Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness

Yannick Molgat-Seon, Liam M Hannan, Paolo B Dominelli, Carli M Peters, Renee J Fougere, Douglas A McKim, A William Sheel, Jeremy D Road, Yannick Molgat-Seon, Liam M Hannan, Paolo B Dominelli, Carli M Peters, Renee J Fougere, Douglas A McKim, A William Sheel, Jeremy D Road

Abstract

The aim of the present study was to determine whether lung volume recruitment (LVR) acutely increases respiratory system compliance (Crs) in individuals with severe respiratory muscle weakness (RMW). Individuals with RMW resulting from neuromuscular disease or quadriplegia (n=12) and healthy controls (n=12) underwent pulmonary function testing and the measurement of Crs at baseline, immediately after, 1 h after and 2 h after a single standardised session of LVR. The LVR session involved 10 consecutive supramaximal lung inflations with a manual resuscitation bag to the highest tolerable mouth pressure or a maximum of 50 cmH2O. Each LVR inflation was followed by brief breath-hold and a maximal expiration to residual volume. At baseline, individuals with RMW had lower Crs than controls (37±5 cmH2O versus 109±10 mL·cmH2O-1, p<0.001). Immediately after LVR, Crs increased by 39.5±9.8% to 50±7 mL·cmH2O-1 in individuals with RMW (p<0.05), while no significant change occurred in controls (p=0.23). At 1 h and 2 h post-treatment, there were no within-group differences in Crs compared to baseline (all p>0.05). LVR had no significant effect on measures of pulmonary function at any time point in either group (all p>0.05). During inflations, mean arterial pressure decreased significantly relative to baseline by 10.4±2.8 mmHg and 17.3±3.0 mmHg in individuals with RMW and controls, respectively (both p<0.05). LVR acutely increases Crs in individuals with RMW. However, the high airway pressures during inflations cause reductions in mean arterial pressure that should be considered when applying this technique.

Figures

FIGURE 1
FIGURE 1
Compliance of the respiratory system (Crs) at baseline and 0 h, 1 h and 2 h following lung volume recruitment. a) Absolute Crs in the respiratory muscle weakness (RMW) group (see also table 3); b) absolute Crs in the control group (see also table 3); c) changes in Crs expressed as a function of baseline in the RMW group; d) changes in Crs expressed as a function of baseline in the control group. All data are presented as mean±sem. *: p<0.05 for RMW versus control subjects; #: p<0.05 relative to baseline.
FIGURE 2
FIGURE 2
Peak expiratory flow (PEF) at baseline and PEF during lung volume recruitment (PEFLVR) in the a) respiratory muscle weakness and b) control groups. Data are presented as mean±sem. *: significantly greater than PEF (p<0.05).
FIGURE 3
FIGURE 3
Average mean arterial pressure (Pa) during lung volume recruitment (LVR) in (a) the respiratory muscle weakness (RMW) group and (b) the control group. Average heart rate during LVR in (c) the RMW group and (d) the control group. Data for each time point are presented as mean±sem. Baseline: 5 s prior to each LVR manoeuvre; LVR: the entire plateau phase of inflation; post: during the 5 s following each LVR manoeuvre. *: p<0.05 for RMW versus control subjects. #: p<0.05 relative to baseline.
FIGURE 4
FIGURE 4
Mouth pressure (Pmo), flow rate and mean arterial blood pressure (Pa) data during a single lung volume recruitment manoeuvre in representative subjects in the respiratory muscle weakness (RMW) group in (a), (c), and (e), and in the control group in (b), (d), and (f). Data are presented for a subject in the RMW group with Duchenne muscular dystrophy and a healthy age- and sex-matched subject in the control group. All data presented are raw traces.

