scholarly journals Abdominal stimulation for respiratory support in tetraplegia: A tutorial review

2008 ◽  
Vol 18 (2) ◽  
pp. 85-92 ◽  
Author(s):  
H. Gollee ◽  
K.J. Hunt ◽  
M.H. Fraser ◽  
A.N. Mclean
Keyword(s):  
Muscle Contraction ◽  
Tidal Volume ◽  
Abdominal Wall ◽  
Abdominal Muscle ◽  
Respiratory Support ◽  
Muscle Stimulation ◽  
Future Developments ◽  
Expiratory Muscles ◽  
Simple Surface ◽  
Stimulation Of

Neuromuscular stimulation of the abdominal wall muscles can provide respiratory support in tetraplegia, where the main expiratory muscles are affected by paralysis. Stimulation may be applied by simple surface stimulation, resulting in a uniform muscle contraction which can help to improve expiratory function for coughing and breathing. In this review, an overview of methods and approaches available for abdominal muscle stimulation is given. Studies are discussed which show that this technique can lead to improvements in expiratory flow and tidal volume, resulting in enhanced cough and breathing functions. Approaches are introduced which aim to integrate abdominal stimulation with the subject's own voluntary breathing functions. These are illustrated with experimental results from the evaluation of automatic stimulation methods in tetraplegic patients. Clinical significance and applications are discussed and future developments are outlined.

scholarly journals Changes in Respiratory Muscle Thickness during Mechanical Ventilation

2020 ◽  
Author(s):  
Zhong-Hua Shi ◽  
Heder de Vries ◽  
Harm-Jan de Grooth ◽  
Annemijn H. Jonkman ◽  
Yingrui Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Abdominal Wall ◽  
Intraclass Correlation ◽  
Muscle Thickness ◽  
Diaphragm Thickness ◽  
Lateral Abdominal Wall ◽  
Expiratory Muscle ◽  
Expiratory Muscles ◽  
Muscle Ultrasound

Background The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproducibility of expiratory muscle (i.e., lateral abdominal wall muscles and rectus abdominis muscle) ultrasound and the impact of tidal volume on expiratory muscle thickness, to evaluate changes in expiratory muscle thickness during mechanical ventilation, and to compare this to changes in diaphragm thickness. Methods Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation. Results The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332). Conclusions Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Automatic electrical stimulation of abdominal wall muscles increases tidal volume and cough peak flow in tetraplegia

2008 ◽  
Vol 16 (4) ◽  
pp. 273-281 ◽  
Author(s):  
H. Gollee ◽  
K.J. Hunt ◽  
D.B. Allan ◽  
M.H. Fraser ◽  
A.N. McLean
Keyword(s):  
Electrical Stimulation ◽  
Tidal Volume ◽  
Abdominal Wall ◽  
Peak Flow ◽  
Stimulation Of

Expiratory muscle contribution to tidal volume in head-up dogs

1989 ◽  
Vol 67 (4) ◽  
pp. 1438-1442 ◽  
Author(s):  
G. A. Farkas ◽  
M. Estenne ◽  
A. De Troyer
Keyword(s):  
Tidal Volume ◽  
Lung Volume ◽  
Muscle Relaxation ◽  
Rib Cage ◽  
Expiratory Muscle ◽  
Residual Capacity ◽  
Anesthetized Dogs ◽  
Expiratory Muscles ◽  
S Period ◽  
Average Contribution

A change from the supine to the head-up posture in anesthetized dogs elicits increased phasic expiratory activation of the rib cage and abdominal expiratory muscles. However, when this postural change is produced over a 4- to 5-s period, there is an initial apnea during which all the muscles are silent. In the present studies, we have taken advantage of this initial silence to determine functional residual capacity (FRC) and measure the subsequent change in end-expiratory lung volume. Eight animals were studied, and in all of them end-expiratory lung volume in the head-up posture decreased relative to FRC [329 +/- 70 (SE) ml]. Because this decrease also represents the increase in lung volume as a result of expiratory muscle relaxation at the end of the expiratory pause, it can be used to determine the expiratory muscle contribution to tidal volume (VT). The average contribution was 62 +/- 6% VT. After denervation of the rib cage expiratory muscles, the reduction in end-expiratory lung volume still amounted to 273 +/- 84 ml (49 +/- 10% VT). Thus, in head-up dogs, about two-thirds of VT result from the action of the expiratory muscles, and most of it (83%) is due to the action of the abdominal rather than the rib cage expiratory muscles.

