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Fogarty MJ, Zhan WZ, Mantilla CB, Sieck GC. Cervical spinal cord hemisection impacts sigh and the respiratory reset in male rats. Physiol Rep 2024; 12:e15973. [PMID: 38467570 DOI: 10.14814/phy2.15973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
Cervical spinal cord injury impacts ventilatory and non-ventilatory functions of the diaphragm muscle (DIAm) and contributes to clinical morbidity and mortality in the afflicted population. Periodically, integrated brainstem neural circuit activity drives the DIAm to generate a markedly augmented effort or sigh-which plays an important role in preventing atelectasis and thus maintaining lung function. Across species, the general pattern of DIAm efforts during a normal sigh is variable in amplitude and the extent of post-sigh "apnea" (i.e., the post-sigh inter-breath interval). This post-sigh inter-breath interval acts as a respiratory reset, following the interruption of regular respiratory rhythm by sigh. We examined the impact of upper cervical (C2 ) spinal cord hemisection (C2 SH) on the transdiaphragmatic pressure (Pdi ) generated during sighs and the post-sigh respiratory reset in rats. Sighs were identified in Pdi traces by their characteristic biphasic pattern. We found that C2 SH results in a reduction of Pdi during both eupnea and sighs, and a decrease in the immediate post-sigh breath interval. These results are consistent with partial removal of descending excitatory synaptic inputs to phrenic motor neurons that results from C2 SH. Following cervical spinal cord injury, a reduction in the amplitude of Pdi during sighs may compromise the maintenance of normal lung function.
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Affiliation(s)
- Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Wen-Zhi Zhan
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos B Mantilla
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gary C Sieck
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Liu H, Wiedman CM, Lovelace-Chandler V, Gong S, Salem Y. Deep Diaphragmatic Breathing-Anatomical and Biomechanical Consideration. J Holist Nurs 2024; 42:90-103. [PMID: 36734111 DOI: 10.1177/08980101221149866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Deep diaphragmatic breathing (DDB) involves slow and fully contraction of the diaphragm with expansion of the belly during inhalation, and slow and fully contraction of the abdominal muscles with reduction of the belly during exhalation. It is the key component of the holistic mind-body exercises commonly used for patients with multimorbidity. Purpose: The purpose of this study was to re-visit and address the fundamental anatomical and biomechanical consideration of the DDB with the relevant literature. Method: Peer-reviewed publications from last the 15 years were retrieved, reviewed, and analyzed. Findings: In this article, we described the updated morphological and anatomical characteristics of the diaphragm. Then, we elucidated in a biomechanical approach how and why the DDB can work on the gastrointestinal, cardiopulmonary, and nervous systems as well as on regulating the intra-abdominopelvic pressure and mind-body interaction to coordinate the diaphragm-pelvic floor-abdominal complex for a variety of physical and physiological activities. Conclusion: Understanding of this updated DDB knowledge may help holistic healthcare professionals including holistic nurses provide better patient education and care management during the DDB or DDB-based mind-body intervention time.
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Affiliation(s)
- Howe Liu
- Physical Therapy Program, Allen College, Waterloo, IA, USA
| | | | | | - Suzhen Gong
- Office of Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yasser Salem
- Physical Therapy Program, Hofstra University, Hempstead, NY, USA
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Ren M, Liou L, Vinit S, Lee K. Trans-spinal magnetic stimulation induces co-activation of the diaphragm and biceps in healthy subjects. Physiol Rep 2024; 12:e15941. [PMID: 38325910 PMCID: PMC10849884 DOI: 10.14814/phy2.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
The present study was designed to examine the effect of trans-spinal magnetic stimulation on bilateral respiratory and forelimb muscles in healthy subjects. Two wings of a figure-of-eight magnetic coil were placed on the dorsal vertebrae, from the fifth cervical to the second thoracic dorsal vertebra with a center at the seventh cervical vertebra. The surface electromyograms of bilateral diaphragm and biceps were recorded in response to trans-spinal magnetic stimulation with 20%-100% maximum output of the stimulatory device in male (n = 12) and female participants (n = 8). Trans-spinal magnetic stimulation can induce a co-activation of bilateral diaphragm and biceps when the stimulation intensity is above 60%. The onset latency was comparable between the left and right sides of the muscles, suggesting bilateral muscles could be simultaneously activated by trans-spinal magnetic stimulation. In addition, the intensity-response curve of the biceps was shifted upward compared with that of the diaphragm in males, indicating that the responsiveness of the biceps was greater than that of the diaphragm. This study demonstrated the feasibility of utilizing trans-spinal magnetic stimulation to co-activate the bilateral diaphragm and biceps. We proposed that this stimulatory configuration can be an efficient approach to activate both respiratory and forelimb muscles.
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Affiliation(s)
- Ming‐Yue Ren
- Department of Biological SciencesNational Sun Yat‐sen UniversityKaohsiungTaiwan
| | - Li‐Min Liou
- Department of NeurologyKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
- Department of Neurology, School of Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Graduate Institute of Clinical Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Stéphane Vinit
- Université Paris‐Saclay, UVSQ, Inserm, END‐ICAPVersaillesFrance
| | - Kun‐Ze Lee
- Department of Biological SciencesNational Sun Yat‐sen UniversityKaohsiungTaiwan
- Department of Biomedical Science and Environmental BiologyKaohsiung Medical UniversityKaohsiungTaiwan
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Tashiro D, Oki Y, Nonomura N, Takeyama Y, Osaki T, Morimoto Y. Maximum abdominal excursion assessment using an abdominal excursion measuring device: Reliability and validity of a new device for simple and quantitative assessment of respiratory function. Med Eng Phys 2024; 124:104093. [PMID: 38418023 DOI: 10.1016/j.medengphy.2023.104093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024]
Abstract
This study aimed to verify the reliability and validity of abdominal expansion and respiratory function measurements. Forty healthy adult males underwent lung capacity, effort lung capacity, respiratory muscle strength, cough strength, diaphragm ultrasound, and abdominal expansion measurements. Abdominal expansion was measured using a device developed to accurately evaluate abdominal movements and calculate maximum abdominal expansion on the ventral side (AE-max: the difference between maximal abdominal contraction at the same time as maximal-effort expiration and maximal abdominal expansion at the same time as maximal-effort inspiration). Intra- and inter-rater reliabilities of the AE-max measurements were examined, the paired t-test was used for assessing the ratios of the expansion and contraction displacement components in AE-max, and regression analysis was used to obtain equations for predicting maximum inspiratory pressure (MIP) based on AE-max. Both intra- and inter-rater reliabilities were high. Criterion-related validity showed that AE-max was associated with all respiratory function parameters, especially MIP, and a high percentage of expansion displacement. Regression analysis showed that AE-max was significantly associated with MIP. Based on its association with MIP, the large proportion of expansion displacement in AE-max, and the results of the multiple regression analysis, we conclude that AE-max is a helpful measure for estimating MIP.
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Affiliation(s)
- Daisuke Tashiro
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan.
| | - Yutaro Oki
- Department of Public Health Kobe University Graduate School of Health Sciences, Kobe City, Hyogo, Japan
| | - Natsuha Nonomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Yuki Takeyama
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Tohmi Osaki
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Yosuke Morimoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan; Department of Rehabilitation, Nishi-Kinen Port-island Rehabilitation Hospital, Kobe City, Hyogo, Japan
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Lee KZ, Vinit S. Modulatory effect of trans-spinal magnetic intermittent theta burst stimulation on diaphragmatic activity following cervical spinal cord contusion in the rat. Spine J 2024; 24:352-372. [PMID: 37774983 DOI: 10.1016/j.spinee.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND CONTEXT Magnetic stimulation can noninvasively modulate the neuronal excitability through different stimulatory patterns. PURPOSE The present study hypothesized that trans-spinal magnetic stimulation with intermittent theta burst stimulatory pattern can modulate respiratory motor outputs in a pre-clinical rat model of cervical spinal cord injury. STUDY DESIGN In vivo animal study. METHODS The effect of trans-spinal magnetic intermittent theta burst stimulation on diaphragmatic activity was assessed in adult rats with unilateral cervical spinal cord contusion at 2 weeks postinjury. RESULTS The results demonstrated that unilateral cervical spinal cord contusion significantly attenuated the inspiratory activity and motor evoked potential of the diaphragm. Trans-spinal magnetic intermittent theta burst stimulation significantly increased the inspiratory activity of the diaphragm in cervical spinal cord contused rats. Inspiratory bursting was also recruited by trans-spinal magnetic intermittent theta burst stimulation in the rats without diaphragmatic activity after cervical spinal cord injury. In addition, trans-spinal magnetic intermittent theta burst stimulation is associated with increases in oxygen consumption and carbon dioxide production. CONCLUSIONS These results suggest that trans-spinal magnetic intermittent theta burst stimulation can induce respiratory neuroplasticity. CLINICAL SIGNIFICANCE We propose that trans-spinal theta burst magnetic stimulation may be considered a potential rehabilitative strategy for improving the respiratory activity after cervical spinal cord injury. This will require future clinical study.
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Affiliation(s)
- Kun-Ze Lee
- Department of Biological Sciences, National Sun Yat-sen University, #70 Lien-Hai Rd, Kaohsiung, 804 Taiwan; Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, 9F, First Teaching Building, 100, Shih-Chuan 1st Road, Kaohsiung, 807, Taiwan.
| | - Stéphane Vinit
- END-ICAP, UVSQ, Inserm, Université Paris-Saclay, Versailles 78000, France
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Scholten AWJ, van Leuteren RW, de Waal CG, Kraaijenga JV, de Jongh FH, van Kaam AH, Hutten GJ. Diaphragmatic electromyography in infants: an overview of possible clinical applications. Pediatr Res 2024; 95:52-58. [PMID: 37660179 DOI: 10.1038/s41390-023-02800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
Preterm infants often experience breathing instability and a hampered lung function. Therefore, these infants receive cardiorespiratory monitoring and respiratory support. However, the current respiratory monitoring technique may be unreliable for especially obstructive apnea detection and classification and it does not provide insight in breathing effort. The latter makes the selection of the adequate mode and level of respiratory support difficult. Electromyography of the diaphragm (dEMG) has the potential of monitoring heart rate (HR) and respiratory rate (RR), and it provides additional information on breathing effort. This review summarizes the available evidence on the clinical potential of dEMG to provide cardiorespiratory monitoring, to synchronize patient-ventilator interaction, and to optimize the mode and level of respiratory support in the individual newborn infant. We also try to identify gaps in knowledge and future developments needed to ensure widespread implementation in clinical practice. IMPACT: Preterm infants require cardiorespiratory monitoring and respiratory support due to breathing instability and a hampered lung function. The current respiratory monitoring technique may provide unreliable measurements and does not provide insight in breathing effort, which makes the selection of the optimal respiratory support settings difficult. Measuring diaphragm activity could improve cardiorespiratory monitoring by providing insight in breathing effort and could potentially have an important role in individualizing respiratory support in newborn infants.
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Affiliation(s)
- Anouk W J Scholten
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development research institute, Amsterdam, the Netherlands
| | - Ruud W van Leuteren
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development research institute, Amsterdam, the Netherlands
| | - Cornelia G de Waal
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development research institute, Amsterdam, the Netherlands
| | - Juliette V Kraaijenga
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development research institute, Amsterdam, the Netherlands
| | - Frans H de Jongh
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Faculty of Science and Technology, University of Twente, Drienerlolaan 5, Enschede, the Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development research institute, Amsterdam, the Netherlands
| | - Gerard J Hutten
- Department of Neonatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Reproduction & Development research institute, Amsterdam, the Netherlands.
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Guy EFS, Clifton JA, Knopp JL, Holder-Pearson LR, Chase JG. Non-Invasive Assessment of Abdominal/Diaphragmatic and Thoracic/Intercostal Spontaneous Breathing Contributions. Sensors (Basel) 2023; 23:9774. [PMID: 38139620 PMCID: PMC10747041 DOI: 10.3390/s23249774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
(1) Background: Technically, a simple, inexpensive, and non-invasive method of ascertaining volume changes in thoracic and abdominal cavities are required to expedite the development and validation of pulmonary mechanics models. Clinically, this measure enables the real-time monitoring of muscular recruitment patterns and breathing effort. Thus, it has the potential, for example, to help differentiate between respiratory disease and dysfunctional breathing, which otherwise can present with similar symptoms such as breath rate. Current automatic methods of measuring chest expansion are invasive, intrusive, and/or difficult to conduct in conjunction with pulmonary function testing (spontaneous breathing pressure and flow measurements). (2) Methods: A tape measure and rotary encoder band system developed by the authors was used to directly measure changes in thoracic and abdominal circumferences without the calibration required for analogous strain-gauge-based or image processing solutions. (3) Results: Using scaling factors from the literature allowed for the conversion of thoracic and abdominal motion to lung volume, combining motion measurements correlated to flow-based measured tidal volume (normalised by subject weight) with R2 = 0.79 in data from 29 healthy adult subjects during panting, normal, and deep breathing at 0 cmH2O (ZEEP), 4 cmH2O, and 8 cmH2O PEEP (positive end-expiratory pressure). However, the correlation for individual subjects is substantially higher, indicating size and other physiological differences should be accounted for in scaling. The pattern of abdominal and chest expansion was captured, allowing for the analysis of muscular recruitment patterns over different breathing modes and the differentiation of active and passive modes. (4) Conclusions: The method and measuring device(s) enable the validation of patient-specific lung mechanics models and accurately elucidate diaphragmatic-driven volume changes due to intercostal/chest-wall muscular recruitment and elastic recoil.
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Affiliation(s)
- Ella F. S. Guy
- Centre for Bioengineering, Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand (J.L.K.); (J.G.C.)
| | - Jaimey A. Clifton
- Centre for Bioengineering, Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand (J.L.K.); (J.G.C.)
| | - Jennifer L. Knopp
- Centre for Bioengineering, Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand (J.L.K.); (J.G.C.)
| | - Lui R. Holder-Pearson
- Electrical and Computer Engineering, University of Canterbury, Christchurch 8041, New Zealand;
| | - J. Geoffrey Chase
- Centre for Bioengineering, Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand (J.L.K.); (J.G.C.)
