The influence of supine posture on chest wall volume changes is higher in obese than in normal weight children

2015 ◽  
Vol 40 (2) ◽  
pp. 178-183
Author(s):  
Letícia Silva ◽  
Jacqueline de Melo Barcelar ◽  
Catarina Souza Rattes ◽  
Larissa Bouwman Sayão ◽  
Cyda Albuquerque Reinaux ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Tidal Volume ◽  
Chest Wall ◽  
Supine Position ◽  
Normal Weight ◽  
Obese Children ◽  
Rib Cage ◽  
Percentage Contribution ◽  
Supine Posture ◽  
And Control

The objective of this study was to analyze thoraco-abdominal kinematics in obese children in seated and supine positions during spontaneous quiet breathing. An observational study of pulmonary function and chest wall volume assessed by optoelectronic plethysmography was conducted on 35 children aged 8–12 years that were divided into 2 groups according to weight/height ratio percentiles: there were 18 obese children with percentiles greater than 95 and 17 normal weight children with percentiles of 5–85. Pulmonary function (forced expiratory volume in 1 s (FEV1); forced vital capacity (FVC); and FEV1/FVC ratio), ventilatory pattern, total and compartment chest wall volume variations, and thoraco-abdominal asynchronies were evaluated. Tidal volume was greater in seated position. Pulmonary and abdominal rib cage tidal volume and their percentage contribution to tidal volume were smaller in supine position in both obese and control children, while abdominal tidal volume and its percentage contribution was greater in the supine position only in obese children and not in controls. No statistically significant differences were found between obese and control children and between supine and seated positions regarding thoraco-abdominal asynchronies. We conclude that in obese children thoraco-abdominal kinematics is influenced by supine posture, with an increase of the abdominal and a decreased rib cage contribution to ventilation, suggesting that in this posture areas of hypoventilation can occur in the lung.

Effect of position on the mechanical interaction between the rib cage and abdomen in preterm infants

1992 ◽  
Vol 72 (3) ◽  
pp. 1032-1038 ◽  
Author(s):  
M. R. Wolfson ◽  
J. S. Greenspan ◽  
K. S. Deoras ◽  
J. L. Allen ◽  
T. H. Shaffer
Keyword(s):  
Pulmonary Function ◽  
Chest Wall ◽  
Preterm Infants ◽  
Prone Position ◽  
Phase Angle ◽  
Supine Position ◽  
Pulmonary Mechanics ◽  
Rib Cage ◽  
Lissajous Figures ◽  
Significant Difference

To determine the influence of body position on chest wall and pulmonary function, we studied the ventilatory, pulmonary mechanics, and thoracoabdominal motion profiles in 20 preterm infants recovering from respiratory disease who were positioned in both the supine and prone position. Thoracoabdominal motion was assessed from measurements of relative rib cage and abdominal movement and the calculated phase angle (an index of thoracoabdominal synchrony) of the rib and abdomen Lissajous figures. The ventilatory and pulmonary function profiles were assessed from simultaneous measurements of transpulmonary pressure, airflow, and tidal volume. The infants were studied in quiet sleep, and the order of positioning was randomized across patients. The results demonstrated no significant difference in ventilatory and pulmonary function measurements as a function of position. In contrast, there was a significant reduction (-49%) in the phase angle of the Lissajous figures and an increase (+66%) in rib cage motion in prone compared with the supine position. In addition, the degree of improvement in phase angle in the prone position was correlated to the severity of asynchrony in the supine position. We speculate that the improvement in thoracoabdominal synchrony in the prone position is related to alterations of chest wall mechanics and respiratory muscle tone mediated by a posturally related shift in the area of apposition of the diaphragm to the anterior inner rib cage wall and increase in passive tension of the muscles of the rib cage. This study suggests that the mechanical advantage associated with prone positioning may confer a useful alternative breathing pattern to the preterm infant in whom elevated respiratory work loads and respiratory musculoskeletal immaturity may predispose to respiratory failure.

