DOI QR코드

DOI QR Code

Application of respiratory function tests in patients with neurological diseases

  • Ilhan Yoo (Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine) ;
  • Seok-Jin Choi (Department of Neurology, Seoul National University Hospital) ;
  • Jung-Joon Sung (Department of Neurology, Seoul National University Hospital)
  • Received : 2022.08.30
  • Accepted : 2022.10.18
  • Published : 2023.04.30

Abstract

Breathing is controlled by complex interactions between the central and peripheral nervous systems in conjunction with the respiratory system. Neurological diseases predispose patients to nocturnal desaturation and pneumonia due to respiratory dysfunction, which increases mortality, daytime sleepiness and fatigue, and reduces the quality of life. Respiratory function tests are required to identify respiratory function decline and to consider compensatory management. This review summarizes the characteristics of several respiratory function tests and their applications to neurological diseases.

Keywords

References

  1. Vaporidi K, Akoumianaki E, Telias I, Goligher EC, Brochard L, Georgopoulos D. Respiratory drive in critically ill patients. Pathophysiology and clinical implications. Am J Respir Crit Care Med 2020;201:20-32. https://doi.org/10.1164/rccm.201903-0596SO
  2. Ikeda K, Kawakami K, Onimaru H, Okada Y, Yokota S, Koshiya N, et al. The respiratory control mechanisms in the brainstem and spinal cord: integrative views of the neuroanatomy and neurophysiology. J Physiol Sci 2017;67:45-62. https://doi.org/10.1007/s12576-016-0475-y
  3. Routal RV, Pal GP. Location of the phrenic nucleus in the human spinal cord. J Anat 1999;195:617-621. https://doi.org/10.1046/j.1469-7580.1999.19540617.x
  4. Polkey MI, Lyall RA, Moxham J, Leigh PN. Respiratory aspects of neurological disease. J Neurol Neurosurg Psychiatry 1999;66:5-15. https://doi.org/10.1136/jnnp.66.1.5
  5. Mellies U, Dohna-Schwake C, Voit T. Respiratory function assessment and intervention in neuromuscular disorders. Curr Opin Neurol 2005;18:543-547. https://doi.org/10.1097/01.wco.0000180662.03544.5f
  6. Howard RS. Respiratory failure because of neuromuscular disease. Curr Opin Neurol 2016;29:592-601. https://doi.org/10.1097/WCO.0000000000000363
  7. Diebold D. Management of respiratory complications in neuromuscular weakness. Clin Pulm Med 2011;18:175-180. https://doi.org/10.1097/CPM.0b013e3182241ef4
  8. Boentert M, Wenninger S, Sansone VA. Respiratory involvement in neuromuscular disorders. Curr Opin Neurol 2017;30:529-537. https://doi.org/10.1097/WCO.0000000000000470
  9. Polatli M, Akyol A, Cildag O, Bayulkem K. Pulmonary function tests in Parkinson's disease. Eur J Neurol 2001;8:341-345. https://doi.org/10.1046/j.1468-1331.2001.00253.x
  10. Chiang J, Mehta K, Amin R. Respiratory diagnostic tools in neuromuscular disease. Children (Basel) 2018;5:78.
  11. DePalo VA, McCool FD. Respiratory muscle evaluation of the patient with neuromuscular disease. Semin Respir Crit Care Med 2002;23:201-209. https://doi.org/10.1055/s-2002-33028
  12. Crapo RO. Pulmonary-function testing. N Engl J Med 1994;331:25-30. https://doi.org/10.1056/NEJM199407073310107
  13. Lyall RA, Donaldson N, Polkey MI, Leigh PN, Moxham J. Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis. Brain 2001;124:2000-2013. https://doi.org/10.1093/brain/124.10.2000
  14. Morgan RK, McNally S, Alexander M, Conroy R, Hardiman O, Costello RW. Use of sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis. Am J Respir Crit Care Med 2005;171:269-274. https://doi.org/10.1164/rccm.200403-314OC
  15. Davis MD, Walsh BK, Sittig SE, Restrepo RD. AARC clinical practice guideline: blood gas analysis and hemoximetry: 2013. Respir Care 2013;58:1694-1703. https://doi.org/10.4187/respcare.02786
  16. Ak A, Ogun CO, Bayir A, Kayis SA, Koylu R. Prediction of arterial blood gas values from venous blood gas values in patients with acute exacerbation of chronic obstructive pulmonary disease. Tohoku J Exp Med 2006;210:285-290. https://doi.org/10.1620/tjem.210.285
