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López-Rey JM, D'Angelo Del Campo MD, Seldes V, García-Martínez D, Bastir M. Eco-geographic and sexual variation of the ribcage in Homo sapiens. Evol Anthropol 2024; 33:e22040. [PMID: 38951738 DOI: 10.1002/evan.22040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024]
Abstract
Up to now, Allen and Bergmann's rules have been studied in modern humans by analyzing differences in limb length, height, or body mass. However, there are no publications studying the effects of latitude in the 3D configuration of the ribcage. To assess this issue, we digitally reconstructed the ribcages of a balanced sample of 109 adult individuals of global distribution. Shape and size of the ribcage was quantified using geometric morphometrics. Our results show that the ribcage belonging to tropical individuals is smaller and slenderer compared to others living in higher latitudes, which is in line with Allen and Bergmann's rules and suggests an allometric relationship between size and shape. Although sexual dimorphism was observed in the whole sample, significant differences were only found in tropical populations. Our proposal is that, apart from potential sexual selection, avoiding heat loss might be the limiting factor for sexual dimorphism in cold-adapted populations.
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Affiliation(s)
- José M López-Rey
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (MNCN-CSIC), Madrid, Spain
- Laboratorio de Poblaciones del Pasado (LAPP), Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Manuel D D'Angelo Del Campo
- Laboratorio de Poblaciones del Pasado (LAPP), Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro Científico Tecnológico - Tandil (CONICET, CTT Tandil), Tandil, Argentina
- Laboratorio de Ecología Evolutiva Humana (LEEH), Facultad de Ciencias Sociales (FACSO), Unidad de Enseñanza Universitaria Quequén (UEUQ), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPB), Quequén, Argentina
- Museo de Antropología, Instituto de Investigación Arqueológica y Antropológica (INIAA), Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca (UMRPSFXCH), Sucre, Bolivia
| | - Verónica Seldes
- Consejo Nacional de Investigaciones Científicas y Técnicas, Centro Científico Tecnológico - Tandil (CONICET, CTT Tandil), Tandil, Argentina
- Instituto de Ciencias Antropológicas, Sección de Antropología Biológica - Instituto de Arqueología, Facultad de Filosofía y Letras (FFYL), Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Daniel García-Martínez
- Physical Anthropology Unit, Faculty of Biological Sciences, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Department of Life Sciences, Laboratory of Forensic Anthropology, Center for Functional Ecology - Science for People and the Planet (CFE), Centre for Functional Ecology, University of Coimbra (UC), Calçada Martim de Freitas, Coimbra, Portugal
- Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), Burgos, Spain
| | - Markus Bastir
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (MNCN-CSIC), Madrid, Spain
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2
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Mogicato G, Cavalerie R, Daniels-Treffandier H, Cartiaux B, Montel C, Verwaerde P, Jourdan G. Morphological comparative study of canine and feline diaphragms: Effect of bodyweight, body condition score, gender, age and breed. Anat Histol Embryol 2024; 53:e13039. [PMID: 38563610 DOI: 10.1111/ahe.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
The canine diaphragm is a muscular and tendinous dome-like plate and is largely involved in digestive and respiratory functions. Very few studies compared morphology of the diaphragm between dogs and cats and no studies have investigated the effects of individual factors on this morphology. So the aim of this study was to (1) study the effects of individual factors on the morphology of the diaphragm and (2) to compare its morphology between cats and dogs. Surface measurements of 86 diaphragms were performed. The tendinous centre (TC), the lumbar part of the peripheral muscular (LP) and the sternal and costal parts of the peripheral muscular (SCPM) were measured. Measurement ratios (surface of anatomical part of the diaphragm/total surface of the diaphragm) were used for statistical analysis (TC%S, LP%S, SCPM%S). The SCPM%S are significantly lower, and the LP%S are significantly higher when bodyweight increases in dogs and cats. The TC%S are significantly lower when the body condition score of dogs increases. The SCPM%S are significantly higher, and therefore, the TC%S and LP%S lower in brachycephalic animals as opposed to mesocephalic animals. The TC%S are significantly higher in dogs than in cats and the SCPM%S are significantly higher in cats than in dogs. This study proposed a cartography of the diaphragm morphology in cats and dogs taking into account individual animal factors. Significant differences in the diaphragm morphology between cats and dogs and between mesocephalic and brachycephalic animals were found. Further studies are necessary to confirm these results and to investigate the consequences of these variations.
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Affiliation(s)
- Giovanni Mogicato
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, ENVT, Toulouse, France
| | - Robin Cavalerie
- Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - Hélène Daniels-Treffandier
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Université de Toulouse, CNRS, INSERM, UPS, ENVT, Toulouse, France
| | - Benjamin Cartiaux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, ENVT, Toulouse, France
| | - Charles Montel
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, ENVT, Toulouse, France
| | - Patrick Verwaerde
- ENVA/UPEC/IMRB-Inserm U955, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Géraldine Jourdan
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Toulouse, France
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Wu H, Chasteen B. Rapid review of ventilator-induced diaphragm dysfunction. Respir Med 2024; 223:107541. [PMID: 38290603 DOI: 10.1016/j.rmed.2024.107541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/01/2024]
Abstract
Ventilator-induced diaphragm dysfunction is gaining increased recognition. Evidence of diaphragm weakness can manifest within 12 h to a few days after the initiation of mechanical ventilation. Various noninvasive and invasive methods have been developed to assess diaphragm function. The implementation of diaphragm-protective ventilation strategies is crucial for preventing diaphragm injuries. Furthermore, diaphragm neurostimulation emerges as a promising and novel treatment option. In this rapid review, our objective is to discuss the current understanding of ventilator-induced diaphragm dysfunction, diagnostic approaches, and updates on strategies for prevention and management.
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Affiliation(s)
- Huimin Wu
- Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States; Department of Adult Respiratory Care, University of Oklahoma Medical Center, Oklahoma City, OK, 73104, United States.
| | - Bobby Chasteen
- Department of Adult Respiratory Care, University of Oklahoma Medical Center, Oklahoma City, OK, 73104, United States.
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Liebsch C, Spering C, Wilke HJ. [Biomechanics of thoracic wall instability]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:180-187. [PMID: 37964040 DOI: 10.1007/s00113-023-01389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/16/2023]
Abstract
Traumatic injuries of the thorax can entail thoracic wall instability (flail chest), which can affect both the shape of the thorax and the mechanics of respiration; however, so far little is known about the biomechanics of the unstable thoracic wall and the optimal surgical fixation. This review article summarizes the current state of research regarding experimental models and previous findings. The thoracic wall is primarily burdened by complex muscle and compression forces during respiration and the mechanical coupling to spinal movement. Previous experimental models focused on the burden caused by respiration, but are mostly not validated, barely established, and severely limited with respect to the simulation of physiologically occurring forces. Nevertheless, previous results suggested that osteosynthesis of an unstable thoracic wall is essential from a biomechanical point of view to restore the native respiratory mechanics, thoracic shape and spinal stability. Moreover, in vitro studies also showed better stabilizing properties of plate osteosynthesis compared to intramedullary splints, wires or screws. The optimum number and selection of ribs to be fixated for the different types of thoracic wall instability is still unknown from a biomechanical perspective. Future biomechanical investigations should simulate respiratory and spinal movement by means of validated models.
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Affiliation(s)
- Christian Liebsch
- Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Traumaforschung Ulm, Universitätsklinikum Ulm, Helmholtzstr. 14, 89081, Ulm, Deutschland.
| | - Christopher Spering
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Hans-Joachim Wilke
- Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Traumaforschung Ulm, Universitätsklinikum Ulm, Helmholtzstr. 14, 89081, Ulm, Deutschland
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Lebschy C, Gradischar A, Krach W, Krall M, Fediuk M, Krall A, Lindenmann J, Smolle-Jüttner F, Hammer N, Beyer B, Smolle J, Schäfer U. Measuring the global mechanical properties of the human thorax: Costo-vertebral articulation. J Biomech 2024; 163:111923. [PMID: 38219554 DOI: 10.1016/j.jbiomech.2023.111923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 12/31/2023] [Indexed: 01/16/2024]
Abstract
Biomechanical simulation of the human thorax, e.g. for 3D-printed rib implant optimisation, requires an accurate knowledge of the associated articulation and tissue stiffness. The present study is focusing on determining the stiffness of the costo-vertebral articulations. Specimens of rib segments including the adjacent thoracic vertebrae and ligaments were obtained from two human post-mortem bodies at four different rib levels. The rib samples were loaded with a tensile force in the local longitudinal, sagittal and transverse direction and the resulting displacement was continuously measured. The moment-angle response of the rib articulations was also determined by applying a load at the rib end in the cranial - caudal direction and measuring the resulting displacement. The torsional load response of the costo-vertebral articulations at an applied moment between -0.1 Nm and 0.1 Nm corresponded to a median range of motion of 13.2° (6.4° to 20.9°). An almost uniform stiffness was measured in all tensile loading directions. The median displacement at the defined force of 28 N was 1.41 mm in the longitudinal, 1.55 mm in the sagittal, and 1.08 mm in the transverse direction. The measured moment-angle response of the costo-vertebral articulation is in line with the data from literature. On the contrary, larger displacements in longitudinal, sagittal and transverse directions were measured compared to the values found in literature.