Chest wall mechanics in sustained microgravity

1998 ◽  
Vol 84 (6) ◽  
pp. 2060-2065 ◽  
Author(s):  
Muriel Wantier ◽  
Marc Estenne ◽  
Sylvia Verbanck ◽  
G. Kim Prisk ◽  
Manuel Paiva
Keyword(s):  
Tidal Volume ◽  
Chest Wall ◽  
Functional Residual Capacity ◽  
Postural Change ◽  
Rib Cage ◽  
Chest Wall Mechanics ◽  
Supine Posture ◽  
Abdominal Compliance ◽  
Residual Capacity ◽  
Measured Flow

We assessed the effects of sustained weightlessness on chest wall mechanics in five astronauts who were studied before, during, and after the 10-day Spacelab D-2 mission ( n = 3) and the 180-day Euromir-95 mission ( n= 2). We measured flow and pressure at the mouth and rib cage and abdominal volumes during resting breathing and during a relaxation maneuver from midinspiratory capacity to functional residual capacity. Microgravity produced marked and consistent changes (Δ) in the contribution of the abdomen to tidal volume [ΔVab/(ΔVab + ΔVrc), where Vab is abdominal volume and Vrc is rib cage volume], which increased from 30.7 ± 3.5 (SE)% at 1 G head-to-foot acceleration to 58.3 ± 5.7% at 0 G head-to-foot acceleration ( P < 0.005). Values of ΔVab/(ΔVab + ΔVrc) did not change significantly during the 180 days of the Euromir mission, but in the two subjects ΔVab/(ΔVab + ΔVrc) was greater on postflight day 1 than on subsequent postflight days or preflight. In the two subjects who produced satisfactory relaxation maneuvers, the slope of the Konno-Mead plot decreased in microgravity; this decrease was entirely accounted for by an increase in abdominal compliance because rib cage compliance did not change. These alterations are similar to those previously reported during short periods of weightlessness inside aircrafts flying parabolic trajectories. They are also qualitatively similar to those observed on going from upright to supine posture; however, in contrast to microgravity, such postural change reduces rib cage compliance.

Mechanics of the rib cage and diaphragm during sleep

1977 ◽  
Vol 43 (4) ◽  
pp. 600-602 ◽  
Author(s):  
K. Tusiewicz ◽  
H. Moldofsky ◽  
A. C. Bryan ◽  
M. H. Bryan
Keyword(s):  
Tidal Volume ◽  
Supine Position ◽  
Marked Reduction ◽  
Normal Subjects ◽  
Upright Position ◽  
Rapid Eye Movement Sleep ◽  
Sleep State ◽  
Quiet Sleep ◽  
Rib Cage ◽  
The Subject

The pattern of motion of the rib cage and abdomen/diaphragm was studied in three normal subjects during sleep. Sleep state was monitored by electroencephalograph and electrocculograph. Intercostal electromyographs (EMG's) were recorded from the second interspace parasternally. Abdominothoracic motion was monitored with magnetometers and these signals calibrated by isovolume lines either immediately before going to sleep, or if there was movement, on awakening. Respiration was recorded using a jerkin plethysmograph. In the awake subject in the supine position, the rib cage contributed 44% to the tidal volume and had essentially the same contribution in quiet sleep. However, in active or rapid eye movement sleep the rib cage contribution fell to 19% of the tidal volume. This was accompanied by a marked reduction in the intercostal EMG. With the subject in the upright position the rib cage appears to be passively driven by the diaphragm. However, the present data suggest that active contraction of the intercostal muscles is required for normal rib cage expansion in the supine position.

scholarly journals Determinants of the esophageal-pleural pressure relationship in humans

2020 ◽  
Vol 128 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Iacopo Pasticci ◽  
Paolo Cadringher ◽  
Lorenzo Giosa ◽  
Michele Umbrello ◽  
Paolo Formenti ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Chest Wall ◽  
Supine Position ◽  
Body Position ◽  
Esophageal Pressure ◽  
Lateral Position ◽  
Pleural Pressure ◽  
Absolute Value ◽  
Gravitational Forces ◽  
Chest Wall Elastance

Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and intrathoracic pressures and their differences. The esophageal pressure (through esophageal balloon) and the intrathoracic/pleural pressure (through the chest tube on the surgery side) were measured after surgery in 28 patients immediately after lobectomy or wedge resection. Measurements were made in the nondependent lateral position (without or with ventilation of the operated lung) and in the supine position. In the lateral position with the nondependent lung, collapsed or ventilated, the differences between esophageal and pleural pressure amounted to 4.4 ± 1.6 and 5.1 ± 1.7 cmH2O. In the supine position, the difference amounted to 7.3 ± 2.8 cmH2O. In the supine position, the estimated compressive forces on the mediastinum were 10.5 ± 3.1 cmH2O and on the iso-gravitational pleural plane 3.2 ± 1.8 cmH2O. A simple model describing the roles of chest, lung, and pneumothorax volume matching on the pleural pressure genesis was developed; modeled pleural pressure = 1.0057 × measured pleural pressure + 0.6592 ( r2 = 0.8). Whatever the position and the ventilator settings, the esophageal pressure changed in a 1:1 ratio with the changes in pleural pressure. Consequently, chest wall elastance (Ecw) measured by intrathoracic (Ecw = ΔPpl/tidal volume) or esophageal pressure (Ecw = ΔPes/tidal volume) was identical in all the positions we tested. We conclude that esophageal and pleural pressures may be largely different depending on body position (gravitational forces) and lung-chest wall volume matching. Their changes, however, are identical. NEW & NOTEWORTHY Esophageal and pleural pressure changes occur at a 1:1 ratio, fully justifying the use of esophageal pressure to compute the chest wall elastance and the changes in pleural pressure and in lung stress. The absolute value of esophageal and pleural pressures may be largely different, depending on the body position (gravitational forces) and the lung-chest wall volume matching. Therefore, the absolute value of esophageal pressure should not be used as a surrogate of pleural pressure.

Comparison Of Compartmental Volume Distribution In Chest Wall Of Normal Weight And Obese Children In The Sitting And Supine

2012 ◽  
Author(s):  
Letícia M. Mendonça ◽  
Cyda Reinaux ◽  
Jacqueline Barcelar ◽  
Catarina Rattes ◽  
Rafael Silva ◽  
...  
Keyword(s):  
Chest Wall ◽  
Normal Weight ◽  
Volume Distribution ◽  
Obese Children

Rib cage vs. abdominal displacement in dogs during forced oscillation to 32 Hz

1989 ◽  
Vol 67 (4) ◽  
pp. 1472-1478 ◽  
Author(s):  
B. R. Boynton ◽  
G. Glass ◽  
I. D. Frantz ◽  
J. J. Fredberg
Keyword(s):  
Mechanical Behavior ◽  
Tidal Volume ◽  
Chest Wall ◽  
Forced Oscillation ◽  
Body Plethysmography ◽  
Volume Changes ◽  
Volume Increase ◽  
Rib Cage ◽  
Anesthetized Dogs ◽  
Inductive Plethysmography

Allen et al. (J. Clin. Invest. 76: 620–629, 1985) reported that during oscillatory forcing the base of isolated canine lungs distends preferentially relative to the apex as frequency and tidal volume increase. The tendency toward such nonuniform phasic lung distension might influence phasic displacement of the rib cage (RC) relative to the abdomen (ABD). To test this hypothesis we measured RC and ABD displacement in four anesthetized dogs during forced oscillation. Sinusoidal volume changes were delivered through a tracheostomy at 1–32 Hz and measured by body plethysmography. RC and ABD displacements were measured by inductive plethysmography. During oscillation with air at fixed tidal volumes (10–80 ml) RC, normalized to unity at 1 Hz, increased to 2.06–2.22 at 8 Hz (P less than 0.001) and then decreased to 1.06–1.35 (P less than 0.0025) at 32 Hz. ABD, normalized to unity at 1 Hz, was 1.12–1.16 at 4 Hz (P less than 0.001) and decreased to 0.12–0.14 at 32 Hz (P less than 0.001). Displacement of ABD relative to RC did not increase systematically with increasing tidal volume during sinusoidal forcing at any frequency. Thus we found no discernible influence of nonuniform phasic lung distension on chest wall behavior. We infer that in the dog the nonuniform mechanical behavior of the chest wall dominates the nonuniform (but opposing) mechanical tendency of the lung.

Respiratory cross-sectional area-flux measurements of the human chest wall

1990 ◽  
Vol 68 (4) ◽  
pp. 1605-1614 ◽  
Author(s):  
R. Sartene ◽  
P. Martinot-Lagarde ◽  
M. Mathieu ◽  
A. Vincent ◽  
M. Goldman ◽  
...  
Keyword(s):  
Magnetic Field ◽  
Tidal Volume ◽  
Chest Wall ◽  
Normal Subjects ◽  
Cross Sectional Area ◽  
7 Tesla ◽  
Sectional Area ◽  
Cross Sectional ◽  
Rib Cage ◽  
Orientation Effects

