Comparison of thoracoabdominal calibration methods in normal human subjects

The design of RIP belts impacts the reliability and quality of the measured respiratory signals

Purpose

Evaluate the effect of respiratory inductance plethysmography (RIP) belt design on the reliability and quality of respiratory signals. A comparison of cannula flow to disposable cut-to-fit, semi-disposable folding and disposable RIP belts was performed in clinical home sleep apnea testing (HSAT) studies.

Methods

This was a retrospective study using clinical HSAT studies. The signal reliability of cannula, thorax, and abdomen RIP belts was determined by automatically identifying periods during which the signals did not represent respiratory airflow and breathing movements. Results were verified by manual scoring. RIP flow quality was determined by examining the correlation between the RIP flow and cannula flow when both signals were considered reliable.

Results

Of 767 clinical HSAT studies, mean signal reliability of the cut-to-fit, semi-disposable, and disposable thorax RIP belts was 83.0 ± 26.2%, 76.1 ± 24.4%, and 98.5 ± 9.3%, respectively. The signal reliability of the cannula was 92.5 ± 16.1%, 87.0 ± 23.3%, and 85.5 ± 24.5%, respectively. The automatic assessment of signal reliability for the RIP belts and cannula flow had a sensitivity of 50% and a specificity of 99% compared with manual assessment. The mean correlation of cannula flow to RIP flow from the cut-to-fit, semi-disposable, and disposable RIP belts was 0.79 ± 0.24, 0.52 ± 0.20, and 0.86 ± 0.18, respectively.

Conclusion

The design of RIP belts affects the reliability and quality of respiratory signals. The disposable RIP belts that had integrated contacts and did not fold on top of themselves performed the best. The cut-to-fit RIP belts were most likely to be unreliable, and the semi-disposable folding belts produced the lowest-quality RIP flow signals compared to the cannula flow signal.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11325-020-02268-x.

Estimation of respiratory volume from thoracoabdominal breathing distances: comparison of two models of machine learning

PURPOSE

The purposes of this study were to both improve the accuracy of respiratory volume (V) estimates using the respiratory magnetometer plethysmography (RMP) technique and facilitate the use of this technique.

METHOD

We compared two models of machine learning (ML) for estimating [Formula: see text]: a linear model (multiple linear regression-MLR) and a nonlinear model (artificial neural network-ANN), and we used cross-validation to validate these models. Fourteen healthy adults, aged [Formula: see text] years participated in the present study. The protocol was conducted in a laboratory test room. The anteroposterior displacements of the rib cage and abdomen, and the axial displacements of the chest wall and spine were measured using two pairs of magnetometers. [Formula: see text] was estimated from these four signals, and the respiratory volume was simultaneously measured using a spirometer ([Formula: see text]) under lying, sitting and standing conditions as well as various exercise conditions (working on computer, treadmill walking at 4 and 6 km[Formula: see text], treadmill running at 9 and 12  km [Formula: see text] and ergometer cycling at 90 and 110 W).

RESULTS

The results from the ANN model fitted the spirometer volume significantly better than those obtained through MLR. Considering all activities, the difference between [Formula: see text] and [Formula: see text] (bias) was higher for the MLR model ([Formula: see text] L) than for the ANN model ([Formula: see text] L).

CONCLUSION

Our results demonstrate that this new processing approach for RMP seems to be a valid tool for estimating V with sufficient accuracy during lying, sitting and standing and under various exercise conditions.

Evaluation of bedside pulmonary function in the neonate: From the past to the future

Pulmonary function testing and monitoring plays an important role in the respiratory management of neonates. A noninvasive and complete bedside evaluation of the respiratory status is especially useful in critically ill neonates to assess disease severity and resolution and the response to pharmacological interventions as well as to guide mechanical respiratory support. Besides traditional tools to assess pulmonary gas exchage such as arterial or transcutaenous blood gas analysis, pulse oximetry, and capnography, additional valuable information about global lung function is provided through measurement of pulmonary mechanics and volumes. This has now been aided by commercially available computerized pulmonary function testing systems, respiratory monitors, and modern ventilators with integrated pulmonary function readouts. In an attempt to apply easy-to-use pulmonary function testing methods which do not interfere with the infant́s airflow, other tools have been developed such as respiratory inductance plethysmography, and more recently, electromagnetic and optoelectronic plethysmography, electrical impedance tomography, and electrical impedance segmentography. These alternative technologies allow not only global, but also regional and dynamic evaluations of lung ventilation. Although these methods have proven their usefulness for research applications, they are not yet broadly used in a routine clinical setting. This review will give a historical and clinical overview of different bedside methods to assess and monitor pulmonary function and evaluate the potential clinical usefulness of such methods with an outlook into future directions in neonatal respiratory diagnostics.