  17. Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients? Diabet Med 2012;29:32-35. https://doi.org/10.1111/j.1464-5491.2011.03390.x
  18. Deane JC, Dagleish MP, Benamou AE, Wolf BT, Marlin D. Effects of syringe material and temperature and duration of storage on the stability of equine arterial blood gas variables. Vet Anaesth Analg 2004;31:250-257. https://doi.org/10.1111/j.1467-2995.2004.00173.x
  19. Fox MJ, Brody JS, Weintraub LR. Leukocyte larceny: a cause of spurious hypoxemia. Am J Med 1979;67:742-746. https://doi.org/10.1016/0002-9343(79)90728-9
  20. Woolley A, Hickling K. Errors in measuring blood gases in the intensive care unit: effect of delay in estimation. J Crit Care 2003;18:31-37. https://doi.org/10.1053/jcrc.2003.YJCRC7
  21. Folke M, Cernerud L, Ekstrom M, Hok B. Critical review of non-invasive respiratory monitoring in medical care. Med Biol Eng Comput 2003;41:377-383. https://doi.org/10.1007/BF02348078
  22. Friesen RH, Alswang M. End-tidal PCO2 monitoring via nasal cannulae in pediatric patients: accuracy and sources of error. J Clin Monit 1996;12:155-159.
  23. Loughnan TE, Monagle J, Copland JM, Ranjan P, Chen MF. A comparison of carbon dioxide monitoring and oxygenation between facemask and divided nasal cannula. Anaesth Intensive Care 2000;28:151-154. https://doi.org/10.1177/0310057X0002800204
  24. Linko K, Paloheimo M. Monitoring of the inspired and end-tidal oxygen, carbon dioxide, and nitrous oxide concentrations: clinical applications during anesthesia and recovery. J Clin Monit 1989;5:149-156. https://doi.org/10.1007/BF01627446
  25. Kavanagh BP, Sandler AN, Turner KE, Wick V, Lawson S. Use of end-tidal PCO2 and transcutaneous PCO2 as noninvasive measurement of arterial PCO2 in extubated patients recovering from general anesthesia. J Clin Monit 1992;8:226-230. https://doi.org/10.1007/BF01616780
  26. Santos LJ, Varon J, Pic-Aluas L, Combs AH. Practical uses of end-tidal carbon dioxide monitoring in the emergency department. J Emerg Med 1994;12:633-644. https://doi.org/10.1016/0736-4679(94)90416-2
  27. Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest 1996;110:1566-1571. https://doi.org/10.1378/chest.110.6.1566
  28. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care 2009;54:1348-1359.
  29. De Troyer A, Borenstein S, Cordier R. Analysis of lung volume restriction in patients with respiratory muscle weakness. Thorax 1980;35:603-610. https://doi.org/10.1136/thx.35.8.603
  30. Tully K, Koke K, Garshick E, Lieberman SL, Tun CG, Brown R. Maximal expiratory pressures in spinal cord injury using two mouthpieces. Chest 1997;112:113-116. https://doi.org/10.1378/chest.112.1.113
  31. Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis 1982;126:5-8.
  32. Stefanutti D, Benoist MR, Scheinmann P, Chaussain M, Fitting JW. Usefulness of sniff nasal pressure in patients with neuromuscular or skeletal disorders. Am J Respir Crit Care Med 2000;162:1507-1511. https://doi.org/10.1164/ajrccm.162.4.9910034
  33. Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M. Assessment of diaphragm weakness. Am Rev Respir Dis 1988;137:877-883. https://doi.org/10.1164/ajrccm/137.4.877
  34. Koulouris N, Mulvey DA, Laroche CM, Sawicka EH, Green M, Moxham J. The measurement of inspiratory muscle strength by sniff esophageal, nasopharyngeal, and mouth pressures. Am Rev Respir Dis 1989;139:641-646. https://doi.org/10.1164/ajrccm/139.3.641
  35. Laroche CM, Mier AK, Moxham J, Green M. The value of sniff esophageal pressures in the assessment of global inspiratory muscle strength. Am Rev Respir Dis 1988;138:598-603. https://doi.org/10.1164/ajrccm/138.3.598
  36. Miller JM, Moxham J, Green M. The maximal sniff in the assessment of diaphragm function in man. Clin Sci (Lond) 1985;69:91-96. https://doi.org/10.1042/cs0690091
  37. Mier A, Brophy C, Moxham J, Green M. Twitch pressures in the assessment of diaphragm weakness. Thorax 1989;44:990-996. https://doi.org/10.1136/thx.44.12.990
  38. Polkey MI, Duguet A, Luo Y, Hughes PD, Hart N, Hamnegard CH, et al. Anterior magnetic phrenic nerve stimulation: laboratory and clinical evaluation. Intensive Care Med 2000;26:1065-1075. https://doi.org/10.1007/s001340051319