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Helou LB, Dum RP. Volitional inspiration is mediated by two independent output channels in the primary motor cortex. J Comp Neurol 2023; 531:1796-1811. [PMID: 37723869 PMCID: PMC10591979 DOI: 10.1002/cne.25540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
The diaphragm is a multifunctional muscle that mediates both autonomic and volitional inspiration. It is critically involved in vocalization, postural stability, and expulsive core-trunk functions, such as coughing, hiccups, and vomiting. In macaque monkeys, we used retrograde transneuronal transport of rabies virus injected into the left hemidiaphragm to identify cortical neurons that have multisynaptic connections with phrenic motoneurons. Our research demonstrates that representation of the diaphragm in the primary motor cortex (M1) is split into two spatially separate and independent sites. No cortico-cortical connections are known to exist between these two sites. One site is located dorsal to the arm representation within the central sulcus and the second site is lateral to the arm. The dual representation of the diaphragm warrants a revision to the somatotopic map of M1. The dorsal diaphragm representation overlaps with trunk and axial musculature. It is ideally situated to coordinate with these muscles during volitional inspiration and in producing intra-abdominal pressure gradients. The lateral site overlaps the origin of M1 projections to a laryngeal muscle, the cricothyroid. This observation suggests that the coordinated control of laryngeal muscles and the diaphragm during vocalization may be achieved, in part, by co-localization of their representations in M1. The neural organization of the two diaphragm sites underlies a new perspective for interpreting functional imaging studies of respiration and/or vocalization. Furthermore, our results provide novel evidence supporting the concept that overlapping output channels within M1 are a prerequisite for the formation of muscle synergies underlying fine motor control.
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Affiliation(s)
- Leah B. Helou
- University of Pittsburgh, Department of Communication Science and Disorders, Pittsburgh, PA 15260
| | - Richard P. Dum
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260
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Mohamed MSA, Moerer O, Harnisch LO. Recording of a left ventricle assist device electrical current with a neurally adjusted ventilation assist (NAVA) catheter: a small case series. J Clin Monit Comput 2023; 37:1635-1639. [PMID: 37458915 DOI: 10.1007/s10877-023-01055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/27/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Neurally Adjusted Ventilatory Assist (NAVA) is an adaptive ventilation mode that recognizes electromyographic diaphragmatic activation as a sensory input to control the ventilator. NAVA may be of interest in prolonged mechanical ventilation and weaning, as it provides effort-adapted support, improves patient-ventilator synchronization, and allows additional monitoring of neuromuscular function and drive. Ventricular assist devices (VAD), especially for the left ventricle (LVAD), are increasingly entering clinical practice, and intensivists are faced with distinct challenges such as the interaction between the system and other measures of organ support. CASE PRESENTATION We present two cases in which a NAVA mode was intended to support ventilator weaning in patients with recent LVAD implantation (HeartMate III®). However, in these patients, the electrical activity of the diaphragm (Edi) could not be used to control the ventilator, because the LVAD current detected by the catheter superposed the Edi current, making usage of this mode impossible. DISCUSSION/CONCLUSIONS An implanted LVAD can render the NAVA signal unusable for ventilatory support because the LVAD signal can interfere with the recording of electromyographic activation of the diaphragm. Therefore, patients with implanted LVAD may need other modes of ventilation than NAVA for advanced weaning strategies.
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Affiliation(s)
- M Salaheldin Atta Mohamed
- Department of Anaesthesiology, University Medical Center of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany
| | - O Moerer
- Department of Anaesthesiology, University Medical Center of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany
| | - L O Harnisch
- Department of Anaesthesiology, University Medical Center of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany.
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Scholten AWJ, Zhan Z, Niemarkt HJ, Vervoorn M, van Leuteren RW, de Jongh FH, van Kaam AH, Heuvel ERVD, Hutten GJ. Cardiorespiratory monitoring with a wireless and nonadhesive belt measuring diaphragm activity in preterm and term infants: A multicenter non-inferiority study. Pediatr Pulmonol 2023; 58:3574-3581. [PMID: 37795597 DOI: 10.1002/ppul.26695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION We determined if the heart rate (HR) monitoring performance of a wireless and nonadhesive belt is non-inferior compared to standard electrocardiography (ECG). Secondary objective was to explore the belt's respiratory rate (RR) monitoring performance compared to chest impedance (CI). METHOD In this multicenter non-inferiority trial, preterm and term infants were simultaneously monitored with the belt and conventional ECG/CI for 24 h. HR monitoring performance was estimated with the HR difference and ability to detect cardiac events compared to the ECG, and the incidence of HR-data loss per second. These estimations were statistically compared to prespecified margins to confirm equivalence/non-inferiority. Exploratory RR analyses estimated the RR trend difference and ability to detect apnea/tachypnea compared to CI, and the incidence of RR-data loss per second. RESULTS Thirty-nine infants were included. HR monitoring with the belt was non-inferior to the ECG with a mean HR difference of 0.03 beats per minute (bpm) (standard error [SE] = 0.02) (95% limits of agreement [LoA]: [-5 to 5] bpm) (p < 0.001). Second, sensitivity and positive predictive value (PPV) for cardiac event detection were 94.0% (SE = 0.5%) and 92.6% (SE = 0.6%), respectively (p ≤ 0.001). Third, the incidence of HR-data loss was 2.1% (SE = 0.4%) per second (p < 0.05). The exploratory analyses of RR showed moderate trend agreement with a mean RR-difference of 3.7 breaths/min (SE = 0.8) (LoA: [-12 to 19] breaths/min), but low sensitivities and PPV's for apnea/tachypnea detection. The incidence of RR-data loss was 2.2% (SE = 0.4%) per second. CONCLUSION The nonadhesive, wireless belt showed non-inferior HR monitoring and a moderate agreement in RR trend compared to ECG/CI. Future research on apnea/tachypnea detection is required.
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Affiliation(s)
- Anouk W J Scholten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Zhuozhao Zhan
- Department of Mathemaatics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hendrik J Niemarkt
- Department of Neonatology, Màxima Medical Center, Veldhoven, The Netherlands
| | - Marieke Vervoorn
- Department of Neonatology, Màxima Medical Center, Veldhoven, The Netherlands
| | - Ruud W van Leuteren
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Frans H de Jongh
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Edwin R van den Heuvel
- Department of Mathemaatics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerard J Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
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Saldarriaga CA, Alatout MH, Khurram OU, Gransee HM, Sieck GC, Mantilla CB. Chloroquine impairs maximal transdiaphragmatic pressure generation in old mice. J Appl Physiol (1985) 2023; 135:1126-1134. [PMID: 37823202 PMCID: PMC10979802 DOI: 10.1152/japplphysiol.00365.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023] Open
Abstract
Aging results in increased neuromuscular transmission failure and denervation of the diaphragm muscle, as well as decreased force generation across a range of motor behaviors. Increased risk for respiratory complications in old age is a major health problem. Aging impairs autophagy, a tightly regulated multistep process responsible for clearing misfolded or aggregated proteins and damaged organelles. In motor neurons, aging-related autophagy impairment may contribute to deficits in neurotransmission, subsequent muscle atrophy, and loss of muscle force. Chloroquine is commonly used to inhibit autophagy. We hypothesized that chloroquine decreases transdiaphragmatic pressure (Pdi) in mice. Old mice (16-28 mo old; n = 26) were randomly allocated to receive intraperitoneal chloroquine (50 mg/kg) or vehicle 4 h before measuring Pdi during eupnea, hypoxia (10% O2)-hypercapnia (5% CO2) exposure, spontaneous deep breaths ("sighs"), and maximal activation elicited by bilateral phrenic nerve stimulation (Pdimax). Pdi amplitude and ventilatory parameters across experimental groups and behaviors were evaluated using a mixed linear model. There were no differences in Pdi amplitude across treatments during eupnea (∼8 cm H2O), hypoxia-hypercapnia (∼10 cm H2O), or sigh (∼36 cm H2O), consistent with prior studies documenting a lack of aging effects on ventilatory behaviors. In vehicle and chloroquine-treated mice, average Pdimax was 61 and 46 cm H2O, respectively. Chloroquine decreased Pdimax by 24% compared to vehicle (P < 0.05). There were no sex or age effects on Pdi in older mice. The observed decrease in Pdimax suggests aging-related susceptibility to impairments in autophagy, consistent with the effects of chloroquine on this important homeostatic process.NEW & NOTEWORTHY Recent findings suggest that autophagy plays a role in the development of aging-related neuromuscular dysfunction; however, the contribution of autophagy impairment to the maintenance of diaphragm force generation in old age is unknown. This study shows that in old mice, chloroquine administration decreases maximal transdiaphragmatic pressure generation. These chloroquine effects suggest a susceptibility to impairments in autophagy in old age.
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Affiliation(s)
- Carlos A Saldarriaga
- Department of Anesthesiology and Perioperative Medicine, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
| | - Mayar H Alatout
- Department of Anesthesiology and Perioperative Medicine, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
| | - Obaid U Khurram
- Department of Physiology and Biomedical Engineering, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
| | - Heather M Gransee
- Department of Anesthesiology and Perioperative Medicine, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
| | - Gary C Sieck
- Department of Anesthesiology and Perioperative Medicine, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
- Department of Physiology and Biomedical Engineering, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos B Mantilla
- Department of Anesthesiology and Perioperative Medicine, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
- Department of Physiology and Biomedical Engineering, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
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12
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Khurram OU, Mantilla CB, Sieck GC. Neuromotor control of spontaneous quiet breathing in awake rats evaluated by assessments of diaphragm EMG stationarity. J Neurophysiol 2023; 130:1344-1357. [PMID: 37877195 DOI: 10.1152/jn.00267.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023] Open
Abstract
The neuromotor control of the diaphragm muscle (DIAm) is dynamic. The activity of the DIAm can be recorded via electromyography (EMG), which represents the temporal summation of motor unit action potentials. Our goal in the present study was to investigate DIAm neuromotor control during quiet spontaneous breathing (eupnea) in awake rats by evaluating DIAm EMG at specific temporal locations defined by motor unit recruitment and derecruitment. We evaluated the nonstationarity of DIAm EMG activity to identify DIAm motor unit recruitment and derecruitment durations. Combined with assessments of root mean square (RMS) and sum of squares (SS) EMG, the durations of these phases provide physiological information about the temporal aspects of motor control. During eupnea in awake rats (n = 10), the duration of motor unit recruitment comprised 61 ± 19 ms of the onset-to-peak duration (214 ± 62 ms) of the DIAm RMS EMG. The peak-to-offset duration of DIAm EMG activity was 453 ± 96 ms, with a terminating period of derecruitment of 161 ± 44 ms. The burst duration was 673 ± 128 ms. Both the RMS EMG amplitude and the SS EMG were higher at the completion of motor unit recruitment than at the start of motor unit derecruitment, suggesting that offset discharge rates were lower than onset discharge rates. Our analyses provide novel insights into the time domain aspects of DIAm neuromotor control and allow indirect estimates of the contribution of recruitment and frequency to RMS EMG amplitude during eupnea in awake rats.NEW & NOTEWORTHY We characterized three phases of neuromotor control-motor unit recruitment, sustained activity, and derecruitment-based on statistical assessments of stationarity of the diaphragm muscle (DIAm) EMG activity in awake rats. Our findings may allow indirect estimates of the contribution of motor unit recruitment and frequency coding toward generating force and provide novel insights about the temporal aspects of DIAm neuromotor control and descending respiratory drive in unanesthetized animals.
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Affiliation(s)
- Obaid U Khurram
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos B Mantilla
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Gary C Sieck
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Sheng Y, Shao W, Wang Y, Kang X, Hu R. [Research advances on neurally adjusted ventilatory assist]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2023; 35:1229-1232. [PMID: 37987137 DOI: 10.3760/cma.j.cn121430-20230222-00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to diverse modes of assisted ventilation. Conventional mechanical ventilators depend on flow sensors and pneumatic pressure and controllers to complete the respiratory cycle. Neurally adjusted ventilatory assist (NAVA) is a new form of assisted ventilation in recent years, which monitors the electrical activity of the diaphragm (EAdi) to provide an appropriately level of pressure support. And EAdi is the best available signal to sense central respiratory drive and trigger ventilatory assist. Unlike other ventilation modes, NAVA breathing instructions come from the center. Therefore, NAVA have the synchronous nature of the breaths and the patient-adjusted nature of the support. Compared with traditional ventilation mode, NAVA can efficiently unload respiratory muscles, relieve the risk of ventilator-induced lung injury (VILI), improve patient-ventilator coordination, enhance gas exchange, increase the success rate of weaning, etc. This article reviews the research progress of NAVA in order to provide theoretical guidance for clinical applications.
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Affiliation(s)
- Yuliang Sheng
- Department of Respiratory and Critical Care Medicine, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, Jiangsu, China
| | - Wei Shao
- Jinzhou Medical University, Jinzhou 121000, Liaoning, China
| | - Yuhao Wang
- Department of Respiratory and Critical Care Medicine, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, Jiangsu, China
| | - Xiuwen Kang
- Department of Critical Care Medicine, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, Jiangsu, China. Corresponding author: Hu Rong,
| | - Rong Hu
- Department of Respiratory and Critical Care Medicine, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, Jiangsu, China
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14
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Sannasi R, Dakshinamurthy A, Dommerholt J, Desai V, Kumar A, Sugavanam T. Diaphragm and core stabilization exercises in low back pain: A narrative review. J Bodyw Mov Ther 2023; 36:221-227. [PMID: 37949564 DOI: 10.1016/j.jbmt.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/03/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Core stabilization is a vital concept in clinical rehabilitation (including low back pain rehabilitation) and competitive athletic training. The core comprises of a complex network of hip, trunk and neck muscles including the diaphragm. AIMS The paper aims to discuss the role of the diaphragm in core stability, summarize current evidence and put forth ideal core training strategies involving the diaphragm. METHOD Narrative review RESULTS: The diaphragm has a dual role of respiration and postural control. Evidence suggests that current core stability exercises for low back pain are superior than minimal or no treatment, however, no more beneficial than general exercises and/or manual therapy. There appears to be a higher focus on the transversus abdominis and multifidi muscles and minimal attention to the diaphragm. We propose that any form of core stabilization exercises for low back pain rehabilitation should consider the diaphragm. Core stabilization program could commence with facilitation of normal breathing patterns and progressive systematic restoration of the postural control role of the diaphragm muscle. CONCLUSION The role of the diaphragm is often overlooked in both research and practice. Attention to the diaphragm may improve the effectiveness of core stability exercise in low back pain rehabilitation.