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Affiliation(s)
| | | | | | - Marcell Krall
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | - Melanie Fediuk
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | - Anja Krall
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | - Jörg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
| | | | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University Graz, Graz, Austria; Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology (IWU), Dresden, Germany
| | - Benoît Beyer
- ULB Laboratory for Functional Anatomy, Université Libre de Bruxelles, Belgium
| | - Josef Smolle
- Institute of Medical Informatics, Statistics and Documentation, Medical University Graz, Austria
| | - Ute Schäfer
- Medical University Graz, Experimental Neurotraumatology, Austria
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Terada M, Kosik KB, Gribble PA. Association of Diaphragm Contractility and Postural Control in a Chronic Ankle Instability Population: A Preliminary Study. Sports Health 2024; 16:19-25. [PMID: 36691689 PMCID: PMC10732118 DOI: 10.1177/19417381221147304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Altered reorganization of the sensorimotor system after an initial lateral ankle sprain may lead to a chronic neuromuscular maladaptation in multiple body locations. Specifically, decreased diaphragm contractility has been observed in patients with chronic ankle instability (CAI). The diaphragm has an essential role in postural control. Decreased diaphragm contractility could associate with diminished postural control commonly observed in patients with CAI. However, no study has determined if diaphragm contractility contributes to postural control in a CAI population. HYPOTHESIS Decreased diaphragm contractility would be negatively associated with static postural control in patients with CAI. STUDY DESIGN Cross-sectional study design. LEVEL OF EVIDENCE Level 4. METHODS A total of 15 participants with CAI participated voluntarily. An ultrasonography assessment was performed to quantify the right and left hemidiaphragm thickness at the end of resting inspiration and expiration in supine while breathing quietly. The degree of diaphragm contractility was calculated from the diaphragm thickness. Participants performed 3 eyes-open trials of a 20-second single-leg balance task on the involved limb. Static postural control measures included the center of pressure velocity (COPV) and mean of time-to-boundary (TTB) minima in the anteroposterior (AP) and mediolateral directions. RESULTS Moderate correlations of the right hemidiaphragm contractility were observed with COPV (ρ = -0.54) and TTB mean minima (ρ = 0.56) (P < 0.05) in the AP direction. The left hemidiaphragm contractility was moderately correlated with COPV (ρ = -0.56) and TTB mean minima (ρ = 0.60) (P < 0.05) in the AP direction. CONCLUSION Lower diaphragm contractility may be associated with diminished static postural control in the AP direction in patients with CAI. CLINICAL RELEVANCE This study highlights diaphragm contractility could be a potential connection with diminished static postural control in patients with CAI. Our data raise new avenues for future exploration including potential beneficial effects of implementation of diaphragm breathing exercises and techniques for restoring static postural control in patients with CAI.
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Affiliation(s)
- Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Kyle B. Kosik
- The Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Phillip A. Gribble
- The Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
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López-Rey JM, García-Martínez D, Martelli S, Beyer B, Palancar CA, Torres-Sánchez I, García-Río F, Bastir M. Estimation of the upper diaphragm in KNM-WT 15000 (Homo erectus s.l.) and Kebara 2 (Homo neanderthalensis) using a Homo sapiens model. J Hum Evol 2023; 185:103442. [PMID: 37862773 DOI: 10.1016/j.jhevol.2023.103442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/22/2023]
Affiliation(s)
- José M López-Rey
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales, Calle José Gutiérrez Abascal, 2, 28006 Madrid, Spain; Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid, Calle Darwin, 2, 28049 Madrid, Spain.
| | - Daniel García-Martínez
- Physical Anthropology Unit, Department of Biodiversity, Ecology, and Evolution, Faculty of Biological Sciences, Universidad Complutense de Madrid, Calle José Antonio Novais, 12, 28040 Madrid, Spain; Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, Universidade de Coimbra, CC Martim de Freitas, 3000-456 Coimbra, Portugal
| | - Sandra Martelli
- UCL Centre for Integrative Anatomy, Department of Cell & Developmental Biology, Division of Biosciences, Gower Street, London WC1E 6BT, UK
| | - Benoît Beyer
- Laboratory for Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Bruxelles, Belgium
| | - Carlos A Palancar
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales, Calle José Gutiérrez Abascal, 2, 28006 Madrid, Spain
| | - Isabel Torres-Sánchez
- Instituto de Investigación Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Francisco García-Río
- Instituto de Investigación Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Avenida de Monforte de Lemos, 5, 28029 Madrid, Spain; Department of Medicine, Faculty of Medicine, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo, 4, 28029 Madrid, Spain
| | - Markus Bastir
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales, Calle José Gutiérrez Abascal, 2, 28006 Madrid, Spain
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Shimozawa Y, Kurihara T, Kusagawa Y, Hori M, Numasawa S, Sugiyama T, Tanaka T, Suga T, Terada RS, Isaka T, Terada M. Point Prevalence of the Biomechanical Dimension of Dysfunctional Breathing Patterns Among Competitive Athletes. J Strength Cond Res 2023; 37:270-276. [PMID: 35612946 DOI: 10.1519/jsc.0000000000004253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ABSTRACT Shimozawa, Y, Kurihara, T, Kusagawa, Y, Hori, M, Numasawa, S, Sugiyama, T, Tanaka, T, Suga, T, Terada, RS, Isaka, T, and Terada, M. Point prevalence of the biomechanical dimension of dysfunctional breathing patterns among competitive athletes. J Strength Cond Res 37(2): 270-276, 2023-There is growing evidence of associations between altered biomechanical breathing patterns and numerous musculoskeletal and psychological conditions. The prevalence of dysfunctional and diaphragmatic breathing patterns is unknown among athletic populations. The purpose of this study was to examine the prevalence of dysfunctional and diaphragmatic breathing patterns among athletic populations with a clinical measure to assess the biomechanical dimension of breathing patterns. Using a cross-sectional design, 1,933 athletes across multiple sports and ages were screened from 2017 to 2020. Breathing patterns were assessed using the Hi-Lo test in the standing position. Scores of the Hi-Lo test were determined based on the presence or absence of abdominal excursion, anterior-posterior chest expansion, superior rib cage migration, and shoulder elevation. The Hi-Lo test scores were used to categorize observational breathing mechanics as dysfunctional and diaphragmatic breathing patterns. The prevalence of athletes with dysfunctional breathing patterns was 90.6% (1,751 of 1,933). Athletes with diaphragmatic breathing patterns accounted for 9.4% of all athletes in our sample (182 of 1,933). There were no differences in the proportion of breathing patterns between male and female athletes ( p = 0.424). Breathing patterns observations were associated with sport-setting categories ( p = 0.002). The highest percentages of dysfunctional breathers were in middle school student athletes (93.7%), followed by elementary school student athletes (91.2%), high school student athletes (90.6%), professional/semiprofessional athletes (87.5%), and collegiate athletes (84.8%). The current study observed that dysfunctional breathing patterns (90.6%) in the biomechanical dimension were more prevalent than diaphragmatic breathing pattern (9.4%) among competitive athletes. These results suggest that clinicians may need to consider screening breathing patterns and implementing intervention programs aimed to improve the efficiency of biomechanical dimensions of breathing patterns in athletic populations. This study may help raise awareness of impacts of dysfunctional breathing patterns on athletes' health and performance.