  39. De Carvalho M. Electrodiagnostic assessment of respiratory dysfunction in motor neuron disease. Handbook of Clinical Neurophysiology 2004;4:513-528. https://doi.org/10.1016/S1567-4231(04)04029-8
  40. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders e-book: clinical-electrophysiologic-ultrasound correlations. 4th ed. Philadelphia: Elsevier Health Sciences, 2020;713-728.
  41. Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 1997;155:1570-1574. https://doi.org/10.1164/ajrccm.155.5.9154859
  42. Wang Y, Shao WB, Gao L, Lu J, Gu H, Sun LH, et al. Abnormal pulmonary function and respiratory muscle strength findings in Chinese patients with Parkinson's disease and multiple system atrophy--comparison with normal elderly. PLoS One 2014;9:e116123.
  43. Howard RS, Rudd AG, Wolfe CD, Williams AJ. Pathophysiological and clinical aspects of breathing after stroke. Postgrad Med J 2001;77:700-702. https://doi.org/10.1136/pmj.77.913.700
  44. Houston JG, Morris AD, Grosset DG, Lees KR, McMillan N, Bone I. Ultrasonic evaluation of movement of the diaphragm after acute cerebral infarction. J Neurol Neurosurg Psychiatry 1995;58:738-741. https://doi.org/10.1136/jnnp.58.6.738
  45. Cohen E, Mier A, Heywood P, Murphy K, Boultbee J, Guz A. Diaphragmatic movement in hemiplegic patients measured by ultrasonography. Thorax 1994;49:890-895. https://doi.org/10.1136/thx.49.9.890
  46. Zimmer MB, Nantwi K, Goshgarian HG. Effect of spinal cord injury on the respiratory system: basic research and current clinical treatment options. J Spinal Cord Med 2007;30:319-330. https://doi.org/10.1080/10790268.2007.11753947
  47. Hughes RA, Bihari D. Acute neuromuscular respiratory paralysis. J Neurol Neurosurg Psychiatry 1993;56:334-343. https://doi.org/10.1136/jnnp.56.4.334
  48. Laroche CM, Mier AK, Spiro SG, Newsom-Davis J, Moxham J, Green M. Respiratory muscle weakness in the Lambert-Eaton myasthenic syndrome. Thorax 1989;44:913-918. https://doi.org/10.1136/thx.44.11.913
  49. Wilcox P, Andolfatto G, Fairbarn MS, Pardy RL. Long-term follow-up of symptoms, pulmonary function, respiratory muscle strength, and exercise performance after botulism. Am Rev Respir Dis 1989;139:157-163. https://doi.org/10.1164/ajrccm/139.1.157
  50. Tsao TC, Juang YC, Lan RS, Shieh WB, Lee CH. Respiratory failure of acute organophosphate and carbamate poisoning. Chest 1990;98:631-636. https://doi.org/10.1378/chest.98.3.631
  51. Howard RS, Wiles CM, Hirsch NP, Spencer GT. Respiratory involvement in primary muscle disorders: assessment and management. Q J Med 1993;86:175-189.
  52. Shahrizaila N, Kinnear WJ, Wills AJ. Respiratory involvement in inherited primary muscle conditions. J Neurol Neurosurg Psychiatry 2006;77:1108-1115. https://doi.org/10.1136/jnnp.2005.078881
  53. Rimmer KP, Golar SD, Lee MA, Whitelaw WA. Myotonia of the respiratory muscles in myotonic dystrophy. Am Rev Respir Dis 1993;148:1018-1022. https://doi.org/10.1164/ajrccm/148.4_Pt_1.1018
  54. Howard RS, Russell S, Losseff N, Harding AE, Hughes JM, Wiles CM, et al. Management of mitochondrial disease on an intensive care unit. QJM 1995;88:197-207.
  55. Braun NM, Arora NS, Rochester DF. Respiratory muscle and pulmonary function in polymyositis and other proximal myopathies. Thorax 1983;38:616-623.  https://doi.org/10.1136/thx.38.8.616
  56. Niedermeyer S, Murn M, Choi PJ. Respiratory failure in amyotrophic lateral sclerosis. Chest 2019;155:401-408. https://doi.org/10.1016/j.chest.2018.06.035
  57. Atsuta N, Watanabe H, Ito M, Banno H, Suzuki K, Katsuno M, et al. Natural history of spinal and bulbar muscular atrophy (SBMA): a study of 223 Japanese patients. Brain 2006;129:1446-1455. https://doi.org/10.1093/brain/awl096
  58. Wijngaarde CA, Veldhoen ES, van Eijk RPA, Stam M, Otto LAM, Asselman FL, et al. Natural history of lung function in spinal muscular atrophy. Orphanet J Rare Dis 2020;15:88.