Respiratory inductance plethysmography-a rationale for validity during exercise

INTRODUCTION

The aim of this study was to provide a rationale for future validations of a priori calibrated respiratory inductance plethysmography (RIP) when used under exercise conditions. Therefore, the validity of a posteriori-adjusted gain factors and accuracy in resultant breath-by-breath RIP data recorded under resting and running conditions were examined.

METHODS

Healthy subjects, 98 men and 88 women (mean ± SD: height = 175.6 ± 8.9 cm, weight = 68.9 ± 11.1 kg, age = 27.1 ± 8.3 yr), underwent a standardized test protocol, including a period of standing still, an incremental running test on treadmill, and multiple periods of recovery. Least square regression was used to calculate gain factors, respectively, for complete individual data sets as well as several data subsets. In comparison with flowmeter data, the validity of RIP in breathing rate (fR) and inspiratory tidal volume (VTIN) were examined using coefficients of determination (R). Accuracy was estimated from equivalence statistics.

RESULTS

Calculated gains between different data subsets showed no equivalence. After gain adjustment for the complete individual data set, fR and VTIN between methods were highly correlated (R = 0.96 ± 0.04 and 0.91 ± 0.05, respectively) in all subjects. Under conditions of standing still, treadmill running, and recovery, 86%, 98%, and 94% (fR) and 78%, 97%, and 88% (VTIN), respectively, of all breaths were accurately measured within ± 20% limits of equivalence.

CONCLUSION

In case of the best possible gain adjustment, RIP confidentially estimates tidal volume accurately within ± 20% under exercise conditions. Our results can be used as a rationale for future validations of a priori calibration procedures.

Nonlinear model for estimating respiratory volume based on thoracoabdominal breathing movements

BACKGROUND AND OBJECTIVE

Respiratory inductive plethysmography is a non-invasive technique for measuring respiratory function. However, there are challenges associated with using linear methods for calibration of respiratory inductive plethysmography. In this study, we developed two nonlinear models, artificial neural network and adaptive neuro-fuzzy inference system, to estimate respiratory volume based on thoracoabdominal movements, and compared these models with routine linear approaches, including qualitative diagnostic calibration and multiple linear regression.

METHODS

Recordings of spirometry volume and respiratory inductive plethysmography were obtained for 10 normal subjects and 10 asthmatic patients, during asynchronous breathing for 7 min. The first 5 min of recording were used to develop the models; the remaining data were used for subsequent validation of the results.

RESULTS

The results from the nonlinear models fitted the spirometry volume curve significantly better than those obtained by linear methods, particularly during asynchrony (P < 0.05). On a breath-by-breath analysis, estimates of tidal volume, total cycle time and sigh values using the artificial neural network model were accurate by comparison with qualitative diagnostic calibration. In contrast to the artificial neural network model, there was a significant correlation between values for thoracoabdominal asynchrony and increased error of qualitative diagnostic calibration (P < 0.05).

CONCLUSIONS

These results indicate that the nonlinear methods can be adapted to closely simulate variable conditions and used to study the patterns of volume changes during normal and asynchronous breathing.

Pletismografia respiratória por indutância: estudo comparativo entre calibração por manobra de isovolume e calibração qualitativa diagnóstica em voluntários saudáveis avaliados em diferentes posturas

OBJETIVO: Comparar dois métodos de calibração da pletismografia respiratória por indutância (PRI) em três posturas diferentes. MÉTODOS: Foram avaliados 28 indivíduos saudáveis (18 mulheres e 10 homens), com média de idade de 25,4 ± 3,9 anos. Todos os indivíduos foram submetidos a isovolume maneuver calibration (ISOCAL, calibração por manobra de isovolume) e qualitative diagnostic calibration (QDC, calibração diagnóstica qualitativa) em ortostatismo, sedestação e decúbito dorsal. Foi utilizada ANOVA e a disposição gráfica de Bland-Altman para a avaliação da concordância dos métodos de calibração. RESULTADOS: Os valores da constante de proporcionalidade (K) foram significativamente distintos entre ISOCAL e QDC nas três posturas avaliadas: 1,6 ± 0,5 vs. 2,0 ± 1,2, em decúbito dorsal; 2,5 ± 0,8 vs. 0,6 ± 0,3, em sedestação; e 2,0 ± 0,8 vs. 0,6 ± 0,3, em ortostatismo (p < 0,05 para todos). CONCLUSÕES: Nossos resultados sugerem que QDC não é um método acurado para a calibração da PRI. Os valores de K obtidos por ISOCAL mostram que a PRI deve ser calibrada para cada postura avaliada.

