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Moravec T, Lomax M, Ušaj A, Kapus J. Inspiratory muscle fatigue at the swimming tumble turns: its occurrence and effects on kinematic parameters of the turns. Front Physiol 2023; 14:1219520. [PMID: 37383142 PMCID: PMC10293647 DOI: 10.3389/fphys.2023.1219520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction: The present study had two objectives: 1) to investigate the effects of tumble turns on the development of inspiratory muscle fatigue (IMF) and compare this to whole swimming, and 2) to evaluate the effects of pre-induced IMF on the kinematic parameters of tumble turns. Fourteen young club-level swimmers (13 ± 2 years of ages) completed three swim trials. Methods: The first trial was used to determine the 400-m front crawl swim time at maximal effort (400FC). The other two trials consisted of a series of 15 tumble turns at the 400FC pace. In one of the turn-only trials, IMF was pre-induced (TURNS-IMF), whereas in the other turn-only trial it was not (TURNS-C). Results: Compared with baseline values, the values for maximal inspiratory mouth pressure (PImax) at the end of the swim were significantly lower at all trials. However, the magnitude of inspiratory muscle fatigue was less after TURNS-C (PImax decreased by 12%) than after 400FC (PImax decreased by 28%). The tumble turns were slower during 400FC than during TURNS-C and TURNS-IMF. In addition, compared to TURNS-C, turns in the TURNS-IMF were performed with higher rotation times and shorter apnea and swim-out times. Discussion: The results of the present study suggest that tumble turns put a strain on the inspiratory muscles and directly contribute to the IMF observed during 400FC swimming. Furthermore, pre-induced IMF resulted in significantly shorter apneas and slower rotations during tumble turns. IMF therefore has the potential to negatively affect overall swimming performance, and strategies should be sought to reduce its effects.
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Affiliation(s)
| | - Mitch Lomax
- School of Sport, Health, and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Anton Ušaj
- Laboratory of Biodynamics, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Kapus
- Laboratory of Biodynamics, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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Wanderley e Lima TB, Sarmento A, da Silva Vieira RG, de Freitas Castro EL, Pennati F, Aliverti A, Resqueti VR, Augusto de Freitas Fregonezi G. Non-invasive assessment of fatigue and recovery of inspiratory rib cage muscles during endurance test in healthy individuals. PLoS One 2022; 17:e0277131. [PMID: 36477075 PMCID: PMC9728934 DOI: 10.1371/journal.pone.0277131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/21/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Fatigue is defined as loss of capacity to develop muscle force and/or velocity that is reversible at rest. We assessed non-invasively the fatigue and recovery of inspiratory rib cage muscles during two respiratory endurance tests in healthy individuals. METHODS The sniff nasal inspiratory pressure (SNIP) was assessed before and after two respiratory endurance tests: normocapnic hyperpnea (NH) and inspiratory pressure threshold loading (IPTL). Contractile (maximum rate of pressure development and time to peak pressure) and relaxation parameters (maximum relaxation rate [MRR], time constant of pressure decay [τ], and half relaxation time) obtained from sniff curves and shortening velocity and mechanical power estimated using optoelectronic plethysmography were analyzed during SNIP maneuvers. Respiratory muscle activity (electromyography) and tissue oxygenation (near-infrared spectroscopy-NIRS) were obtained during endurance tests and SNIP maneuvers. Fatigue development of inspiratory rib cage muscles was assessed according to the slope of decay of median frequency. RESULTS Peak pressure during SNIP decreased after both protocols (p <0.05). MRR, shortening velocity, and mechanical power decreased (p <0.05), whereas τ increased after IPTL (p <0.05). The median frequency of inspiratory rib cage muscles (i.e., sum of sternocleidomastoid, scalene, and parasternal) decreased linearly during IPTL and exponentially during NH, mainly due to the sternocleidomastoid. CONCLUSION Fatigue development behaved differently between protocols and relaxation properties (MRR and τ), shortening velocity, and mechanical power changed only in the IPTL.
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Affiliation(s)
- Thiago Bezerra Wanderley e Lima
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes (HUOL), Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Antonio Sarmento
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes (HUOL), Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rayane Grayce da Silva Vieira
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes (HUOL), Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Esmívany Lhara de Freitas Castro
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes (HUOL), Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Vanessa Regiane Resqueti
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes (HUOL), Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Guilherme Augusto de Freitas Fregonezi
- PneumoCardioVascular Lab/Hospital Universitário Onofre Lopes (HUOL), Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Departamento de Fisioterapia, Laboratório de Inovação Tecnológica em Reabilitação, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
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Schreiber AF, Bertoni M, Coiffard B, Fard S, Wong J, Reid WD, Brochard LJ, Piva S, Goligher EC. Abdominal Muscle Use During Spontaneous Breathing and Cough in Patients Who Are Mechanically Ventilated: A Bi-center Ultrasound Study. Chest 2021; 160:1316-1325. [PMID: 34090872 DOI: 10.1016/j.chest.2021.05.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ultrasound may be useful to assess the structure, activity, and function of the abdominal muscles in patients who are mechanically ventilated. RESEARCH QUESTION Does measurement of abdominal muscle thickening on ultrasound in patients who are mechanically ventilated provide clinically relevant information about abdominal muscle function and weaning outcomes? STUDY DESIGN AND METHODS This study consisted of two parts, a physiological study conducted in healthy subjects and a prospective observational study in patients who were mechanically ventilated. Abdominal muscle thickness and thickening fraction were measured during cough and expiratory efforts in 20 healthy subjects and prior to and during a spontaneous breathing trial in 57 patients being ventilated. RESULTS In healthy subjects, internal oblique and rectus abdominis thickening fraction correlated with pressure generated during expiratory efforts (P < .001). In patients being ventilated, abdominal muscle thickness and thickening fraction were feasible to measure in all patients, and reproducibility was moderately acceptable. During a failed spontaneous breathing trial, thickening fraction of transversus abdominis and internal oblique increased substantially from baseline (13.2% [95% CI, 0.9-24.8] and 7.2% [95% CI, 2.2-13.2], respectively). The combined thickening fraction of transversus abdominis, internal oblique, and rectus abdominis measured during cough was associated with an increased risk of reintubation or reconnection to the ventilator following attempted liberation (OR, 2.1; 95% CI, 1.1-4.4 per 10% decrease in thickening fraction). INTERPRETATION Abdominal muscle thickening on ultrasound was correlated to the airway pressure generated by expiratory efforts. In patients who were mechanically ventilated, abdominal muscle ultrasound measurements are feasible and moderately reproducible. Among patients who passed a spontaneous breathing trial, reduced abdominal muscle thickening during cough was associated with a high risk of liberation failure. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03567564; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Annia F Schreiber
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre and Li Ka Shing Knowledge Institute, Unity Health Toronto (St. Michael's Hospital) Toronto, ON, Canada
| | - Michele Bertoni
- Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Benjamin Coiffard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Intensive Care Medicine, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Samira Fard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Jenna Wong
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - W Darlene Reid
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Laurent J Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre and Li Ka Shing Knowledge Institute, Unity Health Toronto (St. Michael's Hospital) Toronto, ON, Canada
| | - Simone Piva
- Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
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Blanco-Almazan D, Groenendaal W, Lozano-Garcia M, Estrada-Petrocelli L, Lijnen L, Smeets C, Ruttens D, Catthoor F, Jane R. Combining Bioimpedance and Myographic Signals for the Assessment of COPD During Loaded Breathing. IEEE Trans Biomed Eng 2020; 68:298-307. [PMID: 32746014 DOI: 10.1109/tbme.2020.2998009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic conditions. The current assessment of COPD requires a maximal maneuver during a spirometry test to quantify airflow limitations of patients. Other less invasive measurements such as thoracic bioimpedance and myographic signals have been studied as an alternative to classical methods as they provide information about respiration. Particularly, strong correlations have been shown between thoracic bioimpedance and respiratory volume. The main objective of this study is to investigate bioimpedance and its combination with myographic parameters in COPD patients to assess the applicability in respiratory disease monitoring. We measured bioimpedance, surface electromyography and surface mechanomyography in forty-three COPD patients during an incremental inspiratory threshold loading protocol. We introduced two novel features that can be used to assess COPD condition derived from the variation of bioimpedance and the electrical and mechanical activity during each respiratory cycle. These features demonstrate significant differences between mild and severe patients, indicating a lower inspiratory contribution of the inspiratory muscles to global respiratory ventilation in the severest COPD patients. In conclusion, the combination of bioimpedance and myographic signals provides useful indices to noninvasively assess the breathing of COPD patients.
