scholarly journals Role of Functional Indicators in the Multifactorial Pathologies in Cardiopulmonary Rehabilitatiion

2007 ◽  
Vol 30 (3) ◽  
pp. 45
Author(s):  
Sergio Pulici ◽  
Piergiorgio Schiavoni
Keyword(s):  
Heart Rate ◽  
Respiratory Muscle ◽  
Respiratory Muscles ◽  
Coronary Bypass ◽  
Exercise Intolerance ◽  
Admission Diagnosis ◽  
Valve Prosthesis ◽  
Function Recovery ◽  
Recovery Program ◽  
Ventilatory Limitation

Background: Patients in cardiopulmonary rehabilitation often complain of exercise intolerance. While ventilatory limitation is often present, other factors are also important: cardiovascular deconditioning, respiratory muscle dysfunction, gas exchange abnormalities and ventricular dysfunction. Methods: Forty patients, hospitalized for a consecutive 6 month-period, with persistent exercise intolerance due to cardiopulmonary pathologies were included. 90% were COPD II to IV GOLD stage; 5% had chronic cardiac decompensation; 5% had undergone surgery for coronary bypass and/or cardiac valve prosthesis. Patients were excluded who were clinically unstable, unable to cooperate correctly, had arrythmia due to atrial fibrillation and/or receiving beta-blocking therapy. We have, furthermore, measured parameters of ventilatory dysfunction (ventilatory reserve, dynamic inspiratory capacity), the parameters of cardiovascular limitation (peak heart rate and recovery heart rate at the first minute), parametes of respiratory muscles dysfunction (maximal inspiratory pressure and at the end of the 6 min walking test). Afterwards we classified patients into three groups: ventilatory-limited, cardiovascular-limited, respiratory muscles-limited. Results: Exercise performance limitation resulted from ventilatory limitation in 60% of the patients, second by cardiovascular limitation in 30% of the patients and also by respiratory muscle limitation in 10% of the patients. Conclusions: Based on admission diagnosis of 40 patients, 90% were defined as subject to pulmonary rehabilitation and in 10% were receiving cardiac rehabilitation. They divided into three specific functional recovery programs: ventilatory function recovery program (60%), cardiac function recovery program (30%), respiratory muscles recovery program (10%).

scholarly journals Unraveling the Role of Respiratory Muscle Metaboloreceptors under Inspiratory Training in Patients with Heart Failure

2021 ◽  
Vol 18 (4) ◽  
pp. 1697
Author(s):  
Hugo Fernández-Rubio ◽  
Ricardo Becerro-de-Bengoa-Vallejo ◽  
David Rodríguez-Sanz ◽  
César Calvo-Lobo ◽  
Davinia Vicente-Campos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Scientific Evidence ◽  
Pulmonary Ventilation ◽  
Respiratory Muscles ◽  
Exercise Intolerance ◽  
Muscle Metaboreflex ◽  
Structural Deterioration ◽  
Adrenal System

Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic–adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic–adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients’ exercise tolerance under HF condition.

Assessment of exercise capacity and respiratory muscle oxygenation in healthy children and children with congenital heart diseases

2008 ◽  
Vol 33 (3) ◽  
pp. 434-440 ◽  
Author(s):  
Wassim Moalla ◽  
Grégory Dupont ◽  
Abdou Temfemo ◽  
Yves Maingourd ◽  
Matthew Weston ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Power Output ◽  
Respiratory Muscle ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Respiratory Muscles ◽  
Muscle Oxygenation ◽  
Exercise Intolerance ◽  
Congenital Heart Diseases ◽  
Healthy Children

Muscular and cardiorespiratory dysfunction contributes to exercise intolerance. Therefore, the aim of the present study was to characterize the cardiopulmonary response andrespiratory muscle oxygenation of children with congenital heart diseases (CHD) when compared with those of healthy children. Twelve children with CHD in New York Heart Association (NYHA) class II or III, and 14 healthy children participated in the study. All subjects performed conventional spirographic measurements and a cardiopulmonary exercise test on a cycle ergometer. Oxygen uptake (VO2), carbon dioxide production (VCO2), minute ventilation (VE), heart rate (HR), and power output were measured. Oxygenation of respiratory muscles was assessed by near-infrared spectroscopy (NIRS) during exercise and recovery. Pulmonary function was normal and no significant difference was found between groups. At rest, CHD patients had cardiorespiratory variables comparable with those of the healthy group. At submaximal intensity (ventilatory threshold) and at peak exercise, power output, HR, VO2, VCO2, and VE were significantly reduced (p < 0.01) in CHD patients. Respiratory muscles deoxygenated during exercise in both groups. However, deoxygenation was more pronounced in the CHD group than in the healthy children from an intensity of 40% up to exhaustion. Likewise, children with CHD showed a slower recovery of oxygenation than healthy children (113.4 ± 17.5 vs. 74.6 ± 13.0 s; p < 0.001). Compared with healthy children, these results demonstrated that children with CHD have reduced performance and present a defected exercise capacity. Children with CHD showed a more pronounced decrease of respiratory muscle oxygenation and slower recovery of oxygen kinetics.

