Neural Drive to the Diaphragm After Lung Volume Reduction Surgery
| Autor: | Monika Wild, Walter Klepetko, Theodor Wanke, Heinz Lahrmann, Edda Tschernko, Wilfried Wisser, Hartmut Zwick |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Diaphragm Diaphragmatic breathing Lung volume reduction surgery Critical Care and Intensive Care Medicine Humans Medicine Lung volumes Lung Diseases Obstructive Prospective Studies Respiratory system Pneumonectomy Tidal volume Expiratory Time Electromyography business.industry VO2 max Middle Aged Respiratory Muscles Anesthesia Exercise Test Respiratory Mechanics Arterial blood Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 116:1593-1600 |
| ISSN: | 0012-3692 |
| Popis: | The aim of this study was to investigate prospectively the changes in neural drive to the diaphragm in the first year after lung volume reduction surgery (LVRS) in patients with COPD.In 14 patients with severe emphysema (mean +/- SD; age, 53.7 +/- 8.3 years; FEV(1), 0.64 +/- 0. 18 L; residual volume [RV], 5.33 +/- 1.25 L; PaO(2), 62.3 +/- 9.0 mm Hg; PaCO(2), 39.0 +/- 6.0 mm Hg), we assessed lung function, arterial blood gases, maximal exercise capacity (Wmax), and oxygen uptake (f1.gif" BORDER="0"O(2)max); intrinsic positive end-expiratory pressure (PEEPi); diaphragmatic strength (transdiaphragmatic pressure, Pdisniff) and endurance capacity (tlim); central diaphragmatic drive assessed by root mean square analysis of the esophageal electromyogram (rmsdia); and isotime dyspnea during loaded breathing tests (BS).Despite a significant increase (expressed as a percentage of baseline) in FEV(1) (40.6%) and a decrease in RV (30.0%) and PEEPi (75.7%) 1 month after LVRS, the improvements in Wmax (31.2%) and f1.gif" BORDER="0"O(2)max (13.7%); Pdisniff (25.4%) and tlim (64.9%); rmsdia (34.6%); and BS (21.7%) did not reach statistical significance (p0.05) until 6 months after LVRS. Arterial blood gases did not change significantly. Significant correlations were found between decrease in rmsdia and changes in PEEPi (r = 0.69), Wmax (r = -0.56), Pdisniff (r = -0.65), tlim (r = -0.59), and BS (r = 0.71) 6 months after LVRS.Our results show that LVRS is able to increase the efficacy of the respiratory pump and by this way reduce ventilatory drive and respiratory effort sensation. |
| Databáze: | OpenAIRE |
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