{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T23:50:23Z","timestamp":1778802623201,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T00:00:00Z","timestamp":1624233600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2021,11]]},"abstract":"\n BACKGROUND:<\/jats:title>\n \n The generation of excessive inspiratory muscle pressure (P\n mus<\/jats:sub>\n ) during assisted mechanical ventilation in patients with respiratory failure may result in acute respiratory muscle injury and\/or fatigue, and exacerbate ventilator-induced lung injury. A readily available noninvasive surrogate measure of P\n mus<\/jats:sub>\n may help in titrating both mechanical ventilation and sedation to minimize these risks. This bench study explored the feasibility and accuracy of using a ventilator\u2019s expiratory pause hold function to measure P\n mus<\/jats:sub>\n across multiple operators.\n <\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n \n A standardized technique for executing a brief (<1 s) expiratory pause maneuver was used to measure the airway occlusion pressure change (\u0394 P\n aw<\/jats:sub>\n ) by using 3 simulated P\n mus<\/jats:sub>\n (\u0394 P\n mus<\/jats:sub>\n : 5, 10, 15 cm H\n 2<\/jats:sub>\n O) under (1) pressure support ventilation (0, 10, 15 cm H\n 2<\/jats:sub>\n O), (2) volume and pressure-regulated volume ventilation, (3) flow and pressure-triggering, and (4) varying levels of PEEP and pressure-rise time. Individual and grouped measurements were made by 4\u20137 clinicians on 3 different ventilators. The concordance between occlusion \u0394 P\n aw<\/jats:sub>\n and \u0394 P\n mus<\/jats:sub>\n was arbitrarily set at \u2264 2 cm H\n 2<\/jats:sub>\n O. Data were evaluated by using analysis of variance and the Tukey-Kramer posttest. Correlation was assessed by using the Pearson R test; bias and precision were assessed by using the Bland-Altman method. Alpha was set at 0.05.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n Grouped expiratory pause maneuver measurements of occlusion \u0394 P\n aw<\/jats:sub>\n across simulated \u0394 P\n mus<\/jats:sub>\n , mode and level of ventilatory support showed reasonable concordance, regardless of the ventilator used. Occlusion \u0394 P\n aw<\/jats:sub>\n accuracy frequently decreased by \u223c3 cm H\n 2<\/jats:sub>\n O when both pressure support ventilation and \u0394 P\n mus<\/jats:sub>\n reached 15 cm H\n 2<\/jats:sub>\n O. Expiratory pause maneuver accuracy was not affected by trigger mechanism and\/or sensitivity, PEEP, or the post-trigger pressurization rate. In general, only small differences in \u0394 P\n aw<\/jats:sub>\n occurred among the individual operators.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n \n The expiratory pause maneuver generally provided reproducible, stable approximations of \u0394 P\n mus<\/jats:sub>\n across ventilators and ventilator settings, and a range of simulated effort. Technique standardization produced relatively consistent results across multiple operators. The expiratory pause maneuver seemed feasible for general use in monitoring inspiratory effort during assisted mechanical ventilation.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4187\/respcare.09047","type":"journal-article","created":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T11:20:33Z","timestamp":1624274433000},"page":"1649-1656","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Expiratory Pause Maneuver to Assess Inspiratory Muscle Pressure During Assisted Mechanical Ventilation: A Bench Study"],"prefix":"10.1177","volume":"66","author":[{"given":"Richard H","family":"Kallet","sequence":"first","affiliation":[{"name":"Respiratory Care Division."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S","family":"Phillips","sequence":"additional","affiliation":[{"name":"Respiratory Care Division."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis J","family":"Summers","sequence":"additional","affiliation":[{"name":"Respiratory Care Division."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Burns","sequence":"additional","affiliation":[{"name":"Respiratory Care Division."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lance","family":"Pangilinan","sequence":"additional","affiliation":[{"name":"Respiratory Care Division."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Logan","family":"Carothers","sequence":"additional","affiliation":[{"name":"Respiratory Care Division."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Earl R","family":"Mangalindan","sequence":"additional","affiliation":[{"name":"Respiratory Care Division."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S","family":"Lipnick","sequence":"additional","affiliation":[{"name":"Critical Care Division, Department of Anesthesia and Perioperative Care, University of California, San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,6,21]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198209233071304"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.00964"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/002013240204700807"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.116.6.1826"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000194538.32158.AF"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05501623"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000121"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182451c40"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/002013249804300602"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6825"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1987.62.1.315"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01006"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-5231(21)00486-X"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07520989"},{"issue":"4","key":"e_1_3_2_16_2","first-page":"253","article-title":"Studies of respiratory air flow; significance of the normal pneumotachogram","volume":"85","author":"Proctor DF","year":"1949","unstructured":"Proctor DF, , Hardy JB. Studies of respiratory air flow; significance of the normal pneumotachogram. Bull Johns Hopkins Hosp, 1949; 85(4):253-280.","journal-title":"Bull Johns Hopkins Hosp"},{"issue":"5","key":"e_1_3_2_17_2","first-page":"461","article-title":"Air flow measurements on human subjects with and without respiratory resistance at several work rates","volume":"3","author":"Silverman L","year":"1951","unstructured":"Silverman L, , Lee G, , Plotkin T, , Sawyers LA, , Yancey AR. Air flow measurements on human subjects with and without respiratory resistance at several work rates. 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