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Blanco-Almazan D, Groenendaal W, Catthoor F, Jane R. Analysis of Time Delay between Bioimpedance and Respiratory Volume Signals under Inspiratory Loaded Breathing. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2365-2368. [PMID: 31946375 DOI: 10.1109/embc.2019.8857705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Bioimpedance is known for its linear relation with volume during normal breathing. For that reason, bioimpedance can be used as a noninvasive and comfortable technique for measuring respiration. The goal of this study is to analyze the temporal behavior of bioimpedance measured in four different electrode configurations during inspiratory loaded breathing. We measured four bioimpedance channels and airflow simultaneously in 10 healthy subjects while incremental inspiratory loads were imposed. Inspiratory loading threshold protocols are associated with breathing pattern changes and were used in respiratory mechanics studies. Consequently, this respiratory protocol allowed us to induce breathing pattern changes and evaluate the temporal relationship of bioimpedance with volume. We estimated the temporal delay between bioimpedance and volume respiratory cycles to evaluate the differences in their temporal behavior. The delays were computed as the lag which maximize the cross-correlation of the signals cycle by cycle. Six of the ten subjects showed delays in at least two different inspiratory loads. The delays were dependent on electrode configuration, hence the appearance of the delays between bioimpedance and volume were conditioned to the location and geometry of the electrode configuration. In conclusion, the delays between these signals could provide information about breathing pattern when breathing conditions change.
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Blanco-Almazán D, Groenendaal W, Catthoor F, Jané R. Chest Movement and Respiratory Volume both Contribute to Thoracic Bioimpedance during Loaded Breathing. Sci Rep 2019; 9:20232. [PMID: 31882841 PMCID: PMC6934864 DOI: 10.1038/s41598-019-56588-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/10/2019] [Indexed: 11/22/2022] Open
Abstract
Bioimpedance has been widely studied as alternative to respiratory monitoring methods because of its linear relationship with respiratory volume during normal breathing. However, other body tissues and fluids contribute to the bioimpedance measurement. The objective of this study is to investigate the relevance of chest movement in thoracic bioimpedance contributions to evaluate the applicability of bioimpedance for respiratory monitoring. We measured airflow, bioimpedance at four electrode configurations and thoracic accelerometer data in 10 healthy subjects during inspiratory loading. This protocol permitted us to study the contributions during different levels of inspiratory muscle activity. We used chest movement and volume signals to characterize the bioimpedance signal using linear mixed-effect models and neural networks for each subject and level of muscle activity. The performance was evaluated using the Mean Average Percentage Errors for each respiratory cycle. The lowest errors corresponded to the combination of chest movement and volume for both linear models and neural networks. Particularly, neural networks presented lower errors (median below 4.29%). At high levels of muscle activity, the differences in model performance indicated an increased contribution of chest movement to the bioimpedance signal. Accordingly, chest movement contributed substantially to bioimpedance measurement and more notably at high muscle activity levels.
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Affiliation(s)
- Dolores Blanco-Almazán
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028, Barcelona, Spain.
- Universitat Politècnica de Catalunya · BarcelonaTech (UPC), Barcelona, Spain.
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.
| | - Willemijn Groenendaal
- imec the Netherlands/Holst Centre, High tech campus 31, 5656AE, Eindhoven, The Netherlands
| | | | - Raimon Jané
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028, Barcelona, Spain
- Universitat Politècnica de Catalunya · BarcelonaTech (UPC), Barcelona, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
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Goligher EC. Myotrauma in mechanically ventilated patients. Intensive Care Med 2019; 45:881-884. [PMID: 30741329 DOI: 10.1007/s00134-019-05557-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada. .,Toronto General Hospital Research Institute, 585 University Ave., 11-PMB Room 192, Toronto, ON, M5G 2N2, Canada.
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Lozano-García M, Sarlabous L, Moxham J, Rafferty GF, Torres A, Jané R, Jolley CJ. Surface mechanomyography and electromyography provide non-invasive indices of inspiratory muscle force and activation in healthy subjects. Sci Rep 2018; 8:16921. [PMID: 30446712 PMCID: PMC6240075 DOI: 10.1038/s41598-018-35024-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/28/2018] [Indexed: 11/30/2022] Open
Abstract
The current gold standard assessment of human inspiratory muscle function involves using invasive measures of transdiaphragmatic pressure (Pdi) or crural diaphragm electromyography (oesEMGdi). Mechanomyography is a non-invasive measure of muscle vibration associated with muscle contraction. Surface electromyogram and mechanomyogram, recorded transcutaneously using sensors placed over the lower intercostal spaces (sEMGlic and sMMGlic respectively), have been proposed to provide non-invasive indices of inspiratory muscle activation, but have not been directly compared to gold standard Pdi and oesEMGdi measures during voluntary respiratory manoeuvres. To validate the non-invasive techniques, the relationships between Pdi and sMMGlic, and between oesEMGdi and sEMGlic were measured simultaneously in 12 healthy subjects during an incremental inspiratory threshold loading protocol. Myographic signals were analysed using fixed sample entropy (fSampEn), which is less influenced by cardiac artefacts than conventional root mean square. Strong correlations were observed between: mean Pdi and mean fSampEn |sMMGlic| (left, 0.76; right, 0.81), the time-integrals of the Pdi and fSampEn |sMMGlic| (left, 0.78; right, 0.83), and mean fSampEn oesEMGdi and mean fSampEn sEMGlic (left, 0.84; right, 0.83). These findings suggest that sMMGlic and sEMGlic could provide useful non-invasive alternatives to Pdi and oesEMGdi for the assessment of inspiratory muscle function 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), Barcelona, Spain.
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain.
| | - Leonardo Sarlabous
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain
| | - John Moxham
- Faculty of Life Sciences & Medicine, King's College London, King's Health Partners, London, United Kingdom
| | - Gerrard F Rafferty
- King's College Hospital NHS Foundation Trust, King's Health Partners, London, United Kingdom
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, King's Health Partners, London, United Kingdom
| | - Abel Torres
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain
| | - Raimon Jané
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain
| | - Caroline J Jolley
- King's College Hospital NHS Foundation Trust, King's Health Partners, London, United Kingdom
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, King's Health Partners, London, United Kingdom
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Ceriana P, Vitacca M, Carlucci A, Paneroni M, Pisani L, Nava S. Changes of Respiratory Mechanics in COPD Patients from Stable State to Acute Exacerbations with Respiratory Failure. COPD 2016; 14:150-155. [PMID: 27997251 DOI: 10.1080/15412555.2016.1254173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Symptoms, clinical course, functional and biological data during an exacerbation of chronic obstructive pulmonary disease (EXCOPD) have been investigated, but data on physiological changes of respiratory mechanics during a severe exacerbation with respiratory acidosis requiring noninvasive mechanical ventilation (NIMV) are scant. The aim of this study was to evaluate changes of respiratory mechanics in COPD patients comparing data observed during EXCOPD with those observed during stable state in the recovery phase. In 18 COPD patients having severe EXCOPD requiring NIMV for global respiratory failure, we measured respiratory mechanics during both EXCOPD (T0) and once the patients achieved a stable state (T1). The diaphragm and inspiratory muscles effort was significantly increased under relapse, as well as the pressure-time product of the diaphragm and the inspiratory muscle (PTPdi and PTPes). The resistive loads to breathe (i.e., PEEPi,dyn, compliance and inspiratory resistances) were also markedly increased, while the maximal pressures generated by the diaphragm and the inspiratory muscles, together with forced expired volumes were decreased. All these indices statistically improved but with a great intrasubject variability in stable condition. Moreover, tension-time index (TTdi) significantly improved from the EXCOPD state to the condition of clinical stability (0.156 ± 0.04 at T0 vs. 0.082 ± 0.02 at T1 p < 0.001). During an EXCOPD, the load/capacity of the respiratory pump is impaired, and although the patients exhibit a rapid shallow breathing pattern, this does not necessarily correlate with a TTdi ≥ 0.15. These changes are reverted once they recover from the EXCOPD, despite a large variability between patients.
