Transverse abdominis length changes during eupnea, hypercapnia, and airway occlusion

Expiratory and Inspiratory Action of Transversus Abdominis During Eupnea and Hypercapnic Ventilation

BACKGROUND

Recently, there is interest in the clinical importance of monitoring abdominal muscles during respiratory failure. The clinical interpretation relies on the assumption that expiration is a passive physiologic process and, since diaphragm and abdomen are arranged in series, any inward motion of the abdominal wall represents a sign of diaphragm dysfunction. However, previous studies suggest Transversus Abdominis might be active even during eupnea and is preferentially recruited over the other abdominal muscles.

OBJECTIVE

1) Is Transversus Abdominis normally recruited during eupnea? 2) What is the degree of activation of Transversus Abdominis during hypercapnia? 3) Does the end-inspiratory length of Transversus Abdominis change during hypercapnia, while diaphragm function is normal?

METHODS

In 30 spontaneously breathing canines, awake without confounding anesthetic, we measured directly both electrical activity and corresponding mechanical length and shortening of Transversus Abdominis during eupnea and hypercapnia.

RESULTS

Transversus Abdominis is consistently recruited during eupnea. During hypercapnia, Transversus Abdominis recruitment is progressive and significant. Throughout hypercapnia, Transversus Abdominis baseline end-inspiratory length is not constant: baseline length decreases progressively throughout hypercapnia. After expiration, into early inspiration, Transversus Abdominis shows a consistent neural mechanical post -expiratory expiratory activity (PEEA) at rest, which progressively increases during hypercapnia.

CONCLUSION

Transversus Abdominis is an obligatory expiratory muscle, reinforcing the fundamental principle expiration is not a passive process. Beyond expiration, during hypercapnic ventilation, Transversus Abdominis contributes as an "accessory inspiratory muscle" into the early phase of inspiration. Clinical monitoring of abdominal wall motion during respiratory failure may be confounded by action of Transversus Abdominis.

Fiber architecture of canine abdominal muscles

During respiration, abdominal muscles experience loads, not only in the muscle-fiber direction but also transverse to the fibers. We wondered whether the abdominal muscles exhibit a fiber architecture that is similar to the diaphragm muscle, and, therefore, we chose two adjacent muscles: the internal oblique (IO), with about the same muscle length as the diaphragm, and the transverse abdominis (TA), which is twice as long as the diaphragm. First, we used acetylcholinesterase staining to examine the distribution of neuromuscular junctions on both surfaces of the TA and IO muscles in six dogs. A maximum of four irregular bands of neuromuscular junctions crossed the IO, and as many as six bands crossed the TA, which is consistent with a discontinuous fiber architecture. In six additional dogs, we examined fiber architecture of these muscles by microdissecting 103 fascicles from the IO and 139 from the TA. Each fascicle contained between 20 and 30 muscle fibers. The mean length of nonspanning fibers (NSF) ranged from 2.8 +/- 0.3 cm in the IO to 4.3 +/- 0.5 cm in the TA, and the mean length of spanning fibers ranged from 4.3 +/- 0.5 cm in the IO to 7.6 +/- 1.4 cm in the TA. NSF accounted for 89.6 +/- 1.5% of all fibers dissected from the IO and 99.1 +/- 0.2% of all fibers dissected from the TA. The percentage of NSF with both ends tapered was 6.2 +/- 1.0 and 41.0 +/- 2.3% for IO and TA, respectively. These data show that fiber architecture in either IO or TA is discontinuous, with much more short-tapered fibers in the TA than in the IO. When abdominal muscles are submaximally activated, as during both normal expiration and maximal expiratory efforts, muscle force could be transmitted to the cell membrane and to the extracellular intramuscular connective tissue by shear linkage, presumably via structural transmembrane proteins.

