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Shah NM, Apps C, Kaltsakas G, Madden-Scott S, Suh ES, D'Cruz RF, Arbane G, Patout M, Lhuillier E, Hart N, Murphy PB. The Effect of Pressure Changes During Mechanical Insufflation-Exsufflation on Respiratory and Airway Physiology. Chest 2024; 165:929-941. [PMID: 37844796 DOI: 10.1016/j.chest.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Respiratory muscle weakness can impair cough function, leading to lower respiratory tract infections. These infections are an important contributor to morbidity and mortality in patients with neuromuscular disease. Mechanical insufflation-exsufflation (MIE) is used to augment cough function in these patients. Although MIE is widely used, there are few data to advise on the optimal technique. Since the introduction of MIE, the recommended pressures to be delivered have increased. There are concerns regarding the use of higher pressures and their potential to cause lung derecruitment and upper airway closure. RESEARCH QUESTION What is the impact of high-pressure MIE (HP-MIE) on lung recruitment, respiratory drive, upper airway flow, and patient comfort, compared with low-pressure MIE (LP-MIE), in patients with respiratory muscle weakness? STUDY DESIGN AND METHODS Clinically stable patients using domiciliary MIE with respiratory muscle weakness secondary to Duchenne muscle dystrophy, spinal cord injury, or long-term tracheostomy ventilation received LP-MIE (30/-30 cm H2O) and HP-MIE (60/-60 cm H2O) in a random sequence. Lung recruitment, neural respiratory drive, and cough peak expiratory flow were measured throughout, and patients reported comfort and breathlessness following each intervention. RESULTS A total of 29 patients (10 with Duchenne muscle dystrophy, eight with spinal cord injury, and 11 with long-term tracheostomy ventilation) were included in this study. HP-MIE augmented cough peak expiratory flow compared with LP-MIE (mean cough peak expiratory flow HP-MIE 228 ± 81 L/min vs LP-MIE 179 ± 67 L/min; P = .0001) without any significant change in lung recruitment, neural respiratory drive, or patient-reported breathlessness. However, in patients with more pronounced respiratory muscle weakness, HP-MIE resulted in an increased rate of upper airway closure and patient discomfort that may have an impact on clinical efficacy. INTERPRETATION HP-MIE did not lead to lung derecruitment or breathlessness compared with LP-MIE. However, it was poorly tolerated in individuals with advanced respiratory muscle weakness. HP-MIE generates more upper airway closure than LP-MIE, which may be missed if cough peak expiratory flow is used as the sole titration target. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02753959; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom.
| | - Chloe Apps
- Critical Care, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; GKT School of Medical Education, King's College London, London, United Kingdom
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Sophie Madden-Scott
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Critical Care, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Eui-Sik Suh
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Rebecca F D'Cruz
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Gill Arbane
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | | | - Nicholas Hart
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
| | - Patrick B Murphy
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom
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2
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Aljohani H, Russell D, Kim YI, Bassler J, Lowman J. The Neuromechanics of Inspiratory Muscles in Mechanical Ventilation Liberation Success and Failure. Cureus 2024; 16:e51570. [PMID: 38313921 PMCID: PMC10835747 DOI: 10.7759/cureus.51570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Assessing the neuromechanical coupling of inspiratory muscles during mechanical ventilation (MV) could reveal the physiological mechanism of MV failure. This study examined the respiratory neuromechanical characteristics between MV liberation success and failure. METHODS This is an observational prospective study that included patients during their ventilator liberation process. Assessment of surface electromyography (sEMG) of inspiratory muscles, including the diaphragm and extra-diaphragmatic (scalene, sternocleidomastoid, and parasternal) muscles, was performed 15 minutes after the initiation of spontaneous breathing trials. Neuromechanical efficiency of the diaphragm (NMEDia) and extra-diaphragmatic muscles (NMEExtra) were compared in patients who were successfully liberated from MV with those who failed MV liberation within 72 hours after extubation. RESULTS A total of 45 patients were enrolled and 28 were female (67%). The sample median age was 63 (IQR 47, 69) years old. One-third of patients failed MV liberation within 72 hours of their spontaneous breathing trials (SBTs). NMEDia was significantly lower in patients who failed MV liberation with a root mean square of (M 0.27), (IQR 0.21, 0.37) compared with (M 0.371), (IQR 0.3, 0.631) for the success group (p=0.0222). The area under the curve for NMEDia was lower in the failure group (M 0.270), (IQR 0.160, 0.370) and (M 0.485), (IQR 0.280, 0.683) for the success group (p=0.024). However, NMEExtra was not statistically different between the two groups. CONCLUSION Reduced NMEDia is a predictor of MV liberation failure. NMEExtra was not a major contributor to MV liberation outcomes. Further studies should assess the performance of inspiratory muscles NME indices to predict MV liberation outcomes.