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Affiliation(s)
- Piero Ceriana
- a Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Pavia , Pavia , Italy
| | - Michele Vitacca
- b Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane , Lumezzane , Italy
| | - Annalisa Carlucci
- a Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Pavia , Pavia , Italy
| | - Mara Paneroni
- b Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane , Lumezzane , Italy
| | - Lara Pisani
- c Institute of Respiratory Diseases, Policlinico S. Orsola and Alma Mater University , Bologna , Italy
| | - Stefano Nava
- c Institute of Respiratory Diseases, Policlinico S. Orsola and Alma Mater University , Bologna , Italy
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Walker DJ, Farquharson F, Klenze H, Walterspacher S, Storz L, Duerschmied D, Roecker K, Kabitz HJ. Diaphragmatic fatigue during inspiratory muscle loading in normoxia and hypoxia. Respir Physiol Neurobiol 2016; 227:1-8. [PMID: 26845453 DOI: 10.1016/j.resp.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/15/2016] [Accepted: 01/26/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Diaphragmatic fatigue (DF) occurs during strenuous loading of respiratory muscles (e.g., heavy-intensity whole-body exercise, normocapnic hyperpnea, inspiratory resistive breathing). DF develops early on during normoxia, without further decline toward task failure; however, its progression during inspiratory muscle loading in during hypoxia remains unclear. Therefore, the present study used volume-corrected transdiaphragmatic pressures during supramaximal magnetic phrenic nerve stimulation (Pdi,twc) to investigate the effect of hypoxia on the progression of diaphragmatic fatigue during inspiratory muscle loading. METHODS Seventeen subjects completed two standardized rounds of inspiratory muscle loading (blinded, randomized) under the following conditions: (i) normoxia, and (ii) normobaric hypoxia (SpO2 80%), with Pdi,twc assessment every 45 s. RESULTS In fatiguers (i.e., Pdi,twc reduction >10%, n=10), biometric approximation during normoxia is best represented by Pdi,twc=4.06+0.83 exp(-0.19 × x), in contrast to Pdi,twc=4.38-(0.05 × x) during hypoxia. CONCLUSION Progression of diaphragmatic fatigue during inspiratory muscle loading assessed by Pdi,tw differs between normoxia and normobaric hypoxia: in the former, Pdi,tw follows an exponential decay, whereas during hypoxia, Pdi,tw follows a linear decline.
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Affiliation(s)
- David Johannes Walker
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany; Department of Pneumology, University Hospital Freiburg, Germany.
| | - Franziska Farquharson
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany; Department of Pneumology, University Hospital Freiburg, Germany
| | - Hannes Klenze
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany; Department of Pneumology, University Hospital Freiburg, Germany
| | - Stephan Walterspacher
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany
| | - Lucia Storz
- Department of Pneumology, University Hospital Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany
| | - Kai Roecker
- Department of Applied Public Health (AGW), Furtwangen University, Germany
| | - Hans-Joachim Kabitz
- Department of Pneumology and Intensive Care Medicine, Academic Teaching Hospital Klinikum Konstanz, Germany
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Pisani L, Fasano L, Corcione N, Comellini V, Guerrieri A, Ranieri MV, Nava S. Effects of Extracorporeal CO2 Removal on Inspiratory Effort and Respiratory Pattern in Patients Who Fail Weaning from Mechanical Ventilation. Am J Respir Crit Care Med 2016; 192:1392-4. [PMID: 26623688 DOI: 10.1164/rccm.201505-0930le] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Luca Fasano
- 2 Sant'Orsola Malpighi Hospital Bologna, Italy
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Scheibe N, Sosnowski N, Pinkhasik A, Vonderbank S, Bastian A. Sonographic evaluation of diaphragmatic dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:1925-30. [PMID: 26392767 PMCID: PMC4574853 DOI: 10.2147/copd.s85659] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Diaphragmatic dysfunction is an important reason for dyspnea in COPD patients. But diaphragmatic dysfunction is difficult to evaluate. Ultrasound is an option. We measure sonographically the up- and downward movement of the lung silhouette on both hemidiaphragms. The aim of this prospective investigation was to compare this method with another sonographic method that visualizes the right hemidiaphragm directly and to compare the sonographic results with lung function parameters. Methods and patients Eighty participants – 20 healthy persons and 60 COPD patients – three groups each with 20 patients with COPD GOLD II, III, and IV – were investigated. The sonographic measurements of the diaphragms were performed. Lung function parameters, blood gases, and 6-minute walk test were also collected and compared to the sonographic results. Results The sonographic measurement of the lung silhouette was easy to perform in all study participants. The correlation between the sonographic methods measuring the right hemidiaphragmatic movement was strong (r=0.85). There was also a strong correlation between the demonstrated sonographic measurement of the up- and downward movement of the lung silhouette and the forced expiratory volume in the first second (r=0.83). Conclusion We demonstrated that the sonographic measurement of the movement of the lung silhouette is an easy way to establish diaphragmatic dysfunction in COPD patients; it can be done in all patients with reliable results for the right and the left hemidiaphragm.
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Affiliation(s)
- Nadine Scheibe
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Natalia Sosnowski
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Alina Pinkhasik
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Sandy Vonderbank
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Andreas Bastian
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
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Diaphragmatic neuromechanical coupling and mechanisms of hypercapnia during inspiratory loading. Respir Physiol Neurobiol 2014; 198:32-41. [DOI: 10.1016/j.resp.2014.03.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/25/2014] [Accepted: 03/12/2014] [Indexed: 12/26/2022]
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Laghi F, D’Alfonso N, Tobin MJ. A paper on the pace of recovery from diaphragmatic fatigue and its unexpected dividends. Intensive Care Med 2014; 40:1220-6. [DOI: 10.1007/s00134-014-3340-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
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Bachasson D, Wuyam B, Pepin JL, Tamisier R, Levy P, Verges S. Quadriceps and respiratory muscle fatigue following high-intensity cycling in COPD patients. PLoS One 2013; 8:e83432. [PMID: 24324843 PMCID: PMC3855800 DOI: 10.1371/journal.pone.0083432] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/05/2013] [Indexed: 11/24/2022] Open
Abstract
Exercise intolerance in COPD seems to combine abnormal ventilatory mechanics, impaired O2 transport and skeletal muscle dysfunction. However their relatie contribution and their influence on symptoms reported by patients remain to be clarified. In order to clarify the complex interaction between ventilatory and neuromuscular exercise limiting factors and symptoms, we evaluated respiratory muscles and quadriceps contractile fatigue, dynamic hyperinflation and symptoms induced by exhaustive high-intensity cycling in COPD patients. Fifteen gold II-III COPD patients (age = 67±6 yr; BMI = 26.6±4.2 kg.m-2) performed constant-load cycling test at 80% of their peak workload until exhaustion (9.3±2.4 min). Before exercise and at exhaustion, potentiated twitch quadriceps strength (Qtw), transdiaphragmatic (Pdi,tw) and gastric (Pga,tw) pressures were evoked by femoral nerve, cervical and thoracic magnetic stimulation, respectively. Changes in operational lung volumes during exercise were assessed via repetitive inspiratory capacity (IC) measurements. Dyspnoea and leg discomfort were measured on visual analog scale. At exhaustion, Qtw (-33±15%, >15% reduction observed in all patients but two) and Pdi,tw (-20±15%, >15% reduction in 6 patients) were significantly reduced (P<0.05) but not Pga,tw (-6±10%, >15% reduction in 3 patients). Percentage reduction in Qtw correlated with the percentage reduction in Pdi,tw (r=0.66; P<0.05). Percentage reductions in Pdi,tw and Pga,tw negatively correlated with the reduction in IC at exhaustion (r=-0.56 and r=-0.62, respectively; P<0.05). Neither dyspnea nor leg discomfort correlated with the amount of muscle fatigue. In conclusion, high-intensity exercise induces quadriceps, diaphragm and less frequently abdominal contractile fatigue in this group of COPD patients. In addition, the rise in end-expiratory lung volume and diaphragm flattening associated with dynamic hyperinflation in COPD might limit the development of abdominal and diaphragm muscle fatigue. This study underlines that both respiratory and quadriceps fatigue should be considered to understand the complex interplay of factors leading to exercise intolerance in COPD patients.
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Affiliation(s)
- Damien Bachasson
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France
- INSERM, U1042, Grenoble, France
- CHU, Grenoble Locomotor Unit, Reeducation & Physiology, Clinical Physiology, Sleep and Exercise, Grenoble, France
| | - Bernard Wuyam
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France
- INSERM, U1042, Grenoble, France
- CHU, Grenoble Locomotor Unit, Reeducation & Physiology, Clinical Physiology, Sleep and Exercise, Grenoble, France
| | - Jean-Louis Pepin
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France
- INSERM, U1042, Grenoble, France
- CHU, Grenoble Locomotor Unit, Reeducation & Physiology, Clinical Physiology, Sleep and Exercise, Grenoble, France
| | - Renaud Tamisier
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France
- INSERM, U1042, Grenoble, France
- CHU, Grenoble Locomotor Unit, Reeducation & Physiology, Clinical Physiology, Sleep and Exercise, Grenoble, France
| | - Patrick Levy
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France
- INSERM, U1042, Grenoble, France
- CHU, Grenoble Locomotor Unit, Reeducation & Physiology, Clinical Physiology, Sleep and Exercise, Grenoble, France
| | - Samuel Verges
- Grenoble Alpes University, HP2 Laboratory, Grenoble, France
- INSERM, U1042, Grenoble, France
- * E-mail:
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Tobin MJ, Laghi F, Jubran A. Ventilatory failure, ventilator support, and ventilator weaning. Compr Physiol 2013; 2:2871-921. [PMID: 23720268 DOI: 10.1002/cphy.c110030] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The development of acute ventilatory failure represents an inability of the respiratory control system to maintain a level of respiratory motor output to cope with the metabolic demands of the body. The level of respiratory motor output is also the main determinant of the degree of respiratory distress experienced by such patients. As ventilatory failure progresses and patient distress increases, mechanical ventilation is instituted to help the respiratory muscles cope with the heightened workload. While a patient is connected to a ventilator, a physician's ability to align the rhythm of the machine with the rhythm of the patient's respiratory centers becomes the primary determinant of the level of rest accorded to the respiratory muscles. Problems of alignment are manifested as failure to trigger, double triggering, an inflationary gas-flow that fails to match inspiratory demands, and an inflation phase that persists after a patient's respiratory centers have switched to expiration. With recovery from disorders that precipitated the initial bout of acute ventilatory failure, attempts are made to discontinue the ventilator (weaning). About 20% of weaning attempts fail, ultimately, because the respiratory controller is unable to sustain ventilation and this failure is signaled by development of rapid shallow breathing. Substantial advances in the medical management of acute ventilatory failure that requires ventilator assistance are most likely to result from research yielding novel insights into the operation of the respiratory control system.
