Neck and Abdominal Muscle Activity in Patients with Severe Thoracic Scoliosis
|
|
- Emerald Casey
- 6 years ago
- Views:
Transcription
1 Neck and Abdominal Muscle Activity in Patients with Severe Thoracic Scoliosis MARC ESTENNE, ERIC DEROM, and ANDRÉ DE TROYER Chest Service, Erasme University Hospital, and Laboratory of Cardiorespiratory Physiology, Brussels School of Medicine, Brussels; and Department of Respiratory Diseases, University Hospital, Gent, Belgium Patients with severe chronic obstructive pulmonary disease (COPD) do not use the sternocleidomastoid muscles when breathing at rest, but have a greater than normal neural drive to the rib-cage inspiratory muscles, the abdominal muscles, and the diaphragm. Yet the increased activation of the abdominal muscles and diaphragm in such patients has only limited mechanical effects, and this has led to the suggestion that the overall increase in neural drive is simply an automatic response of the respiratory system to a greater than resting stimulation. To test this hypothesis, we examined the pattern of respiratory-muscle activation in eight patients with severe thoracic scoliosis (Cobb angle between 100 and 136 ). We recorded electromyograms of the sternocleidomastoid, scalene, rectus abdominis, external oblique, and transversus abdominis muscles; esophageal (Pes) and gastric (Pga) pressures; and the anteroposterior (AP) diameter of the abdomen during resting breathing in the seated posture. All patients had invariable phasic inspiratory activity in the scalenes; and five patients had invariable phasic expiratory activity in the transversus; intermittent expiratory activity in the transversus was also recorded in three patients. In contrast, only one patient had invariable phasic inspiratory activity in the sternocleidomastoid, and only one patient had invariable phasic expiratory activity in the external oblique. The decrease in abdominal AP diameter during expiration was commonly associated with a rise in Pga. These observations therefore indicate that the pattern of respiratory-muscle activation in patients with severe thoracic scoliosis is essentially similar to that seen in patients with severe COPD. This supports the concept that the order of recruitment of the respiratory muscles during breathing is an automatic response of the central controller. Estenne M, Derom E, De Troyer A. Neck and abdominal muscle activity in patients with severe thoracic scoliosis. AM J RESPIR CRIT CARE MED 1998;158: Although most patients with chronic obstructive pulmonary disease (COPD) do not use the sternocleidomastoid muscles when breathing at rest (1), recent electromyographic studies have shown that these patients have increased firing frequencies in the parasternal intercostal, scalene, and diaphragmatic motor units as compared with control subjects (2, 3). In contrast to healthy individuals, many resting patients with severe COPD also contract the abdominal muscles, in particular the transversus abdominis, during expiration (4, 5). Thus, such patients have a greater than normal neural drive to the rib cage inspiratory muscles, the diaphragm, and the abdominal muscles, but the mechanism of this overall increase in drive remains uncertain. It is well established that the inspiratory muscles of the rib cage are not severely affected by hyperinflation, and essentially maintain their ability to shorten (6). The increased activation of the parasternal intercostal and scalene muscles in COPD therefore results in a greater than normal elevation of (Received in original form October 31, 1997 and in revised form March 23, 1998) Correspondence and requests for reprints should be addressed to Marc Estenne, Chest Service, Erasme University Hospital, 808, Route de Lennik, B-1070 Brussels, Belgium. Am J Respir Crit Care Med Vol 158. pp , 1998 Internet address: the ribs and expansion of the rib cage (7). On the other hand, the diaphragm in such patients is low and flat. Consequently, irrespective of the degree of neural activation, the ability of the diaphragmatic dome to descend and to produce an increase in lung volume is impaired, and indeed, measurements of thoracoabdominal motion during breathing have repeatedly shown that many patients with severe COPD have a reduced outward displacement or a paradoxical inward displacement of the ventral abdominal wall during inspiration (7). Similarly, many patients with severe COPD are flow-limited at rest (8), and it therefore appears unlikely that an expiratory contraction of the transversus abdominis may cause a significant increase in expiratory flow or a significant reduction in end-expiratory lung volume (4). In severe COPD, the increased activation of the diaphragm and abdominal muscles would thus have limited beneficial effects on the act of breathing, and this has led to the suggestion that the overall increase in neural drive is simply an automatic response of the respiratory system to a greater than resting stimulation (4). If this hypothesis were correct, it would imply that the pattern of respiratory-muscle activation in humans with chronic respiratory diseases would be relatively uniform and essentially independent of the nature of the disease. With this in mind, we examined the pattern of respiratory-muscle activation in a group of patients with thoracic scoliosis. Such pa-
2 Estenne, Derom, and De Troyer: Respiratory Muscle Activity in Scoliosis 453 TABLE 1 ANTHROPOMETRIC CHARACTERISTICS OF THE PATIENTS STUDIED Patient No. Age (yr) tients resemble patients with COPD in that they also breathe against an increased load and have impaired diaphragmatic function (9). However, whereas COPD is primarily characterized by increased airflow resistance and hyperinflation, patients with scoliosis have a severe restrictive ventilatory impairment, with marked reductions in lung and chest-wall compliance. METHODS Sex Weight (kg) Height (cm)* Cobb angle (degrees) Origin of Scoliosis 1 43 M Congenital 2 47 M Idiopathic 3 47 F Traumatic 4 37 F Congenital 5 48 M Traumatic 6 60 M Idiopathic 7 56 M Traumatic 8 48 F Idiopathic * Values for height were corrected from arm span (10). The study was performed with eight patients (five men and three women) who were 37 to 60 yr of age (mean SD: yr) and had severe thoracic scoliosis. Their principal anthropometric characteristics are listed in Table 1. The scoliosis was congenital in two patients, idiopathic in three patients, and traumatic in three others; no patient, therefore, had any neuromuscular disease. Because the deformity in one patient was exclusively in the sagittal plane, the Lipmann Cobb angle could be measured on anteroposterior (AP) chest X-ray films in only seven patients; in all of these, this angle was 100 or greater. Four patients were treated with nocturnal assisted ventilation, either noninvasively (Patients 2 and 4) or through a tracheostomy (Patients 3 and 8), and one patient (Patient 1) had undergone corrective surgery by the Harrington instrumentation method. All patients gave verbal informed consent to the study procedures as approved by the human studies committee of our institution. Although all patients had been in a clinically stable condition for at least 4 wk before the study, they had a severe restrictive ventilatory