title: Bilateral anterolateral magnetic stimulation of the phrenic nerves can detect diaphragmatic fatigue.
abstract: OBJECTIVE
  Measurement of twitch transdiaphragmatic pressure (TwPdi) during bilateral phrenic nerve stimulation is presently the best method to detect diaphragmatic fatigue in humans. The stimulation methods that are currently employed (ie, transcutaneous electrical stimulation [TES] and cervical magnetic stimulation [CMS]) have limitations. Bilateral anterolateral magnetic stimulation of the phrenic nerves (BAMPS) was recently described. The purpose of this study was to determine whether BAMPS can reliably detect diaphragmatic fatigue, and to compare the results with BAMPS with those obtained with the other stimulation techniques.
  
  
  METHODS
  Twelve healthy subjects participated in the study.
  
  
  METHODS
  TwPdi was measured during TES, CMS, and BAMPS before and 10, 30, and 60 min after a potentially fatiguing task. Voluntary hyperpnea to task failure was used as the fatiguing task because this task has previously been shown to reliably produce contractile fatigue of the diaphragm. To determine the reproducibility of BAMPS, TwPdi was measured before and after a nonfatiguing task in 10 of the subjects.
  
  
  RESULTS
  TwPdi fell significantly after the hyperpneic task with all three stimulation techniques, and the amount by which TwPdi fell after hyperpnea was not significantly different for the different stimulation techniques. The percentage fall in TwPdi after hyperpnea was significantly correlated between stimulation techniques (CMS vs BAMPS, r = 0.72; TES vs BAMPS, r = 0.84; and TES vs CMS, r = 0.67). The mean (+/- SE) within-subject, between-trial coefficient of variation for TwPdi during BAMPS was 5.1 +/- 0.1%.
  
  
  CONCLUSIONS
  BAMPS is highly reproducible and at least as good at detecting diaphragmatic fatigue as the other stimulation techniques.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo, Buffalo, NY 14215, USA. Mador@acsu.buffalo.edu
authors.forename: M Jeffery
authors.initials: MJ
authors.lastname: Mador
authors.forename: Saadat
authors.initials: S
authors.lastname: Khan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kufel
mesh_terms: D003964:Diaphragm / Q000502:physiology*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008280:Magnetics; D008297:Male; D018763:Muscle Fatigue / Q000502:physiology*; D010791:Phrenic Nerve / Q000502:physiology*; D015203:Reproducibility of Results