title: How many maneuvers are required to measure maximal inspiratory pressure accurately.
abstract: OBJECTIVE
  To determine whether performing more maximal inspiratory pressure (MIP) maneuvers per test provides a more accurate assessment of the true maximal inspiratory strength.
  
  
  METHODS
  Review of MIP data from 367 tests. Each subject was encouraged to perform 20 MIP maneuvers per test, unless the patient reached the highest measurable pressure three times, or because of poor cooperation, fatigue, or respiratory distress. From the same raw data, MIP was calculated in two ways: (1) the "short MIP" was defined as the average of the first three highest values with < or = 5% variability; the results from further maneuvers were ignored; and (2) the "long MIP" is defined as the average of the three highest values with < or = 5% variability from all recorded maneuvers.
  
  
  METHODS
  Pulmonary Physiology Laboratory, Childrens Hospital Los Angeles.
  
  
  METHODS
  One hundred seventy-eight pediatric and adult subjects (age, 14 +/- 3 [SD] years; 53% male) with suspected inspiratory muscle weakness.
  
  
  RESULTS
  The long MIP (91 +/- 39 cm H2O) was significantly greater than the short MIP (82 +/- 39 cm H2O) (p < 0.000005). In 177 of 367 tests, the short MIP underestimated the peak performance.
  
  
  CONCLUSIONS
  From the same raw data, the long MIP was significantly greater than the short MIP. In 48% of the tests, the short MIP method underestimated the peak performance determined by the long MIP method. We speculate that the difference between the long MIP and the short MIP can be attributed to a learning effect.
authors.affiliation: Childrens Hospital Los Angeles, Department of Pediatrics, USC School of Medicine 90027, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Wen
authors.forename: M S
authors.initials: MS
authors.lastname: Woo
authors.forename: T G
authors.initials: TG
authors.lastname: Keens
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity; D008297:Male; D012129:Respiratory Function Tests / Q000379:methods*; D012132:Respiratory Muscles / Q000502:physiology