defect. As shown in Table 2, their vital capacity (VC) and plethysmographic total lung capacity (TLC) were reduced to % (mean SD) and % of the predicted values (10), as calculated for body height corrected from arm span (11). The patients functional residual capacity (FRC) and residual volume (RV) were also decreased to % and %, respectively of the predicted values. Their Pa O2 during breathing of room air ranged from 48 to 75 mm Hg, and their Pa CO2 was between 40 and 67 mm Hg. Maximal inspiratory mouth pressure (PI max ) measured during maximal static inspiratory efforts at FRC ranged from 38 to 60 cm H 2 O, which corresponded to 61.1% to 91.6% of the predicted normal value (12). All subjects were studied while seated in a comfortable highbacked armchair. Airflow was measured with a heated Fleisch pneumotachograph connected to a Validyne differential pressure transducer (Validyne Corp., Northridge, CA), and volume was obtained by electrical integration of the flow signal. After all garments were removed, a pair of linearized magnetometers (N.H. Peterson, Boston, MA) was attached to the midline 2 cm above the umbilicus to measure the respiratory changes in the AP diameter of the abdomen. Esophageal (Pes) and gastric (Pga) pressures were measured with conventional balloon-catheter systems placed in the midesophagus and the stomach, respectively; the esophageal balloon was filled with 0.5 ml of air and the gastric balloon contained 2.0 ml of air. The transdiaphragmatic pressure (Pdi Pga Pes) generated during maximum sniffs at FRC was measured in four patients (Patients 1 and 4 to 6), and the values ranged between 49 cm H 2 O and 66 cm H 2 O (normal values 90 cm H 2 O [13]). When the magnetometers and balloon-catheter systems were in place, concentric needle electrodes were implanted into the sternocleidomastoid muscle, midway between the angle of the jaw and the clavicle, and into the scalene muscle, 0.5 to 1.0 cm above the clavicle, just behind the clavicular fibers of the sternocleidomastoid. The side selected for investigation was usually the one on which the distance between the angle of the jaw and the clavicle was the largest (making the muscles more accessible), but in two patients, recordings of sternocleidomastoid and scalene electromyographic activity were obtained on both sides of the neck. Concentric needle electrodes were also inserted in the rectus abdominis, external oblique, and transversus abdominis muscles with the aid of a high-resolution, 5-MHz linear ultrasound probe (Acuson 128 computed sonography system; Acuson, Inc., Mountain View, CA). This technique has previously been described in detail (14). The probe was first placed 2 to 3 cm above the umbilicus, 2 to 3 cm from the midline, to insert an electrode into the rectus abdominis muscle. When this electrode was in place, the probe was moved to the right or left anterior axillary line to locate and visualize the three muscle layers of the lateral abdomen. Under continuous sonographic monitoring, two electrodes were then inserted perpendicular to the skin, 2 to 3 cm apart, and advanced progressively until their tips were embedded in the external oblique and transversus abdominis muscles, respectively. All electromyographic signals were processed with amplifiers (PA 63; Medelec, Surrey, UK), and filtered below 80 Hz and above 800 Hz. None of the patients suffered discomfort attributable to the needles. The patients were nevertheless allowed to recover for 10 to 15 TABLE 2 FUNCTIONAL CHARACTERISTICS OF THE PATIENTS STUDIED Patient No. VC TLC FRC RV PI max Pa O2 L %pred L %pred L %pred L %pred cm H 2 O %pred (mm Hg) Pa CO 2 (mm Hg) Mean SD Definition of abbreviations: FRC functional residual capacity; Pa CO 2 arterial partial pressure of carbon dioxide; Pa O2 arterial partial pressure of oxygen measured at rest during room-air breathing; PI max maximal static inspiratory mouth pressure measured at FRC; RV residual volume; TLC total lung capacity; VC vital capacity. Predicted values for lung volumes were derived from the ECCS Working Party regression equations (10) according to the subjects body height corrected from arm span (11).
3 454 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL TABLE 3 NECK AND ABDOMINAL MUSCLE ACTIVITY IN THE PATIENTS STUDIED Patient No. SCA SM RA EO TA End-expiratory Pga (cm H 2 O) 1 P I I P P P I I P I P P I P P I I P I I P P I I P P I P Definition of abbreviations: EO external oblique; I intermittent phasic inspiratory or expiratory activity; P permanent phasic inspiratory (for SCA and SM) or expiratory (for RA, EO, and TA) activity; Pga end-expiratory gastric pressure is the difference between expiration and the initial part of inspiration; RA rectus abdominis; SCA scalene; SM sternocleidomastoid; (dash) absence of electrical activity. min after instrumentation so that variations in their breathing patterns could stabilize. The respiratory changes in abdominal AP diameter, Pes, Pga, and electromyographic activity during resting breathing were then recorded for 3 to 4 min. The patient was subsequently connected to the mouthpiece assembly, and another set of measurements was obtained. The patient was then engaged in a quiet conversation in the hope that his or her attention would be diverted from the study. He or she was then asked to remain silent for 2 to 3 min, after which another period of resting breathing was recorded. At least five periods with and five periods without the mouthpiece were recorded for each subject. Tidal volume (VT), breathing frequency (f), inspiratory duration (TI), inspiratory duty cycle (TI/Ttot), and dynamic pulmonary compliance (Cdyn) were averaged over at least 10 consecutive breaths from each run, and the results were compared with the predicted normal values reported by Sorli and colleagues (15). In addition, the change in Pga resulting from contraction of the abdominal muscles during expiration was assessed by measuring the pressure difference between expiration and the initial part of inspiration, as described in our previous study (5). The respiratory changes in Pga and abdominal AP diameter were also displayed as X Y plots on a Tektronix 5111 storage oscilloscope (Tektronix Corp., Beaverton, OR) and photographed with a Polaroid camera. RESULTS Pattern of Breathing and Pulmonary Compliance The patients had a rapid, shallow breathing pattern with a VT of L (mean SD) (predicted: L) and a f of min 1 (predicted: min 1 ). TI/ Ttot was within normal limits ( ) because the increased f resulted from a proportional decrease in TI ( s) and Te ( s). However, Cdyn was markedly reduced, and amounted to L/cm H 2 O. Neck Muscle Activity The electromyographic data obtained from the eight patients are summarized in Table 3. When breathing at rest, all patients invariably had phasic inspiratory activity in the scalene muscles. As shown by the records of two representative patients in Figure 1, this activity started together with the onset of inspiration, involved many motor units, and reached its Figure 1. Records of Pes, abdominal AP diameter (increase upward), and electromyographic activity of the scalene (SCA) and sternocleidomastoid (SM) muscles during unencumbered breathing in Patient 8 (top panel) and Patient 4 (bottom panel).