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Affiliation(s)
- Rajasekar Sannasi
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Anandhi Dakshinamurthy
- SRM College of Physiotherapy, Faculty of Medical and Health Sciences, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, 603203, Kanchipuram, Chennai, Tamil Nadu, India.
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA; Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
| | - Vidhi Desai
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Ajay Kumar
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Thavapriya Sugavanam
- Health Services Research Unit, Oxford Population Health, University of Oxford, Oxford, United Kingdom.
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15
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Namdev S, Tarafdar O, Fusch G, Beck J, Mukerji A. Pressure transmission and electrical diaphragm activity in preterm infants during nasal intermittent positive pressure ventilation-an exploratory prospective physiological study. J Perinatol 2023; 43:1004-1006. [PMID: 37138164 DOI: 10.1038/s41372-023-01686-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Sunita Namdev
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Oishika Tarafdar
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gerhard Fusch
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Jennifer Beck
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Department of Critical Care, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Member, Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael's Hospital, Toronto, ON, Canada
| | - Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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Fogarty MJ, Rana S, Mantilla CB, Sieck GC. Size-dependent differences in mitochondrial volume density in phrenic motor neurons. J Appl Physiol (1985) 2023; 134:1332-1340. [PMID: 37022966 PMCID: PMC10190832 DOI: 10.1152/japplphysiol.00021.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/07/2023] Open
Abstract
Neuromotor control of diaphragm muscle (DIAm) motor units is dependent on an orderly size-dependent recruitment of phrenic motor neurons (PhMNs). Slow (type S) and fast, fatigue resistant (type FR) DIAm motor units, which are frequently recruited to sustain ventilation, comprise smaller PhMNs that innervate type I and IIa DIAm fibers. More fatigable fast (type FF) motor units, which are infrequently recruited for higher force, expulsive behaviors, comprise larger PhMNs that innervate more type IIx/IIb DIAm fibers. We hypothesize that due to the more frequent activation and thus higher energy demand of type S and FR motor units, the mitochondrial volume density (MVD) of smaller PhMNs is greater compared with larger PhMNs. In eight adult (6 mo old) Fischer 344 rats, PhMNs were identified via intrapleural injection of Alexa488-conjugated cholera toxin B (CTB). Following retrograde CTB labeling, mitochondria in PhMNs were labeled by transdural infusion of MitoTracker Red. PhMNs and mitochondria were imaged using multichannel confocal microscopy using a ×60 oil objective. Following optical sectioning and three-dimensional (3-D) rendering, PhMNs and mitochondria were analyzed volumetrically using Nikon Elements software. Analysis of MVD in somal and dendritic compartments was stratified by PhMN somal surface area. Smaller PhMNs (likely S and FR units) had greater somal MVDs compared with larger PhMNs (likely FF units). By contrast, proximal dendrites or larger PhMNs had higher MVD compared with dendrites of smaller PhMNs. We conclude that more active smaller PhMNs have a higher mitochondrial volume density to support their higher energy demand in sustaining ventilation.NEW & NOTEWORTHY Type S and FR motor units, comprising smaller phrenic motor neurons (PhMNs) are regularly activated to perform indefatigable ventilatory requirements. By contrast, type FF motor units, comprising larger PhMNs, are infrequently activated to perform expulsive straining and airway defense maneuvers. This difference in activation history is mirrored in the mitochondrial volume density (MVD), with smaller PhMNs having higher MVD than larger PhMNs. In proximal dendrites, this trend was reversed, with larger PhMNs having higher MVD than smaller PhMNs, likely due to the maintenance requirements for the larger dendritic arbor of FF PhMNs.
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Affiliation(s)
- Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Sabhya Rana
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos B Mantilla
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Gary C Sieck
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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17
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Etienne H, Morris IS, Hermans G, Heunks L, Goligher EC, Jaber S, Morelot-Panzini C, Assouad J, Gonzalez-Bermejo J, Papazian L, Similowski T, Demoule A, Dres M. Diaphragm Neurostimulation Assisted Ventilation in Critically Ill Patients. Am J Respir Crit Care Med 2023; 207:1275-1282. [PMID: 36917765 PMCID: PMC10595441 DOI: 10.1164/rccm.202212-2252cp] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Diaphragm neurostimulation consists of placing electrodes directly on or in proximity to the phrenic nerve(s) to elicit diaphragmatic contractions. Since its initial description in the 18th century, indications have shifted from cardiopulmonary resuscitation to long-term ventilatory support. Recently, the technical development of devices for temporary diaphragm neurostimulation has opened up the possibility of a new era for the management of mechanically ventilated patients. Combining positive pressure ventilation with diaphragm neurostimulation offers a potentially promising new approach to the delivery of mechanical ventilation which may benefit multiple organ systems. Maintaining diaphragm contractions during ventilation may attenuate diaphragm atrophy and accelerate weaning from mechanical ventilation. Preventing atelectasis and preserving lung volume can reduce lung stress and strain and improve homogeneity of ventilation, potentially mitigating ventilator-induced lung injury. Furthermore, restoring the thoracoabdominal pressure gradient generated by diaphragm contractions may attenuate the drop in cardiac output induced by positive pressure ventilation. Experimental evidence suggests diaphragm neurostimulation may prevent neuroinflammation associated with mechanical ventilation. This review describes the historical development and evolving approaches to diaphragm neurostimulation during mechanical ventilation and surveys the potential mechanisms of benefit. The review proposes a research agenda and offers perspectives for the future of diaphragm neurostimulation assisted mechanical ventilation for critically ill patients.
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Affiliation(s)
- Harry Etienne
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Idunn S. Morris
- Interdepartmental Division of Critical Care Medicine and
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Greet Hermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospital Leuven, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ewan C. Goligher
- Interdepartmental Division of Critical Care Medicine and
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Samir Jaber
- Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Pneumologie
| | - Jalal Assouad
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Jésus Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Soins de Suite Réadaptation
| | - Laurent Papazian
- Service de Médecine Intensive Reanimation, Centre Hospitalier de Bastia, Bastia, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Département R3S, and
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Médecine Intensive – Réanimation, Hopital Pitie Salpetriere, APHP, Sorbonne Universite, Paris, France; and
| | - Martin Dres
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Médecine Intensive – Réanimation, Hopital Pitie Salpetriere, APHP, Sorbonne Universite, Paris, France; and
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18
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Mantilla CB, Ermilov LG, Greising SM, Gransee HM, Zhan WZ, Sieck GC. Electrophysiological effects of BDNF and TrkB signaling at type-identified diaphragm neuromuscular junctions. J Neurophysiol 2023; 129:781-792. [PMID: 36883761 PMCID: PMC10069962 DOI: 10.1152/jn.00015.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
Previous studies show that synaptic quantal release decreases during repetitive stimulation, i.e., synaptic depression. Neurotrophin brain-derived neurotrophic factor (BDNF) enhances neuromuscular transmission via activation of tropomyosin-related kinase receptor B (TrkB). We hypothesized that BDNF mitigates synaptic depression at the neuromuscular junction and that the effect is more pronounced at type IIx and/or IIb fibers compared to type I or IIa fibers given the more rapid reduction in docked synaptic vesicles with repetitive stimulation. Rat phrenic nerve-diaphragm muscle preparations were used to determine the effect of BDNF on synaptic quantal release during repetitive stimulation at 50 Hz. An ∼40% decline in quantal release was observed during each 330-ms duration train of nerve stimulation (intratrain synaptic depression), and this intratrain decline was observed across repetitive trains (20 trains at 1/s repeated every 5 min for 30 min for 6 sets). BDNF treatment significantly enhanced quantal release at all fiber types (P < 0.001). BDNF treatment did not change release probability within a stimulation set but enhanced synaptic vesicle replenishment between sets. In agreement, synaptic vesicle cycling (measured using FM4-64 fluorescence uptake) was increased following BDNF [or neurotrophin-4 (NT-4)] treatment (∼40%; P < 0.05). Conversely, inhibiting BDNF/TrkB signaling with the tyrosine kinase inhibitor K252a and TrkB-IgG (which quenches endogenous BDNF or NT-4) decreased FM4-64 uptake (∼34% across fiber types; P < 0.05). The effects of BDNF were generally similar across all fiber types. We conclude that BDNF/TrkB signaling acutely enhances presynaptic quantal release and thereby may serve to mitigate synaptic depression and maintain neuromuscular transmission during repetitive activation.NEW & NOTEWORTHY Neurotrophin brain-derived neurotrophic factor (BDNF) enhances neuromuscular transmission via activation of tropomyosin-related kinase receptor B (TrkB). Rat phrenic nerve-diaphragm muscle preparations were used to determine the rapid effect of BDNF on synaptic quantal release during repetitive stimulation. BDNF treatment significantly enhanced quantal release at all fiber types. BDNF increased synaptic vesicle cycling (measured using FM4-64 fluorescence uptake); conversely, inhibiting BDNF/TrkB signaling decreased FM4-64 uptake.
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Affiliation(s)
- Carlos B Mantilla
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Leonid G Ermilov
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Sarah M Greising
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Heather M Gransee
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Wen-Zhi Zhan
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Gary C Sieck
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
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19
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Popp NM, Holmes TC, Streeter KA. Diaphragm stimulation elicits phrenic afferent-induced neuromuscular plasticity. Respir Physiol Neurobiol 2023; 310:104014. [PMID: 36642318 PMCID: PMC9945879 DOI: 10.1016/j.resp.2023.104014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/29/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
We hypothesized that activation of phrenic afferents induces diaphragm motor plasticity. In anesthetized and spontaneously breathing rats we delivered 40 Hz, low threshold (twitch and 1.5X twitch threshold), inspiratory-triggered stimulation to the left hemidiaphragm for 30 min to activate ipsilateral phrenic afferents. Diaphragm amplitude ipsilateral and contralateral to stimulation were increased for 60 min following both currents compared to time controls not receiving stimulation. Diaphragm stimulation was repeated in laminectomy controls or following a unilateral C3-C6 dorsal rhizotomy to eliminate phrenic afferent volleys. Laminectomy controls expressed neuromuscular plasticity post-stimulation. In contrast, ipsilateral and contralateral diaphragm amplitude following dorsal rhizotomy was lower than laminectomy controls and no different than time controls, suggesting diaphragm motor plasticity was not induced post-rhizotomy. Our results indicate that diaphragm stimulation induces a novel form of plasticity in the phrenic motor system which requires phrenic afferent activation. Respiratory motor plasticity elicited by diaphragm stimulation may have value as a therapeutic strategy to improve diaphragm output in neuromuscular conditions.
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Affiliation(s)
- Nicole M Popp
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Taylor C Holmes
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Kristi A Streeter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States.
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Kalbaran Kısmet G, Okutan O, Ayten Ö, Samancı C, Yeşildal M, Kartaloğlu Z. Diaphragmatic ultrasonography in patients with IPF: Is diaphragmatic structure and mobility related to fibrosis severity and pulmonary functional changes? Tuberk Toraks 2023; 71:13-23. [PMID: 36912405 PMCID: PMC10795268 DOI: 10.5578/tt.20239903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Introduction There is evidence to suggest that dyspnea and impaired exercise capacity are associated with respiratory muscle dysfunction in idiopathic pulmonary fibrosis (IPF) patients. We aimed to evaluate the functions of the diaphragm with ultrasonography (US) and to determine the correlation of the data obtained with the pulmonary function parameters of the patients, exercise capacity, and the extent of fibrosis radiologically. Materials and Methods Diaphragmatic mobility, thickness, and thickening fraction (TF) were measured by ultrasonography in IPF patients and the control group. The correlation between these measurements, pulmonary function tests (PFT), six-minute walking test (6MWT), mMRC score, and total fibrosis score (TFS) was evaluated. Result Forty-one IPF patients and twenty-one healthy volunteers were included in the study. No difference was found between the patient and control groups in diaphragmatic mobility during quiet breathing (QB) on ultrasound (2.35 cm and 2.56 cm; p= 0.29). Diaphragmatic mobility during deep breathing (DB) was found to be lower in the patient group when compared to the control group (5.02 cm and 7.66 cm; p<0.0001). Diaphragmatic thickness was found to be higher during QB and DB in IPF patients (0.33 cm and 0.31 cm, p= 0.043; 0.24 cm and 0.22 cm, p= 0.045). No difference was found between the two groups in terms of thickening fraction (39.37%, 44.16%; p= 0.49). No significant correlation was found between US measurements and PFT, 6MWT, mMRC score, and TFS in IPF patients (p> 0.05). Conclusions The functions of the diaphragm do not appear to be affected in patients with mild-to-moderate restrictive IPF. This study showed that there was no relationship between diaphragmatic functions and respiratory function parameters and the extent of fibrosis. Further studies, including advanced stages of the disease, are needed to understand the changes in diaphragmatic functions in IPF and to determine whether this change is associated with respiratory function parameters and the extent of fibrosis.
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Affiliation(s)
- Gözde Kalbaran Kısmet
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Oğuzhan Okutan
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Ömer Ayten
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Cesur Samancı
- Department of Radiology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Türkiye
| | - Melike Yeşildal
- Clinic of Radiology, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
| | - Zafer Kartaloğlu
- Clinic of Pulmonary Medicine, Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
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Dreyfus L, Butin M, Plaisant F, Claris O, Baudin F. Respiratory physiology during NAVA ventilation in neonates born with a congenital diaphragmatic hernia: The "NAVA-diaph" pilot study. Pediatr Pulmonol 2023; 58:1542-1550. [PMID: 36807570 DOI: 10.1002/ppul.26357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that delivers synchronized ventilation, proportional to the electrical activity of the diaphragm (EAdi). Although it has been proposed in infants with a congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm. AIM To evaluate, in a pilot study, the relationship between the respiratory drive (EAdi) and the respiratory effort in neonates with CDH during the postsurgical period under either NAVA ventilation or conventional ventilation (CV). METHODS This prospective physiological study included eight neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric, and transdiaphragmatic pressure, as well as clinical parameters, were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the postsurgical period. RESULTS EAdi was detectable and there was a correlation between the ΔEAdi (maximal - minimal values) and the transdiaphragmatic pressure (r = 0.26, 95% confidence interval [CI] [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing. CONCLUSION Respiratory drive and effort were correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. EAdi can also be used to monitor the diaphragm for individualized support.