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Affiliation(s)
- Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois, USA.
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Mills DE, Johnson MA, McPhilimey MJ, Williams NC, Gonzalez JT, Barnett YA, Sharpe GR. The effects of inspiratory muscle training on plasma interleukin-6 concentration during cycling exercise and a volitional mimic of the exercise hyperpnea. J Appl Physiol (1985) 2013; 115:1163-72. [DOI: 10.1152/japplphysiol.00272.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
It is unknown whether the respiratory muscles contribute to exercise-induced increases in plasma interleukin-6 (IL-6) concentration, if this is related to diaphragm fatigue, and whether inspiratory muscle training (IMT) attenuates the plasma IL-6 response to whole body exercise and/or a volitional mimic of the exercise hyperpnea. Twelve healthy males were divided equally into an IMT or placebo (PLA) group, and before and after a 6-wk intervention they undertook, on separate days, 1 h of 1) passive rest, 2) cycling exercise at estimated maximal lactate steady state power (EX), and 3) volitional hyperpnea at rest, which mimicked the breathing and respiratory muscle recruitment patterns achieved during EX (HYPEX). Plasma IL-6 concentration remained unchanged during passive rest. The plasma IL-6 response to EX was reduced following IMT (main effect of intervention, P = 0.039) but not PLA ( P = 0.272). Plasma IL-6 concentration increased during HYPEX (main effect of time, P < 0.01) and was unchanged postintervention. There was no evidence of diaphragm fatigue (measured by phrenic nerve stimulation) following each trial. In conclusion, plasma IL-6 concentration is increased during EX and HYPEX and this occurred in the absence of diaphragm fatigue. Furthermore, IMT reduced the plasma IL-6 response to EX but not HYPEX. These findings suggest that the respiratory muscles contribute to exercise-induced increases in plasma IL-6 concentration in the absence of diaphragm fatigue and that IMT can reduce the magnitude of the response to exercise but not a volitional mimic of the exercise hyperpnea.
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Affiliation(s)
- Dean E. Mills
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Michael A. Johnson
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Martin J. McPhilimey
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Neil C. Williams
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Javier T. Gonzalez
- School of Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Yvonne A. Barnett
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Graham R. Sharpe
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
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Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation perspective. Respir Physiol Neurobiol 2013; 189:377-83. [PMID: 23692928 DOI: 10.1016/j.resp.2013.05.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022]
Abstract
Most patients are easily liberated from mechanical ventilation (MV) following resolution of respiratory failure and a successful trial of spontaneous breathing, but about 25% of patients experience difficult weaning. MV use leads to cellular changes and weakness, which has been linked to weaning difficulties and has been labeled ventilator induced diaphragm dysfunction (VIDD). Aggravating factors in human studies with prolonged weaning include malnutrition, chronic electrolyte abnormalities, hyperglycemia, excessive resistive and elastic loads, corticosteroids, muscle relaxant exposure, sepsis and compromised cardiac function. Numerous animal studies have investigated the effects of MV on diaphragm function. Virtually all these studies have concluded that MV use rapidly leads to VIDD and have identified cellular and molecular mechanisms of VIDD. Molecular and functional studies on the effects of MV on the human diaphragm have largely confirmed the animal results and identified potential treatment strategies. Only recently potential VIDD treatments have been tested in humans, including pharmacologic interventions and diaphragm "training". A limited number of human studies have found that specific diaphragm training can increase respiratory muscle strength in FTW patients and facilitate weaning, but larger, multicenter trials are needed.
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Janssens L, Brumagne S, McConnell AK, Raymaekers J, Goossens N, Gayan-Ramirez G, Hermans G, Troosters T. The assessment of inspiratory muscle fatigue in healthy individuals: A systematic review. Respir Med 2013; 107:331-46. [DOI: 10.1016/j.rmed.2012.11.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/15/2012] [Indexed: 01/11/2023]
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Effect of exercise training in patients with chronic obstructive pulmonary disease compared with healthy elderly subjects. J Cardiopulm Rehabil Prev 2012; 32:155-62. [PMID: 22487615 DOI: 10.1097/hcr.0b013e31824e16e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Exercise training in patients with chronic obstructive pulmonary disease (COPD) can be challenging because whole-body exercise often elicits disabling symptoms of dyspnea before the exercising muscles reach their critical limits. The extent that this factor limits training has not been totally defined. The purpose of this study was to compare the response to training of patients with moderate to severe COPD with that achieved by healthy elderly subjects who were exercising using an identical program. METHODS Eight healthy subjects and 20 patients with COPD (forced expiratory volume in 1 second 42 ± 13% predicted) exercised 3 times a week for 8 weeks. Outcome measures included 6-minute walk distance, maximal exercise capacity (Wmax) during an incremental cycle ergometer test, and submaximal constant workload (60%-70% of subject Wmax) exercise time. RESULTS Six-minute walk distance and Wmax increased after training to a significantly greater extent in the healthy controls compared with the patients with COPD; 65 ± 24 versus 32 ± 50 m, P = .03; and 25.1±13.9 versus 11.5±13.1 watts, P = .025, respectively. However, these differences disappeared when data were expressed as percent improvement, 12.1 ± 5.3% versus 10.0 ± 15.8%, and 25.6 ± 13.5% versus 23.1 ± 33.3%. Improvement in submaximal constant workload exercise time after training was similar in healthy controls 21.6 ± 6.1 versus patients with COPD 18.8 ± 11.2 minutes. CONCLUSIONS Patients with COPD can show similar relative improvements in exercise capacity compared with healthy elderly subjects. The difference in absolute values reflects, at least in part, the greater baseline exercise capacity.
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Doorduin J, Sinderby CA, Beck J, Stegeman DF, van Hees HWH, van der Hoeven JG, Heunks LMA. The Calcium Sensitizer Levosimendan Improves Human Diaphragm Function. Am J Respir Crit Care Med 2012; 185:90-5. [DOI: 10.1164/rccm.201107-1268oc] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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22
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Compartmental chest wall volume changes during volitional normocapnic hyperpnoea. Respir Physiol Neurobiol 2011; 177:294-300. [DOI: 10.1016/j.resp.2011.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 04/28/2011] [Accepted: 05/10/2011] [Indexed: 11/22/2022]
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23
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Tang H, Lee M, Budak MT, Pietras N, Hittinger S, Vu M, Khuong A, Hoang CD, Hussain SNA, Levine S, Shrager JB. Intrinsic apoptosis in mechanically ventilated human diaphragm: linkage to a novel Fos/FoxO1/Stat3-Bim axis. FASEB J 2011; 25:2921-36. [PMID: 21597002 DOI: 10.1096/fj.11-183798] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mechanical ventilation (MV) is a life-saving measure in many critically ill patients. However, prolonged MV results in diaphragm dysfunction that contributes to the frequent difficulty in weaning patients from the ventilator. The molecular mechanisms underlying ventilator-induced diaphragm dysfunction (VIDD) remain poorly understood. We report here that MV induces myonuclear DNA fragmentation (3-fold increase; P<0.01) and selective activation of caspase 9 (P<0.05) and Bcl2-interacting mediator of cell death (Bim; 2- to 7-fold increase; P<0.05) in human diaphragm. MV also statistically significantly down-regulates mitochondrial gene expression and induces oxidative stress. In cultured muscle cells, we show that oxidative stress activates each of the catabolic pathways thought to underlie VIDD: apoptotic (P<0.05), proteasomal (P<0.05), and autophagic (P<0.01). Further, silencing Bim expression blocks (P<0.05) oxidative stress-induced apoptosis. Overlapping the gene expression profiles of MV human diaphragm and H₂O₂-treated muscle cells, we identify Fos, FoxO1, and Stat3 as regulators of Bim expression as well as of expression of the catabolic markers atrogin and LC3. We thus identify a novel Fos/FoxO1/Stat3-Bim intrinsic apoptotic pathway and establish the centrality of oxidative stress in the development of VIDD. This information may help in the design of specific drugs to prevent this condition.