4 Estenne, Derom, and De Troyer: Respiratory Muscle Activity in Scoliosis 455 Figure 2. Records of Pes, Pga, abdominal AP diameter, and electromyographic activity of the transversus abdominis (TA), rectus abdominis (RA), and external oblique (EO) muscles obtained in Patient 8 during breathing on the mouthpiece. peak at the end of inspiration. In contrast, only one patient showed a similar pattern in the sternocleidomastoid muscles (Figure 1, top). Indeed, four patients did not show any electromyographic activity at all in the sternocleidomastoids during breathing (Figure 1, bottom), and although some inspiratory electromyographic activity was detected in the other three patients, this activity was intermittent, being present only when the patient was connected to the mouthpiece assembly. Even then, sternocleidomastoid activity consisted of only a few discharges originating from one or two motor units. No difference was seen between the right and left side of the neck in the two patients studied. Abdominal Muscle Activity The rectus abdominis and external oblique muscles were electrically silent throughout the study in four patients (Table 3). Intermittent phasic expiratory activity was detected in the rectus abdominis in four patients and in the external oblique in three patients; only one patient showed invariable phasic expiratory activity in the external oblique. On the other hand, five patients had invariable phasic expiratory activity in the transversus abdominis. As illustrated by the records of one representative patient in Figure 2, this activity persisted throughout the expiratory phase of the breathing cycle, and involved many motor units, and was detected whether the patient was breathing freely or through the mouthpiece, although it tended to increase in magnitude in the latter condition. The other three patients also showed phasic expiratory activity in the transversus abdominis, but only after introduction of the mouthpiece. Gastric Pressure and Abdominal Motion Most patients showed an increase in Pga during expiration (Table 3), and Figure 3 shows plots of abdominal AP diameter versus Pga during resting breathing in two patients. In Patient 7 (left panel), the abdominal muscles were electrically silent during unencumbered breathing, and the increase in Pga during inspiration was associated with an increase in abdominal AP diameter, whereas the decrease in Pga during expiration occurred together with a decrease in abdominal AP diameter. Patients 2 and 5 behaved similarly. In contrast, Patient 8 had clear-cut phasic expiratory activity in the transversus (Table 3), and most of the increase in Pga occurred during the expiratory, rather than during the inspiratory, phase of the breathing cycle. As a result, the plot of abdominal AP diameter versus Pga had a figure-eight pattern (Figure 3, right panel). A qualitatively similar pattern was seen in Patients 2, 5, and 7 when they were connected to the mouthpiece, and in the other five patients irrespective of the presence or absence of the mouthpiece. Although these plots reflected well the pattern of abdominal muscle activity, they were not related to the severity of the patients thoracic deformity. DISCUSSION All patients in this study had a severe thoracic deformity, and in the seven patients in whom it could be measured, the Cobb angle was 100 or greater. In addition, the patients had a marked restrictive ventilatory impairment, with an important reduction in dynamic pulmonary compliance and a rapid, shallow breathing pattern. Even though none of the patients had Figure 3. Plots of the respiratory changes in abdominal AP diameter versus Pga in Patient 7 (left panel) and Patient 8 (right panel). In each panel, the open circle corresponds to end-expiration; the arrow indicates the direction of the loop and marks the inspiratory phase of the breathing cycle. Calibration on Pga 5 cm H 2 O.
5 456 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL any neuromuscular disease, values of maximum static inspiratory pressures and sniff Pdi were moderately reduced. Six patients also had chronic hypercapnia, and four of them were treated with nocturnal assisted ventilation. These patients therefore had the clinical and functional characteristics of patients with advanced thoracic scoliosis (9, 16 20). Previous electromyographic studies have shown that there is a marked difference in the recruitment of the scalene and sternocleidomastoid muscles in humans. Campbell (21) first reported that normal subjects breathing at rest frequently use the scalene but not the sternocleidomastoids during inspiration. Delhez (22) and Raper and colleagues (23) have also shown that the scalenes are active during eupnea in virtually all healthy individuals, whereas the sternocleidomastoids are invariably silent. In fact the sternocleidomastoids were recruited only at the end of a maximal inspiration and during maximal voluntary ventilation (22, 23). More recent studies with a group of 40 stable patients with severe COPD have shown a similar difference; all patients had strong phasic inspiratory activity in the scalenes during resting breathing, but only four also had inspiratory activity in the sternocleidomastoids (1). On the basis of these observations, one would thus conclude that the threshold of activation of the sternocleidomastoids in humans is much higher than that of the scalenes, and one would therefore speculate that patients with chronic restrictive ventilatory disorders, including patients with thoracic scoliosis, would also recruit the scalenes much earlier than the sternocleidomastoids. As shown in Figure 1, this is exactly what we observed; whereas all patients had high-amplitude phasic inspiratory activity in the scalenes, only one had invariable phasic inspiratory activity in the sternocleidomastoids. Although normal humans do not use the muscles of the anterolateral wall of the abdomen during resting breathing, these muscles also show differences in their recruitment threshold. When healthy subjects increase their ventilation, such as during hyperoxic hypercapnia, they recruit the transversus abdominis during expiration well before activity can be recorded from the rectus abdominis or external oblique (14, 24). Expiratory activation of the transversus abdominis with little or no activity in the rectus or the external oblique also occurs when normal subjects breathe against increased inspiratory mechanical loads (14). In the absence of expiratory flow limitation, contracting the transversus abdominis during expiration is an appropriate response to these challenges because the associated reduction in end-expiratory lung volume allows the increased work of breathing to be shared between the inspiratory and expiratory muscles. However, many patients with severe COPD also show isolated contraction of the transversus abdominis during expiration (4, 5). Because such patients are flowlimited at rest (8), this contraction is unlikely to have a significant impact on expiratory flow and end-expiratory lung volume (4). Thus, the transversus abdominis has a lower threshold of activation than the rectus or the external oblique in humans, and its recruitment during expiration appears to be independent of its potential benefit to the act of breathing. As for the inspiratory muscles of the neck, the observed behavior of the abdominal muscles in the patients in the present study agreed well