Relationship between transdiaphragmatic and mouth twitch pressures at functional residual capacity

The clinical application of transdiaphragmatic twitch pressure (Pdi,tw) response to phrenic nerve stimulation has been hindered by the requirement for placement of oesophageal and gastric balloons. Investigators have reported that mouth twitch pressure (Pmo,tw) estimates Pdi,tw accurately at lung volumes above and below functional residual capacity (FRC). However, it is not known whether Pmo,tw estimates Pdi,tw accurately when stimulation is performed at FRC during relaxed conditions. The aim of this study was to develop a simple method whereby measurements of Pmo could be used to predict oesophageal twitch pressure (Poes,tw) and possibly Pdi,tw at FRC. The study was performed in 11 healthy volunteers during phrenic nerve stimulation. At FRC, 9 of the 11 subjects showed a poor correlation between Pmo,tw and Poes,tw, and between Pmo,tw and Pdi,tw, probably due to varying degrees of glottic closure. Stimulations performed while subjects maintained an inspiratory flow of approximately 50 mL x s(-1), or at the point of reattaining FRC during an inspiration preceded by a limited exhalation, produced good correlations between Pmo,tw and Poes,tw (r=0.97 in both instances) and Pmo,tw and Pdi,tw (r=0.96 and r=0.95, respectively), with a steep slope. The respective slopes for the Pmo,tw Poes,tw relationship were 0.88 and 0.94, and for the Pmo,tw Pdi,tw relationship, 0.59 and 0.54. Unfortunately, these manoeuvres produced a significant increase in transpulmonary pressure (3.6+/-0.6 (SE) and 5.6+/-1.4 cmH2O, respectively), suggesting change in diaphragmatic length. Stimulations delivered while subjects performed an inspiratory effort or during exhalation against a high resistance preceded by a limited inhalation could not be used to predict Poes,tw and Pdi,tw from Pmo,tw. In conclusion, although transdiaphragmatic and oesophageal twitch pressure could be predicted from mouth twitch pressure during some inspiratory manoeuvres mouth twitch pressure was not reliable for the prediction of the oesophageal and transdiaphragmatic twitch pressure at functional residual capacity during relaxed conditions in healthy volunteers.