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Affiliation(s)
- Huibin Tang
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
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Biometric approximation of diaphragmatic contractility during sustained hyperpnea. Respir Physiol Neurobiol 2011; 176:90-7. [DOI: 10.1016/j.resp.2011.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 11/20/2022]
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Walker DJ, Walterspacher S, Schlager D, Ertl T, Roecker K, Windisch W, Kabitz HJ. Characteristics of diaphragmatic fatigue during exhaustive exercise until task failure. Respir Physiol Neurobiol 2011; 176:14-20. [DOI: 10.1016/j.resp.2011.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 01/11/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Contrasting pressure-support ventilation and helium–oxygen during exercise in severe COPD. Respir Med 2011; 105:494-505. [DOI: 10.1016/j.rmed.2010.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/11/2010] [Accepted: 08/12/2010] [Indexed: 11/20/2022]
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Laviolette L, Lands LC, Dauletbaev N, Saey D, Milot J, Provencher S, LeBlanc P, Maltais F. Combined Effect of Dietary Supplementation with Pressurized Whey and Exercise Training in Chronic Obstructive Pulmonary Disease: A Randomized, Controlled, Double-Blind Pilot Study. J Med Food 2010; 13:589-98. [DOI: 10.1089/jmf.2009.0142] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Louis Laviolette
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Larry C. Lands
- Respiratory Medicine, Montreal Children's Hospital-McGill University Health Centre, Québec, Québec, Canada
| | - Nurlan Dauletbaev
- Respiratory Medicine, Montreal Children's Hospital-McGill University Health Centre, Québec, Québec, Canada
| | - Didier Saey
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Julie Milot
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Steeve Provencher
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Pierre LeBlanc
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
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Hopkinson NS, Dayer MJ, Moxham J, Polkey MI. Abdominal muscle fatigue following exercise in chronic obstructive pulmonary disease. Respir Res 2010; 11:15. [PMID: 20132549 PMCID: PMC2824704 DOI: 10.1186/1465-9921-11-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 02/04/2010] [Indexed: 11/16/2022] Open
Abstract
Background In patients with chronic obstructive pulmonary disease, a restriction on maximum ventilatory capacity contributes to exercise limitation. It has been demonstrated that the diaphragm in COPD is relatively protected from fatigue during exercise. Because of expiratory flow limitation the abdominal muscles are activated early during exercise in COPD. This adds significantly to the work of breathing and may therefore contribute to exercise limitation. In healthy subjects, prior expiratory muscle fatigue has been shown itself to contribute to the development of quadriceps fatigue. It is not known whether fatigue of the abdominal muscles occurs during exercise in COPD. Methods Twitch gastric pressure (TwT10Pga), elicited by magnetic stimulation over the 10th thoracic vertebra and twitch transdiaphragmatic pressure (TwPdi), elicited by bilateral anterolateral magnetic phrenic nerve stimulation were measured before and after symptom-limited, incremental cycle ergometry in patients with COPD. Results Twenty-three COPD patients, with a mean (SD) FEV1 40.8(23.1)% predicted, achieved a mean peak workload of 53.5(15.9) W. Following exercise, TwT10Pga fell from 51.3(27.1) cmH2O to 47.4(25.2) cmH2O (p = 0.011). TwPdi did not change significantly; pre 17.0(6.4) cmH2O post 17.5(5.9) cmH2O (p = 0.7). Fatiguers, defined as having a fall TwT10Pga ≥ 10% had significantly worse lung gas transfer, but did not differ in other exercise parameters. Conclusions In patients with COPD, abdominal muscle but not diaphragm fatigue develops following symptom limited incremental cycle ergometry. Further work is needed to establish whether abdominal muscle fatigue is relevant to exercise limitation in COPD, perhaps indirectly through an effect on quadriceps fatigability.
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Affiliation(s)
- Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, Fulham Rd, London SW3 6NP, UK.
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Interval training versus continuous training in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 2009; 29:126-32. [PMID: 19305238 DOI: 10.1097/hcr.0b013e31819a024f] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare the effects of interval training (IT) and continuous steady-pace training (CT) in patients with COPD. METHODS Patients (n = 21) (mean forced expiratory volume in 1 second ([FEV1] = 44.6% +/- 13.9%) were randomized to IT, and 20 patients (mean FEV1 = 41.7% +/- 12.6%) to CT. Outcome measures included 6-minute walk distance, maximal work capacity, endurance exercise time during constant workload exercise at 60% to 70% of maximal work capacity, and quality of life including fatigue and dyspnea. Participants exercised 3 times per week for 8 weeks, and total work was the same for both training regimens. RESULTS Significant improvement in mean score was observed in each variable within each of the 2 groups: 6-minute walk distance (IT = 158 +/- 178 ft, CT = 106 +/- 165 ft); maximal work capacity (IT = 10.0 +/- 13.0 W, CT = 11.5 +/- 13.1 W); endurance exercise time (IT = 15.0 +/- 12.5 minutes, CT = 18.7 +/- 10.6 minutes); and quality of life domains, fatigue (IT = 3.1 +/- 3.0, CT = 2.8 +/- 4.7), and dyspnea (IT = 4.4 +/- 5.3, CT = 5.4 +/- 5.1). There was no significant difference in the extent of improvement between the 2 training regimens for any of the outcome variables. CONCLUSION Compared with CT, IT was well tolerated and produced similar improvements in exercise performance and quality of life.
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Tobin MJ, Laghi F, Brochard L. Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J Appl Physiol (1985) 2009; 107:962-70. [PMID: 19407256 DOI: 10.1152/japplphysiol.00165.2009] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
It is problematic to withhold therapy in a patient with chronic obstructive pulmonary disease (COPD) who presents with acute respiratory failure so that detailed physiological measurements can be obtained. Accordingly, most information on respiratory muscle activity in patients experiencing acute respiratory failure has been acquired by studying patients who fail a trial of weaning after a period of mechanical ventilation. Such patients experience marked increases in inspiratory muscle load consequent to increases in resistance, elastance, and intrinsic positive end-expiratory pressure. Inspiratory muscle strength is reduced secondary to hyperinflation and possibly direct muscle damage and the release of inflammatory mediators. Most patients recruit both their sternomastoid and expiratory muscles, even though airflow limitation prevents the expiratory muscles from lowering lung volume. Even when acute hypercapnia is present, patients do not exhibit respiratory center depression; indeed, voluntary activation of the diaphragm, in absolute terms, is greater in hypercapnic patients than in normocapnic patients. Instead, the major mechanism of acute hypercapnia is the development of rapid shallow breathing. Despite the marked increase in mechanical load and decreased force-generating capacity of the inspiratory muscles, patients do not develop long-lasting muscle fatigue, at least over the period of a failed weaning trial. Although the disease originates within the lung parenchyma, much of the distress faced by patients with COPD, especially during acute respiratory failure, is caused by the burdens imposed on the respiratory muscles.
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Affiliation(s)
- Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. VA Hospital, Hines, Illinois 60141, USA.
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Renggli AS, Verges S, Notter DA, Spengler CM. Development of respiratory muscle contractile fatigue in the course of hyperpnoea. Respir Physiol Neurobiol 2008; 164:366-72. [DOI: 10.1016/j.resp.2008.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 08/18/2008] [Accepted: 08/22/2008] [Indexed: 11/29/2022]
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Purro A, Appendini L, Polillo C, Musso G, Taliano C, Mecca F, Colombo R, Carbone G. Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study. Intensive Care Med 2008; 35:639-47. [DOI: 10.1007/s00134-008-1353-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 10/25/2008] [Indexed: 01/20/2023]
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Kabitz HJ, Walker D, Sonntag F, Walterspacher S, Kirchberger A, Burgardt V, Roecker K, Windisch W. Post-exercise diaphragm shielding: A novel approach to exercise-induced diaphragmatic fatigue. Respir Physiol Neurobiol 2008; 162:230-7. [DOI: 10.1016/j.resp.2008.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 07/23/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
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Chien MY, Wu YT, Chang YJ. Assessment of Diaphragm and External Intercostals Fatigue from Surface EMG using Cervical Magnetic Stimulation. SENSORS (BASEL, SWITZERLAND) 2008; 8:2174-2187. [PMID: 27879816 PMCID: PMC3673412 DOI: 10.3390/s8042174] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 03/14/2008] [Indexed: 11/17/2022]
Abstract
This study was designed: (1) to test the reliability of surface electromyography (sEMG) recording of the diaphragm and external intercostals contractions response to cervical magnetic stimulation (CMS), (2) to examine the amount and the types of inspiratory muscle fatigue that developed after maximum voluntary ventilation (MVV) maneuvers.Ten male college students without physical disability (22.1±2.0 years old) participated in the study and each completed a control (quiet breathing) trial and a fatigue (MVV maneuvers) trial sequentially. In the quiet breathing trial, the subjects maintained quiet breathing for five minutes. The subjects performed five maximal static inspiratory efforts and received five CMS before and after the quiet breathing. In the MVV trial, subjects performed five maximal inspiratory efforts and received five CMS before, immediately after, and ten minutes after two sets of MVV maneuvers performed five minutes apart. Maximal inspiratory pressure (PImax), sEMG of diaphragm and external intercostals during maximal static inspiratory efforts and during CMS were recorded. In the quiet breathing trial, high intraclass correlation coefficients (ICC=0.95-0.99) were observed in all the variables. In the MVV trial, the PImax, the EMG amplitude and the median power frequency during maximal static inspiratory efforts significantly decreased in both the diaphragm and the external intercostals immediately after the MVV maneuvers (P0.05). It is concluded that the sEMG recordings of the diaphragm during maximal static inspiratory efforts and in response to CMS allow reproducible sequential assessment of diaphragm contractility. MVV maneuvers resulted in inspiratory muscles fatigue, possibly central fatigue.
