Assessment

1. Tests of Overall Respiratory Function

2. Tests of Respiratory Muscle Strength 3. Electrophysiologic Techniques for the

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Assessment of Respiratory Muscle Function Tests of Respiratory Muscle Endurance Assessment of Respiratory Muscle Fatigue Assessment of Chest Wall Function Imaging Respiratory Muscle Function

Tests of Overall Respiratory Function

Static lung volumes VC, TLC. Dynamic spirometry FEV1/ FVC Maximum voluntary ventilation ABG (PaO2 & PCO2) Exercise testing

Test of respiratory muscle strength

Pressure measurement Pressure transducer Probe for internal pressures(balloon catheter system) etc Volitional test of respiratory muscle strength Maximal static inspiratory and expiratory pressure. (PiMax=-30 cmH2O & Pemax=+40 cm H2O) Sniff test Cough test

 Non Volitional tests Pressure after phrenic nerve stimulation TENS Magnetic stimulation Abdominal muscle stimulation

Electrophysiological tests
Respiratory muscle EMG Stimulation test

Respiratory muscle endurance

Pressure time product Ventilatory endurance tests Max voluntary ventilation Max sustained ventilation Work of breathing External load to airways Repeated max inspiratorypressure test 18 repeated tests each lasting 10 sec with

5 sec gap

Assessment of respiratory muscle fatigue

Fatigue types Central High freq fatigue Low freq fatigue

Breathing pattern Thoracoabdominal motion EMG Relaxation rate

Assessment of chest wall function

Chest wall pressures Spirometry Direct measurements Plathysmographs

Assessing respiratory muscles in ICU

Breathing patterns Lung volumes Pressure measurement PEEP

Methods of Ventilatory muscle training

Voluntary isocapnieic hypernea Inspiratory resistive breathing Inspiratory resistive loading Inspiratory threshold loading

Voluntary isocapnic hypernea

It is dynamic process which is used to

increase the endurance of the respiratory muscles. Expiratory muscles also benefits from this method. Technique: in this patient is asked to breath at the highest rate they can manage for 15 to 30 minutes.

Note: A rebreathing circuit or addition of CO2 is necessary to prevent hypocapnea.

Resistive breathing
INSPIRATORY RESISTIVE LOADING This device is used to increase the strength of respiratory muscles. This device offer resistance to the airflow by narrowing the aperture. In this patient is asked to breathe through the device for 15 to 30 mins in one to three daily sessions.

INSPIRATORY THRESHOLD LOADING This device is also used to increase both strength and endurance of respiratory muscle. This device permits respiration only after the threshold mouth pressure is achieved. The load is adjusted by therapist or nurse. usually patients begins with 1/3rd (15-30%) of their Pimax and then progressing to about 60%.