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Affiliation(s)
- Lélia Dreyfus
- Service de Néonatologie et Réanimation Néonatale, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Marine Butin
- Service de Néonatologie et Réanimation Néonatale, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
- Centre International de Recherche en infectiologie (CIRI), Team "Pathogénie des Staphylocoques", CNRS, UMR5308, ENS de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, Lyon, France
| | - Frank Plaisant
- Service de Néonatologie et Réanimation Néonatale, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Olivier Claris
- Service de Néonatologie et Réanimation Néonatale, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
- EA 419, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Florent Baudin
- Service de réanimation pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
- Unité APCSe (UP 2021, A101), Universités de Lyon, VetAgro Sup, Marcy l'Etoile, France
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22
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Teixeira MDS, Ferrari F, Dipp T, Carvalho G, Bitencourt EDS, Saffi M, Stein R. Effects of intradialytic inspiratory muscle training at different intensities on diaphragm thickness and functional capacity: clinical trial protocol in patients undergoing haemodialysis. BMJ Open 2023; 13:e066778. [PMID: 36707111 PMCID: PMC9884932 DOI: 10.1136/bmjopen-2022-066778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) commonly present with a sedentary behaviour and reduced functional capacity, factors that can compromise their prognosis. Intradialytic inspiratory muscle training (IMT) can increase respiratory muscle strength and, consequently, improve functional capacity, besides being easy to apply, cheap and performed in a supervised setting. However, few studies show the effects of this type of training applied at different intensities in this population. This study aims to compare the effects of IMT at different intensities in adults with ESRD undergoing HD. METHODS AND ANALYSIS A randomised, double-blind, sham-controlled trial will be conducted on 36 subjects randomly allocated into three groups: IMT at intensities of 30% or 50% of maximal inspiratory pressure (intervention groups), or 10% of maximal inspiratory pressure (sham-IMT). All the interventions will be supervised and performed three times per week, for 12 weeks, totalling 36 sessions. The primary outcomes are the 6-minute walk test, diaphragm thickness and the response of VO2peak post-intervention. Respiratory muscle strength, 24-hour ambulatory blood pressure measurement and the Kidney Disease Quality of Life 36-item short form survey will be evaluated as secondary outcomes. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (ID: 2020-0458). The results of this study will be disseminated by conference presentations and peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04660383.
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Affiliation(s)
- Marcelo de S Teixeira
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Thiago Dipp
- Graduate Program in Collective Health, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Gabriel Carvalho
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduarda da S Bitencourt
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marco Saffi
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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23
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Reinhard PA, Archiza B, Welch JF, Benbaruj J, Guenette JA, Koehle MS, Sheel AW. Effects of hypoxia on exercise-induced diaphragm fatigue in healthy males and females. Physiol Rep 2023; 11:e15589. [PMID: 36695726 PMCID: PMC9875747 DOI: 10.14814/phy2.15589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023] Open
Abstract
Following high-intensity, normoxic exercise there is evidence to show that healthy females, on average, exhibit less fatigue of the diaphragm relative to males. In the present study, we combined hypoxia with exercise to test the hypothesis that males and females would develop a similar degree of diaphragm fatigue following cycle exercise at the same relative exercise intensity. Healthy young participants (n = 10 male; n = 10 female) with a high aerobic capacity (120% predicted) performed two time-to-exhaustion (TTE; ~85% maximum) cycle tests on separate days breathing either a normoxic or hypoxic (FiO2 = 0.15) gas mixture. Fatigue of the diaphragm was assessed in response to cervical magnetic stimulation prior to, immediately post-exercise, 10-, 30-, and 60-min post-exercise. Males and females had similar TTE durations in normoxia (males: 690 ± 181 s; females: 852 ± 401 s) and hypoxia (males: 381 ± 160 s; females: 400 ± 176 s) (p > 0.05). Cycling time was significantly shorter in hypoxia versus normoxia in both males and females (p < 0.05) and did not differ on the basis of sex (p > 0.05). Following the hypoxic TTE tests, males and females experienced a similar degree of diaphragm fatigue compared to normoxia as shown by 20%-25% reductions in transdiaphragmatic twitch pressure. This occurred despite the fact that exercise time in hypoxia was substantially shorter relative to normoxia and the cumulative diaphragm work was lower. We also observed that females did not fully recover from diaphragm fatigue in hypoxia, whereas males did (p < 0.05). Sex differences in the rate of diaphragm contractility recovery following exercise in hypoxia might relate to sex-based differences in substrate utilization or diaphragm blood flow.
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Affiliation(s)
- Paige A. Reinhard
- School of KinesiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Bruno Archiza
- School of KinesiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Physical TherapyFederal University of São CarlosSão CarlosSPBrazil
| | - Joseph F. Welch
- Breathing Research and Therapeutics Center, Department of Physical TherapyUniversity of FloridaGainesvilleFloridaUSA
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | - Jenna Benbaruj
- School of KinesiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jordan A. Guenette
- School of KinesiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Physical TherapyThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Michael S. Koehle
- School of KinesiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - A. William Sheel
- School of KinesiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
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24
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Ramsook AH, Schaeffer MR, Mitchell RA, Dhillon SS, Milne KM, Ferguson ON, Puyat JH, Koehle MS, Sheel AW, Guenette JA. Voluntary activation of the diaphragm after inspiratory pressure threshold loading. Physiol Rep 2023; 11:e15575. [PMID: 36695772 PMCID: PMC9875816 DOI: 10.14814/phy2.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/28/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023] Open
Abstract
After a bout of isolated inspiratory work, such as inspiratory pressure threshold loading (IPTL), the human diaphragm can exhibit a reversible loss in contractile function, as evidenced by a decrease in transdiaphragmatic twitch pressure (PDI,TW ). Whether or not diaphragm fatigability after IPTL is affected by neural mechanisms, measured through voluntary activation of the diaphragm (D-VA) in addition to contractile mechanisms, is unknown. It is also unknown if changes in D-VA are similar between sexes given observed differences in diaphragm fatigability between males and females. We sought to determine whether D-VA decreases after IPTL and whether this was different between sexes. Healthy females (n = 11) and males (n = 10) completed an IPTL task with an inspired duty cycle of 0.7 and targeting an intensity of 60% maximal transdiaphragmatic pressure until task failure. PDI,TW and D-VA were measured using cervical magnetic stimulation of the phrenic nerves in combination with maximal inspiratory pressure maneuvers. At task failure, PDI,TW decreased to a lesser degree in females vs. males (87 ± 15 vs. 73 ± 12% baseline, respectively, p = 0.016). D-VA decreased after IPTL but was not different between females and males (91 ± 8 vs. 88 ± 10% baseline, respectively, p = 0.432). When all participants were pooled together, the decrease in PDI,TW correlated with both the total cumulative diaphragm pressure generation (R2 = 0.43; p = 0.021) and the time to task failure (TTF, R2 = 0.40; p = 0.30) whereas the decrease in D-VA correlated only with TTF (R2 = 0.24; p = 0.041). Our results suggest that neural mechanisms can contribute to diaphragm fatigability, and this contribution is similar between females and males following IPTL.
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Affiliation(s)
- Andrew H. Ramsook
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Michele R. Schaeffer
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Reid A. Mitchell
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Satvir S. Dhillon
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Kathryn M. Milne
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
- Division of Respiratory Medicine, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Olivia N. Ferguson
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Joseph H. Puyat
- Centre for Health Evaluation and Outcome Services, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Michael S. Koehle
- School of Kinesiology, Faculty of EducationThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Family Practice, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - A. William Sheel
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
- School of Kinesiology, Faculty of EducationThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jordan A. Guenette
- Department of Physical Therapy, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung Innovation, Providence ResearchThe University of British Columbia and St. Paul's HospitalVancouverBritish ColumbiaCanada
- Division of Respiratory Medicine, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- School of Kinesiology, Faculty of EducationThe University of British ColumbiaVancouverBritish ColumbiaCanada
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25
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Fogarty MJ, Sieck GC. Aging affects the number and morphological heterogeneity of rat phrenic motor neurons and phrenic motor axons. Physiol Rep 2023; 11:e15587. [PMID: 36695744 PMCID: PMC9875821 DOI: 10.14814/phy2.15587] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/26/2023] Open
Abstract
Diaphragm muscle (DIAm) motor units comprise a phrenic motor neuron (PhMN), the phrenic nerve and the muscle fibers innervated, with the size of PhMNs and axons characteristic of motor unit type. Smaller PhMNs and their axons comprise slow (type S) and fatigue-resistant (type FR) DIAm motor units, while larger PhMNs and their axons comprise more fatigable (type FF) motor units. With aging, we have shown a loss of larger PhMNs, consistent with selective atrophy of type IIx/IIb DIAm fibers and reduced maximum DIAm force. In the present study, we hypothesized that with aging there is a loss of larger myelinated phrenic α motor axons. Female and male young (6 months) and old (24 months) Fischer 344 rats were studied. PhMNs were retrogradely labeled by intrapleural injection of 488-conjugated CTB. The phrenic nerves were excised ~1 cm from the DIAm insertion and mounted in resin, and phrenic α motor axons were delineated based on size (i.e., >4 μm diameters). In older rats, the number of larger PhMNs and larger phrenic α motor axons were reduced. There were no differences in non-α axons. In addition, there was evidence of demyelination of larger phrenic α motor axons in older rats. Together, these findings are consistent with the selective age-related vulnerability of larger PhMNs and denervation of type FF motor units, which may underlie DIAm sarcopenia.
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Affiliation(s)
- Matthew J. Fogarty
- Department of Physiology & Biomedical EngineeringMayo ClinicRochesterMinnesotaUSA
| | - Gary C. Sieck
- Department of Physiology & Biomedical EngineeringMayo ClinicRochesterMinnesotaUSA
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26
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Kowalski KE, DiMarco AF. Phrenic-to-intercostal reflex activity in response to high frequency spinal cord stimulation (HF-SCS). Respir Physiol Neurobiol 2022; 306:103962. [PMID: 36064141 DOI: 10.1016/j.resp.2022.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE HF-SCS is a novel technique of inspiratory muscle activation which results in coincident activation of the diaphragm and inspiratory intercostal muscles via spinal cord pathways and has the potential to provide respiratory support in ventilator dependent persons with spinal cord injury. The purpose of the present study was to examine the phrenic-to-intercostal reflex during HF-SCS. METHODS In 5 anesthetized and C2 spinalized dogs, electrical stimulation was applied via a stimulating electrode located on the ventral surface of the upper thoracic spinal cord at the T2 level. Fine wire recording electrodes were used to assess single motor unit (SMU) activity of the left and right external intercostal muscles (EI) in the 3rd interspace before and after sequential left and right phrenicotomy. RESULTS Mean control peak firing frequency of the right EI and left EI was 11.4 ± 0.3 Hz and 10.6 ± 0.3 Hz respectively. Following unilateral right phrenic nerve section, mean SMU peak firing frequency of right EI (ipsilateral to the section) was significantly greater when compared to control (15.9 ± 0.5 Hz vs 11.4 ± 0.3 Hz; p = 0.01). Mean SMU peak firing frequency of the contralateral left EI remained unchanged (10.2 ± 0.3 Hz vs 10.6 ± 0.3 Hz, p = 0.40). Subsequent, section of the left phrenic nerve resulted in significantly higher mean SMU peak firing frequency of the left EI (16.2 ± 0.5 Hz vs 10.2 ± 0.3 Hz) when compared to before section p = 0.01). Contralateral, right EI peak firing frequency was not different if compared to before left phrenic nerve section (16.9 ± 0.4 Hz vs. 15.9 ± 0.5 Hz; p = 0.14). CONCLUSION This study demonstrates that during HF-SCS: 1) unilateral diaphragmatic afferents reflexly inhibit motor activity to the ipsilateral EI muscles, 2) the neural circuitry mediating the phrenic-to-intercostal reflex is preserved at a spinal level and does not require supraspinal input and 3) unilateral compensatory increases were observed in EI muscle activation following ipsilateral diaphragm paralysis.
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Affiliation(s)
- Krzysztof E Kowalski
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA; MetroHealth Research Institute, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, USA.
| | - Anthony F DiMarco
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA; MetroHealth Research Institute, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, USA.
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27
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Li S, Zhou X, Zeng R, Lin L, Zou X, Yan Y, Lu Z, Xia J, Zhang L, Ni S, Dai S, Chen H, Zhao Y. YAP1 silencing attenuated lung injury/fibrosis but worsened diaphragmatic function by regulating oxidative stress and inflammation response in mice. Free Radic Biol Med 2022; 193:485-498. [PMID: 36336232 DOI: 10.1016/j.freeradbiomed.2022.10.323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Oxidative stress is a crucial mechanism in the pathophysiology of lung injury/fibrosis and diaphragmatic dysfunction. Yes-associated protein 1 (YAP1) is a key oxidative stress response regulator. However, how lung injury/fibrosis and the subsequent YAP1 silencing treatment affect diaphragmatic function remains largely uncharacterized. In this study, mice models of acute lipopolysaccharide (LPS) and paraquat exposure were used to establish acute lung injury and chronic pulmonary fibrosis. AT2 and C2C12 cells were co-cultured under LPS and paraquat challenge. YAP1 was interfered with shRNA given in vivo and verteporfin administration in vitro. Pulmonary histology, contractile properties, and cross-sectional areas (CSAs) of the diaphragm and gastrocnemius were evaluated. Histological and biochemical analyses were performed for targeted biomarker determination. We found that LPS and paraquat caused significant lung injury/fibrosis and significantly reduced the diaphragmatic-specific force and CSAs compared with the control. YAP1 silencing alleviated inflammatory cell infiltration or collagen deposition in the lungs yet worsened the already impaired diaphragmatic function by increasing inflammatory cytokines (IL-6 and TNF-α), mitochondrial reactive oxidative species (ROS) emission, protein degradation (Murf-1, atrogin-1, and calpain), and decreasing antioxidant capabilities (superoxide dismutase 2 and glutathione peroxidase). No significant improvements were observed in diaphragmatic function by transient YAP1 knockdown in the gastrocnemius. In vitro, LPS- or paraquat-caused cytotoxicity in AT2 cells was mostly alleviated by verteporfin in a concentration that was 20-fold higher than that in C2C12 cells (20 and 1 μg/mL, respectively). Finally, 0.5 μg/mL of verteporfin significantly ameliorated hydrogen peroxide-induced proteolytic activity and antioxidant enzyme suppression in C2C12 cells, whereas 2 μg/mL of verteporfin deteriorated the same. Collectively, lung injury/fibrosis adversely affects the diaphragm. YAP1 inhibition alleviates lung injury/fibrosis but worsens diaphragmatic function potentially by enhancing inflammatory cytokines and ROS-mediated protein degradation. This disparity might be attributed to differences in susceptibility to YAP1 inhibition between muscles and the lungs.
