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Cunsolo F, Ottaviani V, Capobianco S, Calcinoni O, Dellacà RL. Simultaneous monitoring of vocal doses and breathing patterns in professional singers. Comput Biol Med 2022; 144:105352. [DOI: 10.1016/j.compbiomed.2022.105352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
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Grandville BDL, Petak F, Albu G, Bayat S, Pichon I, Habre W. High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children: a double-blind randomised controlled trial. Br J Anaesth 2019; 122:682-691. [DOI: 10.1016/j.bja.2019.01.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022] Open
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Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Analytic Reviews : Acute Abdominal Compartment Syndrome in the Critically Ill. J Intensive Care Med 2016. [DOI: 10.1177/088506669901400501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Salomoni S, van den Hoorn W, Hodges P. Breathing and Singing: Objective Characterization of Breathing Patterns in Classical Singers. PLoS One 2016; 11:e0155084. [PMID: 27159498 PMCID: PMC4861272 DOI: 10.1371/journal.pone.0155084] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/23/2016] [Indexed: 11/19/2022] Open
Abstract
Singing involves distinct respiratory kinematics (i.e. movements of rib cage and abdomen) to quiet breathing because of different demands on the respiratory system. Professional classical singers often advocate for the advantages of an active control of the abdomen on singing performance. This is presumed to prevent shortening of the diaphragm, elevate the rib cage, and thus promote efficient generation of subglottal pressure during phonation. However, few studies have investigated these patterns quantitatively and inter-subject variability has hindered the identification of stereotypical patterns of respiratory kinematics. Here, seven professional classical singers and four untrained individuals were assessed during quiet breathing, and when singing both a standard song and a piece of choice. Several parameters were extracted from respiratory kinematics and airflow, and principal component analysis was used to identify typical patterns of respiratory kinematics. No group differences were observed during quiet breathing. During singing, both groups adapted to rhythmical constraints with decreased time of inspiration and increased peak airflow. In contrast to untrained individuals, classical singers used greater percentage of abdominal contribution to lung volume during singing and greater asynchrony between movements of rib cage and abdomen. Classical singers substantially altered the coordination of rib cage and abdomen during singing from that used for quiet breathing. Despite variations between participants, principal component analysis revealed consistent pre-phonatory inward movements of the abdominal wall during singing. This contrasted with untrained individuals, who demonstrated synchronous respiratory movements during all tasks. The inward abdominal movements observed in classical singers elevates intra-abdominal pressure and may increase the length and the pressure-generating capacity of rib cage expiratory muscles for potential improvements in voice quality.
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Affiliation(s)
- Sauro Salomoni
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Wolbert van den Hoorn
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Paul Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
- * E-mail:
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Haji K, Royse A, Green C, Botha J, Canty D, Royse C. Interpreting diaphragmatic movement with bedside imaging, review article. J Crit Care 2016; 34:56-65. [PMID: 27288611 DOI: 10.1016/j.jcrc.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/09/2016] [Accepted: 03/04/2016] [Indexed: 12/11/2022]
Abstract
The diaphragm is the most important muscle of respiration. At equilibrium, the load imposed on the diaphragmatic muscles from transdiaphragmatic pressure balances the force generated by diaphragmatic muscles. However, procedural and nonprocedural thoracic and abdominal conditions may disrupt this equilibrium and impair diaphragmatic function. Diaphragmatic dysfunction is associated with respiratory insufficiency and poor outcome. Therefore, rapid diagnosis and early intervention may be useful. Ultrasound imaging provides quick and accurate bedside assessment of the diaphragm. Various imaging techniques have been suggested, using 2-dimensional and M-mode technology. Diaphragm viewing depends on the degree of robe movement, determined by the angle of incidence of the ultrasound beam and by the direction of probe movement. In this review, we will discuss the function of the diaphragm focusing on clinically important anatomical and physiological properties of the diaphragm. We will review the literature regarding various sonographic techniques for diaphragm assessment. We will also explore the evidence for the role of the tidal displacement of subdiaphragmatic organs as a surrogate for diaphragm movement.
