of translational myology · 2022Article
- Short-term phrenic nerve stimulation; no longer a therapy in search of a disease.Journal of thoracic disease · 2022Article
- Occurrence and Effects on Weaning From Mechanical Ventilation of Intensive Care Unit Acquired and Diaphragm Weakness: A Pilot Study.Frontiers in medicine · 2022Article
- Magnetic twitch assessment of diaphragm and quadriceps weakness in critically ill mechanically ventilated patients.Respiratory physiology & neurobiology · 2022Article
- Does Standard Physical Therapy Increase Quadriceps Strength in Chronically Ventilated Patients? A Pilot Study.Critical care medicine · 2020Observational
- MitoTEMPOL, a mitochondrial targeted antioxidant, prevents sepsis-induced diaphragm dysfunction.American journal of physiology. Lung cellular and molecular physiology · 2020Article
- SS31, a mitochondrially targeted antioxidant, prevents sepsis-induced reductions in diaphragm strength and endurance.Journal of applied physiology (Bethesda, Md. : 1985) · 2020Article
- Taurine administration ablates sepsis induced diaphragm weakness.Respiratory physiology & neurobiology · 2020Article
- Ventilator-induced diaphragm dysfunction: translational mechanisms lead to therapeutical alternatives in the critically ill.Intensive care medicine experimental · 2019Review
- Diaphragmatic parameters by ultrasonography for predicting weaning outcomes.BMC pulmonary medicine · 2018Article
- Diaphragm Dysfunction in Critical Illness.Chest · 2018Review
- Novel insights in ICU-acquired respiratory muscle dysfunction: implications for clinical care.Critical care (London, England) · 2017Review
- Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease.International journal of chronic obstructive pulmonary disease · 2017Observational
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
backgroundRespiratory muscle weakness contributes to respiratory failure in ICU patients. Unfortunately, assessment of weakness is difficult since the most objective test, transdiaphragmatic pressure in response to phrenic nerve stimulation (PdiTw), is difficult to perform. While most clinicians utilize maximum inspiratory pressure (Pimax) to assess strength, the relationship of this index to PdiTw has not been evaluated in a large ICU population. The purpose of the present study was to assess both PdiTw and Pimax in ICU patients to determine how these indices correlate with each other, what factors influence these indices, and how well these indices predict outcomes.
methodsStudies were performed on adult mechanically ventilated patients in the University of Kentucky MICU (n = 60). We assessed PdiTw by measuring transdiaphragmatic pressure (Pdi) in response to bilateral twitch stimulation of the phrenic nerves using dual magnetic stimulators (Magstim 200). Pimax was determined by measuring airway pressure during a 30-second inspiratory occlusion. We also assessed the twitch and maximum force generation for diaphragms excised from control and septic mice.
resultsBoth Pimax and PdiTw measurements were profoundly reduced for mechanically ventilated MICU patients when compared to normal reference values, e.g., Pimax averaged 56% of the predicted value for normal subjects. For the ICU population as a whole, PdiTw and Pimax values correlated with each other (r(2) = 0.373, p < 0.001), but there was wide scatter and, as a result, PdiTw could not be reliably calculated from Pimax levels for individual subjects. Infection selectively reduced low-frequency force generation more than high-frequency force generation for both our mouse experiments (comparing muscle twitch to 150 Hz tetanic force) and for MICU patients (comparing PdiTw to Pimax). This effect of infection may contribute to scatter in the PdiTw to Pimax relationship. We also found that both PdiTw and Pimax were significantly correlated with both patient survival and the duration of mechanical ventilation, albeit statistically, PdiTw was the better predictor.
conclusionsWhile more difficult to measure, the PdiTw is a better predictor of outcomes in mechanically ventilated MICU patients than the Pimax. Nevertheless, for some clinical applications, the Pimax determination is a reasonable alternative.
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