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Affiliation(s)
- Hassan Aljohani
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Derek Russell
- Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Young-Il Kim
- Preventive Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - John Bassler
- Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - John Lowman
- Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
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3
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Shah NM, Hart N, Kaltsakas G. Managing breathlessness in end-stage COPD: a neural respiratory drive approach. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220264. [PMID: 36074411 PMCID: PMC9496361 DOI: 10.36416/1806-3756/e20220264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Neeraj M Shah
- . Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,. Centre for Human and Applied Physiological Sciences-CHAPS-King's College London, London, United Kingdom
| | - Nicholas Hart
- . Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,. Centre for Human and Applied Physiological Sciences-CHAPS-King's College London, London, United Kingdom
| | - Georgios Kaltsakas
- . Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,. Centre for Human and Applied Physiological Sciences-CHAPS-King's College London, London, United Kingdom
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4
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Deep learning for predicting respiratory rate from biosignals. Comput Biol Med 2022; 144:105338. [DOI: 10.1016/j.compbiomed.2022.105338] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 12/23/2022]
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5
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Tas B, Kalk NJ, Lozano-García M, Rafferty GF, Cho P, Kelleher M, Moxham J, Strang J, Jolley CJ. Undetected Respiratory Depression in People with Opioid Use Disorder. Drug Alcohol Depend 2022; 234:109401. [PMID: 35306391 DOI: 10.1016/j.drugalcdep.2022.109401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Opioid-related deaths are increasing globally. Respiratory complications of opioid use and underlying respiratory disease in people with Opioid Use Disorder (OUD) are potential contributory factors. Individual variation in susceptibility to overdose is, however, incompletely understood. This study investigated the prevalence of respiratory depression (RD) in OUD treatment and compared this to patients with chronic obstructive pulmonary disease (COPD) of equivalent severity. We also explored the contribution of opioid agonist treatment (OAT) dosage, and type, to the prevalence of RD. METHODS There were four groups of participants: 1) OUD plus COPD ('OUD-COPD', n = 13); 2) OUD without COPD ('OUD', n = 7); 3) opioid-naïve COPD patients ('COPD'n = 13); 4) healthy controls ('HC'n = 7). Physiological indices, including pulse oximetry (SpO2%), end-tidal CO2 (ETCO2), transcutaneous CO2 (TcCO2), respiratory airflow and second intercostal space parasternal muscle electromyography (EMGpara), were recorded continuously over 40 min whilst awake at rest. Significant RD was defined as: SpO2%< 90% for > 10 s, ETCO2 per breath > 6.6 kPa, TcCO2 overall mean > 6 kPa, respiratory pauses > 10 s RESULTS: At least one indicator was observed in every participant with OUD (n = 20). This compared to RD episode occurrence in only 2/7 HC and 2/13 COPD participants (p < 0.05,Fisher's exact test). The occurrence of RD was similar in OUD participants prescribed methadone (n = 6) compared to those prescribed buprenorphine (n = 12). CONCLUSIONS Undetected RD is common in OUD cohorts receiving OAT and is significantly more severe than in opioid-naïve controls. RD can be assessed using simple objective measures. Further studies are required to determine the association between RD and overdose risk.
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Affiliation(s)
- B Tas
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK.