ATP concentrations and muscle tension increase linearly with muscle contraction

2003 ◽  
Vol 95 (2) ◽  
pp. 577-583 ◽  
Author(s):  
Jianhua Li ◽  
Nicholas C. King ◽  
Lawrence I. Sinoway
Keyword(s):  
Skeletal Muscle ◽  
Electrical Stimulation ◽  
Muscle Contraction ◽  
Motor Nerve ◽  
Muscle Tension ◽  
Nerve Fibers ◽  
Ventral Root ◽  
Ventral Roots ◽  
Root Stimulation ◽  
Stimulation Of

Previous studies have suggested that activation of ATP-sensitive P2X receptors in skeletal muscle play a role in mediating the exercise pressor reflex (Li J and Sinoway LI. Am J Physiol Heart Circ Physiol 283: H2636–H2643, 2002). To determine the role ATP plays in this reflex, it is necessary to examine whether muscle interstitial ATP (ATPi) concentrations rise with muscle contraction. Accordingly, in this study, muscle contraction was evoked by electrical stimulation of the L7 and S1 ventral roots of the spinal cord in 12 decerebrate cats. Muscle ATPi was collected from microdialysis probes inserted in the muscle. ATP concentrations were determined by the HPLC method. Electrical stimulation of the ventral roots at 3 and 5 Hz increased mean arterial pressure by 13 ± 2 and 16 ± 3 mmHg ( P < 0.05), respectively, and it increased ATP concentration in contracting muscle by 150% ( P < 0.05) and 200% ( P < 0.05), respectively. ATP measured in the opposite control limb did not rise with ventral root stimulation. Section of the L7 and S1 dorsal roots did not affect the ATPi seen with 5-Hz ventral root stimulation. Finally, ventral roots stimulation sufficient to drive motor nerve fibers did not increase ATP in previously paralyzed cats. Thus ATPi is not largely released from sympathetic or motor nerves and does not require an intact afferent reflex pathway. We conclude that ATPi is due to the release of ATP from contracting skeletal muscle cells.

Respiratory and abdominal muscle responses to expiratory threshold loading in cystic fibrosis

1992 ◽  
Vol 72 (3) ◽  
pp. 842-850 ◽  
Author(s):  
F. Cerny ◽  
L. Armitage ◽  
J. A. Hirsch ◽  
B. Bishop
Keyword(s):  
Cystic Fibrosis ◽  
Tidal Volume ◽  
Body Position ◽  
Minute Ventilation ◽  
Abdominal Muscle ◽  
Abdominal Muscles ◽  
Breathing Frequency ◽  
Control Subjects ◽  
Lung Dysfunction ◽  
Muscle Responses

We hypothesized that the hyperinflation and pulmonary dysfunction of cystic fibrosis (CF) would distort feedback and therefore alter the abdominal muscle response to graded expiratory threshold loads (ETLs). We compared the respiratory and abdominal muscle responses with graded ETLs of seven CF patients with severe lung dysfunction with those of matched healthy control subjects in the supine and 60 degrees head-up positions. Breathing frequency, tidal volume, and ventilatory timing were determined from inspiratory flow recordings. Abdominal electromyograms (EMGs) were detected with surface electrodes placed unilaterally over the external and internal oblique and the rectus abdominis muscles. Thresholds, times of onset, and durations of phasic abdominal activity were determined from raw EMGs; peak amplitudes were determined from integrated EMGs. Graded ETLs were imposed by submerging a tube from the expiratory port of the breathing valve into a column of water at depths of 0–25 cmH2O. We found that breathing frequency, tidal volume, and expired minute ventilation were higher in CF patients than in control subjects during low ETLs; a change in body position did not alter these ventilatory responses in the CF patients but did in the control subjects. All CF patients, but none of the control subjects, had tonic abdominal activity while supine. CF patients recruited abdominal muscles at lower loads, earlier in the respiratory cycle, and to a higher recruitment level in both positions than the control subjects, but burst duration of phasic activity was not different between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Influences of superior laryngeal afferent stimulation on expiratory activity in cats