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Affiliation(s)
- Meng-Yueh Chien
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Tai Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ya-Ju Chang
- Department of Physical Therapy, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan 333, Taiwan.
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Kabitz HJ, Walker D, Prettin S, Walterspacher S, Sonntag F, Dreher M, Windisch W. Non-invasive ventilation applied for recovery from exercise-induced diaphragmatic fatigue. Open Respir Med J 2008; 2:16-21. [PMID: 19340320 PMCID: PMC2606644 DOI: 10.2174/1874306400802010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 01/25/2008] [Accepted: 02/01/2008] [Indexed: 11/25/2022] Open
Abstract
Background: Exercise-induced diaphragmatic fatigue (DF) is conventionally considered to reflect impaired diaphragm function resulting from load imposed on the diaphragm during exercise and is known to be reduced by the application of non-invasive ventilation (NIV) during heavy-intensity exercise testing (HEET). On that physiological condition NIV applied for diaphragm unloading during recovery from exercise should be capable of accelerating recovery from DF and therewith prolonging exercise time to exhaustion and limiting the development of DF during a subsequent HEET compared to recovery during spontaneous breathing. Methods: Seven highly-trained subjects (V’O2max 62.7±7.8 ml/kg/min) performed four HEET at 85% V’O2max with 60 min of recovery during I spontaneous breathing and II NIV between two HEET. Results: Twitch transdiaphragmatic pressure (TwPdi) during supramaximal magnetic phrenic nerve stimulation decreased (p<0.04) following first HEET and subsequently completely recovered (p>0.2) during I and II. Following second HEET TwPdi comparably decreased (I 0.24±0.21 vs II 0.32±0.29 kPa; p=0.17). Exercise time to exhaustion during second HEET was equal during I and II (I 514±49 vs II 511±92 s; p=0.88). Conclusions: In conclusion, NIV applied for diaphragm unloading during recovery following HEET does neither affect recovery from DF nor subsequent exercise performance thereby providing further evidence that DF might reflect post-exercise diaphragm shielding rather than impaired diaphragm function.
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Affiliation(s)
- Hans-Joachim Kabitz
- Department of Pneumologya, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany.
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Hypoventilation and Respiratory Muscle Dysfunction. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Parthasarathy S, Jubran A, Laghi F, Tobin MJ. Sternomastoid, rib cage, and expiratory muscle activity during weaning failure. J Appl Physiol (1985) 2007; 103:140-7. [PMID: 17395760 DOI: 10.1152/japplphysiol.00904.2006] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We hypothesized that patients who fail weaning from mechanical ventilation recruit their inspiratory rib cage muscles sooner than they recruit their expiratory muscles, and that rib cage muscle recruitment is accompanied by recruitment of sternomastoid muscles. Accordingly, we measured sternomastoid electrical activity and changes in esophageal (ΔPes) and gastric pressure (ΔPga) in 11 weaning-failure and 8 weaning-success patients. At the start of trial, failure patients exhibited a higher ΔPga-to-ΔPes ratio than did success patients ( P = 0.05), whereas expiratory rise in Pga was equivalent in the two groups. Between the start and end of the trial, failure patients developed additional increases in ΔPga-to-ΔPes ratio ( P < 0.0014) and the expiratory rise in Pga also increased ( P < 0.004). At the start of trial, sternomastoid activity was present in 8 of 11 failure patients contrasted with 1 of 8 success patients. Over the course of the trial, sternomastoid activity increased by 53.0 ± 9.3% in the failure patients ( P = 0.0005), whereas it did not change in the success patients. Failure patients recruited their respiratory muscles in a sequential manner. The sequence began with activity of diaphragm and greater-than-normal activity of inspiratory rib cage muscles; recruitment of sternomastoids and rib cage muscles approached near maximum within 4 min of trial commencement; expiratory muscles were recruited slowest of all. In conclusion, not only is activity of the inspiratory rib cage muscles increased during a failed weaning trial, but respiratory centers also recruit sternomastoid and expiratory muscles. Extradiaphragmatic muscle recruitment may be a mechanism for offsetting the effects of increased load on a weak diaphragm.
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Affiliation(s)
- Sairam Parthasarathy
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Administration Hospital, and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois, USA
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Kabitz HJ, Walker D, Schwoerer A, Sonntag F, Walterspacher S, Roecker K, Windisch W. New physiological insights into exercise-induced diaphragmatic fatigue. Respir Physiol Neurobiol 2007; 158:88-96. [PMID: 17560177 DOI: 10.1016/j.resp.2007.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 04/26/2007] [Accepted: 04/26/2007] [Indexed: 11/24/2022]
Abstract
Data on the dynamic process and time-point of manifestation of exercise-induced diaphragmatic fatigue (DF) are lacking. Therefore, this study was aimed assessing dynamic changes of diaphragmatic strength during exercise and determining the time-point of DF manifestation. Fourteen trained subjects (maximal oxygen uptake (VO2(max)) 59.3+/-5.5 ml/min/kg) performed standardized exercise protocols (maximal workload: 85% VO2(max)) followed by recovery (6 min). Ergospirometric data and twitch transdiaphragmatic pressure (TwPdi) were consecutively assessed. DF was induced (TwPdi-rest: 2.34+/-0.26 versus TwPdi-end-recovery 2.01+/-0.21 kPa, p<0.01). TwPdi progressively increased during exercise (TwPdi-rest: 2.34+/-0.26 versus TwPdi-maximal-workload: 3.28+/-0.38 kPa, p<0.001). DF was detectable immediately after exercise-termination (TwPdi-maximal-workload: 3.28+/-0.38 versus TwPdi-early-recovery 2.55+/-0.34 kPa, p<0.001). TwPdi during exercise was highly correlated to workload, VO2(max) and dyspnea (r=0.96/r=0.92/r=0.97; all p<0.0001). In conclusion, diaphragmatic strength progressively increases with increasing workload, and DF manifests after - rather than during - exercise. In addition, TwPdi is highly correlated to key-measures of ergospirometry, approving the physiological thesis that muscle strength is progressively enhanced and escapes fatiguing failure during high-intensity exercise performance.
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Affiliation(s)
- Hans-Joachim Kabitz
- Department of Pneumology, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany.
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Ross EZ, Middleton N, Shave R, George K, Nowicky A. Corticomotor excitability contributes to neuromuscular fatigue following marathon running in man. Exp Physiol 2007; 92:417-26. [PMID: 17099060 DOI: 10.1113/expphysiol.2006.035972] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is unknown whether changes in corticomotor excitability follow prolonged exercise in healthy humans. Furthermore, the role of supraspinal fatigue in decrements of force production and voluntary activation following prolonged exercise has not been established. This study investigated peripheral and central fatigue after a marathon (42.2 km) on a treadmill. Isometric ankle dorsiflexion force and electromyographic responses of the tibialis anterior in response to magnetic stimulation of the peroneal nerve (PNMS) and the motor cortex (TMS) were measured before, immediately after, 4 and 24 h post-marathon (MAR) in nine volunteers (mean +/- s.d. completion time, 208 +/- 22 min). Maximal voluntary contraction decreased by 18 +/- 7% immediately after MAR (P = 0.009) and remained significantly decreased after 4 h. The amplitude of the evoked response to TMS, but not to PNMS, was depressed immediately post-MAR by 57 +/- 25% (P = 0.04). Potentiated resting twitch force was reduced in response to both TMS and PNMS post-MAR (71 +/- 8 and 35 +/- 2% decrease, P = 0.035 and 0.037, respectively), and voluntary activation was reduced to 61.9 +/- 18% immediately post-MAR (P < 0.05). All measures had returned to baseline values after 24 h. These results suggest that fatigue was attributable to both a disturbance of the contractile apparatus within the muscle and submaximal output from the motor cortex.