| | - N J Kalk
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - M Lozano-García
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST) & Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) & Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain
| | - G F Rafferty
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
| | - Psp Cho
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, King's Health Partners, London SE5 9RS, UK
| | - M Kelleher
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - J Moxham
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
| | - J Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - C J Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
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6
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Lozano-Garcia M, Estrada-Petrocelli L, Blanco-Almazan D, Tas B, Cho PSP, Moxham J, Rafferty GF, Torres A, Jane R, Jolley CJ. Noninvasive Assessment of Neuromechanical and Neuroventilatory Coupling in COPD. IEEE J Biomed Health Inform 2022; 26:3385-3396. [PMID: 35404825 DOI: 10.1109/jbhi.2022.3166255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study explored the use of parasternal second intercostal space and lower intercostal space surface electromyogram (sEMG) and surface mechanomyogram (sMMG) recordings (sEMGpara and sMMGpara, and sEMGlic and sMMGlic, respectively) to assess neural respiratory drive (NRD), neuromechanical (NMC) and neuroventilatory (NVC) coupling, and mechanical efficiency (MEff) noninvasively in healthy subjects and chronic obstructive pulmonary disease (COPD) patients. sEMGpara, sMMGpara, sEMGlic, sMMGlic, mouth pressure (Pmo), and volume (Vi) were measured at rest, and during an inspiratory loading protocol, in 16 COPD patients (8 moderate and 8 severe) and 9 healthy subjects. Myographic signals were analyzed using fixed sample entropy and normalized to their largest values (fSEsEMGpara%max, fSEsMMGpara%max, fSEsEMGlic%max, and fSEsMMGlic%max). fSEsMMGpara%max, fSEsEMGpara%max, and fSEsEMGlic%max were significantly higher in COPD than in healthy participants at rest. Parasternal intercostal muscle NMC was significantly higher in healthy than in COPD participants at rest, but not during threshold loading. Pmo-derived NMC and MEff ratios were lower in severe patients than in mild patients or healthy subjects during threshold loading, but differences were not consistently significant. During resting breathing and threshold loading, Vi-derived NVC and MEff ratios were significantly lower in severe patients than in mild patients or healthy subjects. sMMG is a potential noninvasive alternative to sEMG for assessing NRD in COPD. The ratios of Pmo and Vi to sMMG and sEMG measurements provide wholly noninvasive NMC, NVC, and MEff indices that are sensitive to impaired respiratory mechanics in COPD and are therefore of potential value to assess disease severity in clinical practice.
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7
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Effect of Test Interface on Respiratory Muscle Activity and Pulmonary Function During Respiratory Testing in Healthy Adults. Cardiopulm Phys Ther J 2022; 33:87-95. [PMID: 36148286 PMCID: PMC9488548 DOI: 10.1097/cpt.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose The mouthpiece is the standard interface for spirometry tests. Although the use of a mouthpiece can be challenging for patients with orofacial weakness, maintaining a proper seal with a facemask can be an issue for healthy individuals during forceful efforts. We compared respiratory muscle activity and tests using a mouthpiece and facemask in healthy adults to investigate whether they can be used interchangeably. Methods In this observational study, subjects (n=12) completed forced vital capacity, maximal respiratory pressure, and peak cough flow with a mouthpiece and facemask. Root mean square values of the genioglossus, diaphragm, scalene, and sternocleidomastoid were compared between conditions. Results When switching from a mouthpiece to a facemask, significantly higher values were seen for peak cough flow (average bias= -54.36 L/min, p<0.05) and the difference seen with MEP and MIP were clinically significant (average bias: MEP=27.33, MIP=-5.2). Additionally, submental activity was significantly greater when MIP was conducted with a mouthpiece. No significant differences were seen in respiratory muscle activity during resting breathing or spirometry. Conclusion There are clinically significant differences with cough and MEP tests and neck muscles are activated differently based on interface. Considering the small sample size, our findings suggest a facemask may be used to complete some PFTs.
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8
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Tagliabue G, Ji MS, Suneby Jagers JV, Zuege DJ, Kortbeek JB, Easton PA. Parasternal intercostal, costal, and crural diaphragm neural activation during hypercapnia. J Appl Physiol (1985) 2021; 131:672-680. [PMID: 34080922 DOI: 10.1152/japplphysiol.00261.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The parasternal intercostal is an obligatory inspiratory muscle working in coordination with the diaphragm, apparently sharing a common pathway of neural response. This similarity has attracted clinical interest, promoting the parasternal as a noninvasive alternative to the diaphragm, to monitor central neural respiratory output. However, this role may be confounded by the distinct and different functions of the costal and crural diaphragm. Given the anatomic location, parasternal activation may significantly impact the chest wall via both mechanical shortening or as a "fixator" for the chest wall. Either mechanical function of the parasternal may also impact differential function of the costal and crural. The objectives of the present study were, during eupnea and hypercapnia, 1) to compare the intensity of neural activation of the parasternal with the costal and crural diaphragm and 2) to examine parasternal recruitment and changes in mechanical action during progressive hypercapnia, including muscle baseline length and shortening. In 30 spontaneously breathing canines, awake without confounding anesthetic, we directly measured the electrical activity of the parasternal, costal, and crural diaphragm, and the corresponding mechanical shortening of the parasternal, during eupnea and hypercapnia. During eupnea and hypercapnia, the parasternal and costal diaphragm share a similar intensity of neural activation, whereas both differ significantly from crural diaphragm activity. The shortening of the parasternal increases significantly with hypercapnia, without a change in baseline end-expiratory length. In conclusion, the parasternal shares an equivalent intensity of neural activation with the costal, but not crural, diaphragm. The parasternal maintains and increases its active inspiratory shortening during augmented ventilation, despite high levels of diaphragm recruitment. Throughout hypercapnic ventilation, the parasternal contributes mechanically; it is not relegated to chest wall fixation.NEW & NOTEWORTHY This investigation directly compares neural activation of the parasternal intercostal muscle with the two distinct segments of the diaphragm, costal and crural, during room air and hypercapnic ventilation. During eupnea and hypercapnia, the parasternal intercostal muscle and costal diaphragm share a similar neural activation, whereas they both differ significantly from the crural diaphragm. The parasternal intercostal muscle maintains and increases active inspiratory mechanical action with shortening during ventilation, even with high levels of diaphragm recruitment.