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Affiliation(s)
- K Haji
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - A Royse
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - C Green
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - J Botha
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - D Canty
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Royse
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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A Teaching Tool to Visually Illustrate How Manipulating the Physiology of the Ventilatory Muscle Pump Alters Functional Performance. Cardiopulm Phys Ther J 2015. [DOI: 10.1097/cpt.0000000000000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grosu HB, Lee YI, Lee J, Eden E, Eikermann M, Rose KM. Diaphragm muscle thinning in patients who are mechanically ventilated. Chest 2013; 142:1455-1460. [PMID: 23364680 DOI: 10.1378/chest.11-1638] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Approximately 40% of patients in medical ICUs require mechanical ventilation (MV). Approximately 20% to 25% of these patients will encounter difficulties in discontinuing MV. Multiple studies have suggested that MV has an unloading effect on the respiratory muscles that leads to diaphragmatic atrophy and dysfunction, a process called ventilator-induced diaphragmatic dysfunction (VIDD). VIDD may be an important factor affecting when and if MV can be discontinued. A sensitive and specific diagnostic test for VIDD could provide the physician with valuable information that might influence decisions regarding extubation or tracheostomy. The purpose of this study was to quantify, using daily sonographic assessments, the rate and degree of diaphragm thinning during MV. METHODS Seven intubated patients receiving MV during acute care were included. Using sonography, diaphragm muscle thickness was measured daily from the day of intubation until the patient underwent extubation or tracheostomy or died. We analyzed our data using standard descriptive statistics, linear regression, and mixed-model effects. RESULTS The overall rate of decrease in the diaphragm thickness of all seven patients over time averaged 6% per day of MV, which differed significantly from zero. Similarly, the diaphragm thickness decreased for each patient over time. CONCLUSION Sonographic assessment of the diaphragm provides noninvasive measurement of diaphragmatic thickness and the degree of diaphragm thinning in patients receiving MV. Our data show that diaphragm muscle thinning starts within 48 h after initiation of MV. However, it is unclear if diaphragmatic thinning correlates with diaphragmatic atrophy or pulmonary function. The relationship between diaphragm thinning and diaphragm strength remains to be elucidated.
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Affiliation(s)
- Horiana B Grosu
- Division of Pulmonary Critical Care and Sleep Medicine, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians and Surgeons, New York, NY
| | - Young Im Lee
- Division of Pulmonary Critical Care and Sleep Medicine, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians and Surgeons, New York, NY
| | - Jarone Lee
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Edward Eden
- Division of Pulmonary Critical Care and Sleep Medicine, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians and Surgeons, New York, NY
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Keith M Rose
- Division of Pulmonary Critical Care and Sleep Medicine, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians and Surgeons, New York, NY.
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Chu I, Fernandez C, Rodowicz KA, Lopez MA, Lu R, Hubmayr RD, Boriek AM. Diaphragm muscle shortening modulates kinematics of lower rib cage in dogs. Am J Physiol Regul Integr Comp Physiol 2010; 299:R1456-62. [PMID: 20739605 DOI: 10.1152/ajpregu.00016.2010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We tested the hypothesis that diaphragm muscle shortening modulates volume displacement and kinematics of the lower rib cage in dogs and that posture and mode of ventilation affect such modulation. Radiopaque markers were surgically attached to the lower three ribs of the rib cage and to the midcostal region of the diaphragm in six dogs of ∼8 kg body masses, and the locations of these markers were determined by a biplane fluoroscopy system. Three-dimensional software modeling techniques were used to compute volume displacement and surface area of the midcostal diaphragm and the lower three ribs during quiet spontaneous breathing, mechanical ventilation, and bilateral phrenic nerve stimulation at different lung volumes spanning the vital capacity. Volume displaced by the diaphragm relative to that displaced by the lower ribs is disproportionately greater under mechanical ventilation than during spontaneous breathing in the supine position (P < 0.05). At maximal stimulation, diaphragm volume displacement grows disproportionately larger than rib volume displacement as lung volume increases (P < 0.05). Surface area of both the diaphragm and the lower ribs during maximal stimulation of the diaphragm is reduced compared with that at spontaneous breathing (P < 0.05). In the prone posture, mechanical ventilation results in a smaller change in diaphragm surface area than spontaneous breathing (P < 0.05). Our data demonstrate that during inspiration the lower rib cage moves not only through the pump- and bucket-handle motion, but also rotates around the spine. Taken together, these data support the observation that the kinematics of the lower rib cage and its mechanical interaction with the diaphragm are more complex than previously known.