Nocturnal thoracoabdominal asynchrony in house dust mite-sensitive nonhuman primates

Nocturnal bronchoconstriction is a common symptom of asthma in humans, but is poorly documented in animal models. Thoracoabdominal asynchrony (TAA) is a noninvasive clinical indication of airway obstruction. In this study, respiratory inductive plethysmography (RIP) was used to document nocturnal TAA in house dust mite (HDM)-sensitive Cynomolgus macaques. Dynamic compliance (C_dyn) and lung resistance (R_L) measured in anesthetized animals at rest and following exposure to HDM allergen, methacholine, and albuterol were highly correlated with three RIP parameters associated with TAA, ie, phase angle of the rib cage and abdomen waveforms (PhAng), baseline effort phase relation (eBPRL) and effort phase relation (ePhRL). Twenty-one allergic subjects were challenged with HDM early in the morning, and eBPRL and ePhRL were monitored for 20 hours after provocation. Fifteen of the allergic subjects exhibited gradual increases in eBPRL and ePhRL between midnight and 6 am, with peak activity at 4 am. However, as in humans, this nocturnal response was highly variable both between subjects and within subjects over time. The results document that TAA in this nonhuman primate model of asthma is highly correlated with C_dyn and R_L, and demonstrate that animals exhibiting acute responses to allergen exposure during the day also exhibit nocturnal TAA.

Scope of linear estimators of tidal and occluded volumes using thoracoabdominal indications of breathing movement coordination

The basic theory for respiratory inductive plethysmography (RIP) applications was re-examined, refined and tested. A realistic model of the RIP interpretation of respiratory mechanics related tidal volumes (VT) to a linear combination of ribcage and abdomen movements. Lissajous plots of asynchronous thoracoabdominal movements revealed their net effect equivalent to the superposition of synchronous and antipathetic respiration modes at right angles, along the principal axes specific to the combined motion. Predictors of relative changes in VT, degree of asynchrony and volume thus being occluded were developed via least squares estimation theory, with an optional validation facility. The approach enabled clinically adequate analysis of 452 h of RIP data from 29 postoperative patients. Correct identification of only seven complete apnoeas in 111 incidences of obstruction during periodic, variable, asynchronous or paradoxical natural breathing was substantiated via non-invasive airflow monitoring. The modelling helped clarify RIP limitations--the possibility of misleading indications from obese or abnormal physiques or movement artefacts degrading its otherwise nearly optimal performance. Nevertheless, our uncalibrated predictors had better theoretical basis, improved reliability and more convenient practical utility than the traditional approach of calibrating RIP by spirometry prior to non-invasive monitoring and identifying and classifying apnoeas.

Key to better qualitative diagnostic calibrations in respiratory inductive plethysmography

Least-squares estimates for coefficients of linear models that predict tidal volume (VT) via respiratory inductive plethysmography (RIP) are given. The qualitative diagnostic calibration sum formula M(RC + KAbd) arises for idealized thoracoabdominal co-ordination within this model-fitting framework. For a normal synchronous breath K is then optimally determined from the ratio of its associated ribcage (RC) and abdomen (Abd) movement standard deviations, not from a ratio that applied to a previously measured breath. M merely rescales relative changes in (RC + KAbd) to absolute changes in VT for correct proportioning. RC and Abd move in complete antipathy during an obstructive apnoea, so use of optimal K ensures (RC + KAbd) tends to zero for such unproductive breathing efforts. The interpretation is extended to more general breathing patterns by using a complementary difference expression M(RC-KAbd) to help identify any antagonistic respiratory actions. The two new constructs are equivalent to the principal components of the combined ribcage and abdomen movements. Together they demonstrate versatile capability in uncalibrated RIP applications for obstructive apnoea detection and tracking relative changes in VT during paradoxical or variable natural breathing. Calibration is appropriate for model-fitting quality assessment but otherwise usually too patient demanding, unnecessary or detrimental to prediction monitoring efficacy.

