Am. J. Respir. Crit. Care Med., Volume 160, Number 4, October 1999, 1369-1374

Can Diaphragmatic Contractility be Assessed by Twitch Airway Pressures in Patients with Chronic Obstructive Pulmonary Disease?

ARZU TOPELI, FRANCO LAGHI, and MARTIN J. TOBIN

The Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Administration Hospital, and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois

In healthy subjects and in patients without lung diseases, twitch airway pressure (Paw_tw) responses to phrenic nerve stimulation can be used to predict twitch esophageal pressure (Pes_tw) and twitch transdiaphragmatic pressure (Pdi_tw), thus overcoming the need for placement of esophageal and gastric balloons. The aim of this study was to determine whether measurements of Paw_tw combined with simple maneuvers could be used to predict Pes_tw, and possibly Pdi_tw, in patients with severe chronic obstructive pulmonary disease (COPD) (n = 12). Stimulations delivered at relaxed FRC produced a correlation coefficient (r) between Paw_tw and Pes_tw of 0.44 (p < 0.001) and of 0.62 (p < 0.001) during stimulations while patients performed a gentle exhalation from FRC. Stimulations performed during a gentle inhalation produced a good correlation between Paw_tw and Pes_tw (r = 0.92, p < 0.001); however, the limits of agreement between Paw_tw and Pes_tw were wide. Correlations between Paw_tw and Pdi_tw during the three experimental conditions were weak. In conclusion, during a gentle inspiratory effort in patients with severe COPD the correlation between Paw_tw and Pdi_tw was weak, whereas the correlation between Paw_tw and Pes_tw was good, but it was not sufficient to allow the prediction of Pes_tw from Paw_tw in all patients.

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