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Affiliation(s)
- Giovanni Tagliabue
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Sukjoon Ji
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenny V Suneby Jagers
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John B Kortbeek
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul A Easton
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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D'Cruz RF, Suh ES, Kaltsakas G, Dewar A, Shah NM, Priori R, Douiri A, Rose L, Hart N, Murphy PB. Home parasternal electromyography tracks patient-reported and physiological measures of recovery from severe COPD exacerbation. ERJ Open Res 2021; 7:00709-2020. [PMID: 33937390 PMCID: PMC8071974 DOI: 10.1183/23120541.00709-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/15/2021] [Indexed: 11/11/2022] Open
Abstract
Exacerbations of COPD remain a leading cause of emergency hospitalisations worldwide, and up to 28% of patients are readmitted within 30 days of discharge [1]. Recent analyses of more than 2.3 million COPD hospitalisations highlight the dynamic and time-dependent nature of readmission risk, which peaks within the first 72 h of discharge [2, 3]. Effective readmission prevention strategies remain elusive and recognition of re-exacerbations beyond daily symptom variability is challenging for both patients and clinicians. Promotion of transitional care services and 30-day readmission penalties implemented by policymakers worldwide have had limited impact [4]. Telemonitoring strategies incorporating symptom and vital observation monitoring (peripheral oxygen saturation (SpO2), heart rate, respiratory frequency) have consistently failed to demonstrate beneficial effects on hospitalisation risk [5]. Objective physiological monitoring has been explored using the forced oscillation technique. However, this also failed to prolong time to first hospitalisation [6]. Physiological phenotyping using daily home-based assessments reveals early improvement in load–capacity–drive imbalance following #AECOPD and feasibility of home parasternal electromyography measurement, which tracks symptoms, health status and spirometryhttps://bit.ly/3o6I0Ty
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Affiliation(s)
- Rebecca Francesca D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Eui-Sik Suh
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Amy Dewar
- Dept of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Neeraj Mukesh Shah
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Rita Priori
- Philips Research, Eindhoven, The Netherlands
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Louise Rose
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Patrick Brian Murphy
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
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Noninvasive Assessment of Neuromechanical Coupling and Mechanical Efficiency of Parasternal Intercostal Muscle during Inspiratory Threshold Loading. SENSORS 2021; 21:s21051781. [PMID: 33806463 PMCID: PMC7961675 DOI: 10.3390/s21051781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022]
Abstract
This study aims to investigate noninvasive indices of neuromechanical coupling (NMC) and mechanical efficiency (MEff) of parasternal intercostal muscles. Gold standard assessment of diaphragm NMC requires using invasive techniques, limiting the utility of this procedure. Noninvasive NMC indices of parasternal intercostal muscles can be calculated using surface mechanomyography (sMMGpara) and electromyography (sEMGpara). However, the use of sMMGpara as an inspiratory muscle mechanical output measure, and the relationships between sMMGpara, sEMGpara, and simultaneous invasive and noninvasive pressure measurements have not previously been evaluated. sEMGpara, sMMGpara, and both invasive and noninvasive measurements of pressures were recorded in twelve healthy subjects during an inspiratory loading protocol. The ratios of sMMGpara to sEMGpara, which provided muscle-specific noninvasive NMC indices of parasternal intercostal muscles, showed nonsignificant changes with increasing load, since the relationships between sMMGpara and sEMGpara were linear (R2 = 0.85 (0.75-0.9)). The ratios of mouth pressure (Pmo) to sEMGpara and sMMGpara were also proposed as noninvasive indices of parasternal intercostal muscle NMC and MEff, respectively. These indices, similar to the analogous indices calculated using invasive transdiaphragmatic and esophageal pressures, showed nonsignificant changes during threshold loading, since the relationships between Pmo and both sEMGpara (R2 = 0.84 (0.77-0.93)) and sMMGpara (R2 = 0.89 (0.85-0.91)) were linear. The proposed noninvasive NMC and MEff indices of parasternal intercostal muscles may be of potential clinical value, particularly for the regular assessment of patients with disordered respiratory mechanics using noninvasive wearable and wireless devices.