with this conclusion. Indeed, many patients showed phasic expiratory activity in the transversus abdominis without any activity in the rectus and external oblique (Figure 2), and this contraction was mechanically significant, since the decrease in abdominal AP diameter during expiration was commonly associated with an increase in gastric pressure (Figure 3). However, because of their thoracic deformity, patients with severe thoracic scoliosis have a marked reduction in FRC and a small expiratory reserve volume; this volume was only 0.24 L for the eight patients in this study. In addition, the restrictive ventilatory impairment in these patients is such that their breathing frequency is markedly increased and their expiratory time substantially reduced. Consequently, the expiratory branch of the tidal flow volume loop in such patients is very close to, or superimposed on, the maximal flow volume curve, and there is little or no possibility of increasing expiratory flow (25) and reducing the end-expiratory lung volume below the neutral position of the respiratory system. In conclusion, the present study has established that the pattern of respiratory-muscle activation during resting breathing in patients with severe thoracic scoliosis is similar to that seen in normal subjects with increased ventilatory drive and in patients with advanced COPD. This pattern of activation is therefore neither load- nor disease-specific. The current observations thus provide strong support for the concept that this pattern of respiratory-muscle activation is essentially an automatic response of the central respiratory controller. References 1. De Troyer, A., R. Peche, J. C. Yernault, and M. Estenne Neck muscle activity in patients with severe chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 150: Gandevia, S. C., J. B. Leeper, D. K. McKenzie, and A. De Troyer Discharge frequencies of parasternal intercostal and scalene motor units during breathing in normal and COPD subjects. Am. J. Respir. Crit. Care Med. 153: De Troyer, A., J. B. Leeper, D. K. McKenzie, and S. C. Gandevia Neural drive to the diaphragm in patients with severe COPD. Am. J. Respir. Crit. Care Med. 155: Ninane, V., F. Rypens, J. C. Yernault, and A. De Troyer Abdominal muscle use during breathing in patients with chronic airflow obstruction. Am. J. Respir. Crit. Care Med. 146: Ninane, V., J. C. Yernault, and A. De Troyer Intrinsic PEEP in patients with chronic obstructive pulmonary disease: role of expiratory muscles. Am. J. Respir. Crit. Care Med. 148: Sharp, J. T., G. A. T. Beard, M. Sunga, T. W. Kim, A. Modh, J. Lind, and J. Walsh The rib cage in normal and emphysematous subjects: a roentgenographic approach. J. Appl. Physiol. 61: Sharp, J. T., N. B. Goldberg, W. S. Druz, H. Fishman, and J. Danon Thoracoabdominal motion in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 115: O Donnel, D. E., R. Sanii, N. R. Anthonisen, and M. Younes Effect of dynamic airway compression on breathing pattern and respiratory sensation in severe chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 135: Lisboa, C., R. Moreno, M. Fava, R. Ferretti, and E. Cruz Inspiratory muscle function in patients with severe kyphoscoliosis. Am. Rev. Respir. Dis. 132: Quanjer, P., G. J. Tammeling, J. E. Cotes, O. F. Pedersen, R. Peslin, and J. C. Yernault Lung volumes and forced ventilatory flows: report on the working party standardization of lung function tests. European Coal and Steel Community. Eur. Respir. J. 6(Suppl. 16): Hepper, N. G. G., L. F. Black, and W. S. Fowler Relationship of lung volume to height and arm span in normal subjects and patients with spinal deformity. Am. Rev. Respir. Dis. 91: Chen, H. I., and C. S. Kuo Relationship between respiratory muscle function and age, sex, and other factors. J. Appl. Physiol. 66: Polkey, M. I., M. L. Harris, P. D. Hughes, C.-H. Hamnegard, D. Lyons, M. Green, and J. Moxham The contractile properties of the elderly human diaphragm. Am. J. Respir. Crit. Care Med. 155: De Troyer, A., M. Estenne, V. Ninane, D. Van Gansbeke, and M. Gorini Transversus abdominis muscle function in humans. J. Appl. Physiol. 68: Sorli, J., A. Grassino, G. Lorange, and J. Milic-Emili Control of breathing in patients with chronic obstructive lung disease. Clin. Sci. Mol. Med. 54: Caro, C. G., and A. B. Dubois Pulmonary function in kyphoscoliosis. Thorax 16: Ting, E. Y., and H. A. Lyons The relation of pressure and volume of the total respiratory system and its components in kyphoscoliosis. Am. Rev. Respir. Dis. 89:
6 Estenne, Derom, and De Troyer: Respiratory Muscle Activity in Scoliosis Sinha, R., and E. H. Bergofsky Prolonged alteration of lung mechanics in kyphoscoliosis by positive pressure hyperinflation. Am. Rev. Respir. Dis. 106: Kafer, E. R Idiopathic scoliosis: mechanical properties of the respiratory system and the ventilatory response to carbon dioxide. J. Clin. Invest. 55: Kearon, C., G. R. Viviani, and K. J. Killian Factors influencing work capacity in adolescent idiopathic thoracic scoliosis. Am. Rev. Respir. Dis. 148: Campbell, E. J. M The role of the scalene and sternomastoid muscles during breathing in normal subjects: an electromyographic study. J. Anat. (Lond.) 89: Delhez, L Contribution Électromyographique à l Étude de la Mécanique et du Contrôle des Mouvements Respiratoires de l Homme. Vaillant-Carmanne, Liège, Belgium. 23. Raper, A. J., W. T. Thompson, Jr., W. Shapiro, and J. L. Patterson, Jr Scalene and sternomastoid muscle function. J. Appl. Physiol. 21: Abe, T., N. Kusuhara, N. Yoshimura, T. Tomita, and P. A. Easton Differential respiratory activity of four abdominal muscles in humans. J. Appl. Physiol. 80: Milic-Emili, J Respiratory mechanics in chest wall disease: implication for expiratory flow limitation during resting breathing. Monaldi Arch. Chest Dis. 48:80 82.
Nasal CPAP, Abdominal muscles, Posture, Diagnostic ultrasound, Electromyogram
Nasal CPAP, Abdominal muscles, Posture, Diagnostic ultrasound, Electromyogram Fig. 1 EMG recordings of activity of four abdominal muscles in a subject on continuous positive airway pressure in supine and
More informationExpiratory muscle pressure and breathing mechanics in chronic obstructive pulmonary disease
Eur Respir J 2; 16: 684±69 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 2 European Respiratory Journal ISSN 93-1936 Expiratory muscle pressure and breathing mechanics in chronic obstructive
More informationDistribution of inspiratory drive to the external intercostal muscles in humans
J Physiol (2003), 546.3, pp. 943 954 DOI: 10.1113/jphysiol.2002.028696 The Physiological Society 2002 www.jphysiol.org Distribution of inspiratory drive to the external intercostal muscles in humans André
More informationRespiratory effects of the scalene and sternomastoid muscles in humans
J Appl Physiol 94: 1467 1472, 2003; 10.1152/japplphysiol.00869.2002. Respiratory effects of the scalene and sternomastoid muscles in humans Alexandre Legrand, Emmanuelle Schneider, Pierre-Alain Gevenois,
More informationMechanical contribution of expiratory muscles to pressure generation during spinal cord stimulation
Mechanical contribution of expiratory muscles to pressure generation during spinal cord stimulation A. F. DIMARCO, J. R. ROMANIUK, K. E. KOWALSKI, AND G. SUPINSKI Pulmonary Division, Department of Medicine,
More informationDifferential Inspiratory Muscle Pressure Contributions to Breathing during Dynamic Hyperinflation