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Affiliation(s)
- Shaoping Li
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China; Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Xianlong Zhou
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China; Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Rong Zeng
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Lian Lin
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Xingnan Zou
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Yu Yan
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Zijun Lu
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Jian Xia
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China; Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Lijuan Zhang
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China; Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Shaozhou Ni
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China; Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Shuai Dai
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Haihua Chen
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China; Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
| | - Yan Zhao
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China; Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
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28
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Morris IS, Dres M, Goligher EC. Phrenic nerve stimulation to protect the diaphragm, lung, and brain during mechanical ventilation. Intensive Care Med 2022; 48:1299-1301. [PMID: 35688993 DOI: 10.1007/s00134-022-06760-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Idunn S Morris
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Martin Dres
- Médecine Intensive-Réanimation (Département "R3S"), APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Neurophysiologie respiratoire expérimentale et clinique, INSERM UMR_S 1158, Sorbonne Université, Paris, France
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada.
- Toronto General Hospital Research Institute, 585 University Ave., 9-MaRS-9024, Toronto, M5G 2N2, Canada.
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29
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Haaksma ME, van Tienhoven AJ, Smit JM, Heldeweg MLA, Lissenberg-Witte BI, Wennen M, Jonkman A, Girbes ARJ, Heunks L, Tuinman PR. Anatomical Variation in Diaphragm Thickness Assessed with Ultrasound in Healthy Volunteers. Ultrasound Med Biol 2022; 48:1833-1839. [PMID: 35691733 DOI: 10.1016/j.ultrasmedbio.2022.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
Ultrasonography of the diaphragm in the zone of apposition has become increasingly popular to evaluate muscle thickness and thickening fraction. However, measurements in this anatomical location are frequently hindered by factors that constrain physical accessibility or that alter diaphragm position. Therefore, other anatomical positions at the chest wall for transducer placement are used, but the variability in diaphragm thickness across the dome has not been systematically studied. The aim of this study was to evaluate anatomical variation of diaphragm thickness in 46 healthy volunteers on three ventrodorsal lines and two craniocaudal positions on these three lines. The intraclass correlation coefficient (ICC) for diaphragm thickness in the craniocaudal direction on the mid-axillary line was significantly higher than those on the posterior axillary and midclavicular lines, suggesting it had the lowest variability (ICCmidaxillary = .89, 95% confidence interval [CI]: 0.83-0.93, ICCposterior axillary = 0.74, 95% CI: 0.62-0.85, ICCmidclavicular = 0.62, 95% CI: 0.43-0.47, p < 0.05). Average diaphragm thickness was comparable on the posterior axillary and midaxillary lines and substantially larger on the midclavicular line (1.24 mm [1.06-1.47], 1.27 mm [1.10-1.42] and 2.32 [1.97-2.70], p < 0.01). We conclude that the normal diaphragm has a large variability in thickness, especially in the ventrodorsal direction. Variability in craniocaudal position is the lowest at the midaxillary line, which therefore appears to be the preferred site for diaphragm thickness measurement.
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Affiliation(s)
- Mark E Haaksma
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Arne J van Tienhoven
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Jasper M Smit
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Micah L A Heldeweg
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Myrte Wennen
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annemijn Jonkman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands; Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Arboleda A, Franco M, Amado L, Naranjo F, Giraldo BF. Coherence Analysis between the Surface Diaphragm EMG Envelope Signal and the Respiratory Signal derived from the ECG in Patients assisted by Mechanical Ventilation. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1923-1926. [PMID: 36085957 DOI: 10.1109/embc48229.2022.9871572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Prolonged use of mechanical ventilation (MV) can lead to greater complications for a patient. In clinical practice, it is important to identify patients who could fail in the extubation process. However, accurately predicting the outcome of this process remains a challenge. The diaphragm muscle is one of the most active elements in the breathing process. On the other hand, there are several techniques to derive respiratory information from the ECG signal. Signals derived from diaphragmatic activity and from the ECG, such as the envelope of the surface diaphragm electromyographic signal (sEMGi) and the respiratory signal derived from the electrocardiogram (ECG) could contribute to analyze the respiratory response in patients assisted by MV. This work proposes the analysis of the coherence between sEMGi and EDR signals to determine possible differences in the respiratory pattern between successful and failed patients undergoing weaning. 40 patients with MV, candidates for weaning trial process and underwent a spontaneous breathing test were analyzed, classified into: a successful group (SG: 19 patients) that maintained spontaneous breathing after the test, and a failed group (FG: 21 patients) that required reconnection to the MV. The cross correlation, power spectral density and magnitude squared coherence (MSC) of the sEMGi and the EDR signals were estimated. According to the results, the MSC parameters such as area under the curve and mean coherence value presented statistically significance differences between the two groups of patients (p = 0.024). Our results suggest that both sEMGi and EDR signals could provide information about the behavior of the respiratory system in these patients. Clinical Relevance- This study analyzes the correlation and the coherence between the envelope of the surface electromyographic signal and the respiratory signal derived from the ECG to characterize the respiratory pattern of successful and failed patients on weaning process.
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Ramsook AH, Schaeffer MR, Mitchell RA, Dhillon SS, Milne KM, Ferguson ON, Puyat JH, Koehle MS, Sheel AW, Guenette JA. Sex Differences in Diaphragm Voluntary Activation after Exercise. Med Sci Sports Exerc 2022; 54:1167-1175. [PMID: 35195102 DOI: 10.1249/mss.0000000000002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The female diaphragm develops less fatigue after high-intensity exercise compared with males. Diaphragm fatigability is typically defined as a decrease in transdiaphragmatic twitch pressure (Pdi,TW) and represents the contractile function of the muscle. However, it is unclear whether this sex difference persists when examining changes in voluntary activation, which represents a neural mechanism contributing to fatigability. PURPOSE This study aimed to determine if high-intensity cycling results in a decrease in diaphragm voluntary activation (D-VA) and to explore if the decrease in D-VA is different between sexes. METHODS Twenty-five participants (15 females) completed a single bout of high-intensity constant load cycling. D-VA and Pdi,TW were measured before and after exercise using cervical magnetic stimulation of the phrenic nerves to assess diaphragm fatigability. RESULTS Participants were of similar aerobic fitness when expressed relative to predicted values (females: 114% ± 25% predicted, males: 111% ± 11% predicted; P = 0.769). Pdi,TW decreased relative to baseline to 85.2% ± 16.7% and 70.3% ± 12.4% baseline (P = 0.012) in females and males, respectively, immediately after exercise. D-VA also decreased in both females and males immediately after exercise. The decrease in D-VA was less in females compared with males (95.4% ± 4.9% baseline vs 87.4% ± 10.8% baseline, respectively; P = 0.018). CONCLUSIONS D-VA decreases after whole-body exercise in both females and males, although the magnitude of the decrease is not as large in females compared with males. The findings of this study suggest that the female diaphragm is more resistant to both contractile and neural mechanisms of fatigability after whole-body exercise.
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Affiliation(s)
| | | | | | - Satvir S Dhillon
- Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, CANADA
| | | | | | - Joseph H Puyat
- Centre for Health Evaluation and Outcome Sciences, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, CANADA
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Lohse A, von Platen P, Benner CF, Leonhardt S, Walter M, Deininger MM, Ziles D, Seemann T, Breuer T. Identification of the Tidal Volume Response to Pulse Amplitudes of Phrenic Nerve Stimulation Using Gaussian Process Regression. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:135-138. [PMID: 36085952 DOI: 10.1109/embc48229.2022.9871563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While mechanical ventilation (MV) can lead to ventilator-induced diaphragmatic atrophy due to diaphragm inactivity, electrical phrenic nerve stimulation (PNS) can keep the diaphragm active and therefore prevent diaphragmatic weakness. To quantify the effectivity of PNS, an identification experiment during PNS is presented, and its data is used in Gaussian process regression (GPR) of the tidal volume based on the constant voltage amplitude of the stimulation pulses. The measurements were split into training data of variable size and test data for cross validation. For variable training sizes and different PNS settings, the GPR had a root mean square deviation (RMSD) between 0.39 and 0.91 mL/kg. An identification experiment as short as one and a half minutes was able to characteristically capture the relationship between tidal volume and voltage amplitude. The proposed method needs to be validated in further experiments.
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Horn AG, Kunkel ON, Schulze KM, Baumfalk DR, Weber RE, Poole DC, Behnke BJ. Supplemental oxygen administration during mechanical ventilation reduces diaphragm blood flow and oxygen delivery. J Appl Physiol (1985) 2022; 132:1190-1200. [PMID: 35323060 PMCID: PMC9054262 DOI: 10.1152/japplphysiol.00021.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/22/2022] Open
Abstract
During mechanical ventilation (MV), supplemental oxygen (O2) is commonly administered to critically ill patients to combat hypoxemia. Previous studies demonstrate that hyperoxia exacerbates MV-induced diaphragm oxidative stress and contractile dysfunction. Whereas normoxic MV (i.e., 21% O2) diminishes diaphragm perfusion and O2 delivery in the quiescent diaphragm, the effect of MV with 100% O2 is unknown. We tested the hypothesis that MV supplemented with hyperoxic gas (100% O2) would increase diaphragm vascular resistance and reduce diaphragmatic blood flow and O2 delivery to a greater extent than MV alone. Female Sprague-Dawley rats (4-6 mo) were randomly divided into two groups: 1) MV + 100% O2 followed by MV + 21% O2 (n = 9) or 2) MV + 21% O2 followed by MV + 100% O2 (n = 10). Diaphragmatic blood flow (mL/min/100 g) and vascular resistance were determined, via fluorescent microspheres, during spontaneous breathing (SB), MV + 100% O2, and MV + 21% O2. Compared with SB, total diaphragm vascular resistance was increased, and blood flow was decreased with both MV + 100% O2 and MV + 21% O2 (all P < 0.05). Medial costal diaphragmatic blood flow was lower with MV + 100% O2 (26 ± 6 mL/min/100 g) versus MV + 21% O2 (51 ± 15 mL/min/100 g; P < 0.05). Second, the addition of 100% O2 during normoxic MV exacerbated the MV-induced reductions in medial costal diaphragm perfusion (23 ± 7 vs. 51 ± 15 mL/min/100 g; P < 0.05) and O2 delivery (3.4 ± 0.2 vs. 6.4 ± 0.3 mL O2/min/100 g; P < 0.05). These data demonstrate that administration of supplemental 100% O2 during MV increases diaphragm vascular resistance and diminishes perfusion and O2 delivery to a significantly greater degree than normoxic MV. This suggests that prolonged bouts of MV (i.e., 6 h) with hyperoxia may accelerate MV-induced vascular dysfunction in the quiescent diaphragm and potentially exacerbate downstream contractile dysfunction.NEW & NOTEWORTHY This is the first study, to our knowledge, demonstrating that supplemental oxygen (i.e., 100% O2) during mechanical ventilation (MV) augments the MV-induced reductions in diaphragmatic blood flow and O2 delivery. The accelerated reduction in diaphragmatic blood flow with hyperoxic MV would be expected to potentiate MV-induced diaphragm vascular dysfunction and consequently, downstream contractile dysfunction. The data presented herein provide a putative mechanism for the exacerbated oxidative stress and diaphragm dysfunction reported with prolonged hyperoxic MV.
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Affiliation(s)
- Andrew G Horn
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Olivia N Kunkel
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Kiana M Schulze
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Dryden R Baumfalk
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Ramona E Weber
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - David C Poole
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas
| | - Bradley J Behnke
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
- Johnson Cancer Research Center, Kansas State University, Manhattan, Kansas
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Horn AG, Kunkel ON, Baumfalk DR, Simon ME, Schulze KM, Hsu WW, Muller-Delp J, Poole DC, Behnke BJ. Prolonged mechanical ventilation increases diaphragm arteriole circumferential stretch without changes in stress/stretch: Implications for the pathogenesis of ventilator-induced diaphragm dysfunction. Microcirculation 2021; 28:e12727. [PMID: 34467606 DOI: 10.1111/micc.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/31/2021] [Accepted: 08/24/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Prolonged mechanical ventilation (MV; ≥6 h) results in large, time-dependent reductions in diaphragmatic blood flow and shear stress. We tested the hypothesis that MV would impair the structural and material properties (ie, increased stress/stretch relation and/or circumferential stretch) of first-order arterioles (1A) from the medial costal diaphragm. METHODS Shear stress was estimated from isolated arterioles and prior blood flow data from the diaphragm during spontaneous breathing (SB) and prolonged MV (6 h MV). Thereafter, female Sprague-Dawley rats (~5 months) were randomly divided into two groups, SB (n = 6) and 6 h MV (n = 6). Following SB and 6 h MV, 1A medial costal diaphragm arterioles were isolated, cannulated, and subjected to stepwise (0-140 cmH2 O) increases in intraluminal pressure in calcium-free Ringer's solution. Inner diameter and wall thickness were measured at each pressure step and used to calculate wall:lumen ratio, Cauchy-stress, and circumferential stretch. RESULTS Compared to SB, there was a ~90% reduction in arteriolar shear stress with prolonged MV (9 ± 2 vs 78 ± 20 dynes/cm2 ; p ≤ .05). In the unloaded condition (0 cmH2 O), the arteriolar intraluminal diameter was reduced (37 ± 8 vs 79 ± 13 μm) and wall:lumen ratio was increased (120 ± 18 vs 46 ± 10%) compared to SB (p ≤ .05). There were no differences in the passive diameter responses or the circumferential stress/stretch relationship between groups (p > .05), but at each pressure step, circumferential stretch was increased with 6 h MV vs SB (p ≤ .05). CONCLUSION During prolonged MV, medial costal diaphragm arteriolar shear stress is severely diminished. Despite no change in the material behavior (stress/stretch), prolonged MV resulted in altered structural and mechanical properties (ie, elevated circumferential stretch) of medial costal diaphragm arterioles. This provides important novel mechanistic insights into the impaired diaphragm blood flow capacity and vascular dysfunction following prolonged MV.