Error analysis of a natural breathing calibration method for respiratory inductive plethysmography

Respiratory volumes are measured non-invasively by recording rib cage and abdominal motions using respiratory inductive plethysmography (RIP). Qualitative diagnostic calibration (QDC) of RIP is based on the natural variability in the relative rib-cage-to-abdomen contribution during tidal breathing. ODC does not require subject cooperation but it has previously been shown that accuracy may deteriorate when breathing pattern changes. The aim of this study was to investigate the causes and situations where QDC accuracy deteriorates. The QDC method was compared to PRA (calibration during voluntarily preferential rib cage or abdomen breathing) in ten adults. A reference RIP calibration was obtained from all validation data (REF). The PRA method had better accuracy than the ODC method (p<0.01). The volumetric error ranged between 10% and 136% with QDC and between 5% and 33% with PRA. The PRA calibration factors were within 6% of those from REF, while the QDC rib-cage factor was underestimated by 15% and the abdominal factor was overestimated by 38%. Small natural variability in the relative rib-cage-to-abdomen contribution was related to poor accuracy. Each compartment's variability depended on its magnitude, which is a violation of the QDC assumptions.

Assessing thoracoabdominal asynchrony

The traditional method of derivation of phase difference between ribcage and abdomen breathing movements from a Lissajous plot is shown to be unsatisfactory for assessing the degree of asynchrony. The signal processing technique of cross-correlation is introduced as a better, statistically based approach. Even so, examination of the latent structure of a Lissajous figure leads to the concept of movement sum and difference components along its principal axes. This more general form of analysis is used for indicating relative changes in tidal volume during postoperative monitoring of Cheyne-Stokes breathing with obstructive apnoea, as well as tracking the degree of asynchrony. The theoretical and practical limitations of inductive plethysmography calibrations are such that the proposed methods of uncalibrated non-invasive respiratory monitoring are also preferable as research tools.

Mathematical assessment of qualitative diagnostic calibration for respiratory inductive plethysmography

We present a critical assessment of qualitative diagnostic calibration (QDC), which claims to provide a relative calibration of respiratory inductive plethysmography during natural breathing (Sackner MA, Watson H, Belsito AS, Feinerman D, Suarez M, Gonzalez G, Bizousky F, and Krieger B. J Appl Physiol 66: 410-420, 1989). QDC computes the calibration factor (K) by considering breaths of constant tidal volume (VT) and provides a criterion to select breaths when VT is unknown. We applied QDC on uncalibrated data constructed from simulated sets of thoracic and abdominal volumes, with a predefined K. As expected, QDC yields a correct K when applied to breaths at constant VT. In breathing at quasi-constant VT, the criterion for breath selection is shown to bias the results toward K = 1. For spontaneous breathing, the calculated K deviates from its predefined value and depends heavily on the selection criterion. We conclude that QDC will only provide a correct calibration factor when applied to an entire set of breaths with constant or quasi-constant VT. More generally, physiological conclusions based on QDC should be critically evaluated on a case-by-case basis.

Progress in non-invasive respiratory monitoring using uncalibrated breathing movement components

The theory for optimal linear combination of uncalibrated breathing movements was developed and applied in non-invasive respiratory monitoring situations for assessment. 16 patients were monitored overnight for respiratory depression during postoperative pain treatment. Intranasal/extra-oral airway pressure monitoring and pulse oximetry signals were recorded at 50 Hz. Respiratory inductive plethysmography (RIP) provided guidance to nurses regarding sensitivity settings of the pressure device during slow, shallow breathing, and vital information about breathing movements to help distinguish central from obstructive apnoeas. Subsequent analysis showed that the principal components of the standardized RIP signals would be helpful in any automated identification of pressure indicator false alarms and could provide a simple means for supplementary breath classification. The sum and difference of the scaled RIP values tracked changes in tidal volume and indicated any breathing movement asynchrony or paradox associated with obstructions. A construction was developed for emulating RIP calibration predictions of relative changes in tidal volume to within about 1%, so that invasive or demanding monitoring preparations could be by-passed altogether. The necessary signal combination and linearcalibration model background is reviewed for this simple formulation, which arises from component analysis and least squares regression. The methods are illustrated for definitive non-invasive postoperative monitoring and calibration situations. Theoretical and physiological reasons for preferring the use of balanced ribcage and abdomen contributions to overall tidal volume are presented that also help clarify the greater limitations of traditional RIP monitoring practices.