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Affiliation(s)
- Yuka Shimozawa
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Toshiyuki Kurihara
- Research Organization of Science and Technology, Ritsumeikan University, Shiga, Japan
| | - Yuki Kusagawa
- Graduate School of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Miyuki Hori
- Graduate School of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Shun Numasawa
- Medical Science Committee of Osaka Basketball Association, Osaka, Japan ; and
| | - Takashi Sugiyama
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Takahiro Tanaka
- Graduate School of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Tadashi Suga
- Research Organization of Science and Technology, Ritsumeikan University, Shiga, Japan
| | | | - Tadao Isaka
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
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Ultrasonographic Assessment of Diaphragmatic Function and Its Clinical Application in the Management of Patients with Acute Respiratory Failure. Diagnostics (Basel) 2023; 13:diagnostics13030411. [PMID: 36766515 PMCID: PMC9914801 DOI: 10.3390/diagnostics13030411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Acute respiratory failure (ARF) is a common life-threatening medical condition, with multiple underlying etiologies. In these cases, many factors related to systemic inflammation, prolonged use of steroids, and lung mechanical abnormalities (such as hyperinflation or increased elastic recoil due to pulmonary oedema or fibrosis) may act as synergic mechanisms leading to diaphragm dysfunction. The assessment of diaphragm function with ultrasound has been increasingly investigated in the emergency department and during hospital stay as a valuable tool for providing additional anatomical and functional information in many acute respiratory diseases. The diaphragmatic ultrasound is a noninvasive and repeatable bedside tool, has no contraindications, and allows the physician to rapidly assess the presence of diaphragmatic dysfunction; this evaluation may help in estimating the need for mechanical ventilation (and the risk of weaning failure), as well as the risk of longer hospital stay and higher mortality rate. This study presents an overview of the recent evidence regarding the evaluation of diaphragmatic function with bedside ultrasound and its clinical applications, including a discussion of real-life clinical cases.
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Zhao X, Guo S, Xiao S, Song Y. Thorax Dynamic Modeling and Biomechanical Analysis of Chest Breathing in Supine Lying Position. J Biomech Eng 2022; 144:101004. [PMID: 35420121 PMCID: PMC9125866 DOI: 10.1115/1.4054346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 04/06/2022] [Indexed: 11/08/2022]
Abstract
During respiration, the expansion and contraction of the chest and abdomen are coupled with each other, presenting a complex torso movement pattern. A finite element (FE) model of chest breathing based on the HUMOS2 human body model was developed. One-dimensional muscle units with active contraction functions were incorporated into the model based on Hill's active muscle model so as to generate muscle contraction forces that can change over time. The model was validated by comparing it to the surface displacement of the chest and abdomen during respiration. Then, the mechanism of the coupled motion of the chest and abdomen was analyzed. The analyses revealed that since the abdominal wall muscles are connected to the lower edge of the rib cage through tendons, the movement of the rib cage may cause the abdominal wall muscles to be stretched in both horizontal and vertical in a supine position. The anteroposterior and the right-left diameters of the chest will increase at inspiration, while the right-left diameter of the abdomen will decrease even though the anteroposterior diameter of the abdomen increases. The external intercostal muscles at different regions had different effects on the motion of the ribs during respiration. In particular, the external intercostal muscles at the lateral region had a larger effect on pump handle movement than bucket handle movement, and the external intercostal muscles at the dorsal region had a greater influence on bucket handle movement than pump handle movement.
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Affiliation(s)
- Xingli Zhao
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China; Hebei Key Laboratory of Robot Sensing and Human-Robot Interaction, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China; School of Mechanical Engineering, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China
| | - Shijie Guo
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China; Hebei Key Laboratory of Robot Sensing and Human-Robot Interaction, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China; School of Mechanical Engineering, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China
| | - Sen Xiao
- School of Mechanical Engineering, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China
| | - Yao Song
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China; Hebei Key Laboratory of Robot Sensing and Human-Robot Interaction, Hebei University of Technology, 8, No. 1 Dingzigu Road, Hongqiao District, Tianjin 300131, China
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11
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Gradischar A, Lebschy C, Krach W, Krall M, Fediuk M, Gieringer A, Smolle-Jüttner F, Hammer N, Beyer B, Smolle J, Schäfer U. Measurement of global mechanical properties of human thorax Part 1: Costal cartilage. J Biomech 2022; 142:111242. [DOI: 10.1016/j.jbiomech.2022.111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
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12
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Relationships between diaphragm ultrasound, spirometry, and respiratory mouth pressures in children. Respir Physiol Neurobiol 2022; 305:103950. [PMID: 35905862 DOI: 10.1016/j.resp.2022.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/12/2022] [Accepted: 07/24/2022] [Indexed: 11/22/2022]
Abstract
Diaphragm ultrasound (DUS) is a noninvasive method of evaluating the diaphragm's structure and function. This study explored the relationships between DUS, spirometry, and respiratory mouth pressures in 10 healthy children (median age: 11 [range: 7-14 years]; 5 females, 5 males). Thickening fraction correlated with maximal inspiratory pressure (MIP) (Spearman's rho [rs] = 0.64, p = 0.05). During quiet breaths, excursion time correlated with MIP (rs = 0.78, p = 0.01) while velocity correlated with maximal expiratory pressure (rs = -0.82, p = 0.01). During deep breaths, MIP correlated with excursion (rs = 0.64, p = 0.05) and time (rs = 0.87, p = 0.01). Excursion time during deep breaths also correlated with forced vital capacity (rs = 0.65, p = 0.04). Our findings suggest that DUS parameters are closely related to spirometry and respiratory mouth pressures in healthy children and further support the use of DUS as a noninvasive method of respiratory assessment.
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Patel N, Chong K, Baydur A. Methods and Applications in Respiratory Physiology: Respiratory Mechanics, Drive and Muscle Function in Neuromuscular and Chest Wall Disorders. Front Physiol 2022; 13:838414. [PMID: 35774289 PMCID: PMC9237333 DOI: 10.3389/fphys.2022.838414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with neuromuscular and chest wall disorders experience respiratory muscle weakness, reduced lung volume and increases in respiratory elastance and resistance which lead to increase in work of breathing, impaired gas exchange and respiratory pump failure. Recently developed methods to assess respiratory muscle weakness, mechanics and movement supplement traditionally employed spirometry and methods to evaluate gas exchange. These include recording postural change in vital capacity, respiratory pressures (mouth and sniff), electromyography and ultrasound evaluation of diaphragmatic thickness and excursions. In this review, we highlight key aspects of the pathophysiology of these conditions as they impact the patient and describe measures to evaluate respiratory dysfunction. We discuss potential areas of physiologic investigation in the evaluation of respiratory aspects of these disorders.
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14
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Vergari C, Skalli W, Clavel L, Demuynck M, Valentin R, Sandoz B, Similowski T, Attali V. Functional analysis of the human rib cage over the vital capacity range in standing position using biplanar X-ray imaging. Comput Biol Med 2022; 144:105343. [DOI: 10.1016/j.compbiomed.2022.105343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
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15
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Ríos-Castro F, González-Seguel F, Molina J. Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times. Medwave 2022; 22:e8724. [DOI: 10.5867/medwave.2022.03.002550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
Technological advances in mechanical ventilation have been essential to increasing the survival rate in intensive care units. Usually, patients needing mechanical ventilation use controlled ventilation to override the patient’s respiratory muscles and favor lung protection. Weaning from mechanical ventilation implies a transition towards spontaneous breathing, mainly using assisted mechanical ventilation. In this transition, the challenge for clinicians is to avoid under and over assistance and minimize excessive respiratory effort and iatrogenic diaphragmatic and lung damage. Esophageal balloon monitoring allows objective measurements of respiratory muscle activity in real time, but there are still limitations to its routine application in intensive care unit patients using mechanical ventilation. Like the esophageal balloon, respiratory muscle electromyography and diaphragmatic ultrasound are minimally invasive tools requiring specific training that monitor respiratory muscle activity. Particularly during the coronavirus disease pandemic, non invasive tools available on mechanical ventilators to monitor respiratory drive, inspiratory effort, and work of breathing have been extended to individualize mechanical ventilation based on patient’s needs. This review aims to identify the conceptual definitions of respiratory drive, inspiratory effort, and work of breathing and to identify non invasive maneuvers available on intensive care ventilators to measure these parameters. The literature highlights that although respiratory drive, inspiratory effort, and work of breathing are intuitive concepts, even distinguished authors disagree on their definitions.