A new device that utilizes the voltages induced in separate coils encircling the rib cage and abdomen by a magnetic field is described for measurement of cross-sectional areas of the human chest wall (rib cage and abdomen) and their variation during breathing. A uniform magnetic field (1.4 X 10(-7) Tesla at 100 kHz) is produced by generating an alternating current at 100 kHz in two square coils, 1.98 m on each side, parallel to the planes of the areas to be measured and placed symmetrically cephalad and caudad to these planes at a mean distance of 0.53 m. We demonstrated that the accuracy of the device on well-defined surfaces (squares, circles, rectangles, ellipses) was within 1% in all cases. Observed errors are due primarily to small inhomogeneities of the magnetic field and variation of the orientation of the coil relative to the field. Using a second magnetic field (80 kHz) perpendicular to the first, we measured the errors due to nonparallel orientation during quiet breathing and inspiratory capacity maneuvers. In 10 normal subjects, orientation effects were less than 2% for the rib cage and less than 0.7% for the abdomen. In five of these subjects, orientation effects at functional residual capacity in lateral and seated postures were generally less than or equal to 5%, but estimated tidal volume during spontaneous breathing was comparable to measurements in the supine posture. In five curarized patients, we assessed the linearity of volume-motion relationships of the rib cage and abdomen, comparing cross-sectional area and circumference measurements. Departures from linearity using cross-sectional areas were only one-third of those using circumferences. In seven normal subjects we compared cross-sectional area measurements with respiratory inductive plethysmography (RIP) and found comparable estimates of lung volume change over a wide range of relative rib cage contributions to tidal volume (-5 to 105%), with slightly higher standard deviations for the RIP (SD = 10% for RIP; SD = 4% for cross-sectional area).

Association of chest wall motion and tidal volume responses during CO2 rebreathing

1996 ◽  
Vol 81 (4) ◽  
pp. 1528-1534 ◽  
Author(s):  
Sheng Yan ◽  
Pawel Sliwinski ◽  
Peter T. Macklem
Keyword(s):  
Tidal Volume ◽  
Chest Wall ◽  
Wall Motion ◽  
Forced Expiratory Volume ◽  
Quiet Breathing ◽  
Rib Cage ◽  
Chest Wall Motion ◽  
Variable Recruitment ◽  
The Individual ◽  
End Tidal

Yan, Sheng, Pawel Sliwinski, and Peter T. Macklem.Association of chest wall motion and tidal volume responses during CO2 rebreathing. J. Appl. Physiol. 81(4): 1528–1534, 1996.—The purpose of this study is to investigate the effect of chest wall configuration at end expiration on tidal volume (Vt) response during CO2 rebreathing. In a group of 11 healthy male subjects, the changes in end-expiratory and end-inspiratory volume of the rib cage (ΔVrc,e and ΔVrc,i, respectively) and abdomen (ΔVab,eand ΔVab,i, respectively) measured by linearized magnetometers were expressed as a function of end-tidal[Formula: see text]([Formula: see text]). The changes in end-expiratory and end-inspiratory volumes of the chest wall (ΔVcw,e and ΔVcw,i, respectively) were calculated as the sum of the respective rib cage and abdominal volumes. The magnetometer coils were placed at the level of the nipples and 1–2 cm above the umbilicus and calibrated during quiet breathing against the Vt measured from a pneumotachograph. The ΔVrc,e/[Formula: see text]slope was quite variable among subjects. It was significantly positive ( P < 0.05) in five subjects, significantly negative in four subjects ( P < 0.05), and not different from zero in the remaining two subjects. The ΔVab,e/[Formula: see text]slope was significantly negative in all subjects ( P < 0.05) with a much smaller intersubject variation, probably suggesting a relatively more uniform recruitment of abdominal expiratory muscles and a variable recruitment of rib cage muscles during CO2rebreathing in different subjects. As a group, the mean ΔVrc,e/[Formula: see text], ΔVab,e/[Formula: see text], and ΔVcw,e/[Formula: see text]slopes were 0.010 ± 0.034, −0.030 ± 0.007, and −0.020 ± 0.032 l / Torr, respectively; only the ΔVab,e/[Formula: see text]slope was significantly different from zero. More interestingly, the individual ΔVt/[Formula: see text]slope was negatively associated with the ΔVrc,e/[Formula: see text]( r = −0.68, P = 0.021) and ΔVcw,e/[Formula: see text]slopes ( r = −0.63, P = 0.037) but was not associated with the ΔVab,e/[Formula: see text]slope ( r = 0.40, P = 0.223). There was no correlation of the ΔVrc,e/[Formula: see text]and ΔVcw,e/[Formula: see text]slopes with age, body size, forced expiratory volume in 1 s, or expiratory time. The group ΔVab,i/[Formula: see text]slope (0.004 ± 0.014 l / Torr) was not significantly different from zero despite the Vt nearly being tripled at the end of CO2 rebreathing. In conclusion, the individual Vtresponse to CO2, although independent of ΔVab,e, is a function of ΔVrc,e to the extent that as the ΔVrc,e/[Formula: see text]slope increases (more positive) among subjects, the Vt response to CO2 decreases. These results may be explained on the basis of the respiratory muscle actions and interactions on the rib cage.