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Affiliation(s)
- Emma Z Ross
- Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK.
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40
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Simpson JA, Iscoe S. Cardiorespiratory failure in rat induced by severe inspiratory resistive loading. J Appl Physiol (1985) 2006; 102:1556-64. [PMID: 17138835 DOI: 10.1152/japplphysiol.00785.2006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The mechanisms underlying acute respiratory failure induced by respiratory loads are unclear. We hypothesized that, in contrast to a moderate inspiratory resistive load, a severe one would elicit central respiratory failure (decreased respiratory drive) before diaphragmatic injury and fatigue. We also wished to elucidate the factors that predict endurance time and peak tracheal pressure generation. Anesthetized rats breathed air against a severe load ( approximately 75% of the peak tracheal pressure generated during a 30-s occlusion) until pump failure (fall in tracheal pressure to half; mean 38 min). Hypercapnia and hypoxemia developed rapidly ( approximately 4 min), coincident with diaphragmatic fatigue (decreased ratio of transdiaphragmatic pressure to peak integrated phrenic activity) and the detection in blood of the fast isoform of skeletal troponin I (muscle injury). At approximately 23 min, respiratory frequency and then blood pressure fell, followed immediately by secondary diaphragmatic fatigue. Blood taken after termination of loading contained cardiac troponin T (myocardial injury). Contrary to our hypothesis, diaphragmatic fatigue and injury occurred early in loading before central failure, evident only as a change in the timing but not the drive component of the central respiratory pattern generator. Stepwise multiple regression analysis selected changes in mean arterial pressure and arterial Pco(2) during loading as the principal contributing factors in load endurance time, and changes in mean arterial pressure as the principal contributing factor in peak tracheal pressure generation. In conclusion, the temporal development of respiratory failure is not stereotyped but depends on load magnitude; moreover respiratory loads induce cardiorespiratory, not just respiratory, failure.
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Affiliation(s)
- Jeremy A Simpson
- Department of Physiology, Queen's University, Kingston, Ontario, Canada
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Hotchkiss JR, Galvan DA. Artificial neural networks and power of breathing: New approaches, expanded utility?*. Crit Care Med 2006; 34:1267-8. [PMID: 16550086 DOI: 10.1097/01.ccm.0000208148.13721.ae] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Saey D, Côté CH, Mador MJ, Laviolette L, LeBlanc P, Jobin J, Maltais F. Assessment of muscle fatigue during exercise in chronic obstructive pulmonary disease. Muscle Nerve 2006; 34:62-71. [PMID: 16583366 DOI: 10.1002/mus.20541] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Contractile fatigue is associated with exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). Contractile fatigue may be assessed by quantifying the decline in strength after a fatiguing protocol but this may pose practical problems. The purpose of this study was to investigate the relationship between the decline in quadriceps strength, quadriceps electrical activity, perception of leg fatigue, and arterial lactate level in patients with COPD during constant work-rate cycling exercise. The decline in quadriceps strength was significantly associated with the decrease in electromyographic median frequency (r = 0.606), leg fatigue perception (r = 0.453), and arterial lactate level (r = 0.384). Using the receiver-operating-characteristic curve, it was found that a 4% decline in electromyographic median frequency had a 94% sensitivity and a 75% specificity to predict contractile fatigue. We conclude that contractile fatigue commonly occurs during cycling exercise in COPD. The electromyographic median frequency appears to be a valuable indirect marker to predict contractile leg fatigue.
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Affiliation(s)
- Didier Saey
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, 2725 Chemin Ste-Foy, Québec G1V 4G5, Canada
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Koechlin C, Matecki S, Jaber S, Soulier N, Prefaut C, Ramonatxo M. Changes in respiratory muscle endurance during puberty. Pediatr Pulmonol 2005; 40:197-204. [PMID: 16032712 DOI: 10.1002/ppul.20271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The evaluation of respiratory muscle endurance provides clinically useful information on muscle function, especially in children with respiratory and neuromuscular diseases. However, endurance may be lower in young children than in older children because of the major physical changes of puberty. We thus compared respiratory muscle endurance in 15 healthy pre- and peripubertal children (S1-S2/P1 group) and 14 healthy children near the end of the pubertal process (S4P4 group). All performed a respiratory muscle endurance test threshold load fixed at 50% of the individual maximal inspiratory pressure; (Pi(max)), using a standardized method with a controlled breathing pattern. No significant difference was found between groups for Pi(max). The mean endurance time limit for the S1-S2/P1 group was 138 +/- 20 sec. The S4P4 group was able to breathe with the threshold valve for more than 20 min (1,200 sec) without task failure, except for one girl (385 sec). This study shows that inspiratory muscle endurance is significantly lower in children in early puberty compared to children at the end of the pubertal process. If the underlying mechanisms are not well-known, the present study revealed that if we use the same inspiratory load in prepubertal children as in adults during clinical testing, we are likely to underestimate the susceptibility to task failure of their respiratory muscles. To define a fatigue threshold for the respiratory muscles, as a function of age, thus appears clinically important in further studies, particularly for the management of children with respiratory diseases.
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Affiliation(s)
- Christelle Koechlin
- Laboratoire de Physiologie des Interactions, Service Central de Physiologie Clinique, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Mador MJ, Deniz O, Deniz O, Aggarwal A, Shaffer M, Kufel TJ, Spengler CM. Effect of Respiratory Muscle Endurance Training in Patients With COPD Undergoing Pulmonary Rehabilitatio. Chest 2005; 128:1216-24. [PMID: 16162709 DOI: 10.1378/chest.128.3.1216] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Respiratory muscle endurance training (hyperpnea training) has been shown to have beneficial effects in patients with COPD. STUDY OBJECTIVES The purpose of this study was to determine whether hyperpnea training, when added to an endurance exercise training program, would lead to additional benefits compared with endurance training alone in patients with COPD. SETTING AND PARTICIPANTS Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program. Fifteen patients (mean [+/- SE] FEV1, 45 +/- 6% predicted) were randomized to combined therapy, and 14 patients (mean FEV1, 44 +/- 4% predicted) were randomized to endurance training. METHODS Peak exercise capacity, exercise endurance time during constant workload cycle exercise, 6-min walk distance, quality of life as measured by the chronic respiratory questionnaire, respiratory muscle strength and endurance, and quadriceps fatigability were measured before and after endurance or combined training. RESULTS After rehabilitation, peak exercise capacity, exercise endurance time, 6-min walk distance, and quality of life all increased in both groups, but there was no significant difference in the extent of improvement between groups. Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group (17.5 +/- 2.7 vs 8.5 +/- 2.5 min, respectively; p = 0.02). Respiratory muscle strength was significantly increased, and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group, but the difference between groups did not reach statistical significance. CONCLUSION The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD. However, this improvement did not translate into additional improvement in quality of life or exercise performance.
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Affiliation(s)
- M Jeffery Mador
- Veterans Affairs Western New York Healthcare System, Buffalo, USA.
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Laghi F, Langbein WE, Antonescu-Turcu A, Jubran A, Bammert C, Tobin MJ. Respiratory and Skeletal Muscles in Hypogonadal Men with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2005; 171:598-605. [PMID: 15591465 DOI: 10.1164/rccm.200412-1643oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hypogonadism, found in about one-third of patients with chronic obstructive pulmonary disease (COPD), has potential for decreasing muscle mass and muscle performance. Compared with eugonadal patients, we hypothesized that hypogonadal patients with COPD have decreased respiratory and skeletal muscle performance. Nineteen hypogonadal and 20 eugonadal men with COPD (FEV(1) 1.14 +/- 0.08 and 1.17 +/- 0.11 L [standard error], respectively) were studied. Diaphragmatic contractility, assessed as transdiaphragmatic twitch pressure generated by phrenic nerve stimulation, was similar in hypogonadal and eugonadal patients: 20.6 +/- 2.2 and 19.8 +/- 2.5 cm H(2)O, respectively. During progressive inspiratory threshold loading, hypogonadal and eugonadal patients had similar respiratory muscle endurance times (302 +/- 29 and 313 +/- 48 seconds, respectively) and airway pressure sustained during the last minute of loading (38.2 +/- 3.0 and 40.5 +/- 4.7 cm H(2)O, respectively) (similar to predicted values in healthy subjects). Hypogonadal and eugonadal patients had equivalent limb muscle strength and endurance. During cycle exercise to exhaustion, exercise performance, gas exchange, and respiratory muscle recruitment (estimated by esophageal and gastric pressure swings during tidal breathing) were similar in both groups. In conclusion, hypogonadism does not decrease respiratory or limb muscle performance and exercise capacity in men with moderate-to-severe COPD who, for the most part, are not underweight.