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16
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Kreit J. Respiratory-Cardiovascular Interactions During Mechanical Ventilation: Physiology and Clinical Implications. Compr Physiol 2022; 12:3425-3448. [PMID: 35578946 DOI: 10.1002/cphy.c210003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Positive-pressure inspiration and positive end-expiratory pressure (PEEP) increase pleural, alveolar, lung transmural, and intra-abdominal pressure, which decrease right and left ventricular (RV; LV) preload and LV afterload and increase RV afterload. The magnitude and clinical significance of the resulting changes in ventricular function are determined by the delivered tidal volume, the total level of PEEP, the compliance of the lungs and chest wall, intravascular volume, baseline RV and LV function, and intra-abdominal pressure. In mechanically ventilated patients, the most important, adverse consequences of respiratory-cardiovascular interactions are a PEEP-induced reduction in cardiac output, systemic oxygen delivery, and blood pressure; RV dysfunction in patients with ARDS; and acute hemodynamic collapse in patients with pulmonary hypertension. On the other hand, the hemodynamic changes produced by respiratory-cardiovascular interactions can be beneficial when used to assess volume responsiveness in hypotensive patients and by reducing dyspnea and improving hypoxemia in patients with cardiogenic pulmonary edema. Thus, a thorough understanding of the physiological principles underlying respiratory-cardiovascular interactions is essential if critical care practitioners are to anticipate, recognize, manage, and utilize their hemodynamic effects. © 2022 American Physiological Society. Compr Physiol 12:1-24, 2022.
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Affiliation(s)
- John Kreit
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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17
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Fayssoil A, Mansencal N, Nguyen LS, Orlikowski D, Prigent H, Bergounioux J, Annane D, Lofaso F. Diaphragm Ultrasound in Cardiac Surgery: State of the Art. MEDICINES 2022; 9:medicines9010005. [PMID: 35049938 PMCID: PMC8779362 DOI: 10.3390/medicines9010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
In cardiac surgery, patients are at risk of phrenic nerve injury, which leads to diaphragm dysfunction and acute respiratory failure. Diaphragm dysfunction (DD) is relatively frequent in cardiac surgery and particularly affects patients after coronary artery bypass graft. The onset of DD affects patients’ prognosis in term of weaning from mechanical ventilation and hospital length of stay. The authors present a narrative review about diaphragm physiology, techniques used to assess diaphragm function, and the clinical application of diaphragm ultrasound in patients undergoing cardiac surgery.
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Affiliation(s)
- Abdallah Fayssoil
- Echo Lab, CHU de Raymond-Poincaré, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- INSERM U1179, END-ICAP, Université de Versailles-Saint Quentin, University of Paris-Saclay, 78180 Montigny-le-Bretonneux, France; (H.P.); (F.L.)
- Raymond Poincaré Hospital, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Versailles-Saint Quentin, 92100 Boulogne, France;
- Correspondence:
| | - Nicolas Mansencal
- Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Versailles-Saint Quentin, 92100 Boulogne, France;
- INSERM U-1018, CESP, Épidémiologie Clinique, 94807 Villejuif, France
| | - Lee S. Nguyen
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, AP-HP, Centre, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France;
- France Research and Innovation Department, CMC Ambroise Paré, RICAP, 27 bd Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - David Orlikowski
- Service de Réanimation Médicale, CHU Raymond Poincaré, AP-HP, Université de Versailles Saint Quentin en Yvelines, 92380 Garches, France;
- Centre d’Investigation Clinique et Innovation Technologique CIC 14.29, INSERM, 92380 Garches, France
| | - Hélène Prigent
- INSERM U1179, END-ICAP, Université de Versailles-Saint Quentin, University of Paris-Saclay, 78180 Montigny-le-Bretonneux, France; (H.P.); (F.L.)
- Raymond Poincaré Hospital, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest—Site Raymond Poincaré—AP-HP, 92380 Garches, France
| | - Jean Bergounioux
- Pediatric Neurology and ICU, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, 92380 Garches, France;
| | - Djillali Annane
- Laboratory Infection and Inflammation, Department of Critical Care, Raymond Poincaré Hospital (AP-HP), U1173, Faculty of Health Science Simone Veil, Université de Versailles-Saint Quentin, University Paris Saclay, INSERM, FHU SEPSIS, RHU RECORDS, 78180 Montigny-le-Bretonneux, France;
| | - Frédéric Lofaso
- INSERM U1179, END-ICAP, Université de Versailles-Saint Quentin, University of Paris-Saclay, 78180 Montigny-le-Bretonneux, France; (H.P.); (F.L.)
- Raymond Poincaré Hospital, AP-HP, Boulevard Raymond Poincaré, 92380 Garches, France
- Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest—Site Raymond Poincaré—AP-HP, 92380 Garches, France
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18
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Li H, Liang J, Shao P, Zheng J, Shi R, Wang Y. Supra-Arcuate Ligament Blocks: Anatomy, Mechanisms, and Techniques. J Pain Res 2021; 14:3837-3848. [PMID: 34938113 PMCID: PMC8685551 DOI: 10.2147/jpr.s347071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/09/2021] [Indexed: 01/06/2023] Open
Abstract
Quadratus lumborum block (QLB) is clinically used for postoperative analgesia of abdominal or hip surgery, which can reduce the dose of general anesthetic, inhibit postoperative pain, and promote postoperative rehabilitation. However, accumulated studies have shown several drawbacks of QLB, such as only a small portion of local anesthetic spread into the thoracic paravertebral space, relatively longer onset time, and easily-influenced block effect by the integrity of lumbar fascia, etc. Therefore, on the basis of traditional anterior QLB, our group proposed the techniques of a supra-arcuate ligament block, which include a paramedian short-axis scanning approach, paramedian long-axis scanning approach, infra-lateral arcuate ligament QLB with the apposition zone between diaphragm and quadratus lumborum as drug diffusion target and supra-arcuate ligament block under direct laparoscopic visualization. Recent studies have demonstrated that the supra-arcuate ligament blocks have the advantages of clear anatomy, are easy to perform, and have rapid onset, which avoid some drawbacks of the conventional QLB techniques. This article reviews the anatomical basis, sonoanatomy, technical points, and clinical considerations of supra-arcuate ligament blocks.
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Affiliation(s)
- Huili Li
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Jinghan Liang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Peiqi Shao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Junwei Zheng
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Rong Shi
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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19
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Hannan LM, De Losa R, Romeo N, Muruganandan S. Diaphragm dysfunction: A comprehensive review from diagnosis to management. Intern Med J 2021; 52:2034-2045. [PMID: 34402156 DOI: 10.1111/imj.15491] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/08/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
Although the diaphragm represents a critical component of the respiratory pump, the clinical presentations of diaphragm dysfunction are often non-specific and can be mistaken for other more common causes of dyspnoea. While acute bilateral diaphragm dysfunction typically presents dramatically, progressive diaphragm dysfunction associated with neuromuscular disorders and unilateral hemidiaphragm dysfunction may be identified incidentally or by recognising subtle associated symptoms. Diaphragm dysfunction should be considered in individuals with unexplained dyspnoea, restrictive respiratory function tests or abnormal diaphragm position on plain chest imaging. A higher index of suspicion should occur for individuals with profound orthopnoea, those who have undergone procedures in proximity to the phrenic nerve(s) or those with co-morbid conditions that are associated with diaphragm dysfunction, particularly neuromuscular disorders. A systematic approach to the evaluation of diaphragm function using non-invasive diagnostic techniques such as respiratory function testing and diaphragm imaging can often confirm a diagnosis. Neurophysiological assessment may confirm diaphragm dysfunction and assist in identifying an underlying cause. Identifying those with or at risk of respiratory failure can allow institution of respiratory support, while specific cases may also benefit from surgical plication or phrenic nerve pacing techniques. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Liam M Hannan
- Department of Respiratory Medicine, Northern Health, Epping, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne Medicine
| | - Rebekah De Losa
- Department of Respiratory Medicine, Northern Health, Epping, Victoria, Australia
| | - Nicholas Romeo
- Department of Respiratory Medicine, Northern Health, Epping, Victoria, Australia
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20
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Azevedo IG, Peres AL, Moran CA, de Oliveira Holanda NS, Gomes DC, Pereira SA. Relationship between thoracoabdominal mobility and hours of life in infants: A cross-sectional study. Respir Physiol Neurobiol 2021; 290:103676. [PMID: 33910080 DOI: 10.1016/j.resp.2021.103676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility.
