title: Noninvasive measurement of the maximum relaxation rate of inspiratory muscles in patients with neuromuscular disorders.
abstract: BACKGROUND
  Slowing of inspiratory muscle relaxation has been used as an index for inspiratory muscle fatigue. However, maximum relaxation rate measured from oesophageal pressure traces after maximum sniff (P(oes) MRR) has limited clinical usefulness because it requires an oesophageal balloon catheter system.
  
  
  OBJECTIVE
  It was the aim of this study to establish whether, in neuromuscular patients, maximum relaxation rate assessed from sniff nasal pressure (P(nasal) MRR) reflects oesophageal MRR and the tension-time index of the diaphragm (TT(di)).
  
  
  METHODS
  Twenty patients with neuromuscular disease and 10 healthy subjects were studied. P(oes) and transdiaphragmatic pressure were measured while P(nasal) was recorded with a balloon advanced through the nose into the nasopharynx. Maximum P(oes), transdiaphragmatic pressure and P(nasal) were simultaneously measured while the patients performed maximal sniffs. The MRR (% pressure fall/10 ms) for each sniff, the TT(di) and the tension-time index of respiratory muscles were determined.
  
  
  RESULTS
  Neuromuscular patients showed higher TT(di), lower P(oes) MRR and lower P(nasal) MRR than the control group. In patients with neuromuscular disease, the correlation coefficient of P(nasal) MRR and P(oes) MRR was 0.985 (p < 0.001). Regression analysis showed that P(oes) MRR = -1.101 + 1.113.P(nasal) MRR (r(2) = 0.929, standard error of the estimate = 0.208). Indeed, P(nasal) MRR was negatively correlated with TT(di) (r = -0.914, p < 0.001) and the tension-time index of respiratory muscles (r = -0.732, p < 0.001). In the neuromuscular group, the mean difference between P(nasal) MRR and P(oes) MRR was 0.286 +/- 0.217%/10 ms.
  
  
  CONCLUSIONS
  P(nasal) MRR obtained from a maximal sniff accurately reflects P(oes) MRR and TT(di) in patients with neuromuscular disorders.
authors.affiliation: Servicio de Neumología, Hospital Universitario La Paz, Madrid, Spain. fgr01m@jazzfree.com
authors.forename: F
authors.initials: F
authors.lastname: García-Río
authors.forename: O
authors.initials: O
authors.lastname: Mediano
authors.forename: J M
authors.initials: JM
authors.lastname: Pino
authors.forename: V
authors.initials: V
authors.lastname: Lores
authors.forename: I
authors.initials: I
authors.lastname: Fernández
authors.forename: J L
authors.initials: JL
authors.lastname: Alvarez-Sala
authors.forename: J
authors.initials: J
authors.lastname: Villamor
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D004576:Electromyography; D045853:Exhalation; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D001239:Inhalation; D008297:Male; D008875:Middle Aged; D009126:Muscle Relaxation; D018482:Muscle, Skeletal / Q000166:cytology / Q000473:pathology; D009468:Neuromuscular Diseases / Q000503:physiopathology*; D012016:Reference Values; D012132:Respiratory Muscles / Q000502:physiology / Q000503:physiopathology*; D012907:Smoking / Q000453:epidemiology; D014797:Vital Capacity