scholarly journals Respiratory muscle function in the newborn: a narrative review

2021 ◽  
Author(s):  
Theodore Dassios ◽  
Aggeliki Vervenioti ◽  
Gabriel Dimitriou
Keyword(s):  
Congenital Anomalies ◽  
Muscle Function ◽  
Respiratory Muscle ◽  
Work Of Breathing ◽  
Respiratory Muscles ◽  
Current Evidence ◽  
Muscle Fibres ◽  
List Type ◽  
Respiratory Muscle Function ◽  
Neurally Adjusted Ventilator Assist

Abstract Our aim was to summarise the current evidence and methods used to assess respiratory muscle function in the newborn, focusing on current and future potential clinical applications. The respiratory muscles undertake the work of breathing and consist mainly of the diaphragm, which in the newborn is prone to dysfunction due to lower muscle mass, flattened shape and decreased content of fatigue-resistant muscle fibres. Premature infants are prone to diaphragmatic dysfunction due to limited reserves and limited capacity to generate force and avoid fatigue. Methods to assess the respiratory muscles in the newborn include electromyography, maximal respiratory pressures, assessment for thoraco-abdominal asynchrony and composite indices, such as the pressure–time product and the tension time index. Recently, there has been significant interest and a growing body of research in assessing respiratory muscle function using bedside ultrasonography. Neurally adjusted ventilator assist is a novel ventilation mode, where the level of the respiratory support is determined by the diaphragmatic electrical activity. Prolonged mechanical ventilation, hypercapnia and hypoxia, congenital anomalies and systemic or respiratory infection can negatively impact respiratory muscle function in the newborn, while caffeine and synchronised or volume-targeted ventilation have a positive effect on respiratory muscle function compared to conventional, non-triggered or pressure-limited ventilation, respectively. Impact Respiratory muscle function is impaired in prematurely born neonates and infants with congenital anomalies, such as congenital diaphragmatic hernia. Respiratory muscle function is negatively affected by prolonged ventilation and infection and positively affected by caffeine and synchronised compared to non-synchronised ventilation modes. Point-of-care diaphragmatic ultrasound and neurally adjusted ventilator assist are recent diagnostic and therapeutic technological developments with significant clinical applicability.

Respiratory response to partial paralysis in anesthetized dogs

1984 ◽  
Vol 56 (6) ◽  
pp. 1583-1588 ◽  
Author(s):  
A. Oliven ◽  
E. C. Deal ◽  
S. G. Kelsen ◽  
N. S. Cherniack
Keyword(s):  
Motor Activity ◽  
Respiratory Muscle ◽  
Respiratory Muscles ◽  
Peak Activity ◽  
Inspiratory Time ◽  
Muscle Paralysis ◽  
Anesthetized Dogs ◽  
Spontaneously Breathing ◽  
Partial Paralysis

The ability to maintain alveolar ventilation is compromised by respiratory muscle weakness. To examine the independent role of reflexly mediated neural mechanisms to decreases in the strength of contraction of respiratory muscles, we studied the effects of partial paralysis on the level and pattern of phrenic motor activity in 22 anesthetized spontaneously breathing dogs. Graded weakness induced with succinylcholine decreased tidal volume and prolonged both inspiratory and expiratory time causing hypoventilation and hypercapnia. Phrenic peak activity as well as the rate of rise of the integrated phrenic neurogram increased. However, when studied under isocapnic conditions, increases in the severity of paralysis, as assessed from the ratio of peak diaphragm electromyogram to peak phrenic activity, produced progressive increases in inspiratory time and phrenic peak activity but did not affect its rate of rise. After vagotomy, partial paralysis induced in 11 dogs with succinylcholine also prolonged the inspiratory burst of phrenic activity, indicating that vagal reflexes were not solely responsible for the alterations in respiratory timing. Muscle paresis was also induced with gallamine or dantrolene, causing similar responses of phrenic activity and respiratory timing. Thus, at constant levels of arterial CO2 in anesthetized dogs, respiratory muscle partial paralysis results in a decrease in breathing rate without changing the rate of rise of respiratory motor activity. This is not dependent solely on vagally mediated reflexes and occurs regardless of the pharmacological agent used. These observations in the anesthetized state are qualitatively different from the response to respiratory muscle paralysis or weakness observed in awake subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Effect of respiratory muscle training on pulmonary function in preoperative preparation of tobacco smokers

