The Maximal Sniff in the Assessment of Diaphragm Function in Man

Abstract

Diaphragm function was studied in a total of 64 normal subjects, who had no past or present respiratory or neuromuscular impairment. Transdiaphragmatic pressure (Pdi) was measured during maximal sniffs and these values were compared with Pdi during maximal static inspiratory efforts (PImax.). The range of Pdi during maximal sniffs (82-204 cm H2O) had better defined lower limits than Pdi during PImax. (16-164 cm H2O) and a higher mean value: mean .+-. SD for maximal sniffs was 137 .+-. 28 cm H2O and for PImax. was 90 .+-. 37 cm H2O. The reproducibility of sniff Pdi was assessed in 8 randomly chosen subjects over 3 days: the mean coefficient of variation was 7.2%. By comparison the coefficient of variation of Pdi during PImax. was 13.0% in 7 subjects. The maximal sniff is a spontaneous maneuver, easily performed, repeatable without tiring, and reproducible. Its measurement provides a more reliable quantitative method for assessment of diaphragm strength, which has potential in clinical practice.