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Affiliation(s)
- Iris Chu
- Baylor College of Medicine, Houston, TX 77030, USA
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Fitz-Clarke JR. Computer simulation of human breath-hold diving: cardiovascular adjustments. Eur J Appl Physiol 2007; 100:207-24. [PMID: 17323072 DOI: 10.1007/s00421-007-0421-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2007] [Indexed: 10/23/2022]
Abstract
The world record for a sled-assisted human breath-hold dive has surpassed 200 m. Lung compression during descent draws blood from the peripheral circulation into the thorax causing engorgement of pulmonary vessels that might impose a physiological limitation due to capillary stress failure. A computer model was developed to investigate cardiopulmonary interactions during immersion, apnea, and compression to elucidate hemodynamic responses and estimate vascular stresses in deep human breath-hold diving. The model simulates active and passive cardiovascular adjustments involving blood volumes, flows, and pressures during apnea at diving depths up to 200 m. Redistribution of blood volume from peripheral to central compartments increases with depth. Pulmonary capillary transmural pressures in the model exceed 50 mm Hg at record depth, producing stresses in the range known to cause alveolar capillary damage in animals. Capillary pressures are partially attenuated by blood redistribution to compliant extra-pulmonary vascular compartments. The capillary pressure differential is due mainly to a large drop in alveolar air pressure from outward elastic chest wall recoil. Autonomic diving reflexes are shown to influence systemic blood pressures, but have relatively little effect on pulmonary vascular pressures. Increases in pulmonary capillary stresses are gradual beyond record depth.
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Affiliation(s)
- John R Fitz-Clarke
- Department of Physiology and Biophysics, Dalhousie University, 5849 University Avenue, Halifax, NS, Canada, B3H 4H7.
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Abstract
BACKGROUND Abdominal compartment syndrome (ACS) is a systemic syndrome involving derangement in cardiovascular haemodynamics, respiratory and renal functions as a result of sustained increase in intra-abdominal pressure (IAP) ending in multi-organ failure. It is a life threatening emergency and requires prompt action and treatment. For the last 20 years, there has been more awareness among surgeons and intensivists of ACS being a distinct disease entity but still widespread ignorance prevails. Presentation can be acute, chronic and acute on chronic. Initial diagnosis is clinical, confirmed by measurement of IAP. Treatment is abdominal decompression by laparostomy and delayed abdominal closure. Despite prompt treatment mortality remains high. Awareness among surgeons has increased because laparoscopy has resulted in determination of IAP as a readily measurable quantity and also they have been able to appreciate the benefit of abdominal decompression by performing repeated planned laparotomies for trauma. METHODS A medline, pubmed and Cochrane database search was performed and the articles found were cross referenced. RESULTS AND CONCLUSION Clinical diagnosis is not easy and serial urinary bladder pressure (UBP) monitoring leads to early diagnosis. Treatment is by laprostomy to decompress the abdomen followed by delayed abdominal closure.
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Affiliation(s)
- T Bin Saleem
- Dept of General Surgery, Airedale General Hospital, Keighley, West Yorkshire, UK.