Inductive plethysmography components analysis and improved non-invasive postoperative apnoea monitoring

Twenty-nine patients were monitored overnight for breathing distress patterns during postoperative analgesia. Nasal flow apnoea monitoring and pulse oximetry data were recorded at 50 Hz. Respiratory inductive plethysmography (RIP) tracked tidal volume (TV) thoracoabdominal motion, and supplemented the flow monitoring by identifying detected apnoea type. TVs were computed from linear combinations of the RIP signals, but calibrations showed that multiple regression approaches with fitting errors <1% had highly variable coefficients and estimate precisions. Simple least squares theory showed that unstable parameter calculation and coefficient variation with signal conditions were inherent in RIP calibration models. Principal components (PC) methods were well suited to mitigating these problems because the RIP signals were highly correlated. The two PCs tracked the relative changes in TVs and indicated the degree of signal asynchrony, enabling improved uncalibrated monitoring. For accurately measuring RIP phase differences, the cross-correlation function was calculated. A simple version of PC analysis is developed, avoiding matrices, to help clarify how RIP calibration problems can be addressed. The methods are illustrated for calibration in normal breathing, and for postoperative monitoring during Cheyne-Stokes breathing. Sum and difference combinations of the RIP signals could discriminate central from obstructive apnoeas to help improve flow monitoring efficacy on-line.

Effects of voluntary changes in breathing frequency on respiratory comfort

Previous experiments on voluntary breathing have suggested that spontaneous breathing is partly determined by the minimization of respiratory sensations. However, during instructed breathing, respiratory sensations may be confounded with difficulty in achieving the prescribed pattern. In the present experiment, we tested the hypothesis that the subjective assessment of respiratory comfort and the difficulty in following breathing instructions are closely related. A total of 15 subjects adjusted breathing frequency to prescribed values ranging from 40 to 250% of individual spontaneous levels. Then, they scored the difficulty of this task and the discomfort associated with the target frequency. Difficulty scores sharply increased above 100% (spontaneous level) and discomfort scores displayed a similar shape. A significant positive correlation between discomfort and difficulty was found, thus suggesting a possible influence of the difficulty to follow ventilatory instructions on respiratory sensation scores.

The effect of attentional load on the breathing pattern in children

Experiments designed to establish the effects of video games on breathing patterns have led to contradictory results. Several authors reported that video games tended to increase breathing frequency (i.e. to reduce breath duration), whereas others reported the opposite. We postulated that video games contain different psychophysiological components which may have opposite effects on breathing pattern. On the one hand, arousal and emotion may tend to stimulate breathing. On the other, focusing attention on the game may prompt subject to inhibit any movement--including breathing--which might be a potential nuisance variable. The aim of this study was to assess the specific effects of the attentional load in an experimental environment characterized by its low emotional impact. We measured breathing variables, cardiac frequency and cortisol levels in 10 healthy children (mean age = 9.2 +/- 1.5 years) who were familiar with the environment, the experimenter and the video game. Breath duration rose significantly, from 2.56 to 3.16 s, as a function of game difficulty. Cortisol levels, heart rate and the thoracic contribution to breathing displayed no significant changes. Taken together, these data suggest that focusing attention on the game tended to inhibit breathing and that previous contradictory reports in this respect were due to the confounding effects of emotion.

Influence of thoracoabdominal pattern of breathing on respiratory resistance

The purpose of this study was to test the hypothesis that voluntary changes in thoracoabdominal pattern of breathing may increase total respiratory resistance. Thirty-one normal subjects were asked to control their thoracoabdominal pattern of breathing by using a visual feedback. Thoracic and abdominal volume changes were measured by inductance plethysmography. Respiratory resistance and elastance were measured by forced oscillometry. The mean (+/-SD) percent thoracic contributions to tidal volume during thoracic or abdominal breathing were 75 (+/-11) and 25% (+/-9), respectively. These changes induced small but significant increases in resistance (P < 0.005) and elastance (P < 0.002). The increased resistance was observed in 22 subjects for thoracic breathing (P < 0.016) and in 21 subjects for abdominal breathing (P < 0.043). The mean value (+/-SD) of individual increases in resistance during thoracic or abdominal breathing, compared with normal breathing, were 9.2 +/- 17.5 and 9.4 +/- 19.9%, respectively. The fact that departing from spontaneous pattern increases respiratory resistance is consistent with the notion that breathing pattern is optimally adjusted on the basis of mechanical criteria.