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11
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Limitations of surface EMG estimate of parasternal intercostal to infer neural respiratory drive. Respir Physiol Neurobiol 2020; 285:103572. [PMID: 33161120 DOI: 10.1016/j.resp.2020.103572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recently, surface EMG of parasternal intercostal muscle has been incorporated in the "ERS Statement of Respiratory Muscle Testing" as a clinical technique to monitor the neural respiratory drive (NRD). However, the anatomy of the parasternal muscle risks confounding EMG "crosstalk" activity from neighboring muscles. OBJECTIVES To determine if surface "parasternal" EMG: 1) reliably estimates parasternal intercostal EMG activity, 2) is a valid surrogate expressing neural respiratory drive (NRD). METHODS Fine wire electrodes were implanted into parasternal intercostal muscle in 20 severe COPD patients along with a pair of surface EMG electrodes at the same intercostal level. We recorded both direct fine wire parasternal EMG (EMGPARA) and surface estimated "parasternal" EMG (SurfEMGpara) simultaneously during resting breathing, volitional inspiratory maneuvers, apnoea with extraneous movement of upper extremity, and hypercapnic ventilation. RESULTS Surface estimated "parasternal" EMG showed spurious "pseudobreathing" activity without any airflow while real parasternal EMG was silent, during apnoea with body extremity movement. Surface estimated "parasternal" EMG did not faithfully represent real measured parasternal EMG. Surface estimated "parasternal" EMG was significantly less active than directly measured parasternal EMG during all conditions including baseline, inspiratory capacity and hypercapnic ventilation. Bland-Altman analysis showed consistent bias between direct parasternal EMG recording and surface estimated EMG during stimulated breathing. CONCLUSION Surface "parasternal" EMG does not consistently or reliably express EMG activity of parasternal intercostal as recorded directly by implanted fine wires. A chest wall surface estimate of parasternal intercostal EMG may not faithfully express NRD and is of limited utility as a biomarker in clinical applications.
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Burns DP, O'Halloran KD. Is non‐normalized chest wall electromyogram activity a reliable index of respiratory neural drive? On the surface – yes! Exp Physiol 2019; 104:621-622. [DOI: 10.1113/ep087680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 11/08/2022]
Affiliation(s)
- David P. Burns
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork T12 K8AF Ireland
| | - Ken D. O'Halloran
- Department of PhysiologySchool of MedicineCollege of Medicine & HealthUniversity College Cork Cork T12 K8AF Ireland
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Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dubé BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich R, Rossi A, Series F, Similowski T, Spengler C, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53:13993003.01214-2018. [DOI: 10.1183/13993003.01214-2018] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.
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14
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Chuang SY, Teng A, Butler J, Gandevia S, Narang I, Briggs N, Selvadurai H, Jaffe A. Quantitative assessment of nocturnal neural respiratory drive in children with and without obstructive sleep apnoea using surface EMG. Exp Physiol 2019; 104:755-764. [PMID: 30821402 DOI: 10.1113/ep087441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 01/10/2023]
Abstract
NEW FINDINGS What is the central question of this study? Recent studies have suggested potential utility of non-normalized respiratory muscle EMG as an index of neural respiratory drive (NRD). Whether NRD measured using non-normalized surface EMG of the lateral chest wall overlying the diaphragm (sEMGcw) recorded during nocturnal clinical polysomnography can differentiate children with and without obstructive sleep apnoea (OSA) is not known. What is the main finding and its importance? Non-normalized sEMGcw was increased in children with OSA and an additional group of snoring children without OSA but subjectively increased respiratory effort compared with primary snorers. The sEMGcw has potential clinical utility in evaluation of children with sleep-disordered breathing as an objective, non-invasive, non-volitional marker of NRD. ABSTRACT Our aim was to investigate whether neural respiratory drive measured by non-normalized surface EMG recorded from the chest wall overlying the diaphragm (sEMGcw) differentiates children with and without obstructive sleep apnoea (OSA). Polysomnography data of children aged 0-18 years were divided into the following three groups: (i) primary snorers (PS); (ii) snoring children without OSA but with increased work of breathing (incWOB; subjective physician report of increased respiratory effort during sleep); and (iii) children with OSA [obstructive apnoea-hypopnoea index (OAHI) >1 h-1 ]. Excerpts of sEMGcw obtained during tidal unobstructed breathing from light, deep and rapid eye movement sleep were exported for quantitative analysis. Overnight polysomnography data from 45 PS [median age 4.4 years (interquartile range 3.0-7.7 years), OAHI 0 h-1 (0.0-0.2 h-1 )], 19 children with incWOB [age 2.8 years (2.4-5.7 years), OAHI 0.1 h-1 (0.0-0.4 h-1 )] and 27 children with OSA [age 3.6 years (2.6-6.2 years), OAHI 3.7 h-1 (2.3-6.9 h-1 )] were analysed. The sEMGcw was higher in those with OSA [8.47 μV (5.98-13.07 μV); P < 0.0001] and incWOB [8.97 μV (5.94-13.43 μV); P < 0.001] compared with PS [4.633 μV (2.98-6.76 μV)]. There was no significant difference in the sEMGcw between children with incWOB and OSA (P = 0.78). Log sEMGcw remained greater in children with OSA and incWOB compared with PS after age, body mass index centiles, sleep stages and sleep positions were included in the mixed linear models (P < 0.0001). The correlation between sEMGcw and OAHI in children without OSA was small (rs = 0.254, P = 0.04). The sEMGcw is increased in children with OSA and incWOB compared with PS.