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Affiliation(s)
- Andrew G Horn
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Olivia N Kunkel
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Dryden R Baumfalk
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Mikaela E Simon
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Kiana M Schulze
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Wei-Wen Hsu
- Division of Biostatistics and Bioinformations, Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Judy Muller-Delp
- Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - David C Poole
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Bradley J Behnke
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
- Johnson Cancer Research Center, Kansas State University, Manhattan, KS, USA
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Kim YB, Choi J, Park C, Choi H, In J, Yang H. Effects of sevoflurane and adenosine receptor antagonist on the sugammadex-induced recovery from rocuronium-induced neuromuscular blockade in rodent phrenic nerve-hemidiaphragm tissue specimens. Pharmacol Res Perspect 2021; 9:e00827. [PMID: 34337892 PMCID: PMC8326504 DOI: 10.1002/prp2.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Sevoflurane affects on the A1 receptor in the central nervous system and potentiates the action of neuromuscular blocking agents. In the present study, we investigated whether sevoflurane (SEVO) has the ability to potentiate the neuromuscular blocking effect of rocuronium and if the specific antagonist of adenosine receptor (SLV320) can reverse this effect. In this study, phrenic nerve-hemidiaphragm tissue specimens were obtained from 40 Sprague-Dawley (SD) rats. The specimens were immersed in an organ bath filled with Krebs buffer and stimulated by a train-of-four (TOF) pattern using indirect supramaximal stimulation at 20 s intervals. The specimens were randomly allocated to control, 2-chloroadenosine (CADO), SEVO, or SLV320 + SEVO groups. In the CADO and SLV320 + SEVO groups, CADO and SLV320 were added to the organ bath from the start to a concentration of 10 μM and 10 nM, respectively. We then proceeded with rocuronium-induced blockade of >95% depression of the first twitch tension of TOF (T1) and TOF ratio (TOFR). In the SEVO and SLV320 + SEVO groups, SEVO was added to the Krebs buffer solution to concentration of 400-500 μM for 10 min. Sugammadex-induced T1 and TOFR recovery was monitored for 30 min until >95% of T1 and >0.9 of TOFR were confirmed, and the recovery pattern was compared by plotting these data. T1 recovery in the SEVO and CADO groups was significantly delayed compared with the control and SLV320 + SEVO groups (p < .05). In conclusion, sevoflurane affects on the A1 receptor at the neuromuscular junction and delays sugammadex-induced recovery from neuromuscular blockade.
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Affiliation(s)
- Yong Beom Kim
- Department of Anesthesiology and Pain MedicineCollege of MedicineGil Medical CenterGachon UniversityIncheonRepublic of Korea
| | - Jae‐Moon Choi
- Department of Anesthesiology and Pain MedicineAsan Medical CenterUlsan University, College of MedicineSeoulRepublic of Korea
| | - Chungon Park
- Department of Anesthesiology and Pain MedicineCollege of MedicineGil Medical CenterGachon UniversityIncheonRepublic of Korea
| | - Hey‐Ran Choi
- Department of Anaesthesiology and Pain MedicineSeoul Paik HospitalInje University, College of MedicineSeoulRepublic of Korea
| | - Junyong In
- Department of Anesthesiology and Pain MedicineCollege of MedicineIlsan HospitalDonggook UniversityGoyangGyeonggi DoRepublic of Korea
| | - Hong‐Seuk Yang
- Department of Anaesthesiology and Pain MedicineDaejeon Eulji HospitalEulji UniversityDaejeonRepublic of Korea
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Benício K, Resqueti VR, Dias FAL, Pennati F, Aliverti A, Medeiros da Fonseca JD, Fregonezi GAF. Effects of diaphragmatic control on multiparametric analysis of the sniff nasal inspiratory pressure test and inspiratory muscle activity in healthy subjects. PLoS One 2021; 16:e0253132. [PMID: 34292943 PMCID: PMC8297810 DOI: 10.1371/journal.pone.0253132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We investigated the influence of diaphragmatic activation control (diaphC) on the relaxation rate, contractile properties and electrical activity of the inspiratory muscles of healthy subjects. Assessments were performed non-invasively using the sniff inspiratory pressure test (SNIP) and surface electromyography, respectively. METHODS Twenty-two subjects (10 men and 12 women) performed 10 sniff maneuvers in two different days: with and without diaphC instructions. For the SNIP test with diaphC, the subjects were instructed to perform intense activation of the diaphragm. The tests with the best SNIP values were used for analysis. RESULTS The maneuver with diaphC when compared to the maneuver without diaphC exhibited significant lower values for: SNIP (p <0.01), maximum relaxation rate (MRR) (p <0.01), maximum rate of pressure development (MRPD) (p <0.01), contraction times (CT) (p = 0.02) and electrical activity of the sternocleidomastoid (SCM) (p <0.01), scalene (SCL) (p = 0.01) and intercostal (CI) (p = 0.03) muscles. In addition, the decay constant (tau, τ) and relaxation time (½ RT) did not present any changes. CONCLUSION The diaphragmatic control performed during the SNIP test influences the inspiratory pressure and the contractile properties of inspiratory muscles. This occurs due to changes in the pattern of muscle recruitment, which change force velocity characteristics of the test. Thus, instruction on diaphC should be encouraged for better performance of the SNIP test and for evaluation targeting the diaphragm muscle activity.
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Affiliation(s)
- Kadja Benício
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Vanessa R. Resqueti
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Fernando A. L. Dias
- Departamento de Fisiologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Jéssica Danielle Medeiros da Fonseca
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Guilherme A. F. Fregonezi
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- * E-mail:
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Welch JF, Perim RR, Argento PJ, Sutor TW, Vose AK, Nair J, Mitchell GS, Fox EJ. Effect of acute intermittent hypoxia on cortico-diaphragmatic conduction in healthy humans. Exp Neurol 2021; 339:113651. [PMID: 33607080 PMCID: PMC8678369 DOI: 10.1016/j.expneurol.2021.113651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/06/2023]
Abstract
Acute intermittent hypoxia (AIH) is a strategy to improve motor output in humans with neuromotor impairment. A single AIH session increases the amplitude of motor evoked potentials (MEP) in a finger muscle (first dorsal interosseous), demonstrating enhanced corticospinal neurotransmission. Since AIH elicits phrenic/diaphragm long-term facilitation (LTF) in rodent models, we tested the hypothesis that AIH augments diaphragm MEPs in humans. Eleven healthy adults (7 males, age = 29 ± 6 years) were tested. Transcranial and cervical magnetic stimulation were used to induce diaphragm MEPs and compound muscle action potentials (CMAP) recorded by surface EMG, respectively. Stimulus-response curves were generated prior to and 30-60 min after AIH. Diaphragm LTF was assessed by measurement of integrated EMG burst amplitude and frequency during eupnoeic breathing before and after AIH. Following baseline measurements, AIH was delivered from an oxygen generator connected to a facemask under poikilocapnic conditions (15 one minute episodes of 9% inspired oxygen with one minute room air intervals). There were no detectable changes in MEP (-1.5 ± 12.1%, p = 0.96) or CMAP (+0.1 ± 7.8%, p = 0.97) amplitudes across the stimulus-response curve. At stimulation intensities approximating 50% of the difference between minimum and maximum baseline amplitudes, MEP and CMAP amplitudes were also unchanged (p > 0.05). Further, no AIH effect was observed on diaphragm EMG activity during eupnoea post-AIH (p > 0.05). We conclude that unlike hand muscles, poikilocapnic AIH does not enhance diaphragm MEPs or produce diaphragm LTF in healthy humans.
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Affiliation(s)
- Joseph F Welch
- Breathing Research and Therapeutics Centre, Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
| | - Raphael R Perim
- Breathing Research and Therapeutics Centre, Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Patrick J Argento
- Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Tommy W Sutor
- Breathing Research and Therapeutics Centre, Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Alicia K Vose
- Breathing Research and Therapeutics Centre, Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Jayakrishnan Nair
- Breathing Research and Therapeutics Centre, Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Gordon S Mitchell
- Breathing Research and Therapeutics Centre, Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Emily J Fox
- Breathing Research and Therapeutics Centre, Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Brooks Rehabilitation, Jacksonville, FL, USA
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Pareja-Cajiao M, Gransee HM, Sieck GC, Mantilla CB. TrkB signaling contributes to transdiaphragmatic pressure generation in aged mice. J Neurophysiol 2021; 125:1157-1163. [PMID: 33596726 PMCID: PMC8282218 DOI: 10.1152/jn.00004.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/19/2022] Open
Abstract
Ventilatory deficits are common in old age and may result from neuromuscular dysfunction. Signaling via the tropomyosin-related kinase receptor B (TrkB) regulates neuromuscular transmission and, in young mice, is important for the generation of transdiaphragmatic pressure (Pdi). Loss of TrkB signaling worsened neuromuscular transmission failure and reduced maximal Pdi, and these effects are similar to those observed in old age. Administration of TrkB agonists such as 7,8-dihydroxyflavone (7,8-DHF) improves neuromuscular transmission in young and old mice (18 mo; 75% survival). We hypothesized that TrkB signaling contributes to Pdi generation in old mice, particularly during maximal force behaviors. Old male and female TrkBF616A mice, with a mutation that induces 1NMPP1-mediated TrkB kinase inhibition, were randomly assigned to systemic treatment with vehicle, 7,8-DHF, or 1NMPP1 1 h before experiments. Pdi was measured during eupneic breathing (room air), hypoxia-hypercapnia (10% O2/5% CO2), tracheal occlusion, spontaneous deep breaths ("sighs"), and bilateral phrenic nerve stimulation (Pdimax). There were no differences in the Pdi amplitude across treatments during ventilatory behaviors (eupnea, hypoxia-hypercapnia, occlusion, or sigh). As expected, Pdi increased from eupnea and hypoxia-hypercapnia (∼7 cm H2O) to occlusion and sighs (∼25 cm H2O), with no differences across treatments. Pdimax was ∼50 cm H2O in the vehicle and 7,8-DHF groups and ∼40 cm H2O in the 1NMPP1 group (F8,74 = 2; P = 0.02). Our results indicate that TrkB signaling is necessary for generating maximal forces by the diaphragm muscle in old mice and are consistent with aging effects of TrkB signaling on neuromuscular transmission.NEW & NOTEWORTHY TrkB signaling is necessary for generating maximal forces by the diaphragm muscle. In 19- to 21-mo-old TrkBF616A mice susceptible to 1NMPP1-induced inhibition of TrkB kinase activity, maximal Pdi generated by bilateral phrenic nerve stimulation was ∼20% lower after 1NMPP1 compared with vehicle-treated mice. Treatment with the TrkB agonist 7,8-dihydroxyflavone did not affect Pdi generation when compared with age-matched mice. Inhibition of TrkB kinase activity did not affect the forces generated during lower force behaviors in old age.
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Affiliation(s)
- Miguel Pareja-Cajiao
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic, College of Medicine and Science, Rochester, Minnesota
| | - Heather M Gransee
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic, College of Medicine and Science, Rochester, Minnesota
| | - Gary C Sieck
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic, College of Medicine and Science, Rochester, Minnesota
- Physiology and Biomedical Engineering, Mayo Clinic, College of Medicine and Science, Rochester, Minnesota
| | - Carlos B Mantilla
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic, College of Medicine and Science, Rochester, Minnesota
- Physiology and Biomedical Engineering, Mayo Clinic, College of Medicine and Science, Rochester, Minnesota
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Vang P, Baumann CW, Barok R, Larson AA, Dougherty BJ, Lowe DA. Impact of estrogen deficiency on diaphragm and leg muscle contractile function in female mdx mice. PLoS One 2021; 16:e0249472. [PMID: 33788896 PMCID: PMC8011782 DOI: 10.1371/journal.pone.0249472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
Female carriers of Duchenne muscular dystrophy (DMD) presenting with DMD symptomology similar to males with DMD, such as skeletal muscle weakness and cardiomyopathy, are termed manifesting carriers. There is phenotypic variability among manifesting carriers including the age of onset, which can range from the first to fourth decade of life. In females, estrogen levels typically begin to decline during the fourth decade of life and estrogen deficiency contributes to loss of muscle strength and recovery of strength following injury. Thus, we questioned whether the decline of estrogen impacts the development of DMD symptoms in females. To address this question, we studied 6-8 month-old homozygous mdx female mice randomly assigned to a sham or ovariectomy (OVX) surgical group. In vivo whole-body plethysmography assessed ventilatory function and diaphragm muscle strength was measured in vitro before and after fatigue. Anterior crural muscles were analyzed in vivo for contractile function, fatigue, and in response to eccentric contraction (ECC)-induced injury. For the latter, 50 maximal ECCs were performed by the anterior crural muscles to induce injury. Body mass, uterine mass, hypoxia-hypercapnia ventilatory response, and fatigue index were analyzed by a pooled unpaired t-test. A two-way ANOVA was used to analyze ventilatory measurements. Fatigue and ECC-injury recovery experiments were analyzed by a two-way repeated-measures ANOVA. Results show no differences between sham and OVX mdx mice in ventilatory function, strength, or recovery of strength after fatigue in the diaphragm muscle or anterior crural muscles (p ≥ 0.078). However, OVX mice had significantly greater eccentric torque loss and blunted recovery of strength after ECC-induced injury compared to sham mice (p ≤ 0.019). Although the results show that loss of estrogen has minimal impact on skeletal muscle contractile function in female mdx mice, a key finding suggests that estrogen is important in muscle recovery in female mdx mice after injury.