Evaluation of respiratory inductive plethysmography: accuracy for analysis of respiratory waveforms

OBJECTIVE

To assess the accuracy of respiratory inductive plethysmography (RIP) waveforms to those obtained with whole body plethysmograph (BP) as this device gives a plethysmographic signal and a pneumotachograph (PNT).

DESIGN

Randomized controlled trial.

SETTING

Physiologic laboratory in a university hospital.

PARTICIPANTS

Eleven subjects from the laboratory staff.

INTERVENTIONS

This study was achieved during four consecutive periods in subjects breathing spontaneously and through different added resistive loads. Using the least square method calibration, two RIP waveforms, VRIP.BP(t) and VRIP.PNT(t), were simultaneously calculated with coefficients obtained from BP and from PNT volume waveforms, respectively VBP(t) and VPNT(t). For each recording, to compare volume waveforms, we calculated their differences in term of distances, DRIP-BP and DRIP-PNT, between the normalized RIP volume signal (respectively, VRIP.BP[t] and VRIP.PNT[t]) and its normalized reference (respectively, VBP[t] and VPNT[t]). We also calculated the distance DPNT-BP between the two normalized references VBP(t) and VPNT(t).

RESULTS

No significant effect of load or time on the distance occurred. Including all the recordings, the mean distance DRIP-BP (3.4+/-1.1%) appears significantly lower than both the mean distance DRIP-PNT (4.5+/-1.3%; p<0.04) and the mean distance DPNT-BP (4.6+/-0.9%; p<0.008). For each period or load level, DRIP-BP appears to be lower than DRIP-PNT and DPNT-BP.

CONCLUSION

The RIP seems reasonably accurate for analysis of respiratory waveform while subjects subsequently breathe against resistive loads.

Ventilatory responses to imagined exercise

We studied whether the ventilatory responses to imagined exercise are influenced by automatic processes. Twentynine athletes produced mental images of a sport event with successive focus on the environment, the preparation, and the exercise. Mean breathing frequency increased from 15 to 22 breaths/min. Five participants reported having voluntarily controlled breathing, two of them during preparation. Twenty participants reported that their breathing pattern changed during the experiment: 11 participants were unable to correctly report on the direction of changes in frequency, and 13 incorrectly reported changes in amplitude. This finding suggests that these changes were not voluntary in most participants and may therefore reveal automatic forebrain influences on exercise hyperpnea. However, these changes may also reflect nonspecific processes (e.g., arousal) different from those occurring during actual exercise.

Thoracoabdominal pattern of breathing in neuromuscular disorders

STUDY OBJECTIVE

To assess abnormalities in thoracoabdominal pattern of breathing (TAPB) in neuromuscular disorders during spontaneous breathing, intermittent positive pressure ventilation (IPPV) with and without abdominal (AB) binder, and immediately after IPPV.

DESIGN

Repeated measures design: Pre-IPPV spontaneous breathing, IPPV, IPPV with AB binder, and post-IPPV spontaneous breathing. In protocol 1, ventilator pressure was held constant at the individual value habitually adopted in sessions of IPPV. In protocol 2, it was increased stepwise from 5 to 30 cm H2O.

SETTING

University hospital, Department of Pediatrics, Intensive Care, and Neuro-Ventilatory Rehabilitation.

PATIENTS

Thirty-one patients with spinal muscular atrophy (SMA) and 19 patients with myopathy, mean age (+/- SD) 9.7 +/- 3 years.

MEASUREMENTS

Tidal volume (VT), percent thoracic contribution to VT (%RC), the phase angle between the thoracic and the AB volume changes and the labored breathing index, which is an index of asynchrony taking into account both the phase relationships and relative volumes of rib cage and AB compartments.

RESULTS

We observed marked abnormalities in TAPB during spontaneous breathing, especially in the SMA group. %RC, labored breathing index, and phase angle displayed nearly normal values during IPPV. IPPV pressures of 25 to 30 cm H2O were necessary to increase %RC above 80%. AB binding decreased VT, but led to larger thoracic volumes, especially in patients with SMA. Thoracic contribution to VT and thoracic volume after IPPV were higher than baseline levels.

CONCLUSIONS

The quantitative assessment of TAPB enhances the ability to estimate pulmonary function in neuromuscular disorders, and the efficiency of mechanical ventilation.