This section of the statement has reviewed the complex process of muscle fatigue and has discussed the available direct and indirect measurements relevant to the assessment of fatigue of the respiratory muscles.

Although a variety of measures and indices have been employed to assess the development of respiratory muscle fatigue in research, there is no well described technique that has been successfully developed and tested to permit precise identification of respiratory muscle fatigue in the clinical setting. of the tests reviewed, breathing pattern analysis and measurement of thoraco-abdominal motion are nonspecific indices that do not directly measure fatigue. Analysis of the pressure-time index provides a useful conceptual framework, but not a specific test of fatigue.

in the research environment, serial measurement of maximal voluntary respiratory pressures, assessment of maximum relaxation rates, frequency domain EMG analysis, and measurement of respiratory muscle pressures in response to electrical or magnetic nerve stimulation are all techniques that can be used to assess the evolution of respiratory muscle fatigue. of these techniques, serial measurement of respiratory muscle pressure generation in response to electrical or magnetic stimulation is arguably the best technique to directly assess the development of respiratory muscle fatigue at the present time, and it offers the greatest promise for future development into an objective test of respiratory muscle fatigue in the clinical arena.


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