Unilateral diaphragmatic paralysis: inspiratory muscles, breathlessness and exercise capacity.

Autor: Caleffi Pereira M; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Cardenas LZ; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil., Ferreira JG; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil., Iamonti VC; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Santana PV; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil., Apanavicius A; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Caruso P; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil., Fernandez A; Thoracic Surgery Division, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., de Carvalho CRR; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Langer D; Faculty of Kinesiology and Rehabilitation Sciences, Dept of Rehabilitation Sciences, Research Group for Cardiovascular and Respiratory Rehabilitation, KU Leuven - University of Leuven, and Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium., de Albuquerque ALP; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Sírio-Libanês Teaching and Research Institute, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: ERJ open research [ERJ Open Res] 2021 Feb 01; Vol. 7 (1). Date of Electronic Publication: 2021 Feb 01 (Print Publication: 2021).
DOI: 10.1183/23120541.00357-2019
Abstrakt: Background: Patients with unilateral diaphragmatic paralysis (UDP) may present with dyspnoea without specific cause and limited ability to exercise. We aimed to investigate the diaphragm contraction mechanisms and nondiaphragmatic inspiratory muscle activation during exercise in patients with UDP, compared with healthy individuals.
Methods: Pulmonary function, as well as volitional and nonvolitional inspiratory muscle strength were evaluated in 35 patients and in 20 healthy subjects. Respiratory pressures and electromyography of scalene and sternocleidomastoid muscles were continuously recorded during incremental maximal cardiopulmonary exercise testing until symptom limitation. Dyspnoea was assessed at rest, every 2 min during exercise and at the end of exercise with a modified Borg scale.
Main Results: Inspiratory muscle strength measurements were significantly lower for patients in comparison to controls (all p<0.05). Patients achieved lower peak of exercise (lower oxygen consumption) compared to controls, with both gastric (-9.8±4.6 cmH 2 O versus 8.9±6.0 cmH 2 O) and transdiaphragmatic (6.5±5.5 cmH 2 O versus 26.9±10.9 cmH 2 O) pressures significantly lower, along with larger activation of both scalene (40±22% EMGmax versus 18±14% EMGmax) and sternocleidomastoid (34±22% EMGmax versus 14±8% EMGmax). In addition, the paralysis group presented significant differences in breathing pattern during exercise (lower tidal volume and higher respiratory rate) with more dyspnoea symptoms compared to the control group.
Conclusion: The paralysis group presented with exercise limitation accompanied by impairment in transdiaphragmatic pressure generation and larger accessory inspiratory muscles activation compared to controls, thereby contributing to a neuromechanical dissociation and increased dyspnoea perception.
Competing Interests: Conflict of interest: M. Caleffi Pereira has nothing to disclose. Conflict of interest: L.Z. Cardenas has nothing to disclose. Conflict of interest: J.G. Ferreira has nothing to disclose. Conflict of interest: V.C. Iamonti has nothing to disclose. Conflict of interest: P.V. Santana has nothing to disclose Conflict of interest: A. Apanavius has nothing to disclose. Conflict of interest: P. Caruso has nothing to disclose. Conflict of interest: A. Fernandez has nothing to disclose. Conflict of interest: C.R.R. de Carvalho has nothing to disclose. Conflict of interest: D. Langer has nothing to disclose. Conflict of interest: A.L.P. de Albuquerque has nothing to disclose.
(Copyright ©ERS 2021.)
Databáze: MEDLINE
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