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Dellacà RL, Black LD, Atileh H, Pedotti A, Lutchen KR. Effects of posture and bronchoconstriction on low-frequency input and transfer impedances in humans. J Appl Physiol (1985) 2004; 97:109-18. [PMID: 14966017 DOI: 10.1152/japplphysiol.00721.2003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We simultaneously evaluated the mechanical response of the total respiratory system, lung, and chest wall to changes in posture and to bronchoconstriction. We synthesized the optimal ventilation waveform (OVW) approach, which simultaneously provides ventilation and multifrequency forcing, with optoelectronic plethysmography (OEP) to measure chest wall flow globally and locally. We applied an OVW containing six frequencies from 0.156 to 4.6 Hz to the mouth of six healthy men in the seated and supine positions, before and after methacholine challenge. We measured mouth, esophageal, and transpulmonary pressures, airway flow by pneumotachometry, and total chest wall, pulmonary rib cage, and abdominal volumes by OEP. We computed total respiratory, lung, and chest wall input impedances and the total and regional transfer impedances (Ztr). These data were appropriately sensitive to changes in posture, showing added resistance in supine vs. seated position. The Ztr were also highly sensitive to lung constriction, more so than input impedance, as the former is minimally distorted by shunting of flow into alveolar gas compression and airway walls. Local impedances show that, during bronchoconstriction and at typical breathing frequencies, the contribution of the abdomen becomes amplified relative to the rib cage. A similar redistribution occurs when passing from seated to supine. These data suggest that the OEP-OVW approach for measuring Ztr could noninvasively track important lung and respiratory conditions, even in subjects who cannot cooperate. Applications might range from routine evaluation of airway hyperreactivity in asthmatic subjects to critical conditions in the supine position during mechanical ventilation.
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Affiliation(s)
- Raffaele L Dellacà
- Dipartimento di Bioingegneria, Politecnico di Milano, I-20133 Milano, Italy.
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Abstract
Respiratory motion measured by respiratory inductance plethysmography often deviates from the sinusoidal pattern assumed in the traditional Lissajous figure (loop) analysis used to determine thoraco-abdominal asynchrony, or phase angle phi. We investigated six different time-domain methods of measuring phi, using simulated data with sinusoidal and triangular waveforms, phase shifts of 0-135 degrees, and 10% noise. The techniques were then used on data from 11 lightly anesthetized rhesus monkeys (Macaca mulatta; 7.6 +/- 0.8 kg; 5.7 +/- 0.5 years old), instrumented with a respiratory inductive plethysmograph, and subjected to increasing levels of inspiratory resistive loading ranging from 5-1,000 cmH(2)O. L(-1). sec(-1). The best results were obtained from cross-correlation and maximum linear correlation, with errors less than approximately 5 degrees from the actual phase angle in the simulated data. The worst performance was produced by the loop analysis, which in some cases was in error by more than 30 degrees. Compared to correlation, other analysis techniques performed at an intermediate level. Maximum linear correlation and cross-correlation produced similar results on the data collected from monkeys (SD of the difference, 4.1 degrees ) but all other techniques had a high SD of the difference compared to the correlation techniques. We conclude that phase angles are best measured using cross-correlation or maximum linear correlation, techniques that are independent of waveform shape, and robust in the presence of noise.
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Affiliation(s)
- G Kim Prisk
- Division of Physiology, Department of Medicine, University of California at San Diego, La Jolla, California 92093-0931, USA.
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de Cleva R, Silva FP, Zilberstein B, Machado DJ. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review. REVISTA DO HOSPITAL DAS CLINICAS 2001; 56:123-30. [PMID: 11717720 DOI: 10.1590/s0041-87812001000400006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.