References

    1. De Troyer A, Borenstein S, Cordier R. Analysis of lung volume restriction in patients with respiratory muscle weakness. Thorax 1980; 35: 603–610.
    1. Estenne M, Gevenois PA, Kinnear W, et al. . Lung volume restriction in patients with chronic respiratory muscle weakness: the role of microatelectasis. Thorax 1993; 48: 698–701.
    1. Gibson GJ, Pride NB, Davis JN, et al. . Pulmonary mechanics in patients with respiratory muscle weakness. Am Rev Respir Dis 1977; 115: 389–395.
    1. Almenoff PL, Spungen AM, Lesser M, et al. . Pulmonary function survey in spinal cord injury: influences of smoking and level and completeness of injury. Lung 1995; 173: 297–306.
    1. Rideau Y, Jankowski LW, Grellet J. Respiratory function in the muscular dystrophies. Muscle Nerve 1981; 4: 155–164.
    1. Stone DJ, Keltz H. The effect of respiratory muscle dysfunction on pulmonary function. studies in patients with spinal cord injuries. Am Rev Respir Dis 1963; 88: 621–629.
    1. Estenne M, De Troyer A. The effects of tetraplegia on chest wall statics. Am Rev Respir Dis 1986; 134: 121–124.
    1. Estenne M, Heilporn A, Delhez L, et al. . Chest wall stiffness in patients with chronic respiratory muscle weakness. Am Rev Respir Dis 1983; 128: 1002–1007.
    1. Wang AY, Jaeger RJ, Yarkony GM, et al. . Cough in spinal cord injured patients: the relationship between motor level and peak expiratory flow. Spinal Cord 1997; 35: 299–302.
    1. Suárez AA, Pessolano FA, Monteiro SG, et al. . Peak flow and peak cough flow in the evaluation of expiratory muscle weakness and bulbar impairment in patients with neuromuscular disease. Am J Phys Med Rehabil 2002; 81: 506–511.
    1. Reines HD, Harris RC. Pulmonary complications of acute spinal cord injuries. Neurosurgery 1987; 21: 193–196.
    1. Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest 2000; 118: 1390–1396.
    1. Silver JR, Gibbon NO. Prognosis in tetraplegia. BMJ 1968; 4: 79–83.
    1. Simonds AK. Respiratory complications of the muscular dystrophies. Semin Respir Crit Care Med 2002; 23: 231–238.
    1. McKim DA, Katz SL, Barrowman N, et al. . Lung volume recruitment slows pulmonary function decline in Duchenne muscular dystrophy. Arch Phys Med Rehabil 2012; 93: 1117–1122.
    1. Katz SL, Barrowman N, Monsour A, et al. . Long-term effects of lung volume recruitment on maximal inspiratory capacity and vital capacity in Duchenne muscular dystrophy. Ann Am Thorac Soc 2016; 13: 217–222.
    1. Lechtzin N, Shade D, Clawson L, et al. . Supramaximal inflation improves lung compliance in subjects with amyotrophic lateral sclerosis. Chest 2006; 129: 1322–1329.
    1. Hyatt RE, Schilder DP, Fry DL. Relationship between maximum expiratory flow and degree of lung inflation. J Appl Physiol 1958; 13: 331–336.
    1. Kang SW, Bach JR. Maximum insufflation capacity. Chest 2000; 118: 61–65.
    1. Cleary S, Misiaszek JE, Kalra S, et al. . The effects of lung volume recruitment on coughing and pulmonary function in patients with ALS. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14: 111–115.
    1. McCool FD, Mayewski RF, Shayne DS, et al. . Intermittent positive pressure breathing in patients with respiratory muscle weakness. Alterations in total respiratory system compliance. Chest 1986; 90: 546–552.
    1. De Troyer A, Deisser P. The effects of intermittent positive pressure breathing on patients with respiratory muscle weakness. Am Rev Respir Dis 1981; 124: 132–137.
    1. American Thoracic Society/European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166: 518–624.
    1. Miller MR, Hankinson J, Brusasco V, et al. . Standardisation of spirometry. Eur Respir J 2005; 26: 319–338.
    1. Wanger J, Clausen JL, Coates A, et al. . Standardisation of the measurement of lung volumes. Eur Respir J 2005; 26: 511–522.
    1. Wilson SH, Cooke NT, Edwards RH, et al. . Predicted normal values for maximal respiratory pressures in caucasian adults and children. Thorax 1984; 39: 535–538.
    1. Crapo RO, Morris AH, Clayton PD, et al. . Lung volumes in healthy nonsmoking adults. Bull Eur Physiopathol Respir 1982; 18: 419–425.
    1. Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 1981; 123: 659–664.
    1. Suratt PM, Owens DH, Kilgore WT, et al. . A pulse method of measuring respiratory system compliance. J Appl Physiol Respir Environ Exerc Physiol 1980; 49: 1116–1121.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381.
    1. Sinha R, Bergofsky EH. Prolonged alteration of lung mechanics in kyphoscoliosis by positive pressure hyperinflation. Am Rev Respir Dis 1972; 106: 47–57.
    1. Hodgson C, Denehy L, Ntoumenopoulos G, et al. . An investigation of the early effects of manual lung hyperinflation in critically ill patients. Anaesth Intensive Care 2000; 28: 255–261.
    1. Lessa TB, de Abreu DK, Rodrigues MN, et al. . Morphological and ultrastructural evaluation of the golden retriever muscular dystrophy trachea, lungs, and diaphragm muscle. Microsc Res Tech 2014; 77: 857–861.
    1. Young SL, Tierney DF, Clements JA. Mechanism of compliance change in excised rat lungs at low transpulmonary pressure. J Appl Physiol 1970; 29: 780–785.
    1. Ferris BG, Pollard DS. Effect of deep and quiet breathing on pulmonary compliance in man. J Clin Invest 1960; 39: 143–149.
    1. Suratt PM, Owens DH, Hsiao H, et al. . Lung compliance and its transient elevations measured with pulse-flow method. J Appl Physiol Respir Environ Exerc Physiol 1981; 50: 1318–1324.
    1. Krause M, Olsson T, Law AB, et al. . Effect of volume recruitment on response to surfactant treatment in rabbits with lung injury. Am J Respir Crit Care Med 1997; 156: 862–866.
    1. Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest 1996; 110: 1566–1571.
    1. McKim DA, Road J, Avendano M, et al. . Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline. Can Respir J 2011; 18: 197–215.
    1. Luce JM. The cardiovascular effects of mechanical ventilation and positive end-expiratory pressure. JAMA 1984; 252: 807–811.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다