The effect of posture on asynchronous chest wall movement in COPD

2013 ◽  
Vol 114 (8) ◽  
pp. 1066-1075 ◽  
Author(s):  
Rita Priori ◽  
Andrea Aliverti ◽  
André L. Albuquerque ◽  
Marco Quaranta ◽  
Paul Albert ◽  
...  
Keyword(s):  
Chest Wall ◽  
Body Position ◽  
Respiratory Muscles ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Quiet Breathing ◽  
Obstructive Pulmonary Disease ◽  
Rib Cage ◽  
Copd Patients ◽  
Supine Posture

Chronic obstructive pulmonary disease (COPD) patients often show asynchronous movement of the lower rib cage during spontaneous quiet breathing and exercise. We speculated that varying body position from seated to supine would influence rib cage asynchrony by changing the configuration of the respiratory muscles. Twenty-three severe COPD patients (forced expiratory volume in 1 s = 32.5 ± 7.0% predicted) and 12 healthy age-matched controls were studied. Measurements of the phase shift between upper and lower rib cage and between upper rib cage and abdomen were performed with opto-electronic plethysmography during quiet breathing in the seated and supine position. Changes in diaphragm zone of apposition were measured by ultrasounds. Control subjects showed no compartmental asynchronous movement, whether seated or supine. In 13 COPD patients, rib cage asynchrony was noticed in the seated posture. This asynchrony disappeared in the supine posture. In COPD, upper rib cage and abdomen were synchronous when seated, but a strong asynchrony was found in supine. The relationships between changes in diaphragm zone of apposition and volume variations of chest wall compartments supported these findings. Rib cage paradox was noticed in approximately one-half of the COPD patients while seated, but was not related to impaired diaphragm motion. In the supine posture, the rib cage paradox disappeared, suggesting that, in this posture, diaphragm mechanics improves. In conclusion, changing body position induces important differences in the chest wall behavior in COPD patients.

Rib cage and diaphragm-abdomen compliance in humans: effects of age and posture

1985 ◽  
Vol 59 (6) ◽  
pp. 1842-1848 ◽  
Author(s):  
M. Estenne ◽  
J. C. Yernault ◽  
A. De Troyer
Keyword(s):  
Chest Wall ◽  
Muscle Relaxation ◽  
Abdominal Muscle ◽  
Oblique Muscle ◽  
Rib Cage ◽  
Chest Wall Compliance ◽  
Supine Posture ◽  
Wall Compliance ◽  
External Oblique ◽  
Older Subjects

The influence of age and posture on compliance of the rib cage (Crc) and diaphragm-abdomen (Cab) compartments of the chest wall was studied in 61 healthy adults (33 men, 28 women) aged 24–75 yr. Chest wall compliance (Cw) was measured by the weighted spirometer technique; Crc and Cab were derived from the slope of the relaxation line of the thoracoabdominal system obtained with two pairs of linearized magnetometers. While Cw was being measured, we monitored electrical activity of the abdominal external oblique muscle with a concentric needle electrode and thoracoabdominal configuration. In 52 subjects, the electromyogram did not show any abdominal muscle activity and the end-expiratory level never departed from the relaxed thoracoabdominal configuration, thus suggesting adequate respiratory muscle relaxation. Aging was associated with significant decreases in Crc and Cab. In the upright posture Crc decreased from 0.164 +/- 0.041 (mean +/- SD) l/cmH2O in the younger subjects (24–39 yr) to 0.114 +/- 0.027 l/cmH2O in the older subjects (55–75 yr). Cab concomitantly fell from 0.032 +/- 0.012 l/cmH2O to 0.020 +/- 0.007 l/cmH2O. These reductions were statistically significant (P less than 0.05–0.01) and were also present in the supine posture. Shifting from the seated to the supine posture did not cause any significant change in Cw but was invariably associated with a decrease in Crc and an increase in Cab.

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