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Affiliation(s)
- R de Cleva
- Department of Gastroenterology (Surgical ICU), Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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D'Angelo E, Giglio R, Lafontaine E, Bellemare F. Influence of abdomen on respiratory mechanics in supine rabbits. RESPIRATION PHYSIOLOGY 1999; 115:287-99. [PMID: 10424358 DOI: 10.1016/s0034-5687(99)00011-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous studies showed that abdominal evisceration has no effect on respiratory system compliance. We hypothesized that this could be related to lung distortion in eviscerated animals. Methods were developed for continuous recording of pleural pressure (Ppl) at various sites over the costal (co) and diaphragmatic lung surface (di) in acutely and chronically instrumented rabbits. We compared deltaPpl,co and deltaPpl,di recorded at mid-lung height during inflations in anesthetized, paralyzed supine rabbits before and after evisceration. Cranial and caudal deltaPpl.co were the same under all conditions. In intact animals, deltaPpl.co and deltaPpl,di were equal at all inflation volumes, whilst in eviscerated animals, deltaPpl,di were smaller than deltaPpl,co, the difference increasing with lung inflation. At any given volume, rib cage circumference (Crc) was smaller after evisceration, but the Crc deltaPpl,co relationship remained unchanged. These results are indicative of non-uniform lung expansion after evisceration and are consistent with model predictions based on cylindrical deformation and lung stress-strain relationship. This deformation should mimic the effect of a reduced lung compliance, keeping respiratory system compliance of eviscerated animals nearly normal. Similar deformation should have occurred also in intact rabbits during strong inspiratory efforts and in the erect posture, because lower Ppl,di than Ppl,co values were observed at the same lung height under these conditions.
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Affiliation(s)
- E D'Angelo
- Instituto di Fisiologia Umana I, Cattedra VI, Universitiá di Milano, Italy
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Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Abdominal compartment syndrome. THE JOURNAL OF TRAUMA 1998; 45:597-609. [PMID: 9751558 DOI: 10.1097/00005373-199809000-00033] [Citation(s) in RCA: 266] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The ACS is a clinical entity that develops from progressive, acute increases in IAP and affects multiple organ systems in a graded fashion because of differential susceptibilities. The gut is the organ most sensitive to IAH, and it develops evidence of end-organ damage before the development of the classic renal, pulmonary, and cardiovascular signs. Intracranial derangements with ACS are now well described. Treatment involves expedient decompression of the abdomen, without which the syndrome of end-organ damage and reduced oxygen delivery may lead to the development of multiple organ failure and, ultimately, death. Multiple trauma, massive hemorrhage, or protracted operation with massive volume resuscitation are the situations in which the ACS is most frequently encountered. Knowledge of the ACS, however, is also essential for the management of critically ill pediatric patients (especially those with AWD) and in understanding the limitations of laparoscopy. The role of IAH in the pathogenesis of NEC, central obesity co-morbidities, and pre-eclampsia/eclampsia remains to be fully studied.
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Affiliation(s)
- B H Saggi
- Department of Surgery, Medical College of Virginia of Virginia Commonwealth University, Richmond 23298-0519, USA
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Kenyon CM, Cala SJ, Yan S, Aliverti A, Scano G, Duranti R, Pedotti A, Macklem PT. Rib cage mechanics during quiet breathing and exercise in humans. J Appl Physiol (1985) 1997; 83:1242-55. [PMID: 9338434 DOI: 10.1152/jappl.1997.83.4.1242] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
During exercise, large pleural, abdominal, and transdiaphragmatic pressure swings might produce substantial rib cage (RC) distortions. We used a three-compartment chest wall model (J. Appl. Physiol. 72: 1338-1347, 1992) to measure distortions of lung- and diaphragm-apposed RC compartments (RCp and RCa) along with pleural and abdominal pressures in five normal men. RCp and RCa volumes were calculated from three-dimensional locations of 86 markers on the chest wall, and the undistorted (relaxation) RC configuration was measured. Compliances of RCp and RCa measured during phrenic stimulation against a closed airway were 20 and 0%, respectively, of their values during relaxation. There was marked RC distortion. Thus nonuniform distribution of pressures distorts the RC and markedly stiffens it. However, during steady-state ergometer exercise at 0, 30, 50, and 70% of maximum workload, RC distortions were small because of a coordinated action of respiratory muscles, so that net pressures acting on RCp and RCa were nearly the same throughout the respiratory cycle. This maximizes RC compliance and minimizes the work of RC displacement. During quiet breathing, plots of RCa volume vs. abdominal pressure were to the right of the relaxation curve, indicating an expiratory action on RCa. We attribute this to passive stretching of abdominal muscles, which more than counterbalances the insertional component of transdiaphragmatic pressure.