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Affiliation(s)
| | - Ana Lorena Peres
- Faculty of Health Sciences, Federal University of Rio Grande do Norte (FACISA - UFRN), Santa Cruz, Brazil
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21
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Li H, Shi R, Wang Y. A Modified Approach Below the Lateral Arcuate Ligament to Facilitate the Subcostal Anterior Quadratus Lumborum Block. J Pain Res 2021; 14:961-967. [PMID: 33880061 PMCID: PMC8053522 DOI: 10.2147/jpr.s306696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose The subcostal quadratus lumborum (QL) block was used in postoperative analgesia for abdominal surgery. However, it is difficult to precisely put the needle tip into the target fascia compartment. In the current study, we proposed a modified approach to facilitate the subcostal QL block. Patients and Methods Twenty-four patients scheduled for laparoscopic renal surgery were enrolled. The modified QL block was placed preoperatively. The transducer was placed just laterally to the tip of L1 transverse process to perform the parasagittal scan. The needle was inserted in-plane and advanced toward the target compartment between the QL muscle and the anterior thoracolumbar fascia and just below the lateral arcuate ligament. The 20 mL of 0.5% ropivacaine was injected slowly if the saline spread cranially via the posterior pathway of lateral arcuate ligament was observed on the sonogram. Then, the paramedian transverse scanning at the level of T12-L1 was performed to observe the injectate diffusion. The dermatomal coverage of sensory block was tested at 5 min and 10 min after LA injections. The complications associated with the block were recorded. Results Twenty-three (95.8%) patients received the successful block. All patients achieved the sensory block dermatomes of T9–T12 and T6–L1, at 5 and 10 minutes after injection, respectively. The mean numbers of block dermatomes were 5.6±1.8 at 5 min and 6.5±2.2 at 10 min after injection. Two out of twenty-three (8.7%) patients achieved coverage as cephalad as T5 at 10 min after injections. The lunar-shaped spread of LA along the diaphragm into the T12 paravertebral space was observed in every patient. No complications occurred. Conclusion The modified subcostal QL block has the advantages of clear sonoanatomy, rapid onset time, and consistent dermatomal coverage and provides a new choice for postoperative analgesia of abdominal surgery. Trial Registration Chinese Clinical Trial Registry: ChiCTR2000029210.
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Affiliation(s)
- Huili Li
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Rong Shi
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
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22
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Exploring pulmonary function and physical function in childhood cancer: A systematic review. Crit Rev Oncol Hematol 2021; 160:103279. [PMID: 33716200 DOI: 10.1016/j.critrevonc.2021.103279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Children with cancer experience pulmonary and physical function side effects from the cancer itself and the medical interventions. This systematic review examines the known relationship between pulmonary function and physical function in childhood cancer and identifies gaps in the literature. METHODS A search of Ovid Medline, CINAHL (EbscoHost) and Embase to identify literature from 2009 to March 2020. RESULTS Fifty-seven studies met inclusion criteria. Thirty-seven studies reported impaired pulmonary function. Incidence of pulmonary dysfunction ranged from 45.5 % to 84.1 %. Eighteen studies reported impaired physical function. Three studies investigated the relationship between pulmonary function and physical function. No studies explored inspiratory muscle strength. CONCLUSION Pulmonary function and physical function are related and frequently impaired in children during and after cancer treatment. A literature gap was found in diaphragm function and its relationship with physical function. Future studies should focus on interventions that target the pulmonary mechanisms impacting physical function.
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23
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Kang BH, Tang CT. Acupuncture to abdominal trigger points as treatment for idiopathic dyspnea: A case study. J Bodyw Mov Ther 2021; 27:436-439. [PMID: 34391268 DOI: 10.1016/j.jbmt.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/19/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Brian H Kang
- Washington University in St. Louis, Department of Neurology, Division of Neurorehabilitation, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Chi-Tsai Tang
- Washington University in St. Louis, Department of Orthopedic Surgery, Division of Physical Medicine and Rehabilitation, 14532 S. Outer Forty Drive, Chesterfield, MO, 63107, USA.
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24
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George UZ, Moon KS, Lee SQ. Extraction and Analysis of Respiratory Motion Using a Comprehensive Wearable Health Monitoring System. SENSORS (BASEL, SWITZERLAND) 2021; 21:1393. [PMID: 33671202 PMCID: PMC7923104 DOI: 10.3390/s21041393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/22/2022]
Abstract
Respiratory activity is an important vital sign of life that can indicate health status. Diseases such as bronchitis, emphysema, pneumonia and coronavirus cause respiratory disorders that affect the respiratory systems. Typically, the diagnosis of these diseases is facilitated by pulmonary auscultation using a stethoscope. We present a new attempt to develop a lightweight, comprehensive wearable sensor system to monitor respiration using a multi-sensor approach. We employed new wearable sensor technology using a novel integration of acoustics and biopotentials to monitor various vital signs on two volunteers. In this study, a new method to monitor lung function, such as respiration rate and tidal volume, is presented using the multi-sensor approach. Using the new sensor, we obtained lung sound, electrocardiogram (ECG), and electromyogram (EMG) measurements at the external intercostal muscles (EIM) and at the diaphragm during breathing cycles with 500 mL, 625 mL, 750 mL, 875 mL, and 1000 mL tidal volume. The tidal volumes were controlled with a spirometer. The duration of each breathing cycle was 8 s and was timed using a metronome. For each of the different tidal volumes, the EMG data was plotted against time and the area under the curve (AUC) was calculated. The AUC calculated from EMG data obtained at the diaphragm and EIM represent the expansion of the diaphragm and EIM respectively. AUC obtained from EMG data collected at the diaphragm had a lower variance between samples per tidal volume compared to those monitored at the EIM. Using cubic spline interpolation, we built a model for computing tidal volume from EMG data at the diaphragm. Our findings show that the new sensor can be used to measure respiration rate and variations thereof and holds potential to estimate tidal lung volume from EMG measurements obtained from the diaphragm.
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Affiliation(s)
- Uduak Z. George
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA 92182, USA;
| | - Kee S. Moon
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, USA
| | - Sung Q. Lee
- Electronics and Telecommunications Research Institute, Daejeon 34129, Korea;
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25
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Yoshida R, Tomita K, Kawamura K, Setaka Y, Ishii N, Monma M, Mutsuzaki H, Mizukami M, Ohse H, Imura S. Investigation of inspiratory intercostal muscle activity in patients with spinal cord injury: a pilot study using electromyography, ultrasonography, and respiratory inductance plethysmography. J Phys Ther Sci 2021; 33:153-157. [PMID: 33642691 PMCID: PMC7897523 DOI: 10.1589/jpts.33.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The respiratory function in patients with cervical spinal cord injury is
influenced by inspiratory intercostal muscle function. However, inspiratory intercostal
muscle activity has not been conclusively evaluated. We evaluated the inspiratory
intercostal muscle activity in patients with cervical spinal cord injury by using
inspiratory intercostal electromyography, respiratory inductance plethysmography, and
ultrasonography. [Participants and Methods] Three patients with cervical spinal cord
injury were assessed. The change in mean amplitude (rest vs. maximum inspiration) was
calculated by using intercostal muscle electromyography. Changes in intercostal muscle
thickness (resting expiration and maximum inspiration) were also evaluated on
ultrasonography. The waveform was converted to spirometry ventilation with respiratory
inductance plethysmography, and the waveform at the xiphoid was considered to determine
the rib cage volume. Each index was compared with the inspiratory capacities in each case.
[Results] Intercostal muscle electromyography failed to measure the notable myoelectric
potential in all the patients. The rib cage volume was higher at higher inspiratory
capacities. The changes in muscle thickness were not significantly different between the
patients. [Conclusion] The rib cage volume (measured with inductance plethysmography) was
greater in the patients with cervical spinal cord injury when inspiratory intercostal
muscle activity was high. Respiratory inductance plethysmography can capture inspiratory
intercostal muscle function in patients with cervical spinal cord injury.