Differential Inspiratory Muscle Pressure Contributions to Breathing during Dynamic Hyperinflation SHENG YAN and BENGT KAYSER Montréal Chest Institute, Royal Victoria Hospital, Meakins-Christie Laboratories,
More informationG. Misuri*, S. Colagrande**, M. Gorini +, I. Iandelli ++, M. Mancini ++, R. Duranti ++, G. Scano ++
Eur Respir J 1997; : 2861 2867 DOI:.1183/931936.97.122861 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 93-1936 In vivo ultrasound assessment of
More informationDifference between functional residual capacity and elastic equilibrium volume in patients with chronic obstructive pulmonary disease
Thorax 1996;51:415-419 Osler Chest Unit, Churchill Hospital, Oxford OX3 7LJ, UK M J Morris R G Madgwick D J Lane Correspondence to: Dr J Morris. Received 18 April 1995 Returned to authors 21 July 1995
More informationEffect of bronchoscopic lung volume reduction on dynamic hyperinflation and
Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema Nicholas S Hopkinson, Tudor P Toma, David M Hansell, Peter Goldstraw, John Moxham, Duncan M Geddes & Michael
More informationC-H. Hamnegård*, S. Wragg**, G. Mills +, D. Kyroussis +, J. Road +, G. Daskos +, B. Bake ++, J. Moxham**, M. Green +
Eur Respir J, 1995, 8, 153 1536 DOI: 1.1183/931936.95.89153 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1995 European Respiratory Journal ISSN 93-1936 The effect of lung volume on transdiaphragmatic
More informationAbdominal wall movement in normals and patients with hemidiaphragmatic and bilateral diaphragmatic palsy
Thorax, 1977, 32, 589-595 Abdominal wall movement in normals and patients with hemidiaphragmatic and bilateral diaphragmatic palsy TIM HIGNBOTTAM, DAV ALLN, L. LOH, AND T. J. H. CLARK From Guy's Hospital
More informationEffects of inflation on the coupling between the ribs and the lung in dogs
J Physiol 555.2 pp 481 488 481 Effects of inflation on the coupling between the ribs and the lung in dogs AndréDeTroyer 1,2 and Dimitri Leduc 1,3 1 Laboratory of Cardiorespiratory Physiology, Brussels
More informationMouth occlusion pressure, CO 2 response and hypercapnia in severe chronic obstructive pulmonary disease
Eur Respir J 1998; 12: 666 671 DOI: 1.1183/931936.98.123666 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 93-1936 Mouth occlusion pressure, CO 2
More informationNEUROMUSCULAR DISEASE can disproportionately affect
123 in Lung Volumes in the Assessment of Diaphragmatic Weakness in Neuromuscular Disorders Claudine Fromageot, MD, Frédéric Lofaso, MD, PhD, Djillali Annane, MD, PhD, Line Falaize, Michèle Lejaille, Bernard
More informationDeterminants of Rib Motion in Flail Chest
Determinants of Rib Motion in Flail Chest MATTEO CAPPELLO, ALEXANDRE LEGRAND, and ANDRÉ DE TROYER Laboratory of Cardiorespiratory Physiology, Brussels School of Medicine, and Departments of Chest Medicine
More informationThoracoabdominal mechanics during tidal breathing in normal subjects and in emphysema and fibrosing alveolitis
Thorax 1983;38:62-66 Thoracoabdominal mechanics during tidal breathing in normal subjects and in emphysema and fibrosing alveolitis NJ BRENNAN, AJR MORRIS, MALCOLM GREEN From Brompton Hospital, London
More informationTeacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology
Title: Spirometry Teacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology I. Measurements of Ventilation Spirometry A. Pulmonary Volumes 1. The tidal
More informationSniff nasal inspiratory pressure in patients with chronic obstructive pulmonary disease
Eur Respir J 1997; 1: 1292 1296 DOI: 1.1183/931936.97.161292 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 93-1936 Sniff nasal inspiratory pressure
More informationLung elastic recoil during breathing at increased lung volume
Lung elastic recoil during breathing at increased lung volume JOSEPH R. RODARTE, 1 GASSAN NOREDIN, 1 CHARLES MILLER, 1 VITO BRUSASCO, 2 AND RICCARDO PELLEGRINO 3 (With the Technical Assistance of Todd
More informationLung elastic recoil during breathing at increased lung volume
Lung elastic recoil during breathing at increased lung volume JOSEPH R. RODARTE, 1 GASSAN NOREDIN, 1 CHARLES MILLER, 1 VITO BRUSASCO, 2 AND RICCARDO PELLEGRINO 3 (With the Technical Assistance of Todd
More informationEffect of lung volume on the oesophageal diaphragm EMG assessed by magnetic phrenic nerve stimulation
Eur Respir J 2000; 15: 1033±1038 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 2000 European Respiratory Journal ISSN 0903-1936 Effect of lung volume on the oesophageal diaphragm EMG
More informationThe effect of lung volume on the co-ordinated recruitment of scalene and sternomastoid muscles in humans
J Physiol 584.1 (2007) pp 261 270 261 The effect of lung volume on the co-ordinated recruitment of scalene and sternomastoid muscles in humans Anna L. Hudson, Simon C. Gandevia and Jane E. Butler Prince
More informationThe canine parasternal and external intercostal muscles drive theribsdifferently
Keywords: 0088 Journal of Physiology (2000), 523.3, pp. 799 806 799 The canine parasternal and external intercostal muscles drive theribsdifferently Andr edetroyerand Theodore A. Wilson * Laboratory of
More informationKeywords: Non-invasive mechanical ventilation, Respiratory Failure, Respiratory muscles, Hypercapnia, Breathing pattern.
Monaldi Arch Chest Dis 2004; 61: 2, 81-85 ORIGINAL ARTICLE Inspiratory muscle workload due to dynamic intrinsic PEEP in stable COPD patients: effects of two different settings of non-invasive pressure-support
More informationChapter 3: Thorax. Thorax
Chapter 3: Thorax Thorax Thoracic Cage I. Thoracic Cage Osteology A. Thoracic Vertebrae Basic structure: vertebral body, pedicles, laminae, spinous processes and transverse processes Natural kyphotic shape,
More informationDifference Between The Slow Vital Capacity And Forced Vital Capacity: Predictor Of Hyperinflation In Patients With Airflow Obstruction
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 4 Number 2 Difference Between The Slow Vital Capacity And Forced Vital Capacity: Predictor Of Hyperinflation In Patients With Airflow Obstruction
More informationMonitoring Neural Output
Monitoring Neural Output Christer Sinderby Department of Critical Care & Keenan Research Center for Biomedical Science of St. Michael's Hospital Interdepartmental division of Critical Care Medicine, University
More informationDiaphragm Activation during Exercise in Chronic Obstructive Pulmonary Disease
Diaphragm Activation during Exercise in Chronic Obstructive Pulmonary Disease CHRISTER SINDERBY, JADRANKA SPAHIJA, JENNIFER BECK, DAREK KAMINSKI, SHENG YAN, NORMAN COMTOIS, and PAWEL SLIWINSKI Guy-Bernier
More informationRelationship between transdiaphragmatic and mouth twitch pressures at functional residual capacity
Eur Respir J 1997; 1: 53 536 DOI: 1.1183/931936.97.1353 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 93-1936 Relationship between transdiaphragmatic
More informationEffect of Surgical Lung Volume Reduction on Breathing Patterns in Severe Pulmonary Emphysema
Effect of Surgical Lung Volume Reduction on Breathing Patterns in Severe Pulmonary Emphysema KONRAD E. BLOCH, YIMING LI, JINNONG ZHANG, ROLAND BINGISSER, VLADIMIR KAPLAN, WALTER WEDER, and ERICH W. RUSSI
More informationPulmonary Functions and Effect of Incentive Spirometry During Acute and Post Acute Period in Tetraplegia
