PT - JOURNAL ARTICLE AU - Phoebe E Naughton AU - Nicole Sheers AU - David J Berlowitz AU - Mark E Howard AU - Douglas A McKim AU - Sherri L Katz TI - Objective measurement of lung volume recruitment therapy: laboratory and clinical validation AID - 10.1136/bmjresp-2021-000918 DP - 2021 Jul 01 TA - BMJ Open Respiratory Research PG - e000918 VI - 8 IP - 1 4099 - http://bmjopenrespres.bmj.com/content/8/1/e000918.short 4100 - http://bmjopenrespres.bmj.com/content/8/1/e000918.full SO - BMJ Open Resp Res2021 Jul 01; 8 AB - Lung volume recruitment manoeuvres are often prescribed to maintain respiratory health in neuromuscular disease. Unfortunately, no current system accurately records delivered dose. This study determined the performance characteristics of a novel, objective, manual lung volume recruitment bag counter (‘the counter’) with bench and healthy volunteer testing, as well as in individuals with neuromuscular disease. We undertook (1) bench test determination of activation threshold, (2) bench and healthy volunteer fidelity testing during simulated patient interface leak and different pressure compressions and (3) comparisons with self-report in individuals with neuromuscular disease. The data are reported as summary statistics, compression counts, percentage of recorded versus delivered compressions and concordance (Cohen’s kappa (K) and absolute agreement).Results Minimum counter activation pressure under conditions of zero leak was 1.9±0.4 cm H2O. No difference was observed between the number of repetitions delivered and recorded during high airway pressure condition. Interface leak approximating 25% resulted in underestimation of repetition counts, and once the leak was at 50% or beyond, the counter recorded no activity. Faster sampling frequency collected data with more fidelity. Counter data agreed with diary self-report during community trials (16 participants, 960 participant days, 77% agreement, Cohen’s Κ=0.66 and p<0.001). Disagreement typically favoured more diary reported (18%) than counter (5%) sessions.Conclusions The performance characteristics of a new lung volume recruitment counter have been established in both laboratory and community settings. Objective usage and dosage data should accelerate new knowledge development and better translation of lung volume recruitment therapy into policy and practice.Data are available upon reasonable request from the corresponding author