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Affiliation(s)
- Ryo Yoshida
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Kazuhide Tomita
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Kenta Kawamura
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yukako Setaka
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Nobuhisa Ishii
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Masahiko Monma
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hirotaka Mutsuzaki
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ibaraki 300-0394, Japan.,Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masafumi Mizukami
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Hirotaka Ohse
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Shigeyuki Imura
- Graduate School of Health Care, Takasaki University of Health and Welfare, Japan
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26
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Diaphragm Ultrasound in Weaning From Mechanical Ventilation. Chest 2020; 159:1166-1172. [PMID: 33309837 DOI: 10.1016/j.chest.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/20/2022] Open
Abstract
A 65-year-old man was admitted to the ICU for septic shock due to pneumonia. He remained on mechanical ventilation for 96 hours. His shock resolved, and he no longer required IV vasopressor therapy. His vital signs included a BP of 105/70 mm Hg, heart rate 85 beats/min, respiratory rate 22 breaths/min, and oxygen saturation 95%. His ventilator settings were volume control/assist control with a positive end-expiratory pressure of 5 and an Fio2 set to 40%. On these setting his blood gas showed an Pao2 of 75 mm Hg. He was following simple commands and had minimal tracheobronchial secretions. He was placed on a spontaneous breathing trial with a spontaneous mode of ventilation and pressure support of 7/5. He remained hemodynamically stable and showed no distress through the procedure, so he was extubated to 6 L oxygen by nasal cannula. Eighteen hours later, the patient was found to have increased work of breathing, with use of accessory respiratory muscles. A blood gas showed an elevated level of CO2, so the patient was reintubated. After intubation, the patient again appeared comfortable on minimal ventilator settings. Chest radiography before reintubation showed no new parenchymal process, but an elevated left diaphragm. After a thorough workup, it was determined that diaphragmatic weakness was the most likely reason for respiratory failure. The team questioned whether there was a way to have detected this before extubation.
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Shukla M, Chauhan D, Raj R. Breathing exercises and pranayamas to decrease perceived exertion during breath-holding while locked-down due to COVID-19 online randomized study. Complement Ther Clin Pract 2020; 41:101248. [PMID: 33074110 PMCID: PMC7554491 DOI: 10.1016/j.ctcp.2020.101248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022]
Abstract
AIM to compare anulom vilom pranayama (AVP), kapal bhati pranayama (KBP), diaphragmatic breathing exercises (DBE), and pursed-lip breathing (PLB) for breath holding time (BHT) and rating of perceived exertion (RPE). Methods- Participants were assessed for BHT and RPE, before training on any one intervention using online platforms, for one week during lockdown from COVID-19.15 participants in each group total N = 60 at- (α - 0.05), (1- β - 0.90) & (effect size - 0.55); were analysed. Results - AVP & DBE decreased RPE (p < 0.000). KBP & PLB did not decrease RPE as compared to AVP & DBE (p. > 0.05). DBE increased BHT more than KBP & PLB interventions (p < 0.05), but not more than AVP (p > 0.05). One-way ANOVA of four interventions revealed significant variation for RPE change (p < 0.05), for AVP. Conclusions - AVP reduces RPE maximally during breath-holding, whereas DPE increases BHT more.
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Wittmer VL, Lima RT, Maia MC, Duarte H, Paro FM. RESPIRATORY AND SYMPTOMATIC IMPACT OF ASCITES RELIEF BY PARACENTESIS IN PATIENTS WITH HEPATIC CIRRHOSIS. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:64-68. [PMID: 32294737 DOI: 10.1590/s0004-2803.202000000-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/06/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Liver cirrhosis is a highly prevalent disease that, at an advanced stage, usually causes ascites and associated respiratory changes. However, there are few studies evaluating and quantifying the impact of ascites and its relief through paracentesis on lung function and symptoms such as fatigue and dyspnea in cirrhotic patients. OBJECTIVE To assess and quantify the impact of acute reduction of ascitic volume on respiratory parameters, fatigue and dyspnea symptoms in patients with hepatic cirrhosis, as well as to investigate possible correlations between these parameters. METHODS Thirty patients with hepatic cirrhosis and ascites who underwent the following pre and post paracentesis evaluations: vital signs, respiratory pattern, thoracoabdominal mobility (cirtometry), pulmonary function (ventilometry), degree of dyspnea (numerical scale) and fatigue level (visual analog scale). RESULTS There was a higher prevalence of patients classified as CHILD B and the mean MELD score was 14.73±5.75. The comparison of pre and post paracentesis parameters evidenced after paracentesis: increase of predominantly abdominal breathing pattern, improvement of ventilatory variables, increase of the differences obtained in axillary and abdominal cirtometry, reduction of dyspnea and fatigue level, blood pressure reduction and increased peripheral oxygen saturation. Positive correlations found: xiphoid with axillary cirtometry, degree of dyspnea with fatigue level, tidal volume with minute volume, Child "C" with higher MELD score, volume drained in paracentesis with higher MELD score and with Child "C". We also observed a negative correlation between tidal volume and respiratory rate. CONCLUSION Since ascites drainage in patients with liver cirrhosis improves pulmonary volumes and thoracic expansion as well as reduces symptoms such as fatigue and dyspnea, we can conclude that ascites have a negative respiratory and symptomatological impact in these patients.
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Affiliation(s)
- Verônica Lourenço Wittmer
- Universidade Federal do Espírito Santo, Departamento de Educação Integrada em Saúde, Vitória, ES, Brasil
| | - Rozy Tozetti Lima
- Universidade Federal do Espírito Santo, Empresa Brasileira de Serviços Hospitalares (EBSERH), Serviço de Fisioterapia, Vitória, ES, Brasil
| | - Michele Coutinho Maia
- Universidade Federal do Espírito Santo, Empresa Brasileira de Serviços Hospitalares (EBSERH), Serviço de Fisioterapia, Vitória, ES, Brasil
| | - Halina Duarte
- Universidade Federal do Espírito Santo, Departamento de Educação Integrada em Saúde, Vitória, ES, Brasil
| | - Flávia Marini Paro
- Universidade Federal do Espírito Santo, Departamento de Educação Integrada em Saúde, Vitória, ES, Brasil
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Ramachandran P, Devaraj U, Patrick B, Saxena D, Venkatnarayan K, Louis V, Krishnaswamy UM, D'souza GA. Ultrasonographic assessment of skeletal muscle mass and diaphragm function in patients with chronic obstructive pulmonary disease: A case-control study. Lung India 2020; 37:220-226. [PMID: 32367843 PMCID: PMC7353944 DOI: 10.4103/lungindia.lungindia_103_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although muscle dysfunction is a major contributor to morbidity in chronic obstructive pulmonary disease (COPD), assessment of skeletal muscle, and diaphragm function is not routinely performed in COPD patients. OBJECTIVES (1) The aim is to assess muscle dysfunction in COPD by measuring the zone of apposition of diaphragm, diaphragm excursion, thickness of diaphragm, and rectus femoris cross-sectional area (RFCSA) with ultrasonography.(2) To correlate the above assessments with spirometric parameters; notably forced expiratory volume in 1 s (FEV1). METHODS Twenty-four consecutive stable COPD patients and 18 controls were included after obtaining written informed consent. Demographic and clinical data, spirometric values, 6-min walk distance, and sonographic parameters mentioned above were compiled for the analysis. RESULTS All included participants were male with a mean age of 62.5 ± 8.4 years. The mean FEV1in cases was 1.12 ± 0.4 L versus 2.41 ± 0.5 L in controls. The diaphragm thickness (1.8 ± 0.5 mm vs. 2.2 ± 0.6 mm;P = 0.005) and RFCSA was significantly lower in COPD patients (4.8 ± 1.3 cm[2] vs. 6.12 ± 1.2 cm[2];P = 0.02). However, diaphragm excursion (5.35 ± 2.8 cm vs. 7 ± 2.6 cm) although lower in COPD patients, was not significantly different between the groups. Correlation between FEV1and ultrasound diaphragm measurements and RFCSA by Spearman's Rho correlation was poor (ρ= 0.2). CONCLUSION Ultrasonographic assessment of the diaphragm and rectus femoris can be used as markers to assess skeletal muscle dysfunction in COPD as diaphragmatic function and RFCSA were lower in COPD patients.