  59. Finkel RS, Mercuri E, Meyer OH, Simonds AK, Schroth MK, Graham RJ, et al. Diagnosis and management of spinal muscular atrophy: part 2: pulmonary and acute care; medications, supplements and immunizations; other organ systems; and ethics. Neuromuscul Disord 2018;28:197-207. https://doi.org/10.1016/j.nmd.2017.11.004
  60. Tzelepis GE, McCool FD. Respiratory dysfunction in multiple sclerosis. Respir Med 2015;109:671-679. https://doi.org/10.1016/j.rmed.2015.01.018
  61. Askenasy JJ, Goldhammer I. Sleep apnea as a feature of bulbar stroke. Stroke 1988;19:637-639. https://doi.org/10.1161/01.STR.19.5.637
  62. Devereaux MW, Keane JR, Davis RL. Automatic respiratory failure associated with infarction of the medulla. Report of two cases with pathologic study of one. Arch Neurol 1973;29:46-52. https://doi.org/10.1001/archneur.1973.00490250064007
  63. Andersen PM, Abrahams S, Borasio GD, de Carvalho M, Chio A, Van Damme P, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)--revised report of an EFNS task force. Eur J Neurol 2012;19:360-375. https://doi.org/10.1111/j.1468-1331.2011.03501.x
  64. Shoesmith C, Abrahao A, Benstead T, Chum M, Dupre N, Izenberg A, et al. Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ 2020;192:E1453-E1468. https://doi.org/10.1503/cmaj.191721
  65. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain-Barre syndrome in ten steps. Nat Rev Neurol 2019;15:671-683. https://doi.org/10.1038/s41582-019-0250-9
  66. Kishnani PS, Steiner RD, Bali D, Berger K, Byrne BJ, Case LE, et al. Pompe disease diagnosis and management guideline. Genet Med 2006;8:267-288. https://doi.org/10.1097/01.gim.0000218152.87434.f3
  67. Schmidt EP, Drachman DB, Wiener CM, Clawson L, Kimball R, Lechtzin N. Pulmonary predictors of survival in amyotrophic lateral sclerosis: use in clinical trial design. Muscle Nerve 2006;33:127-132. https://doi.org/10.1002/mus.20450
  68. Gay PC, Westbrook PR, Daube JR, Litchy WJ, Windebank AJ, Iverson R. Effects of alterations in pulmonary function and sleep variables on survival in patients with amyotrophic lateral sclerosis. Mayo Clin Proc 1991;66:686-694. https://doi.org/10.1016/S0025-6196(12)62080-1
  69. Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, et al. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2009;73:1218-1226. https://doi.org/10.1212/WNL.0b013e3181bc0141
  70. Finder JD, Birnkrant D, Carl J, Farber HJ, Gozal D, Iannaccone ST, et al. Respiratory care of the patient with Duchenne muscular dystrophy: ATS consensus statement. Am J Respir Crit Care Med 2004;170:456-465. https://doi.org/10.1164/rccm.200307-885ST
  71. Fromageot C, Lofaso F, Annane D, Falaize L, Lejaille M, Clair B, et al. Supine fall in lung volumes in the assessment of diaphragmatic weakness in neuromuscular disorders. Arch Phys Med Rehabil 2001;82:123-128. https://doi.org/10.1053/apmr.2001.18053
  72. Andrews JA, Meng L, Kulke SF, Rudnicki SA, Wolff AA, Bozik ME, et al. Association between decline in slow vital capacity and respiratory insufficiency, use of assisted ventilation, tracheostomy, or death in patients with amyotrophic lateral sclerosis. JAMA Neurol 2018;75:58-64. https://doi.org/10.1001/jamaneurol.2017.3339
  73. Huang X, Du C, Yang Q, Fan D. Comparison of slow and forced vital capacity on ability to evaluate respiratory function in bulbar-involved amyotrophic lateral sclerosis. Front Neurol 2022;13:938256.
  74. Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in Guillain-Barre syndrome. Arch Neurol 2001;58:893-898. https://doi.org/10.1001/archneur.58.6.893
  75. Tzanis G, Vasileiadis I, Zervakis D, Karatzanos E, Dimopoulos S, Pitsolis T, et al. Maximum inspiratory pressure, a surrogate parameter for the assessment of ICU-acquired weakness. BMC Anesthesiol 2011;11:14.
  76. Karthika M, Al Enezi FA, Pillai LV, Arabi YM. Rapid shallow breathing index. Ann Thorac Med 2016;11:167-176. https://doi.org/10.4103/1817-1737.176876
  77. Lin SJ, Jerng JS, Kuo YW, Wu CL, Ku SC, Wu HD. Maximal expiratory pressure is associated with reinstitution of mechanical ventilation after successful unassisted breathing trials in tracheostomized patients with prolonged mechanical ventilation. PLoS One 2020;15:e0229935.