IJPMR 13, April 2002; 28-34 Pulmonary Functions and Effect of Incentive Spirometry During Acute and Post Acute Period in Tetraplegia Dr M Joshi, M.D., Research Associate Dr N Mathur, M.S., DNB, Associate
More informationNeural respiratory drive, pulmonary mechanics and breathlessness in patients with cystic fibrosis
< Additional data are published online only. To view these files please visit the journal online (http://thorax.bmj.com). 1 King s College London, Department of Asthma, Allergy and Respiratory Science,
More informationEffect of maximum ventilation on abdominal
51 Respiratory Muscle Laboratories, Royal Brompton and King's College Hospitals, London, UK D Kyroussis G H Mills M I Polkey C-H Hamnegard S Wragg J Road M Green J Moxham Correspondence to: Dr D Kyroussis,
More informationMaximal expiratory flow rates (MEFR) measured. Maximal Inspiratory Flow Rates in Patients With COPD*
Maximal Inspiratory Flow Rates in Patients With COPD* Dan Stănescu, MD, PhD; Claude Veriter, MA; and Karel P. Van de Woestijne, MD, PhD Objectives: To assess the relevance of maximal inspiratory flow rates
More informationSpirometry: an essential clinical measurement
Shortness of breath THEME Spirometry: an essential clinical measurement BACKGROUND Respiratory disease is common and amenable to early detection and management in the primary care setting. Spirometric
More informationThe calcium sensitizer levosimendan improves human diaphragm function
The calcium sensitizer levosimendan improves human diaphragm function Jonne Doorduin, Christer A Sinderby, Jennifer Beck, Dick F Stegeman, Hieronymus WH van Hees, Johannes G van der Hoeven, and Leo MA
More informationExpiratory muscle activity and nasal expiratory pressure during reverse sniff
Original Contribution Kitasato Med J 2015; 45: 53-61 Expiratory muscle activity and nasal expiratory pressure during reverse sniff Tsuyoshi Ichikawa, 1,5 Masanori Yokoba, 1,2 Naohito Ishii, 1,2 Akira Takakura,
More informationFunctional Magnetic Stimulation of the Abdominal Muscles in Humans
Functional Magnetic Stimulation of the Abdominal Muscles in Humans MICHAEL I. POLKEY, YUANMING LUO, RANDEEP GULERIA, CARL-HUGO HAMNEGÅRD, MALCOLM GREEN, and JOHN MOXHAM Respiratory Muscle Laboratory, King
More informationRole of inspiratory capacity on exercise tolerance in COPD patients with and without tidal expiratory flow limitation at rest
Eur Respir J 2; 16: 269±275 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 2 European Respiratory Journal ISSN 93-1936 Role of inspiratory capacity on exercise tolerance in COPD patients
More information? Pulmonary Respiratory System
The Structure of The Respiratory System The respiratory system is composed of groups of organelles that filters and transports air into the lungs. The organs comprising of the respiratory system include
More informationRespiratory function of the rib cage muscles
Eur Respir J, 1993, 6, 722-728 Printed In UK all rights reserved Copyright @ERS Journals Ltd 1993 European Respiratory Journal ISSN 0903 1936 REVIEW Respiratory function of the rib cage muscles J.N. Han,
More informationNeurally-adjusted Ventilatory Assist
Neurally-adjusted Ventilatory Assist C. Sinderby, J. Spahija, and J. Beck Introduction In today s commercially available mechanical ventilators, the systems for controlling the assist are almost exclusively
More informationOptoelectronic plethysmography demonstrates abrogation of regional chest wall motion dysfunction in patients with pectus excavatum after Nuss repair
Journal of Pediatric Surgery (2012) 47, 160 164 www.elsevier.com/locate/jpedsurg Optoelectronic plethysmography demonstrates abrogation of regional chest wall motion dysfunction in patients with pectus
More informationPULMONARY FUNCTION. VOLUMES AND CAPACITIES
PULMONARY FUNCTION. VOLUMES AND CAPACITIES The volume of air a person inhales (inspires) and exhales (expires) can be measured with a spirometer (spiro = breath, meter = to measure). A bell spirometer
More informationAssessment of Abdominal Muscle Contractility, Strength, and Fatigue
Assessment of Abdominal Muscle Contractility, Strength, and Fatigue JUNICHI SUZUKI, RYOICHI TANAKA, SHENG YAN, RONCHANG CHEN, PETER T. MACKLEM, and BENGT KAYSER Meakins-Christie Laboratories, Montreal
More informationJournal Club American Journal of Respiratory and Critical Care Medicine. Zhang Junyi
Journal Club 2018 American Journal of Respiratory and Critical Care Medicine Zhang Junyi 2018.11.23 Background Mechanical Ventilation A life-saving technique used worldwide 15 million patients annually
More informationa central pulse located at the apex of the heart Apical pulse Apical-radial pulse a complete absence of respirations Apnea
Afebrile absence of a fever Apical pulse a central pulse located at the apex of the heart Apical-radial pulse measurement of the apical beat and the radial pulse at the same time Apnea a complete absence
More informationBreathing and pulmonary function
EXPERIMENTAL PHYSIOLOGY EXPERIMENT 5 Breathing and pulmonary function Ying-ying Chen, PhD Dept. of Physiology, Zhejiang University School of Medicine bchenyy@zju.edu.cn Breathing Exercise 1: Tests of pulmonary
More informationCERVICAL SPINE TIPS A
CERVICAL SPINE TIPS A Musculoskeletal Approach to managing Neck Pain An ALGORITHM, as a management guide Rick Bernau & Ian Wallbridge June 2010 THE PROCESS An interactive approach to the management of
More informationEffect of salbutamol on dynamic hyperinflation in chronic obstructive pulmonary disease patients
Eur Respir J 1998; 12: 799 84 DOI: 1.1183/931936.98.124799 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 93-1936 Effect of salbutamol on dynamic
More informationSydney, Australia diaphragm fully at functional residual capacity as judged by the failure of stimuli
Journal of Physiology (1990), 428, pp. 387-403 387 With 8 figures Printed in Great Britain ACTIVATION OF HUMAN RESPIRATORY MUSCLES DURING DIFFERENT VOLUNTARY MANOEUVRES BY S. C. GANDEVIA, D. K. McKENZIE
More informationLIVING ANATOMY: IMPLICATIONS OF RESPIRATION CONVOCATION MARCH 16, 2019 PAMELA L. WILSON, D.O.
LIVING ANATOMY: IMPLICATIONS OF RESPIRATION CONVOCATION MARCH 16, 2019 PAMELA L. WILSON, D.O. I believe you are taught anatomy in our school more thoroughly than any other school to date, because we want
More informationTwitch pressures in the assessment of diaphragm weakness
Thorax 1989;44:99-996 Twitch pressures in the assessment of diaphragm weakness ANNE MIER, CONOR BROPHY, JOHN MOXHAM, MALCOLM GREEN From the Department of Respiratory Muscle Physiology, Brompton Hospital,
More informationPulmonary Function Testing. Ramez Sunna MD, FCCP
Pulmonary Function Testing Ramez Sunna MD, FCCP Lecture Overview General Introduction Indications and Uses Technical aspects Interpretation Patterns of Abnormalities When to perform a PFT 1. Evaluation
More informationAssessment of Respiratory Muscles in Children with SMA. Greg Redding, MD Pulmonary and Sleep Medicine Seattle Children s Hospital
Assessment of Respiratory Muscles in Children with SMA Greg Redding, MD Pulmonary and Sleep Medicine Seattle Children s Hospital Disclosures Pediatric Pulmonary Section Editor, UpToDate Inspiratory Respiratory
More informationPULMONARY FUNCTION TESTING. Purposes of Pulmonary Tests. General Categories of Lung Diseases. Types of PF Tests
PULMONARY FUNCTION TESTING Wyka Chapter 13 Various AARC Clinical Practice Guidelines Purposes of Pulmonary Tests Is lung disease present? If so, is it reversible? If so, what type of lung disease is present?