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Affiliation(s)
- Priya Ramachandran
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Uma Devaraj
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Bhavna Patrick
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Deepali Saxena
- Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Varghese Louis
- Department of Pulmonary Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | | | - George A D'souza
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
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LoMauro A, Privitera E, Aliverti A, Nosotti M, Palleschi A. Sniff test: Does what we measure at the nose reflect what happens in the chest wall? CLINICAL RESPIRATORY JOURNAL 2020; 14:589-591. [PMID: 32064775 DOI: 10.1111/crj.13170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Emilia Privitera
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico of Milan, Milan, Italy
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Impact of different respiratory monitoring techniques on respiration-dependent stroke-volume measurements assessed by real-time magnetic resonance imaging. Z Med Phys 2019; 29:349-358. [DOI: 10.1016/j.zemedi.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/15/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022]
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32
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LoMauro A, Aliverti A, Frykholm P, Alberico D, Persico N, Boschetti G, DeBellis M, Briganti F, Nosotti M, Righi I. Adaptation of lung, chest wall, and respiratory muscles during pregnancy: preparing for birth. J Appl Physiol (1985) 2019; 127:1640-1650. [PMID: 31697596 DOI: 10.1152/japplphysiol.00035.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A plethora of physiological and biochemical changes occur during normal pregnancy. The changes in the respiratory system have not been as well elucidated, in part because radioimaging is usually avoided during pregnancy. We aimed to use several noninvasive methods to characterize the adaptation of the respiratory system during the full course of pregnancy in preparation for childbirth. Eighteen otherwise healthy women (32.3 ± 2.8 yr) were recruited during early pregnancy. Spirometry, optoelectronic plethysmography, and ultrasonography were used to study changes in chest wall geometry, breathing pattern, lung and thoraco-abdominal volume variations, and diaphragmatic thickness in the first, second, and third trimesters. A group of nonpregnant women were used as control subjects. During the course of pregnancy, we observed a reorganization of rib cage geometry, in shape but not in volume. Despite the growing uterus, there was no lung restriction (forced vital capacity: 101 ± 15% predicted), but we did observe reduced rib cage expansion. Breathing frequency and diaphragmatic contribution to tidal volume and inspiratory capacity increased. Diaphragm thickness was maintained (1st trimester: 2.7 ± 0.8 mm, 3rd trimester: 2.5 ± 0.9 mm; P = 0.187), possibly indicating a conditioning effect to compensate for the effects of the growing uterus. We conclude that pregnancy preserved lung volumes, abdominal muscles, and the diaphragm at the expense of rib cage muscles.NEW & NOTEWORTHY Noninvasive analysis of the kinematics of the chest wall and the diaphragm during resting conditions in pregnant women revealed significant changes in the pattern of thoracoabdominal breathing across the trimesters. That is, concomitant with the progressive changes of chest wall shape, the diaphragm increased its contribution to both spontaneous and maximal breathing, maintaining its thickness despite its lengthening due to the growing uterus. These results suggest that during pregnancy the diaphragm is conditioned to optimize its active role provided during parturition.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Peter Frykholm
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Daniela Alberico
- Department of Obstetrics and Gynecology "L. Mangiagalli," Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Nicola Persico
- Department of Obstetrics and Gynecology "L. Mangiagalli," Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giulia Boschetti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Michela DeBellis
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Federica Briganti
- Pneumology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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Welch JF, Kipp S, Sheel AW. Respiratory muscles during exercise: mechanics, energetics, and fatigue. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Affiliation(s)
- Bharat Bhushan Sharma
- Department of Medicine, Division of Allergy and Pulmonary Medicine, SMS Medical College Hospital, Jaipur, Rajasthan, India
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35
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Sarkar M, Bhardwaz R, Madabhavi I, Modi M. Physical signs in patients with chronic obstructive pulmonary disease. Lung India 2019; 36:38-47. [PMID: 30604704 PMCID: PMC6330798 DOI: 10.4103/lungindia.lungindia_145_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed the various physical signs of chronic obstructive pulmonary disease, their pathogenesis, and clinical importance. We searched PubMed, EMBASE, and the CINAHL from inception to March 2018. We used the following search terms: chronic obstructive pulmonary disease, physical examination, purse-lip breathing, breath sound intensity, forced expiratory time, abdominal paradox, Hoover's sign, barrel-shaped chest, accessory muscle use, etc. All types of studies were chosen. Globally, history taking and clinical examination of the patients is on the wane. One reason can be a significant development in the field of medical technology, resulting in overreliance on sophisticated diagnostic machines, investigative procedures, and medical tests as first-line modalities of patient's management. In resource-constrained countries, detailed history taking and physical examination should be emphasized as one of the important modalities in patient's diagnosis and management. Declining bedside skills and clinical aptitude among the physician is indeed a concern nowadays. Physical diagnosis of chronic obstructive pulmonary disease (COPD) is the quickest and reliable modalities that can lead to early diagnosis and management of COPD patients. Bedside elicitation of physical signs should always be the starting point for any diagnosis and therapeutic approach.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajeev Bhardwaz
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Irappa Madabhavi
- Department of Medical and Pediatric Oncology, GCRI, Ahmedabad, Gujarat, India
| | - Mitul Modi
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
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de Vries H, Jonkman A, Shi ZH, Spoelstra-de Man A, Heunks L. Assessing breathing effort in mechanical ventilation: physiology and clinical implications. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:387. [PMID: 30460261 DOI: 10.21037/atm.2018.05.53] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent studies have shown both beneficial and detrimental effects of patient breathing effort in mechanical ventilation. Quantification of breathing effort may allow the clinician to titrate ventilator support to physiological levels of respiratory muscle activity. In this review we will describe the physiological background and methodological issues of the most frequently used methods to quantify breathing effort, including esophageal pressure measurement, the work of breathing, the pressure-time-product, electromyography and ultrasound. We will also discuss the level of breathing effort that may be considered optimal during mechanical ventilation at different stages of critical illness.
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Affiliation(s)
- Heder de Vries
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annemijn Jonkman
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Centre, Amsterdam, The Netherlands
| | - Zhong-Hua Shi
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Angélique Spoelstra-de Man
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Centre, Amsterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Centre, Amsterdam, The Netherlands
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37
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Respiratory muscle activation patterns during maximum airway pressure efforts are different in women and men. Respir Physiol Neurobiol 2018; 259:143-148. [PMID: 30227268 DOI: 10.1016/j.resp.2018.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/06/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
Maximum inspiratory and expiratory pressure values (PImax and PEmax) are indirect measures of respiratory muscle strength that, in healthy adults, are known to be significantly lower in women compared to men. In part, sex differences in breathing kinematics, lung size, body composition, muscle mass, and muscle fiber composition are thought to be responsible for these effects. However, it is not known whether respiratory muscle activation during maximum respiratory efforts is also sex-specific. In this study, we addressed whether respiratory multi-muscle activation patterns during PImax and PEmax efforts are different between healthy women and men. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), PImax, PEmax, and surface electromyographic (sEMG) activity recorded from respiratory muscles during these maximum airway pressure efforts were obtained in 13 women and 11 men. Percent predicted values of FVC and FEV1 were not significantly different in these two groups (women vs. men: 112 ± 14 vs. 105 ± 15%, p = 0.29; and 92 ± 12 vs. 93 ± 13, p = 0.82, Mean ± SD, respectively), while PImax and PEmax measures were significantly lower in women compared to men (68 ± 16 vs. 88 ± 19 cmH2O, p = 0.011; and 69 ± 13 vs. 94 ± 17, p = 0.0004, respectively). Using vector-based methodology, by calculating the Similarity Index (SI) as measure of the resemblance between two sEMG patterns and the Magnitude (Mag) representing the overall amount sEMG during motor task, we have found that although the Mag values for both PImax and PEmax tasks were not significantly different in two groups, the SIs revealed significant sex-dependent differences in muscle activation patterns (0.89 ± 0.08 vs. 0.97 ± 0.02, p = 0.016; and 0.77 ± 0.11 vs. 0.92 ± 0.04, p = 0.0006, respectively). During the PImax effort, presented as the percentage of total sEMG amplitude, activity of upper trapezius muscle was significantly larger (p = 0.001) while activation of rectus abdominus, oblique, and lower paraspinal muscles were significantly smaller (p = 0.002, p = 0.040, p = 0.005, respectively) in women when compared to the men (50 ± 21 vs. 22 ± 11%; 2 ± 2 vs. 8 ± 7; 4 ± 3 vs. 9 ± 7, 2 ± 3 vs. 7 ± 6, respectively). During PEmax effort, the percentage of sEMG activity were significantly larger in upper and lower trapezius, and intercostal muscles (p = 0.038, p = 0.049, p = 0.037, respectively) and were significantly smaller in pectoralis, rectus abdominus, and oblique muscles (p = 0.021, p < 0.0001, p = 0.048, respectively) in women compared to men (16 ± 10 vs. 9 ± 4%; 16 ± 9 vs. 8 ± 5; 36 ± 12 vs. 25 ± 9; 6 ± 3 vs. 15 ± 5; 14 ± 5 vs. 20 ± 7, respectively). These findings indicate that respiratory muscle activation patterns during maximum airway pressure efforts in healthy individuals are sex-specific. This information should be considered during respiratory motor control evaluation and treatment planning for people with compromised respiratory motor function.
