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Updated: Jan 23, 2026

Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients
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Expiratory muscle dysfunction in critically ill patients: towards improved understanding.

Zhong-Hua Shi1,2, Annemijn Jonkman1, Heder de Vries1

  • 1Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB,, Amsterdam, The Netherlands.

Intensive Care Medicine
|June 26, 2019
PubMed
Summary

Expiratory muscle weakness in ICU patients is common and linked to difficult ventilator weaning and poor airway clearance. Assessing expiratory muscle function is crucial for better patient outcomes.

Keywords:
Acute respiratory failureExpiratory musclesMechanical ventilationRespiratory muscle monitoringRespiratory muscle weakness

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Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Intensive Care Unit (ICU) Management

Background:

  • Expiratory muscles are vital for the respiratory pump, especially under high load or low inspiratory capacity.
  • These muscles aid in reducing lung volumes and pressures, and enhancing inspiratory capacity.
  • Despite their importance, expiratory muscles are often overlooked in critical care settings.

Purpose of the Study:

  • To review current knowledge on expiratory muscle physiology and pathophysiology in ICU patients.
  • To highlight the clinical significance of expiratory muscle function in the critically ill.
  • To discuss methods for assessing expiratory muscle function.

Main Methods:

  • Narrative review of existing literature.
  • Synthesis of information from multidisciplinary and multinational academic professionals.
  • Inclusion of perspectives from clinicians and physiologists.

Main Results:

  • Expiratory muscles are frequently recruited in ventilated ICU patients.
  • Severe expiratory muscle weakness is associated with adverse outcomes like difficult ventilator weaning and impaired airway clearance.
  • Techniques such as gastric pressure measurement and ultrasound can assess expiratory muscle function.

Conclusions:

  • Expiratory muscles are a neglected but critical component of respiratory muscle function in the ICU.
  • A deeper understanding of expiratory muscle physiology and pathophysiology is needed for critically ill patients.
  • Effective assessment and management of expiratory muscle function can improve patient outcomes.