1988 ◽  
Vol 65 (1) ◽  
pp. 385-392 ◽  
Author(s):  
F. Bongianni ◽  
M. Corda ◽  
G. Fontana ◽  
T. Pantaleo
Keyword(s):  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Tetanic Stimulation ◽  
Bötzinger Complex ◽  
Dependent Activity ◽  
Inspiratory Activity ◽  
Polysynaptic Reflex ◽  
Expiratory Muscles ◽  
Excitatory Responses ◽  
Stimulation Of

The effects of superior laryngeal nerve (SLN) stimulation on the activity of the expiratory muscles and medullary expiration-related (ER) neurons were investigated in 24 pentobarbital-anesthetized cats. In some experiments the animals were also paralyzed and artificially ventilated. Sustained tetanic stimulation of SLN consistently caused an apneic response associated with the appearance of tonic CO2-dependent activity in the expiratory muscles and in ER neurons located in the caudal ventral respiratory group (VRG) and the Botzinger complex. Single shocks or brief tetani at the same stimulation intensities failed to evoke excitatory responses in the expiratory muscles and in the vast majority of ER neurons tested. At higher stimulation strengths, single shocks or short tetani elicited excitatory responses in the expiratory muscles (20- to 35-ms latency) and in the majority of ER neurons of the caudal VRG (7.5- to 15.5-ms latency). These responses were obtained only during the expiratory phase and proved to be CO2 independent. On the contrary, only inhibitory responses were evoked in the activity of Botzinger complex neurons. The observed tonic expiratory activity most likely represents a disinhibition phenomenon due to the suppression of inspiratory activity; activation of expiratory muscles at higher stimulation intensities appears to be a polysynaptic reflex mediated by ER neurons of the caudal VRG but not by Botzinger complex neurons.

Mechanical role of expiratory muscles during breathing in upright dogs

1988 ◽  
Vol 64 (3) ◽  
pp. 1060-1067 ◽  
Author(s):  
G. A. Farkas ◽  
R. E. Baer ◽  
M. Estenne ◽  
A. De Troyer
Keyword(s):  
Tidal Volume ◽  
Progressive Increase ◽  
Substantial Contribution ◽  
Postural Changes ◽  
Before And After ◽  
Cervical Vagotomy ◽  
Anesthetized Dogs ◽  
Expiratory Muscles ◽  
Spontaneously Breathing

To examine the mechanical effects of the abdominal and triangularis sterni expiratory recruitment that occurs when anesthetized dogs are tilted head up, we measured both before and after cervical vagotomy the end-expiratory length of the costal and crural diaphragmatic segments and the end-expiratory lung volume (FRC) in eight spontaneously breathing animals during postural changes from supine (0 degree) to 80 degrees head up. Tilting the animals from 0 degree to 80 degrees head up in both conditions was associated with a gradual decrease in end-expiratory costal and crural diaphragmatic length and with a progressive increase in FRC. All these changes, however, were considerably larger (P less than 0.005 or less) postvagotomy when the expiratory muscles were no longer recruited with tilting. Alterations in the elastic properties of the lung could not account for the effects of vagotomy on the postural changes. We conclude therefore that 1) by contracting during expiration, the canine expiratory muscles minimize the shortening of the diaphragm and the increase in FRC that the action of gravity would otherwise introduce, and 2) the end-expiratory diaphragmatic length and FRC in upright dogs are thus actively determined. The present data also indicate that by relaxing at end expiration, the expiratory muscles make a substantial contribution to tidal volume in upright dogs; in the 80 degrees head-up posture, this contribution would amount to approximately 60% of tidal volume.

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