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Affiliation(s)
- Pangdra Vang
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Cory W. Baumann
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rebecca Barok
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Alexie A. Larson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Brendan J. Dougherty
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Dawn A. Lowe
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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Sunshine MD, Cassarà AM, Neufeld E, Grossman N, Mareci TH, Otto KJ, Boyden ES, Fuller DD. Restoration of breathing after opioid overdose and spinal cord injury using temporal interference stimulation. Commun Biol 2021; 4:107. [PMID: 33495588 PMCID: PMC7835220 DOI: 10.1038/s42003-020-01604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/14/2020] [Indexed: 01/05/2023] Open
Abstract
Respiratory insufficiency is a leading cause of death due to drug overdose or neuromuscular disease. We hypothesized that a stimulation paradigm using temporal interference (TI) could restore breathing in such conditions. Following opioid overdose in rats, two high frequency (5000 Hz and 5001 Hz), low amplitude waveforms delivered via intramuscular wires in the neck immediately activated the diaphragm and restored ventilation in phase with waveform offset (1 Hz or 60 breaths/min). Following cervical spinal cord injury (SCI), TI stimulation via dorsally placed epidural electrodes uni- or bilaterally activated the diaphragm depending on current and electrode position. In silico modeling indicated that an interferential signal in the ventral spinal cord predicted the evoked response (left versus right diaphragm) and current-ratio-based steering. We conclude that TI stimulation can activate spinal motor neurons after SCI and prevent fatal apnea during drug overdose by restoring ventilation with minimally invasive electrodes.
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Affiliation(s)
- Michael D Sunshine
- Rehabilitation Science PhD Program, University of Florida, Gainesville, FL, 32611, USA
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32611, USA
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, 32611, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, 32611, USA
| | - Antonino M Cassarà
- Foundation for Research on Information Technologies in Society (IT'IS), 8004, Zurich, Switzerland
| | - Esra Neufeld
- Foundation for Research on Information Technologies in Society (IT'IS), 8004, Zurich, Switzerland
| | - Nir Grossman
- Division of Brain Sciences, Imperial College London, London, SW7 2BU, United Kingdom
- United Kingdom Dementia Research Institute, Imperial College London, London, SW7 2BU, United Kingdom
| | - Thomas H Mareci
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL, 32611, USA
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA
- Department of Neuroscience, University of Florida, Gainesville, FL, 32611, USA
- Department of Neurology, University of Florida, Gainesville, FL, 32611, USA
- Department of Materials Science and Engineering, University of Florida, Gainesville, FL, 32611, USA
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - Edward S Boyden
- Departments of Brain and Cognitive Sciences, Media Arts and Sciences, and Biological Engineering, McGovern and Koch Institutes, MIT, Cambridge, MA, 02139, USA
- Howard Hughes Medical Institute, Cambridge, MA, 02138, USA
| | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32611, USA.
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, 32611, USA.
- McKnight Brain Institute, University of Florida, Gainesville, FL, 32611, USA.
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Ohira S, Kanayama N, Wada K, Ikawa T, Hirata T, Kishi N, Karino T, Washio H, Ueda Y, Miyazaki M, Koizumi M, Teshima T. Improvement of image quality and assessment of respiratory motion for hepatocellular carcinoma with portal vein tumor thrombosis using contrast-enhanced four-dimensional dual-energy computed tomography. PLoS One 2021; 16:e0244079. [PMID: 33481820 PMCID: PMC7822294 DOI: 10.1371/journal.pone.0244079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
To assess the objective and subjective image quality, and respiratory motion of hepatocellular carcinoma with portal vein tumor thrombosis (PVTT) using the contrast-enhanced four-dimensional dual-energy computed tomography (CE-4D-DECT). For twelve patients, the virtual monochromatic image (VMI) derived from the CE-4D-DECT with the highest contrast to noise ratio (CNR) was determined as the optimal VMI (O-VMI). To assess the objective and subjective image quality, the CNR and five-point score of the O-VMI were compared to those of the standard VMI at 77 keV (S-VMI). The respiratory motion of the PVTT and diaphragm was measured based on the exhale and inhale phase images. The VMI at 60 keV yielded the highest CNR (4.8 ± 1.4) which was significantly higher (p = 0.02) than that in the S-VMI (3.8 ± 1.2). The overall image quality (4.0 ± 0.6 vs 3.1 ± 0.5) and tumor conspicuity (3.8 ± 0.8 vs 2.8 ± 0.6) of the O-VMI determined by three radiation oncologists was significantly higher (p < 0.01) than that of the S-VMI. The diaphragm motion in the L-R (3.3 ± 2.5 vs 1.2 ± 1.1 mm), A-P (6.7 ± 4.0 vs 1.6 ± 1.3mm) and 3D (8.8 ± 3.5 vs 13.1 ± 4.9 mm) directions were significantly larger (p < 0.05) compared to the tumor motion. The improvement of objective and subjective image quality was achieved in the O-VMI. Because the respiratory motion of the diaphragm was larger than that of the PVTT, we need to be pay attention for localizing target in radiotherapy.
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Affiliation(s)
- Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
- * E-mail:
| | - Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Wada
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toshiki Ikawa
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takero Hirata
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Kishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsukasa Karino
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hayate Washio
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Traser L, Burk F, Özen AC, Burdumy M, Bock M, Blaser D, Richter B, Echternach M. Respiratory kinematics and the regulation of subglottic pressure for phonation of pitch jumps - a dynamic MRI study. PLoS One 2020; 15:e0244539. [PMID: 33382744 PMCID: PMC7775092 DOI: 10.1371/journal.pone.0244539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/11/2020] [Indexed: 11/18/2022] Open
Abstract
The respiratory system is a central part of voice production as it contributes to the generation of subglottic pressure, which has an impact on voice parameters including fundamental frequency and sound pressure level. Both parameters need to be adjusted precisely during complex phonation tasks such as singing. In particular, the underlying functions of the diaphragm and rib cage in relation to the phonation of pitch jumps are not yet understood in detail. This study aims to analyse respiratory movements during phonation of pitch jumps using dynamic MRI of the lungs. Dynamic images of the breathing apparatus of 7 professional singers were acquired in the supine position during phonation of upwards and downwards pitch jumps in a high, medium, and low range of the singer's tessitura. Distances between characteristic anatomical landmarks in the lung were measured from the series of images obtained. During sustained phonation, the diaphragm elevates, and the rib cage is lowered in a monotonic manner. During downward pitch jumps the diaphragm suddenly changed its movement direction and presented with a short inspiratory activation which was predominant in the posterior part and was associated with a shift of the cupola in an anterior direction. The magnitude of this inspiratory movement was greater for jumps that started at higher compared to lower fundamental frequency. In contrast, expiratory movement of the rib cage and anterior diaphragm were simultaneous and continued constantly during the jump. The data underline the theory of a regulation of subglottic pressure via a sudden diaphragm contraction during phonation of pitch jumps downwards, while the rib cage is not involved in short term adaptations. This strengthens the idea of a differentiated control of rib cage and diaphragm as different functional units during singing phonation.
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Affiliation(s)
- Louisa Traser
- Institute of Musicians’ Medicine, Medical Center–University of Freiburg, Freiburg, Germany
- Division of Phoniatrics, Department of Otorhinolaryngology, Head Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Fabian Burk
- Department of Otorhinolaryngology, Head- and Neck Surgery, Christian-Albrechts-University, Kiel, Germany
| | - Ali Caglar Özen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Medical Physics, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Consortium for Translational Cancer Research Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Burdumy
- Department of Radiology, Medical Physics, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Medical Physics, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Blaser
- Division of Phoniatrics, Department of Otorhinolaryngology, Head Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Richter
- Institute of Musicians’ Medicine, Medical Center–University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital, Munich, Germany
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Bezdudnaya T, Lane MA, Marchenko V. Pharmacological disinhibition enhances paced breathing following complete spinal cord injury in rats. Respir Physiol Neurobiol 2020; 282:103514. [PMID: 32750492 PMCID: PMC9793860 DOI: 10.1016/j.resp.2020.103514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 12/30/2022]
Abstract
Respiratory dysfunction is one of the most devastating and life-threatening deficits that occurs following cervical spinal cord injury (SCI). Assisted breathing with mechanical ventilators is a necessary part of care for many cervical injured individuals, but it is also associated with increased risk of secondary complications such as infection, muscle atrophy and maladaptive plasticity. Pre-clinical studies with epidural stimulation (EDS) have identified it as an alternative/additional method to support adequate lung ventilation without mechanical assistance. The full potential of EDS, however, may be limited by spinal inhibitory mechanisms within the injured spinal cord. The goal of the present work is to assess the potential improvement for EDS in combination with pharmacological disinhibition of spinal circuits following complete high cervical SCI. All experiments were performed in decerebrate, unanesthetized, non-paralyzed (n = 13) and paralyzed (n = 8) adult Sprague-Dawley rats 6 h following a complete C1 transection. The combination of high-frequency EDS (HF-EDS) at the C4 spinal segment with intrathecal delivery of GABA and glycine receptors antagonists (GABAzine and strychnine, respectively) resulted in significantly increased phrenic motor output, tidal volume and amplitude of diaphragm electrical activity compared to HF-EDS alone. Thus, it appears that spinal fast inhibitory mechanisms limit phrenic motor output and present a new neuropharmacological target to improve paced breathing in individuals with cervical SCI.
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Affiliation(s)
- T Bezdudnaya
- Drexel University College of Medicine, Department of Neurobiology & Anatomy, 2900 W Queen Lane, Philadelphia, PA, 19129, United States
| | - M A Lane
- Drexel University College of Medicine, Department of Neurobiology & Anatomy, 2900 W Queen Lane, Philadelphia, PA, 19129, United States
| | - V Marchenko
- Drexel University College of Medicine, Department of Neurobiology & Anatomy, 2900 W Queen Lane, Philadelphia, PA, 19129, United States; Medical College of Wisconsin, Department of Anesthesiology, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, United States.
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Zakyrjanova GF, Gilmutdinov AI, Tsentsevitsky AN, Petrov AM. Olesoxime, a cholesterol-like neuroprotectant restrains synaptic vesicle exocytosis in the mice motor nerve terminals: Possible role of VDACs. Biochim Biophys Acta Mol Cell Biol Lipids 2020; 1865:158739. [PMID: 32428575 DOI: 10.1016/j.bbalip.2020.158739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
Olesoxime is a cholesterol-like neuroprotective compound that targets to mitochondrial voltage dependent anion channels (VDACs). VDACs were also found in the plasma membrane and highly expressed in the presynaptic compartment. Here, we studied the effects of olesoxime and VDAC inhibitors on neurotransmission in the mouse neuromuscular junction. Electrophysiological analysis revealed that olesoxime suppressed selectively evoked neurotransmitter release in response to a single stimulus and 20 Hz activity. Also olesoxime decreased the rate of FM1-43 dye loss (an indicator of synaptic vesicle exocytosis) at low frequency stimulation and 20 Hz. Furthermore, an increase in extracellular Cl- enhanced the action of olesoxime on the exocytosis and olesoxime increased intracellular Cl- levels. The effects of olesoxime on the evoked synaptic vesicle exocytosis and [Cl-]i were blocked by membrane-permeable and impermeable VDAC inhibitors. Immunofluorescent labeling pointed on the presence of VDACs on the synaptic membranes. Rotenone-induced mitochondrial dysfunction perturbed the exocytotic release of FM1-43 and cell-permeable VDAC inhibitor (but not olesoxime or impermeable VDAC inhibitor) partially mitigated the rotenone-driven alterations in the FM1-43 unloading and mitochondrial superoxide production. Thus, olesoxime restrains neurotransmission by acting on plasmalemmal VDACs whose activation can limit synaptic vesicle exocytosis probably via increasing anion flux into the nerve terminals.
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Affiliation(s)
- Guzalia F Zakyrjanova
- Laboratory of Biophysics of Synaptic Processes, Kazan Institute of Biochemistry and Biophysics, Federal Research Center "Kazan Scientific Center of RAS", 2/31 Lobachevsky Street, box 30, Kazan 420111, Russia; Institute of Neuroscience, Kazan State Medial University, 49 Butlerova Street, Kazan 420012, Russia
| | - Amir I Gilmutdinov
- Laboratory of Biophysics of Synaptic Processes, Kazan Institute of Biochemistry and Biophysics, Federal Research Center "Kazan Scientific Center of RAS", 2/31 Lobachevsky Street, box 30, Kazan 420111, Russia
| | - Andrey N Tsentsevitsky
- Laboratory of Biophysics of Synaptic Processes, Kazan Institute of Biochemistry and Biophysics, Federal Research Center "Kazan Scientific Center of RAS", 2/31 Lobachevsky Street, box 30, Kazan 420111, Russia
| | - Alexey M Petrov
- Laboratory of Biophysics of Synaptic Processes, Kazan Institute of Biochemistry and Biophysics, Federal Research Center "Kazan Scientific Center of RAS", 2/31 Lobachevsky Street, box 30, Kazan 420111, Russia; Institute of Neuroscience, Kazan State Medial University, 49 Butlerova Street, Kazan 420012, Russia.