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Affiliation(s)
- Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. VA Hospital, 111N 5th Avenue and Roosevelt Road, Hines, IL 60141, USA.
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Saey D, Michaud A, Couillard A, Côté CH, Mador MJ, LeBlanc P, Jobin J, Maltais F. Contractile fatigue, muscle morphometry, and blood lactate in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 171:1109-15. [PMID: 15735055 DOI: 10.1164/rccm.200408-1005oc] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We hypothesized that patients with chronic obstructive pulmonary disease developing contractile fatigue of the quadriceps during cycle exercise may have characteristic metabolic and muscle features that could increase their susceptibility to fatigue, thus differentiating them from those who do not develop fatigue. We examined, in 32 patients, the fiber-type proportion, enzymatic activities, and capillary density in the vastus lateralis and the arterial blood lactate level during constant work-rate cycling exercise. Contractile fatigue was defined as a postexercise fall in quadriceps twitch force greater than 15% of resting values. Twenty-two patients developed contractile fatigue after exercise. No significant differences were found between fatiguers and non-fatiguers for the endurance time, fiber-type proportion, and oxidative enzyme activities. The lactate dehydrogenase activity was significantly higher (p < 0.05) and muscle capillarization significantly reduced in fatiguers (p < 0.05). Compared with non-fatiguers, the arterial lactate level during exercise was significantly higher in fatiguers (p < 0.001). A significant relationship was found between the fall in quadriceps twitch force and lactate dehydrogenase activity, capillary/fiber ratio, and blood lactate level. We conclude that changes in muscle enzymatic profile and capillarization with a greater reliance on glycolytic metabolism during exercise are associated with contractile fatigue in patients with chronic obstructive pulmonary disease.
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MESH Headings
- Aged
- Capillaries/pathology
- Citrate (si)-Synthase/metabolism
- Exercise
- Humans
- L-Lactate Dehydrogenase/metabolism
- Lactic Acid/blood
- Male
- Middle Aged
- Muscle Fatigue
- Muscle Fibers, Skeletal/enzymology
- Muscle Fibers, Skeletal/pathology
- Muscle, Skeletal/blood supply
- Muscle, Skeletal/diagnostic imaging
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Muscle, Skeletal/physiopathology
- Pulmonary Disease, Chronic Obstructive/metabolism
- Pulmonary Disease, Chronic Obstructive/pathology
- Pulmonary Disease, Chronic Obstructive/physiopathology
- Radiography
- Rest
- Thigh
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Affiliation(s)
- Didier Saey
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Québec, Canada
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Mador MJ, Bozkanat E, Aggarwal A, Shaffer M, Kufel TJ. Endurance and strength training in patients with COPD. Chest 2004; 125:2036-45. [PMID: 15189919 DOI: 10.1378/chest.125.6.2036] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The purpose of this study was to compare the effects of endurance training only to endurance plus strength (combined) training in a randomized trial of patients with COPD. METHODS Twenty-four patients completed the study: 11 patients in the combined training group (FEV(1) 45 +/- 5% predicted), and 13 patients in the endurance training group (FEV(1) 40 +/- 4% predicted) [mean +/- SE]. Muscle strength, quality of life, exercise performance, and quadriceps fatigability were measured before and after rehabilitation. RESULTS Combined training led to significant improvements in quadriceps (23.6%), hamstring (26.7), pectoralis major (17.5%), and latissimus dorsi (20%) muscle strength. Endurance training alone did not produce significant improvements in muscle strength: quadriceps (1.1% decrease), hamstring (12.2% increase), pectoralis major (7.8% increase), and latissimus dorsi (2.8% decrease). The increase in strength after training was significantly greater in the combined group compared to the endurance group for the quadriceps and latissimus dorsi muscles but not for the hamstring and pectoralis major muscles. Six-minute walk distance, endurance exercise time, and quality of life (as measured by the Chronic Respiratory Questionnaire) significantly increased in both groups after rehabilitation with no significant differences in the extent of improvement between groups. The extent of improvement in quadriceps fatigability after training (assessed by quadriceps twitch force before and after exercise) was not significantly different between groups. CONCLUSION Strength training can lead to significant improvement in muscle strength in elderly patients with COPD. However, this improvement in muscle strength does not translate into additional improvement in quality of life, exercise performance or quadriceps fatigability compared to that achieved by endurance exercise alone.
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Affiliation(s)
- M Jeffery Mador
- Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
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48
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Road J, Jiang TX, Reid WD. Weaning failure, muscle injury, and fatigue. Am J Respir Crit Care Med 2003; 168:1539; author reply 1539-40. [PMID: 14668258 DOI: 10.1164/ajrccm.168.12.952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Simpson JA, Van Eyk J, Iscoe S. Respiratory muscle injury, fatigue and serum skeletal troponin I in rat. J Physiol 2003; 554:891-903. [PMID: 14673191 PMCID: PMC1664786 DOI: 10.1113/jphysiol.2003.051318] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
To evaluate injury to respiratory muscles of rats breathing against an inspiratory resistive load, we measured the release into blood of a myofilament protein, skeletal troponin I (sTnI), and related this release to the time course of changes in arterial blood gases, respiratory drive (phrenic activity), and pressure generation. After approximately 1.5 h of loading, hypercapnic ventilatory failure occurred, coincident with a decrease in the ratio of transdiaphragmatic pressure to integrated phrenic activity (P(di)/ integral Phr) during sighs. This was followed at approximately 1.9 h by a decrease in the P(di)/ integral Phr ratio during normal loaded breaths (diaphragmatic fatigue). Loading was terminated at pump failure (a decline of P(di) to half of steady-state loaded values), approximately 2.4 h after load onset. During 30 s occlusions post loading, rats generated pressure profiles similar to those during occlusions before loading, with comparable blood gases, but at a higher neural drive. In a second series of rats, we tested for sTnI release using Western blot-direct serum analysis of blood samples taken before and during loading to pump failure. We detected only the fast isoform of sTnI, release beginning midway through loading. Differential detection with various monoclonal antibodies indicated the presence of modified forms of fast sTnI. The release of fast sTnI is consistent with load-induced injury of fast glycolytic fibres of inspiratory muscles, probably the diaphragm. Characterization of released fast sTnI may provide insights into the molecular basis of respiratory muscle dysfunction; fast sTnI may also prove useful as a marker of impending respiratory muscle fatigue.
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Affiliation(s)
- Jeremy A Simpson
- Department of Physiology, Queen's University, Kingston, Ontario, Canada K7L 3N6
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Rohrbach M, Perret C, Kayser B, Boutellier U, Spengler CM. Task failure from inspiratory resistive loaded breathing: a role for inspiratory muscle fatigue? Eur J Appl Physiol 2003; 90:405-10. [PMID: 12827367 DOI: 10.1007/s00421-003-0871-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2003] [Indexed: 10/22/2022]
Abstract
The use of non-invasive resistive breathing to task failure to assess inspiratory muscle performance remains a matter of debate. CO2 retention rather than diaphragmatic fatigue was suggested to limit endurance during inspiratory resistive breathing. Cervical magnetic stimulation (CMS) allows discrimination between diaphragmatic and rib cage muscle fatigue. We tested a new protocol with respect to the extent and the partitioning of inspiratory muscle fatigue at task failure. Nine healthy subjects performed two runs of inspiratory resistive breathing at 67 (12)% of their maximal inspiratory mouth pressure, respiratory rate (fR), paced at 18 min(-1), with a 15-min pause between runs. Diaphragm and rib cage muscle contractility were assessed from CMS-induced esophageal (P(es,tw)), gastric (P(ga,tw)), and transdiaphragmatic (P(di,tw)) twitch pressures. Average endurance times of the first and second runs were similar [9.1 (6.7) and 8.4 (3.5) min]. P(di,tw) significantly decreased from 33.1 to 25.9 cmH2O in the first run, partially recovered (27.6 cmH2O), and decreased further in the second run (23.4 cmH2O). P(es,tw) also decreased significantly (-5.1 and -2.4 cmH2O), while P(ga,tw) did not change significantly (-2.0 and -1.9 cmH2O), indicating more pronounced rib cage rather than diaphragmatic fatigue. End-tidal partial pressure of CO2 ( PETCO2) rose from 37.2 to 44.0 and 45.3 mmHg, and arterial oxygen saturation (SaO2) decreased in both runs from 98% to 94%. Thus, task failure in mouth-pressure-targeted, inspiratory resistive breathing is associated with both diaphragmatic and rib cage muscle fatigue. Similar endurance times despite different degrees of muscle fatigue at the start of the runs indicate that other factors, e.g. increases in PETCO2, and/or decreases in SaO2, probably contributed to task-failure.
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Affiliation(s)
- Markus Rohrbach
- Exercise Physiology, Institute for Human Movement Sciences, Swiss Federal Institute of Technology, and Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
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