More informationThe respiratory system
The respiratory system Practical 1 Objectives Respiration, ventilation Intrapleural and intrapulmonary pressure Mechanism of inspiration and expiration Composition of the atmosphere and the expired air
More informationOptimal electrode placement for non-invasive electrical stimulation of human abdominal muscles
Page 1 of 22 Articles in PresS. J Appl Physiol (December 21, 2006). doi:10.1152/japplphysiol.00865.2006 Optimal electrode placement for non-invasive electrical stimulation of human abdominal muscles Julianne
More informationJadranka Spahija, PhD; Michel de Marchie, MD; and Alejandro Grassino, MD
Effects of Imposed Pursed-Lips Breathing on Respiratory Mechanics and Dyspnea at Rest and During Exercise in COPD* Jadranka Spahija, PhD; Michel de Marchie, MD; and Alejandro Grassino, MD Study objectives:
More informationIn normal subjects bracing impairs the function of the inspiratory muscles
Eur Respir J 1999; 13: 178±185 Printed in UK ± all rights reserved Copyright #ERS Journals td 1999 European Respiratory Journal ISSN 93-1936 In normal subjects bracing impairs the function of the inspiratory
More informationI n critically ill patients the assessment of inspiratory muscle
8 RESPIRATORY MUSCLES Can diaphragmatic contractility be assessed by airway twitch pressure in mechanically ventilated patients? S E Cattapan, F Laghi, M J Tobin... See end of article for authors affiliations...
More informationThe Respiratory System
C h a p t e r 24 The Respiratory System PowerPoint Lecture Slides prepared by Jason LaPres North Harris College Houston, Texas Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
More informationPhysiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?
Eur Respir J 1999; 13: 686±696 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 0903-1936 SERIES `LUNG VOLUME REDUCTION SURGERY' EditedbyE.RussiandW.Weder
More informationEffect of hyperinflation on the diaphragm
Eur Respir J 1997; 10: 708 713 DOI: 10.1183/09031936.97.10030708 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 0903-1936 SERIES 'LUNG HYPERINFLATION
More informationAssessing Inspiratory Muscle Strength in Patients With Neurologic and Neuromuscular Diseases* Comparative Evaluation of Two Noninvasive Techniques
Assessing Inspiratory Muscle Strength in Patients With Neurologic and Neuromuscular Diseases* Comparative Evaluation of Two Noninvasive Techniques Iacopo Iandelli, MD; Massimo Gorini, MD; Gianni Misuri,
More information#7 - Respiratory System
#7 - Respiratory System Objectives: Study the parts of the respiratory system Observe slides of the lung and trachea Perform spirometry to measure lung volumes Define and understand the lung volumes and
More informationCurvature of the spine is said to occur in
Influence of spinal deformity on pulmonary function, arterial blood gas values, and exercise capacity in thoracic kyphoscoliosis Balakrishnan Menon, MD, Bhumika Aggarwal, DTCD. ABSTRACT Objective: To evaluate
More informationResearch Journal of Pharmaceutical, Biological and Chemical Sciences
Research Journal of Pharmaceutical, Biological and Chemical Sciences Pre morbid Severity of Chronic Obstructive Pulmonary Disease as Risk Factor for Carbon dioxide Retention during Acute Exacerbation of
More informationExercise 7: Respiratory System Mechanics: Activity 1: Measuring Respiratory Volumes and Calculating Capacities Lab Report
Exercise 7: Respiratory System Mechanics: Activity 1: Measuring Respiratory Volumes and Calculating Capacities Lab Report Pre-lab Quiz Results You scored 100% by answering 5 out of 5 questions correctly.
More informationRespiratory Physiology
Respiratory Physiology Dr. Aida Korish Associate Prof. Physiology KSU The main goal of respiration is to 1-Provide oxygen to tissues 2- Remove CO2 from the body. Respiratory system consists of: Passages
More informationduring resting breathing (Robertson, Foster & Johnson, 1977; De Troyer & Kelly, (Received 30 August 1990) anaesthetized, spontaneously breathing dogs.
Journal of Physiology (1991), 439, pp. 73-88 73 With 10 figures Printed in Great Britain DIFFERENTIAL CONTROL OF THE INSPIRATORY INTERCOSTAL MUSCLES DURING AIRWAY OCCLUSION IN THE DOG BY ANDRE DE TROYER
More informationEFFECTS OF OXYGEN BREATHING ON INSPIRATORY MUSCLE FATIGUE DURING RESISTIVE LOAD IN CYCLING MEN
JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2009, 60, Suppl 5, 111-115 www.jpp.krakow.pl M.O. SEGIZBAEVA, N.P. ALEKSANDROVA EFFECTS OF OXYGEN BREATHING ON INSPIRATORY MUSCLE FATIGUE DURING RESISTIVE LOAD IN
More informationLung mechanics in subjects showing increased residual volume without bronchial obstruction
Lung mechanics in subjects showing increased residual volume without bronchial obstruction S VULTERINI, M R BIANCO, L PELLICCIOTTI, AND A M SIDOTI From the Divisione di Medicina Generale, Ospedale Fatebenefratelli,
More informationThe Trunk and Spinal Column Kinesiology Cuneyt Mirzanli Istanbul Gelisim University
The Trunk and Spinal Column Kinesiology Cuneyt Mirzanli Istanbul Gelisim University The Trunk and Spinal Column Vertebral column 24 articulating vertebrae 31 pairs of spinal nerves Abdominal muscles some
More informationM.W. Elliott, A.K. Simonds
Eur Respir J, 15,, 43 44 DOI: 1.3/313.5.343 Printed in UK - all rights reserved Copyright ERS Journals Ltd 15 European Respiratory Journal ISSN 3-13 Nocturnal assisted ventilation using bilevel positive
More informationThe rib cage and abdominal components of respiratory system compliance in tetraplegic patients
Eur Respir J 1988, 1, 242-247 The rib cage and abdominal components of respiratory system compliance in tetraplegic patients J.M. Goldman*, S.J. Williams**, D.M. Denison* The rib cage and abdominal components
More informationPULMONARY FUNCTION TESTS
Chapter 4 PULMONARY FUNCTION TESTS M.G.Rajanandh, Department of Pharmacy Practice, SRM College of Pharmacy, SRM University. OBJECTIVES Review basic pulmonary anatomy and physiology. Understand the reasons
More informationFigure 1 The respiratory cycle
RESPIRATORY CYCLE Introduction Three primary functions of the respiratory system are to provide oxygen for the body's energy needs, provide an outlet for C0 2 and help maintain the ph of the blood plasma.