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Affiliation(s)
- Sandra Y Chuang
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Arthur Teng
- School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia.,Sleep Medicine Department, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jane Butler
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Kensington, NSW, Australia
| | - Simon Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Kensington, NSW, Australia
| | - Indra Narang
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Nancy Briggs
- School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Hiran Selvadurai
- Respiratory Department, Children's Hospital Westmead, Westmead, NSW, Australia
| | - Adam Jaffe
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia
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15
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Westbrook J, MacBean V. The influence of affective state on respiratory muscle activity. Clin Physiol Funct Imaging 2019; 39:291-295. [PMID: 30801915 DOI: 10.1111/cpf.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/17/2019] [Indexed: 11/26/2022]
Abstract
Measures of neural respiratory drive through the use of electromyography of the parasternal intercostal muscles (EMGpara) are accurate markers of respiratory load and are reflective of pulmonary function. A previous observation of a significant reduction in EMGpara from a first to second measurement occasion was attributed to participants' acclimatization to the laboratory environment and a reduction in anxiety. This study therefore aimed to investigate whether manipulation of participants' affective state would influence EMGpara and related variables. Healthy adult participants underwent measurement of EMGpara and respiratory flow and volume during exposure to four conditions: no stimulus, music, and tense and calm videos. Respiratory rate (RR), raw neural respiratory drive index (rawNRDI, the product of EMGpara in microvolts and RR) and minute ventilation (VE) differed significantly across conditions: RR and VE were significantly higher in the tense condition than all other conditions (all P<0·05); rawNRDI was higher in the tense compared to the calm video condition (P = 0·03). There was also a significant relationship between EMGpara and subjective tension ratings (measured via visual analogue scale) in the tense condition (Spearman's rho = 0·508, P = 0·016), with multivariate modelling indicating significant interactions between rawNRDI and subjective ratings of both tension and calmness. This suggests that anxiety could contribute to elevated respiratory muscle activity and ventilation. Greater consideration should be given to the influence of anxiety when undertaking measurement of respiratory muscle activity to ensure data accurately represent underlying respiratory load.
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Affiliation(s)
| | - Victoria MacBean
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, London, UK.,Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, King's College London, London, UK
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Lozano-García M, Estrada L, Jané R. Performance Evaluation of Fixed Sample Entropy in Myographic Signals for Inspiratory Muscle Activity Estimation. ENTROPY 2019; 21:e21020183. [PMID: 33266898 PMCID: PMC7514665 DOI: 10.3390/e21020183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/16/2022]
Abstract
Fixed sample entropy (fSampEn) has been successfully applied to myographic signals for inspiratory muscle activity estimation, attenuating interference from cardiac activity. However, several values have been suggested for fSampEn parameters depending on the application, and there is no consensus standard for optimum values. This study aimed to perform a thorough evaluation of the performance of the most relevant fSampEn parameters in myographic respiratory signals, and to propose, for the first time, a set of optimal general fSampEn parameters for a proper estimation of inspiratory muscle activity. Different combinations of fSampEn parameters were used to calculate fSampEn in both non-invasive and the gold standard invasive myographic respiratory signals. All signals were recorded in a heterogeneous population of healthy subjects and chronic obstructive pulmonary disease patients during loaded breathing, thus allowing the performance of fSampEn to be evaluated for a variety of inspiratory muscle activation levels. The performance of fSampEn was assessed by means of the cross-covariance of fSampEn time-series and both mouth and transdiaphragmatic pressures generated by inspiratory muscles. A set of optimal general fSampEn parameters was proposed, allowing fSampEn of different subjects to be compared and contributing to improving the assessment of inspiratory muscle activity in health and disease.