Mechanical contribution of expiratory muscles to pressure generation during spinal cord stimulation

Lower thoracic spinal cord stimulation (SCS) results in the generation of large positive airway pressures (Paw) and may be a useful method of restoring cough in patients with spinal cord injury. The purpose of the present study was to assess the mechanical contribution of individual respiratory muscles to pressure generation during SCS. In anesthetized dogs, SCS was applied at different spinal cord levels by using a 15-lead multicontact electrode before and after sequential ablation of the external and internal obliques, transversus abdominis (TA), rectus abdominis, and internal intercostal muscles. Paw was monitored after tracheal occlusion. SCS at the T(9) spinal cord level resulted in maximal changes in Paw (60 +/- 3 cmH(2)O). Section of the oblique muscles resulted in a fall in Paw to 29 +/- 2 cmH(2)O. After subsequent section of the rectus abdominis and TA, Paw fell to 25 +/- 2 and 12 +/- 1 cmH(2)O respectively. There was a small remaining Paw (4 +/- 1 cmH(2)O) after section of the internal intercostal nerves. Stimulation with a two-electrode lead system (T(9) + T(13)) resulted in significantly greater pressure generation compared with a single-electrode lead due to increased contributions from the obliques and transversus muscles. In a separate group of animals, Paw generation was monitored after section of the abdominal muscles and again after section of the external intercostal and levator costae muscles. These studies demonstrated that inspiratory intercostal muscle stimulation resulted in only a small opposing inspiratory action (</=3 cmH(2)O). We conclude that, during SCS, 1) contraction of the obliques and TA muscles makes the largest contribution to changes in Paw, and 2) stimulation with a two-electrode lead system results in more complete abdominal muscle activation and enhanced mechanical actions of the obliques and transversus muscles.

Mechanical characteristics and functional length of canine expiratory muscles

The expiratory muscles of the abdominal region actively contribute to breathing. In dogs, the transversus abdominis appears to be the main abdominal muscle of expiration. The in vitro mechanical properties of the transversus abdominis have not been reported to date, and formed the basis of the present investigation. Moreover, in order to understand better the nature of the mechanical interplay between the various abdominal muscle groups, we also evaluated the effects of posture on the operational length of canine transversus abdominis and external oblique muscles and related their in situ length to optimal length. The experiments were performed on twelve mongrel dogs, anesthetized with pentobarbital sodium. Contractile properties of excised transversus abdominis muscle strips were evaluated at 37 degrees C and revealed similar twitch, force-frequency and length-tension properties as previously reported in canine external oblique (Farkas and Rochester, J. Appl. Physiol. 65: 2427-2433, 1988). In the supine posture, we noted that external oblique was operating at 88% Lo, while the transversus abdominis was operating at a significantly shorter length of 74% Lo. Thus, in the supine posture, the external oblique is better situated than the transversus abdominis to generate tension. In the prone posture, however, we noted that both abdominal muscles were located at similar positions along their length-tension curve, operating at a length of roughly 77% Lo. Since both muscles share common length-tension characteristics, the present results indicate that the tension generating potential of both muscles in prone dogs is equal for a given neural input. However, we conclude that the preferential recruitment of the transversus abdominis in prone animals must be related to factors other than simple tension generation.

Abdominal muscle length during respiratory defensive reflexes

The purpose of the present study was to assess the mechanical behavior of an expiratory muscle during defensive reflexes. Transversus abdominis muscle length changes were measured using sonomicrometry in anesthetized dogs. The abdominal muscle lengthened during the inspiratory phase and shortened at a rapid velocity during the expiratory portion of coughs and sneezes. The mean extent of muscle shortening was not different during coughing compared to breathing (P greater than 0.20) but was approximately double in magnitude during sneezing compared to breathing (P less than 0.005). On the other hand, the peak velocity of muscle shortening was approximately 5-fold greater during coughing (P less than 0.002) and 10-fold greater during sneezing (P less than 0.05) than during breathing. During the largest coughs and sneezes in each animal, peak velocity of muscle shortening averaged 77 +/- 9 and 179 +/- 65% of end-inspiratory length per sec, respectively. Muscle end-inspiratory length during coughs and sneezes differed from values during breathing (range +/- 8%), although for the group of animals the mean changes were small (+/- 1%). Despite these changes in end-inspiratory length, the abdominal muscle continued to operate at lengths both above and below its resting length. These results suggest that during defensive reflexes, greater increases occur in the velocity than in the extent of transversus abdominis muscle shortening relative to during breathing. In addition the transversus abdominis muscle appears to play an active respiratory role during defensive reflexes.