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Affiliation(s)
- C M Kenyon
- Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada H2X 2P4
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Boriek AM, Rodarte JR, Margulies SS. Zone of apposition in the passive diaphragm of the dog. J Appl Physiol (1985) 1996; 81:1929-40. [PMID: 8941512 DOI: 10.1152/jappl.1996.81.5.1929] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We determined the regional area of the diaphragmatic zone of apposition (ZAP) as well as the regional craniocaudal extent of the ZAP (ZAPht) of the passive diaphragm in six paralyzed anesthetized beagle dogs (8-12 kg) at residual lung volume (RV), functional residual capacity (FRC), FRC + 0.25 and FRC + 0.5 inspiratory capacity, and total lung capacity (TLC) in prone and supine postures. To identify the caudal boundary of the ZAP, 17 lead markers (1 mm) were sutured to the abdominal side of the costal and crural diaphragms around the diaphragm insertion on the chest wall. Two weeks later, the dogs' caudal thoraces were scanned by the use of the dynamic spatial reconstructor (DSR), a prototype fast volumetric X-ray computer tomographic scanner, developed at the Mayo Clinic. The three-dimensional spatial coordinates of the markers were identified (+/- 1.4 mm), and the cranial boundary of the ZAP was determined from 30-40 1.4-mm-thick sagittal and coronal slices in each DSR image. We interpolated the DSR data to find the position of the cranial and caudal boundaries of the ZAP every 5 degrees around the thorax and computed the distribution of regional variation of area of the ZAP and ZAPht as well as the total area of ZAP. The ZAPht and area of ZAP increased as lung volume decreased and were largest near the lateral extremes of the rib cage. We measured the surface area of the rib cage cephaled to the ZAP (AL) in both postures in another six beagle dogs (12-16 kg) of similar stature, scanned previously in the DSR. We estimated the entire rib cage surface area (Arc = AZAP + AL). The AZAP as a percentage of Arc increased more than threefold as lung volume decreased from TLC to RV, from approximately 9 to 29% of Arc.
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Affiliation(s)
- A M Boriek
- Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA
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Perez F, Fernandez P, Hernaiz MI, Jackson EG, Lai-Fook SJ, Boynton BR. Pleural pressure measured in the zone of apposition of diaphragm to rib cage in rabbits. Lung 1993; 171:345-53. [PMID: 8295429 DOI: 10.1007/bf00165700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In 10 anesthetized adult rabbits, we studied the effect of spontaneous breathing and positive pressure ventilation on pleural pressure on the costal lung surface (Ppl) and in the zone of apposition of the rib cage to the diaphragm (Papp). Ppl and Papp were measured by rib capsules installed in the 5th or 6th rib and 11th or 12th rib, respectively. Esophageal (Pes) and gastric (Pga) pressures were measured with air-filled balloons. At end expiration (functional residual capacity), Ppl was subatmospheric (-2.5 +/- 1.4 cm H2O), decreased during spontaneous inspiration, and was in phase with Pes. In contrast, Papp was above atmospheric pressure (2.1 +/- 1.8 cm H2O), increased during inspiration, and was in phase with Pga. Papp lagged Ppl by 180 degrees during spontaneous inspiration but was in phase with Ppl during mechanical ventilation. Changes in Ppl (delta Ppl) during inspiration were greater in magnitude than either delta Papp or delta Pga. Changes in transdiaphragmatic pressure in the zone of apposition (delta Pga-delta Papp) were near zero (-0.4 +/- 0.3 cm H2O), much smaller in magnitude than those (delta Pga-delta Ppl) associated with the lung (3.0 +/- 1.5 cm H2O). These results are consistent with the concept that during breathing, abdominal pressure is transmitted to the zone of apposition of the rib cage to the abdomen. During spontaneous breathing at rest, the pleural space in the zone of apposition is mechanically independent of the pleural space associated with the lung.
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Affiliation(s)
- F Perez
- Department of Pediatrics, Wenner-Gren Research Laboratory, University of Kentucky, Lexington 40506-0070
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