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Affiliation(s)
- Manuel Lozano-García
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), UPC Campus Diagonal-Besòs, Av. d’Eduard Maristany 10–14, 08930 Barcelona, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08028 Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, 08028 Barcelona, Spain
| | - Luis Estrada
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), UPC Campus Diagonal-Besòs, Av. d’Eduard Maristany 10–14, 08930 Barcelona, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08028 Barcelona, Spain
| | - Raimon Jané
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), UPC Campus Diagonal-Besòs, Av. d’Eduard Maristany 10–14, 08930 Barcelona, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08028 Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, 08028 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-401-25-38
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Williams S, Porter M, Westbrook J, Rafferty GF, MacBean V. The influence of posture on parasternal intercostal muscle activity in healthy young adults. Physiol Meas 2019; 40:01NT03. [DOI: 10.1088/1361-6579/aafefd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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Adler D, Janssens JP. The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity. Respiration 2018; 97:93-104. [PMID: 30423557 DOI: 10.1159/000494063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
The purpose of this review is to provide an overview on how interactions between control of breathing, respiratory load, and muscle function may lead to respiratory failure. The mechanisms involved vary according to the underlying pathology, but respiratory failure is most often the result of an imbalance between the muscular pump and the mechanical load placed upon it. Changes in respiratory drive and response to CO2 seem to be important contributors to the pathophysiology of respiratory failure. Inspiratory muscle dysfunction is also frequent but is not a mandatory prerequisite to respiratory failure since increased load may also be sufficient to precipitate it. It is crucial to recognize these interactions to be able to timeously establish patients on mechanical ventilation and adapt the ventilator settings to their respiratory system physiology.
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Affiliation(s)
- Dan Adler
- Division of Lung Diseases, University Hospitals of Geneva and Geneva Medical School, Geneva, Switzerland,
| | - Jean-Paul Janssens
- Division of Lung Diseases, University Hospitals of Geneva and Geneva Medical School, Geneva, Switzerland
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Respiratory muscle activation patterns during maximum airway pressure efforts are different in women and men. Respir Physiol Neurobiol 2018; 259:143-148. [PMID: 30227268 DOI: 10.1016/j.resp.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/06/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
Maximum inspiratory and expiratory pressure values (PImax and PEmax) are indirect measures of respiratory muscle strength that, in healthy adults, are known to be significantly lower in women compared to men. In part, sex differences in breathing kinematics, lung size, body composition, muscle mass, and muscle fiber composition are thought to be responsible for these effects. However, it is not known whether respiratory muscle activation during maximum respiratory efforts is also sex-specific. In this study, we addressed whether respiratory multi-muscle activation patterns during PImax and PEmax efforts are different between healthy women and men. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), PImax, PEmax, and surface electromyographic (sEMG) activity recorded from respiratory muscles during these maximum airway pressure efforts were obtained in 13 women and 11 men. Percent predicted values of FVC and FEV1 were not significantly different in these two groups (women vs. men: 112 ± 14 vs. 105 ± 15%, p = 0.29; and 92 ± 12 vs. 93 ± 13, p = 0.82, Mean ± SD, respectively), while PImax and PEmax measures were significantly lower in women compared to men (68 ± 16 vs. 88 ± 19 cmH2O, p = 0.011; and 69 ± 13 vs. 94 ± 17, p = 0.0004, respectively). Using vector-based methodology, by calculating the Similarity Index (SI) as measure of the resemblance between two sEMG patterns and the Magnitude (Mag) representing the overall amount sEMG during motor task, we have found that although the Mag values for both PImax and PEmax tasks were not significantly different in two groups, the SIs revealed significant sex-dependent differences in muscle activation patterns (0.89 ± 0.08 vs. 0.97 ± 0.02, p = 0.016; and 0.77 ± 0.11 vs. 0.92 ± 0.04, p = 0.0006, respectively). During the PImax effort, presented as the percentage of total sEMG amplitude, activity of upper trapezius muscle was significantly larger (p = 0.001) while activation of rectus abdominus, oblique, and lower paraspinal muscles were significantly smaller (p = 0.002, p = 0.040, p = 0.005, respectively) in women when compared to the men (50 ± 21 vs. 22 ± 11%; 2 ± 2 vs. 8 ± 7; 4 ± 3 vs. 9 ± 7, 2 ± 3 vs. 7 ± 6, respectively). During PEmax effort, the percentage of sEMG activity were significantly larger in upper and lower trapezius, and intercostal muscles (p = 0.038, p = 0.049, p = 0.037, respectively) and were significantly smaller in pectoralis, rectus abdominus, and oblique muscles (p = 0.021, p < 0.0001, p = 0.048, respectively) in women compared to men (16 ± 10 vs. 9 ± 4%; 16 ± 9 vs. 8 ± 5; 36 ± 12 vs. 25 ± 9; 6 ± 3 vs. 15 ± 5; 14 ± 5 vs. 20 ± 7, respectively). These findings indicate that respiratory muscle activation patterns during maximum airway pressure efforts in healthy individuals are sex-specific. This information should be considered during respiratory motor control evaluation and treatment planning for people with compromised respiratory motor function.