More informationDiaphragm Activity in
Diaphragm Activity in Obesity Ruy V. LOURENQO From the Department of Medicine, University of Illinois College of Medicine and The Hektoen Institute for Medical Research, Chicago, Illinois 668 A B S T R
More informationKrnjevic & Miledi, 1959; Naess & Storm-Mathisen, 1955) it is unlikely that such. Sydney, Australia 2036
J. Phyriol. (1985), 367, pp. 45-56 45 With 5 text-figures Printed in Great Britain ACTIVATION OF THE HUMAN DIAPHRAGM DURING MAXIMAL STATIC EFFORTS BY S. C. GANDEVIA AND D. K. McKENZIE From the Unit of
More informationCoexistence of confirmed obstruction in spirometry and restriction in body plethysmography, e.g.: COPD + pulmonary fibrosis
Volumes: IRV inspiratory reserve volume Vt tidal volume ERV expiratory reserve volume RV residual volume Marcin Grabicki Department of Pulmonology, Allergology and Respiratory Oncology Poznań University
More informationmainly due to variability of the end-inspiratory point, although subjectively
376 J. Physiol. (I950) III, 376-38I 6I2.2I7 THE NATURE OF THE LIMITATION OF MAXIMAL INSPIRATORY AND EXPIRATORY EFFORTS BY J. N. MILLS, Fellow of Jesus College, Cambridge From the Department of Physiology,
More informationE xercise limitation is a major cause of disability in
210 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Regional chest wall volumes during exercise in chronic obstructive pulmonary disease A Aliverti, N Stevenson, R L Dellacà, A Lo Mauro, A Pedotti, P M A Calverley...
More informationBiology 236 Spring 2002 Campos/Wurdak/Fahey Laboratory 4. Cardiovascular and Respiratory Adjustments to Stationary Bicycle Exercise.
BACKGROUND: Cardiovascular and Respiratory Adjustments to Stationary Bicycle Exercise. The integration of cardiovascular and respiratory adjustments occurring in response to varying levels of metabolic
More informationUse of mouth pressure twitches induced by cervical magnetic stimulation to assess voluntary activation of the diaphragm
Eur Respir J 1998; 12: 672 678 DOI: 1.1183/931936.98.13672 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 93-1936 Use of mouth pressure twitches induced
More informationEvaluation of Effect of Breathe Ventilation System on Work of Breathing in COPD patients. Matthew Cohn, M.D.
Evaluation of Effect of Breathe Ventilation System on Work of Breathing in COPD patients Matthew Cohn, M.D. 1 11/4/2013 Disclosure Slide- Matthew Cohn, M.D. Personal financial relationships with commercial
More informationRespiratory Physiology In-Lab Guide
Respiratory Physiology In-Lab Guide Read Me Study Guide Check Your Knowledge, before the Practical: 1. Understand the relationship between volume and pressure. Understand the three respiratory pressures
More information6- Lung Volumes and Pulmonary Function Tests
6- Lung Volumes and Pulmonary Function Tests s (PFTs) are noninvasive diagnostic tests that provide measurable feedback about the function of the lungs. By assessing lung volumes, capacities, rates of
More information1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation.
Chapter 1: Principles of Mechanical Ventilation TRUE/FALSE 1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. F
More informationRespiratory muscle dynamics and control during exercise with externally imposed expiratory flow limitation
J Appl Physiol 92: 1953 1963, 2002. First published February 1, 2002; 10.1152/japplphysiol.01222.2000. Respiratory muscle dynamics and control during exercise with externally imposed expiratory flow limitation
More informationbrought into action? respiratory cycle? Do they come into action early or late in expiration, or is (Received 5 December 1951)
222 J. Physiol. (I952) II7, 222-233 AN ELECTROMYOGRAPHIC STUDY OF THE ROLE OF THE ABDOMINAL MUSCLES IN BREATHING BY E. J. M. CAMPBELL From the Middlesex Hospital Medical School, London, W. 1 (Received
More informationMechanical advantage of the canine diaphragm
Mechanical advantage of the canine diaphragm THEODORE A. WILSON, 1 ALADIN M. BORIEK, 2 AND JOSEPH R. RODARTE 2 1 Department of Aerospace Engineering and Mechanics, University of Minnesota, Minneapolis,
More informationEFFECTS OF CHEST WALL CONSTRICTION ON AEROBIC CAPACITY DURING EXERCISE. A Thesis by. Kevin Lee Farmer
EFFECTS OF CHEST WALL CONSTRICTION ON AEROBIC CAPACITY DURING EXERCISE A Thesis by Kevin Lee Farmer Bachelor of Science in Education, The University of Kansas, 2003 Submitted to the College of Education
More informationRespiro: le nuove tecnologie
Dipartimento di Elettronica, Informazione e Bioingegneria Respiro: le nuove tecnologie Andrea Aliverti Respiratory function Total ventilation (O 2 consumption) alveolar ventilation diffusion/gas exchange
More informationEvaluation of two techniques for measurement of respiratory resistance by forced oscillation A study in young subjects with obstructive lung disease
Thorax (1973), 28, 136. Evaluation of two techniques for measurement of respiratory resistance by forced oscillation study in young subjects with obstructive lung disease L. I. LNDU and P. D. PHELN Clinical
More informationEfficacy of Combined Inspiratory Intercostal and Expiratory Muscle Pacing to Maintain Artificial Ventilation
Efficacy of Combined Inspiratory Intercostal and Expiratory Muscle Pacing to Maintain Artificial Ventilation ANTHONY F. DIMARCO, JAROSLAW R. ROMANIUK, KRZYSZTOF E. KOWALSKI, and GERALD S. SUPINSKI Pulmonary
More informationAnalysis of Lung Function
Computer 21 Spirometry is a valuable tool for analyzing the flow rate of air passing into and out of the lungs. Flow rates vary over the course of a respiratory cycle (a single inspiration followed by
More informationSTERNUM. Lies in the midline of the anterior chest wall It is a flat bone Divides into three parts:
STERNUM Lies in the midline of the anterior chest wall It is a flat bone Divides into three parts: 1-Manubrium sterni 2-Body of the sternum 3- Xiphoid process The body of the sternum articulates above
More informationIMMEDIATE EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) OF RESPIRATORY MUSCLES ON PULMONARY FUNCTION IN COLLEGIATE STUDENTS.
Original Research Article Allied Science International Journal of Pharma and Bio Sciences ISSN 0975-6299 IMMEDIATE EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) OF RESPIRATORY MUSCLES ON PULMONARY
More informationAnatomy of the Thorax
Anatomy of the Thorax A) THE THORACIC WALL Boundaries Posteriorly by the thoracic part of the vertebral column Anteriorly by the sternum and costal cartilages Laterally by the ribs and intercostal spaces
More information