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Abstract
BACKGROUND Diaphragm-triggered non-invasive respiratory support, commonly referred to as NIV-NAVA (non-invasive neurally adjusted ventilatory assist), uses the electrical activity of the crural diaphragm to trigger the start and end of a breath. It provides variable inspiratory pressure that is proportional to an infant's changing inspiratory effort. NIV-NAVA has the potential to provide effective, non-invasive, synchronised, multilevel support and may reduce the need for invasive ventilation; however, its effects on short- and long-term outcomes, especially in the preterm infant, are unclear. OBJECTIVES To assess the effectiveness and safety of diaphragm-triggered non-invasive respiratory support in preterm infants (< 37 weeks' gestation) when compared to other non-invasive modes of respiratory support (nasal intermittent positive pressure ventilation (NIPPV); nasal continuous positive airway pressure (nCPAP); high-flow nasal cannulae (HFNC)), and to assess preterm infants with birth weight less than 1000 grams or less than 28 weeks' corrected gestation at the time of intervention as a sub-group. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 5), MEDLINE via PubMed (1946 to 10 May 2019), Embase (1947 to 10 May 2019), and CINAHL (1982 to 10 May 2019). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared diaphragm-triggered non-invasive versus other non-invasive respiratory support in preterm infants. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed trial quality and extracted data from included studies. We performed fixed-effect analyses and expressed treatment effects as mean difference (MD), risk ratio (RR), and risk difference (RD) with 95% confidence intervals (CIs). We used the generic inverse variance method to analyse specific outcomes for cross-over trials. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS There were two small randomised controlled trials including a total of 23 infants eligible for inclusion in the review. Only one trial involving 16 infants included in the analysis reported on either of the primary outcomes of the review. This found no difference in failure of modality between NIV-NAVA and NIPPV (RR 0.33, 95% CI 0.02 to 7.14; RD -0.13, 95% CI -0.41 to 0.16; 1 study, 16 infants; heterogeneity not applicable). Both trials reported on secondary outcomes of the review, specific for cross-over trials (total 22 infants; 1 excluded due to failure of initial modality). One study involving seven infants reported a significant reduction in maximum FiO₂ with NIV-NAVA compared to NIPPV (MD -4.29, 95% CI -5.47 to -3.11; heterogeneity not applicable). There was no difference in maximum electric activity of the diaphragm (Edi) signal between modalities (MD -1.75, 95% CI -3.75 to 0.26; I² = 0%) and a significant increase in respiratory rate with NIV-NAVA compared to NIPPV (MD 7.22, 95% CI 0.21 to 14.22; I² = 72%) on a meta-analysis of two studies involving a total of 22 infants. The included studies did not report on other outcomes of interest. AUTHORS' CONCLUSIONS Due to limited data and very low certainty evidence, we were unable to determine if diaphragm-triggered non-invasive respiratory support is effective or safe in preventing respiratory failure in preterm infants. Large, adequately powered randomised controlled trials are needed to determine if diaphragm-triggered non-invasive respiratory support in preterm infants is effective or safe.
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Affiliation(s)
- Dimple Goel
- Westmead HospitalNeonatal Intensive CareHawkesbury Rd & Darcy RoadWestmeadNSWAustralia2145
| | - Ju Lee Oei
- Royal Hospital for WomenNewborn CareBarker StreetRandwickNSWAustralia2031
| | - John Smyth
- Royal Hospital for WomenNewborn CareBarker StreetRandwickNSWAustralia2031
| | - Tim Schindler
- Royal Hospital for WomenNewborn CareBarker StreetRandwickNSWAustralia2031
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O’Hara DN, Pavlov A, Taub E, Ahmad S. Ultrasonographic modeling of diaphragm function: A novel approach to respiratory assessment. PLoS One 2020; 15:e0229972. [PMID: 32163474 PMCID: PMC7067453 DOI: 10.1371/journal.pone.0229972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives Bedside ultrasound techniques have the unique ability to produce instantaneous, dynamic images, and have demonstrated widespread utility in both emergency and critical care settings. The aim of this article is to introduce a novel application of this imaging modality by utilizing an ultrasound based mathematical model to assess respiratory function. With validation, the proposed models have the potential to predict pulmonary function in patients who cannot adequately participate in standard spirometric techniques (inability to form tight seal with mouthpiece, etc.). Methods Ultrasound was used to measure diaphragm thickness (Tdi) in a small population of healthy, adult males at various points of the respiratory cycle. Each measurement corresponded to a generated negative inspiratory force (NIF), determined by a handheld meter. The data was analyzed using mixed models to produce two representative mathematical models. Results Two mathematical models represented the relationship between Tdi and NIFmax, or maximum inspiratory pressure (MIP), both of which were statistically significant with p-values <0.005: 1. log(NIF) = -1.32+4.02×log(Tdi); and 2. NIF = -8.19+(2.55 × Tdi)+(1.79×(Tdi2)). Conclusions With validation, these models intend to provide a method of estimating MIP, by way of diaphragm ultrasound measurements, thereby allowing evaluation of respiratory function in patients who may be unable to reliably participate in standard spirometric tests.
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Affiliation(s)
- Danielle N. O’Hara
- School of Medicine, Stony Brook University Hospital, Stony Brook, New York, United States of America
| | - Andrey Pavlov
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stony Brook University Hospital, Stony Brook, New York, United States of America
| | - Erin Taub
- Department of Biostatistics, Stony Brook University Hospital, Stony Brook, New York, United States of America
| | - Sahar Ahmad
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stony Brook University Hospital, Stony Brook, New York, United States of America
- * E-mail:
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Lee EJ, Kolb J, Hwee DT, Malik FI, Granzier HL. Functional Characterization of the Intact Diaphragm in a Nebulin-Based Nemaline Myopathy (NM) Model-Effects of the Fast Skeletal Muscle Troponin Activator tirasemtiv. Int J Mol Sci 2019; 20:ijms20205008. [PMID: 31658633 PMCID: PMC6829460 DOI: 10.3390/ijms20205008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 02/08/2023] Open
Abstract
Respiratory failure due to diaphragm dysfunction is considered a main cause of death in nemaline myopathy (NM) and we studied both isometric force and isotonic shortening of diaphragm muscle in a mouse model of nebulin-based NM (Neb cKO). A large contractile deficit was found in nebulin-deficient intact muscle that is frequency dependent, with the largest deficits at low–intermediate stimulation frequencies (e.g., a deficit of 72% at a stimulation frequency of 20 Hz). The effect of the fast skeletal muscle troponin activator (FSTA) tirasemtiv on force was examined. Tirasemtiv had a negligible effect at maximal stimulation frequencies, but greatly reduced the force deficit of the diaphragm at sub-maximal stimulation levels with an effect that was largest in Neb cKO diaphragm. As a result, the force deficit of Neb cKO diaphragm fell (from 72% to 29% at 20 Hz). Similar effects were found in in vivo experiments on the nerve-stimulated gastrocnemius muscle complex. Load-clamp experiments on diaphragm muscle showed that tirasemtiv increased the shortening velocity, and reduced the deficit in mechanical power by 33%. Thus, tirasemtiv significantly improves muscle function in a mouse model of nebulin-based nemaline myopathy.
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Affiliation(s)
- Eun-Jeong Lee
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA.
| | - Justin Kolb
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA.
| | - Darren T Hwee
- Research and Early Development, Cytokinetics, Inc., South San Francisco, CA 94080, USA.
| | - Fady I Malik
- Research and Early Development, Cytokinetics, Inc., South San Francisco, CA 94080, USA.
| | - Henk L Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85721, USA.
- Medical Research Building, RM 325, 1656 E Mabel St, Tucson, AZ 85721, USA.
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Maurizio R, Rinaldi VE, Camerini PG, Salvatori C, Leonardi A, Bini V. Right Diaphragmatic Peak Motion Velocities on Pulsed Wave Tissue Doppler Imaging in Neonates: Method, Reproducibility, and Reference Values. J Ultrasound Med 2019; 38:2695-2701. [PMID: 30793336 DOI: 10.1002/jum.14974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/04/2019] [Accepted: 01/27/2019] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To test the reproducibility and report the reference ranges of the right diaphragmatic excursion's peak velocities recorded by pulsed wave tissue Doppler imaging in healthy term neonates. METHODS We formerly assessed intraobserver and interobserver variability of the method for the right hemidiaphragm in a small group of neonates, including ventilated neonates. We did not attempt to test the approach for the left hemidiaphragm because of the recognized high failure rate of visualization. Next, we recorded the peak velocities of both hemidiaphragms throughout inspiration and expiration in 229 healthy term neonates near birth to establish weight-dependent reference ranges for the measurements. RESULTS The study population included 116 male and 113 female neonates. The reproducibility of the technique was excellent even in neonates supported by ventilation. We always recorded the right diaphragmatic peak velocities in the normative study group, whereas the left ones were only recorded in 110 of 229 (48%) and 148 of 229 (65%) neonates from the anterior and lateral views, respectively. The modality of delivery and sex showed no influence on diaphragmatic kinetics. The mean inspiratory peak velocities ± SD were 1.4 ± 0.2 cm/s for the right hemidiaphragm and 1.5 ± 0.3 cm/s for the left hemidiaphragm. The mean expiratory peak velocities were 1.3 ± 0.2 cm/s for the right hemidiaphragm and 1.4 ± 0.3 cm/s for the left hemidiaphragm. CONCLUSIONS Measurement of right diaphragmatic kinetics as assessed by pulsed wave tissue Doppler imaging was found to be a reliable technique. Its clinical applicability for the prompt diagnosis and effective management of neonatal respiratory failure deserves further investigation.
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Affiliation(s)
- Radicioni Maurizio
- Neonatal Intensive Care Unit, Santa Maria Della Misericordia Hospital of Perugia, Perugia, Italy
| | | | - Pier Giorgio Camerini
- Neonatal Intensive Care Unit, Santa Maria Della Misericordia Hospital of Perugia, Perugia, Italy
| | | | | | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
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Ding Y, Lyons SA, Scott GR, Gillis TE. Characterizing the influence of chronic hypobaric hypoxia on diaphragmatic myofilament contractile function and phosphorylation in high-altitude deer mice and low-altitude white-footed mice. J Comp Physiol B 2019; 189:489-499. [PMID: 31278612 DOI: 10.1007/s00360-019-01224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
Deer mice, Peromyscusmaniculatus, live at high altitudes where limited O2 represents a challenge to maintaining oxygen delivery to tissues. Previous work has demonstrated that hypoxia acclimation of deer mice and low altitude white-footed mice (P. leucopus) increases the force generating capacity of the diaphragm. The mechanism behind this improved contractile function is not known. Within myocytes, the myofilament plays a critical role in setting the rate and level of force production, and its ability to generate force can change in response to changes in physiological conditions. In the current study, we examined how chronic hypobaric hypoxia exposure of deer mice and white-footed mice influences the Ca2+ activation of force generation by skinned diaphragmatic myofilaments, and the phosphorylation of myofilament proteins. Results demonstrate that myofilament force production, and the Ca2+ sensitivity of force generation, were not impacted by acclimation to hypobaric hypoxia, and did not differ between preparations from the two species. The cooperativity of the force-pCa relationship, and the maximal rate of force generation were also the same in the preparations from both species, and not impacted by acclimation. Finally, the relative phosphorylation of TnT, and MLC was lower in deer mice than white-footed mice, but was not affected by acclimation. These results indicate that species differences in diaphragm function, and the increase in force production with hypoxia acclimation, are not due to differences, or changes, in myofilament function. However, it appears that diaphragmatic myofilament function in these species is not affected by chronic hypobaric hypoxia exposure.
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Affiliation(s)
- Y Ding
- Department of Integrative Biology, University of Guelph, Guelph, ON, N1G-2W1, Canada
| | - S A Lyons
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - G R Scott
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Todd E Gillis
- Department of Integrative Biology, University of Guelph, Guelph, ON, N1G-2W1, Canada.
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Tralhão A, Cavaleiro P, Arrigo M, Lopes JP, Lebrun M, Rivas-Lasarte M, Le Pimpec-Barthes F, Latrémouille C, Achouh P, Pirracchio R, Cholley B. Early changes in diaphragmatic function evaluated using ultrasound in cardiac surgery patients: a cohort study. J Clin Monit Comput 2019; 34:559-566. [PMID: 31278543 PMCID: PMC7223646 DOI: 10.1007/s10877-019-00350-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
Little is known about the evolution of diaphragmatic function in the early post-cardiac surgery period. The main purpose of this work is to describe its evolution using ultrasound measurements of muscular excursion and thickening fraction (TF). Single-center prospective study of 79 consecutive uncomplicated elective cardiac surgery patients, using motion-mode during quiet unassisted breathing. Excursion and TF were measured sequentially for each patient [pre-operative (D1), 1 day (D2) and 5 days (D3) after surgery]. Pre-operative median for right and left hemidiaphragmatic excursions were 1.8 (IQR 1.6 to 2.1) cm and 1.7 (1.4 to 2.0) cm, respectively. Pre-operative median right and left thickening fractions were 28 (19 to 36) % and 33 (22 to 51) %, respectively. At D2, there was a reduction in both excursion (right: 1.5 (1.1 to 1.8) cm, p < 0.001, left: 1.5 (1.1 to 1.8), p = 0.003) and thickening fractions (right: 20 (15 to 34) %, p = 0.021, left: 24 (17 to 39) %, p = 0.002), followed by a return to pre-operative values at D3. A positive moderate correlation was found between excursion and thickening fraction (Spearman's rho 0.518 for right and 0.548 for left hemidiaphragm, p < 0.001). Interobserver reliability yielded a bias below 0.1 cm with limits of agreement (LOA) of ± 0.3 cm for excursion and - 2% with LOA of ± 21% for thickening fractions. After cardiac surgery, the evolution of diaphragmatic function is characterized by a transient impairment followed by a quick recovery. Although ultrasound diaphragmatic excursion and thickening fraction are correlated, excursion seems to be a more feasible and reproducible method in this population.
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Affiliation(s)
- António Tralhão
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Professor Doutor Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.
| | - Pedro Cavaleiro
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, Portugal
| | - Mattia Arrigo
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jean-Paul Lopes
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Marion Lebrun
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Mercedes Rivas-Lasarte
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Françoise Le Pimpec-Barthes
- Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Université Sorbonne-Paris-Cité, Paris, France
| | - Christian Latrémouille
- Department of Cardiac Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Université Sorbonne-Paris-Cité, Paris, France
| | - Paul Achouh
- Department of Cardiac Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Université Sorbonne-Paris-Cité, Paris, France
| | - Romain Pirracchio
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Université Sorbonne-Paris-Cité, Paris, France
| | - Bernard Cholley
- Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Université Sorbonne-Paris-Cité, Paris, France
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