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Ramsook AH, Mitchell RA, Guenette JA. Reply to: Assessment of 'neural respiratory drive' from the parasternal intercostal muscles. Respir Physiol Neurobiol 2018; 259:173-175. [PMID: 30096376 DOI: 10.1016/j.resp.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Andrew H Ramsook
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Reid A Mitchell
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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Hudson AL, Butler JE. Assessment of 'neural respiratory drive' from the parasternal intercostal muscles. Respir Physiol Neurobiol 2018; 252-253:16-17. [PMID: 29545080 DOI: 10.1016/j.resp.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 10/26/2017] [Accepted: 11/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia, Randwick, 2031, Australia and University of New South Wales, Sydney, 2052, Australia.
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, 2031, Australia and University of New South Wales, Sydney, 2052, Australia
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Inspiratory muscle activation increases with COPD severity as confirmed by non-invasive mechanomyographic analysis. PLoS One 2017; 12:e0177730. [PMID: 28542364 PMCID: PMC5436747 DOI: 10.1371/journal.pone.0177730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022] Open
Abstract
There is a lack of instruments for assessing respiratory muscle activation during the breathing cycle in clinical conditions. The aim of the present study was to evaluate the usefulness of the respiratory muscle mechanomyogram (MMG) for non-invasively assessing the mechanical activation of the inspiratory muscles of the lower chest wall in both patients with chronic obstructive pulmonary disease (COPD) and healthy subjects, and to investigate the relationship between inspiratory muscle activation and pulmonary function parameters. Both inspiratory mouth pressure and respiratory muscle MMG were simultaneously recorded under two different respiratory conditions, quiet breathing and incremental ventilatory effort, in 13 COPD patients and 7 healthy subjects. The mechanical activation of the inspiratory muscles was characterised by the non-linear multistate Lempel–Ziv index (MLZ) calculated over the inspiratory time of the MMG signal. Subsequently, the efficiency of the inspiratory muscle mechanical activation was expressed as the ratio between the peak inspiratory mouth pressure to the amplitude of the mechanical activation. This activation estimated using the MLZ index correlated strongly with peak inspiratory mouth pressure throughout the respiratory protocol in both COPD patients (r = 0.80, p<0.001) and healthy (r = 0.82, p<0.001). Moreover, the greater the COPD severity in patients, the greater the level of muscle activation (r = -0.68, p = 0.001, between muscle activation at incremental ventilator effort and FEV1). Furthermore, the efficiency of the mechanical activation of inspiratory muscle was lower in COPD patients than healthy subjects (7.61±2.06 vs 20.42±10.81, respectively, p = 0.0002), and decreased with increasing COPD severity (r = 0.78, p<0.001, between efficiency of the mechanical activation at incremental ventilatory effort and FEV1). These results suggest that the respiratory muscle mechanomyogram is a good reflection of inspiratory effort and can be used to estimate the efficiency of the mechanical activation of the inspiratory muscles. Both, inspiratory muscle activation and inspiratory muscle mechanical activation efficiency are strongly correlated with the pulmonary function. Therefore, the use of the respiratory muscle mechanomyogram can improve the assessment of inspiratory muscle activation in clinical conditions, contributing to a better understanding of breathing in COPD patients.
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Chuang SYC, Teng A, Butler JE, Gandevia SC, Selvadurai H, Jaffe A. Validation of a quantitative method to measure neural respiratory drive in children during sleep. Respir Physiol Neurobiol 2017; 239:75-80. [DOI: 10.1016/j.resp.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/27/2022]
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