Electromyography of some respiratory muscles in the horse

To investigate activity in respiratory muscles, insulated wire electrodes were used to record electromyographic activity in the costal diaphragm and in the intercostal, serratus ventralis, internal abdominal oblique, transversalis and rectus abdominis muscles in conscious horses and in the same animals when anaesthetised. Electromyographic activity was related to respiratory phases as recorded by a stethograph around the chest wall. The costal diaphragm showed tonic and inspiratory activity in both conscious and anaesthetised animals. The principal muscle actively involved in expiration was the transversalis muscle. Intercostal muscle activity, and any increased activity in the second part of either inspiration or expiration recorded in the conscious animal, was absent under anaesthesia. The very marked tonic activity found in the serratus ventralis muscle in standing horses disappeared during anaesthesia. It was concluded that any stabilisation of the chest wall contributed by activity in the serratus ventralis and intercostal muscles in conscious, standing horses is greatly reduced during anaesthesia.

Abdominal muscle activity in conscious dogs: effect of sleep and route of breathing

Abdominal muscle activity (EMGabd) was studied in 4 adult dogs during wakefulness and sleep. The dogs were previously prepared with a permanent side-hole tracheal stoma, and were trained to sleep with a tightly-fitted snout mask, hermetically sealed in place. They breathed either through a cuffed endotracheal tube inserted distally into the tracheal stoma (tracheal), or through the upper airway, with the tracheal stoma plugged (nasal). Sleep state was determined by behavioural, electroencephalographic and electromyographic criteria. EMGabd activity was measured using fine bipolar needles inserted into the abdominal muscle layers. Expiratory EMGabd augmented progressively from sleep onset to SWS regardless of route of breathing, and without major changes in the animal's ventilation. Maximal EMGabd occurred in SWS during nasal breathing; EMGabd increased from a mean of 16.6 +/- 0.3 mV awake, to 23.8 +/- 0.3 mV in SWS, representing an overall increase of 55.0 +/- 7.5% from the awake level. EMGabd increased similarly during tracheal breathing, with an overall increase of 62.0 +/- 15.4% in SWS. We conclude that the consistent augmentation of expiratory EMGabd activity in sleep indicates that expiration in the dog is an active process, which is enhanced during nasal breathing and NREM sleep.

Respiratory changes in abdominal configuration in supine dogs

In an attempt to understand the respiratory changes in abdominal muscle length in supine dogs (Ninane et al., 1988), we have recorded the electromyographic (EMG) activity of the transversus abdominis, external oblique, and rectus abdominis in eight supine, lightly anesthetized animals, and we have measured the respiratory changes in anteroposterior (AP) and transverse (T) diameters of the abdomen. Five animals had phasic expiratory EMG activity in the transversus during room air breathing, while only two animals had expiratory activity in the external oblique; no animal had phasic expiratory activity in the rectus. Activation of the transversus during expiration was invariably associated with a decrease in the abdominal T diameter and a rise in gastric pressure. In contrast, the abdominal AP diameter tended to increase. These alterations in abdominal configuration remained unchanged after denervation of the triangularis sterni, but decreased in magnitude when activation of the transversus was reduced by supplemental anesthesia. Conversely, these alterations in abdominal configuration increased in magnitude when expiratory activation of the transversus was increased by hyperoxic hypercapnia. These observations indicate that in supine dogs: (1) Expiratory contraction of the transversus acts primarily to reduce the transverse diameter of the abdomen; (2) This reduction, in turn, promotes an increase in abdominal pressure which results secondarily in an outward motion of the ventral abdominal wall; and (3) The latter may explain why the rectus abdominis, although electrically silent, shortens during expiration below its in situ relaxation length. The present observations also establish that in supine dogs breathing at rest, the abdomen does not move with a single degree of freedom.