Respiratory muscle testing allows a quantitative assessment of inspiratory and expiratory muscles in children of any age with primary or secondary respiratory muscle impairment, in order to better understand the pathophysiology of respiratory impairment and guide therapeutic management. The use of an invasive technique (esogastric probe) makes it possible to specifically explore the diaphragm, the accessory inspiratory muscles and the expiratory muscles in order to detect dysfunction or paralysis of these muscles, and to estimate the work of breathing in order to better guide the respiratory management. The primary objective of the study is to evaluate the respiratory effort in children with primary or secondary impairment of the respiratory muscles during spontaneous breathing or during mechanical ventilation.
Respiratory muscle testing allows a quantitative assessment of inspiratory and expiratory muscles in children of any age with primary or secondary respiratory muscle impairment, in order to better understand the pathophysiology of respiratory impairment and guide therapeutic management. The use of an invasive technique (esogastric probe) makes it possible to specifically explore the diaphragm, the accessory inspiratory muscles and the expiratory muscles in order to detect dysfunction or paralysis of these muscles, and to estimate the work of breathing in order to better guide the respiratory management. Respiratory muscle testing by means of esogastric measurements may allow assessing the effect of pharmacological treatment by comparing respiratory muscle strength before and after a few months with treatment. Moreover, esogastric measurements can be used to better adapt mechanical ventilation or to determine the possibility of weaning from the respiratory support. The primary objective of the study is to evaluate the respiratory effort in children with primary or secondary impairment of the respiratory muscles during spontaneous breathing or during mechanical ventilation.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
550
Measurement of work of breathing and respiratory muscles strength using an esogastric catheter. One measurement or before and after (6 months and 1 year) the initiation of a pharmacological treatment in order to assess the effect of the treatment on respiratory muscle function.
Hôpital Necker-Enfants Malades
Paris, France
RECRUITINGEsophageal pressure-time product (PTPoes)
The integral of the esophageal pressure signal over inspiratory time
Time frame: Day 0
Diaphragmatic pressure-time product (PTPdi)
The integral of the transdiaphragmatic pressure signal over inspiratory time
Time frame: Day 0
Work of breathing (WOB)
Total work of breathing (WOBt) is calculated (in Joules/L) as the area under the pressure-volume curve, using the Campbell diagram. Elastic (WOBe) and resistive (WOBr) are estimated as the 2/3 and 1/3 of WOBt value, respectively.
Time frame: Day 0
Vital capacity
Vital capacity is the maximum amount of air a person can expel from the lungs after a maximum inhalation, using spirometry
Time frame: Day 0
Maximal respiratory static pressures
Maximal static inspiratory and expiratory airway pressures
Time frame: Day 0
Maximal sniff pressure
Airway pressure during a sniff test
Time frame: Day 0
Maximal whistle pressure
Airway pressure during a whistle test
Time frame: Day 0
Peak expiratory flow
Maximal flow during expiratory maneuver
Time frame: Day 0
Peak cough flow
Maximal flow during cough
Time frame: Day 0
Esophageal pressure during sniff
Esophageal pressure measurement during a sniff test
Time frame: Day 0
Gastric pressure during sniff
Gastric pressure measurement during a sniff test
Time frame: Day 0
Transdiaphragmatic pressure during sniff
Transdiaphragmatic pressure measurement during a sniff test
Time frame: Day 0
Crying transdiaphragmatic pressure
Transdiaphragmatic pressure measurement during crying in young children
Time frame: Day 0
Gastric pressure during cough
Gastric pressure measurement during a maximal cough maneuver
Time frame: Day 0
Twitch transdiaphragmatic pressure
Transdiaphragmatic pressure measurement during cervical magnetic stimulation
Time frame: Day 0
Inspiratory muscles tension-time index
Measurement of the tension-time index of the inspiratory muscles
Time frame: Day 0
Diaphragmatic tension-time index
Measurement of the tension-time index of the diaphragm
Time frame: Day 0
Correlation between the pressure-time product, the work of breathing and the respiratory muscle strength with the disease severity
The pressure-time product of the respiratory muscles, the work of breathing and the respiratory muscle strength will be correlated with disease severity
Time frame: Day 0
Correlation between the pressure-time product, the work of breathing and the respiratory muscle strength with polysomnography and gas exchange results
The pressure-time product of the respiratory muscles, the work of breathing and the respiratory muscle strength will be correlated with the polysomnography and gas exchange results
Time frame: Day 0
Esophageal pressure-time products in patients with any treatment and in patients with no treatment
The esophageal pressure-time product will be compared between patients with any treatment and patients receiving no treatment
Time frame: Day 0
The total work of breathing in patients with any treatment and in patients with no treatment
The total work of breathing (WOBt), which is calculated (in Joules/L) as the area under the pressure-volume curve using the Campbell diagram, be compared between patients with any treatment and patients receiving no traeatment, using the Student t test
Time frame: Day 0
Measurement of esophageal pressure during a sniff in patients with any treatment and patients with no treatment
The esophageal pressure during a sniff will be compared between patients with any treatment and patients receiving no treatment
Time frame: Day 0
Measurement of the esophageal pressure-time product before and after pharmacological treatment
The esophageal pressure-time product will be compared before treatment, and 6 months and 1 year after pharmacological treatment initiation
Time frame: 6 months and 1 year after treatment initiation
The total work of breathing before and after pharmacological treatment
The total work of breathing (WOBt), which is calculated (in Joules/L) as the area under the pressure-volume curve using the Campbell diagram, will be compared before treatment, and 6 months and 1 year after pharmacological treatment initiation, using the ANOVA on repeated measures
Time frame: 6 months and 1 year after treatment initiation
Measurement of the esophageal pressure during a sniff before and after pharmacological treatment
The esophageal pressure during a sniff will be compared before treatment, and 6 months and 1 year after pharmacological treatment initiation
Time frame: 6 months and 1 year after treatment initiation
Measurement of transdiaphragmatic pressure during a sniff before and after pharmacological treatment
The transdiaphragmatic pressure measurement during a sniff will be compared before treatment, and 6 months and 1 year after pharmacological treatment initiation
Time frame: 6 months and 1 year after treatment initiation
Adaptation of the respiratory support according to the esophageal pressure-time product values
The esophageal pressure-time product will be measured to guide the respiratory support adaptation
Time frame: Day 0
Adaptation of the respiratory support according to the total work of breathing values
The total work of breathing (WOBt), which is calculated (in Joules/L) as the area under the pressure-volume curve using the Campbell diagram, will be measured to guide the respiratory support adaptation
Time frame: Day 0
Measurement of the esophageal pressure-time product in patients with weaning success and in patients with weaning failure
The esophageal pressure-time product will be compared between patients with weaning success and weaning failure
Time frame: Day 0
Measurement of the total work of breathing in patients with weaning success and in patients with weaning failure
The total work of breathing (WOBt), which is calculated (in Joules/L) as the area under the pressure-volume curve using the Campbell diagram, will be compared between patients with weaning success and weaning failure, using the Student t test
Time frame: Day 0
Measurement of the esophageal pressure during a sniff in patients with weaning success and in patients with weaning failure
The esophageal pressure during a sniff will be compared between patients with weaning success and weaning failure
Time frame: Day 0
Correlation between the pressure-time product, the work of breathing and the respiratory muscle strength with the gas exchange during weaning trial
The pressure-time product, the work of breathing and the respiratory muscle strength will be correlated with the gas exchange during a weaning trial
Time frame: Day 0
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.