Source: Annual Congress 2010 - Respiratory and peripheral muscles: From basic mechanisms to altered function
Disease area: Airway diseases, Respiratory critical care

Abstract

Introduction: Tetraplegic subjects (TS) show an inward motion of the ribcage (paradoxical breathing; PB) during inspiration at rest. PB has rarely been investigated during increased ventilatory demands. We hypothesized that, due to recruitment of auxiliary respiratory muscles of the neck, PB would be reduced during (sub)maximal hyperpnoea (HYP) compared to quiet breathing (QB). Methods: Chest wall kinematics were assessed by optoelectronic plethysmography (OEP) in four male TS (C4-C7, ASIA A) during QB and during HYP at 40 and 100% MVV in sitting position. OEP allows partitioning of tidal volume (V_T) into V_T,RCP (RCP = pulmonary ribcage; upper ribcage muscle action), V_T,RCA (RCA = abdominal ribcage; diaphragm action) and V_T,AB (AB = abdomen; diaphragm and abdominal muscle action). In addition to the relative compartmental contribution to V_T (ΔV), inspiratory paradox time (IPT) was calculated as the percentage of inspiratory time (T_I) with a decrease in V_RCP and/or V_RCA. Results: IPT was highest during QB for both RCP and RCA while main volume displacement was achieved by AB. In all but one subject, PB in RCP disappeared during HYP while ΔV_RCP was higher compared to QB in all subjects.

Conclusion: With increased ventilatory demands, PB is reduced in TS, likely resulting from increased activation of auxiliary respiratory muscles of the neck acting on the upper ribcage to increase V_T,RCP. Support: SNF grant no. 32-116777.

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S. K. Illi, S. Hostettler, A. Aliverti, R. Brown, G. Mueller, C. M. Spengler (Zurich, Nottwil, Switzerland; Milan, Italy; Boston, United States Of America). Chest wall kinematics in tetraplegic subjects during different ventilatory demands. Eur Respir J 2010; 36: Suppl. 54, 3409

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