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Fayssoil A, Behin A, Ogna A, Mompoint D, Amthor H, Clair B, Laforet P, Mansart A, Prigent H, Orlikowski D, Stojkovic T, Vinit S, Carlier R, Eymard B, Lofaso F, Annane D. Diaphragm: Pathophysiology and Ultrasound Imaging in Neuromuscular Disorders. J Neuromuscul Dis 2018; 5:1-10. [PMID: 29278898 PMCID: PMC5836400 DOI: 10.3233/jnd-170276] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Respiratory muscles are classically involved in neuromuscular disorders, leading to a restrictive respiratory pattern. The diaphragm is the main respiratory muscle involved during inspiration. Ultrasound imaging is a noninvasive, radiation-free, accurate and safe technique allowing assessment of diaphragm anatomy and function. The authors review the pathophysiology of diaphragm in neuromuscular disorders, the methodology and indications of diaphragm ultrasound imaging as well as possible pitfalls in the interpretation of results.
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Affiliation(s)
- Abdallah Fayssoil
- APHP, Raymond Poincare University Hospital, Garches, France.,Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Anthony Behin
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Adam Ogna
- Lausanne University Hospital, Lausanne, Switzerland
| | | | - Helge Amthor
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Bernard Clair
- APHP, Raymond Poincare University Hospital, Garches, France
| | - Pascal Laforet
- Myology Institute, Pitié Salpetrière Hospital, Paris, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Arnaud Mansart
- APHP, Raymond Poincare University Hospital, Garches, France
| | - Helene Prigent
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | | | - Tanya Stojkovic
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Stéphane Vinit
- INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Robert Carlier
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Bruno Eymard
- Myology Institute, Pitié Salpetrière Hospital, Paris, France
| | - Frederic Lofaso
- APHP, Raymond Poincare University Hospital, Garches, France.,INSERM U1179, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
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39
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Zielinska-Krawczyk M, Krenke R, Grabczak EM, Light RW. Pleural manometry-historical background, rationale for use and methods of measurement. Respir Med 2018; 136:21-28. [PMID: 29501243 DOI: 10.1016/j.rmed.2018.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/14/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022]
Abstract
Subatmospheric pleural pressure (Ppl), which is approximately -3 to -5 cmH2O at functional residual capacity (FRC) makes pleura a unique organ in the human body. The negative Ppl is critical for maintaining the lungs in a properly inflated state and for proper blood circulation within the thorax. Significant and sudden pleural pressure changes associated with major pleural pathologies, as well as therapeutic interventions may be associated with life-threatening complications. The pleural pressure may show two different values depending on the measurement method applied. These are called pleural liquid pressure and pleural surface pressure. It should also be realized that there are significant differences in pleural pressure distribution in pneumothorax and pleural effusion. In pneumothorax, the pressure is the same throughout the pleural space, while in pleural effusion there is a vertical gradient of approximately 1 cm H2O/cm in the pleural pressure associated with the hydrostatic pressure of the fluid column. Currently, two main methods of pleural pressure measurement are used: simple water manometers and electronic systems. The water manometers are conceptually simple, cheap and user-friendly but they only allow the estimation of the mean values of pleural pressure. The electronic systems for pleural pressure measurement are based on pressure transducers. Their major advantages include precise measurements of instantaneous pleural pressure and the ability to display and to store a large amount of data. The paper presents principles and details of pleural pressure measurement as well as the rationale for its use.
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Affiliation(s)
- Monika Zielinska-Krawczyk
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland.
| | - Elzbieta M Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland
| | - Richard W Light
- Department of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical School, Nashville, TN, USA
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40
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Russo MA, Santarelli DM, O'Rourke D. The physiological effects of slow breathing in the healthy human. Breathe (Sheff) 2017; 13:298-309. [PMID: 29209423 PMCID: PMC5709795 DOI: 10.1183/20734735.009817] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Slow breathing practices have been adopted in the modern world across the globe due to their claimed health benefits. This has piqued the interest of researchers and clinicians who have initiated investigations into the physiological (and psychological) effects of slow breathing techniques and attempted to uncover the underlying mechanisms. The aim of this article is to provide a comprehensive overview of normal respiratory physiology and the documented physiological effects of slow breathing techniques according to research in healthy humans. The review focuses on the physiological implications to the respiratory, cardiovascular, cardiorespiratory and autonomic nervous systems, with particular focus on diaphragm activity, ventilation efficiency, haemodynamics, heart rate variability, cardiorespiratory coupling, respiratory sinus arrhythmia and sympathovagal balance. The review ends with a brief discussion of the potential clinical implications of slow breathing techniques. This is a topic that warrants further research, understanding and discussion. Slow breathing techniques have been used in asthma but are there effects in healthy individuals?http://ow.ly/gCPO30eQOPZ
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Affiliation(s)
| | | | - Dean O'Rourke
- Hunter Pain Clinic, Broadmeadow, Australia.,ATUNE Health Centres, Warners Bay, Australia
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Ishizuka T, Nishida N, Homma Y, Hirayama T, Ishida Y, Kakizaki F, Konishi M. Instantaneous changes in respiratory function induced by passive pelvic suspension in the supine position in relation to increased diaphragm excursion. J Phys Ther Sci 2017; 29:432-437. [PMID: 28356625 PMCID: PMC5361004 DOI: 10.1589/jpts.29.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to introduce an approach of pelvic suspension (PS) using sling
cords and to obtain evidence for changes in respiratory function of healthy subjects.
[Subjects and Methods] Subjects were 25 healthy men. In the supine position, with hip and
knee joints flexed at 90°, the subjects’ pelvises were suspended with sling belts.
Diaphragm excursion, respiratory function, and respiratory comfort in these postures were
measured using ultrasonography, respirometry, and visual analog scale (VAS), respectively.
[Results] When the pelvis was passively suspended with sling cords, the diaphragm moved
5 mm cranially and diaphragm excursion showed an instantaneous increase compared with the
control. The tidal volume (VT) showed an increase and the
respiration rate (RR) showed a decrease. The extent of diaphragm excursion was correlated
with changes in VT under the control and PS conditions.
Independent measurements of pulmonary function revealed that PS reduced the expiratory
reserve volume, being correlated positively and negatively to increases in vital and
inspiratory capacities, respectively. Furthermore, VAS values for respiratory ease were
greater with PS than with the control. [Conclusion] These results suggest that PS
effectively changed diaphragm excursion and respiratory function, leading to ease of
breathing (i.e., deep and slow respiration).
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Affiliation(s)
- Tatsuya Ishizuka
- Department of Physiology, Graduate School of Medicine, Tokyo Medical University: 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
- Department of Rehabilitation, IMS group I-Tower Clinic, Japan
| | - Naoya Nishida
- Department of Anatomy, Graduate School of Medicine, Tokyo Medical University, Japan
- Department of Rehabilitation, Sonoda Second Hospital, Japan
| | - Yuuki Homma
- Department of Physiology, Graduate School of Medicine, Showa University, Japan
- Department of Rehabilitation, IMS group Clover no Sato IMS Care Kaupili Itabashi, Japan
| | - Tetsuro Hirayama
- Department of Physiology, Graduate School of Medicine, Showa University, Japan
- Department of Rehabilitation, Hiroo Orthopedics, Japan
| | - Yukisato Ishida
- Graduate School of Health Care Sciences, Bunkyo Gakuin University, Japan
| | - Fujiyasu Kakizaki
- Graduate School of Health Care Sciences, Bunkyo Gakuin University, Japan
| | - Masato Konishi
- Department of Physiology, Graduate School of Medicine, Tokyo Medical University: 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
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