2007 ◽  
Vol 22 (2) ◽  
pp. 98-104 ◽  
Author(s):  
Carrie Chueiri Ramos Galvan ◽  
Antônio José Maria Cataneo
Keyword(s):  
Pulmonary Function ◽  
Respiratory Muscle ◽  
Vital Capacity ◽  
Peak Flow ◽  
Respiratory Muscles ◽  
Forced Expiratory Volume ◽  
Respiratory Muscle Training ◽  
Specific Training ◽  
Muscle Training ◽  
Respiratory Exercises

PURPOSE: To evaluate the effect of utilization of a specific training program of respiratory muscles on pulmonary function in tobacco smokers. METHODS: Fifty asymptomatic tobacco smokers with age superior to 30 years were studied, at the moments: A0 - initial evaluation followed by protocol of respiratory exercises; A1 - reevaluation after 10 minutes of protocol application; and A2 - final reevaluation after 2 weeks of training utilizing the same protocol 3 times per week. The evaluation was realized through measures of maximum respiratory pressures (PImax and PEmax), respiratory peak flow (IPF and EPF), maximum voluntary ventilation (MVV), forced vital capacity (FVC) and forced expiratory volume at the 1st second (FEV1). RESULTS: There was no improvement from initial to final evaluation in FVC and FEV1. But there were significant increases in the variables IPF, EPF, MVV and PImax at evaluations A1 and A2. The PEmax variable increased only at evaluation A2. CONCLUSION: The application of the protocol of respiratory exercises with and without additional load in tobacco smokers produced immediate improvement in the performance of respiratory muscles, but this gain was more accentuated after 2 weeks of exercise.

Respiratory Muscle Conditioning and the Work of Breathing: A Critical Balance in the Weaning Patient

1991 ◽  
Vol 2 (3) ◽  
pp. 405-414 ◽  
Author(s):  
Maureen E. Shekleton
Keyword(s):  
Respiratory Muscle ◽  
Work Of Breathing ◽  
Critical Role ◽  
Respiratory Muscles ◽  
Clinical Intervention ◽  
Ventilatory Function ◽  
Muscle Conditioning ◽  
Ventilatory Capacity ◽  
Demand And Capacity ◽  
Research Show

Normal ventilatory function depends on a balance between ventilatory demand and ventilatory capacity. The respiratory muscles play a critical role in achieving this balance. For patients experiencing ventilatory dysfunction, interventions that improve respiratory muscle function and therefore increase ventilatory capacity may be one way of restoring the balance and promoting ventilatory function. Respiratory muscle conditioning, or training the muscles to improve their strength and endurance, may be a useful clinical intervention in the weaning patient. Results of research show that muscle training may increase the ability of some patients to resume spontaneous ventilation. Continued research is needed to identify the appropriate training protocols for patients experiencing an acute imbalance between ventilatory demand and capacity

scholarly journals Ultrasonographic assessment of parasternal intercostal muscles during mechanical ventilation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Paolo Formenti ◽  
Michele Umbrello ◽  
Martin Dres ◽  
Davide Chiumello
Keyword(s):  
Mechanical Ventilation ◽  
Ultrasound Imaging ◽  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Muscle Activation ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Muscles ◽  
Course Of Illness ◽  
Intercostal Muscles ◽  
Predictive Parameters

Abstract Although mechanical ventilation is a lifesaving treatment, abundant evidence indicates that its prolonged use (1 week or more) promotes respiratory muscle weakness due to both contractile dysfunction and atrophy. Along with the diaphragm, the intercostal muscles are one of the most important groups of respiratory muscles. In recent years, muscular ultrasound has become a useful bedside tool for the clinician to identify patients with respiratory muscle dysfunction related to critical illness and/or invasive mechanical ventilation. Images obtained over the course of illness can document changes in muscle dimension and can be used to estimate changes in function. Recent evidence suggests the clinical usefulness of ultrasound imaging in the assessment of intercostal muscle function. In this narrative review, we summarize the current literature on ultrasound imaging of the parasternal intercostal muscles as used to assess the extent of muscle activation and muscle weakness and its potential impact during discontinuation of mechanical ventilation. In addition, we proposed a practical flowchart based on recent evidence and experience of our group that can be applied during the weaning phase. This approach integrates multiple predictive parameters of weaning success with respiratory muscle ultrasound.

Heart Rate Variability And Respiratory Muscle Strength In Patients With Type Ii Diabetes Practicing Pilates: A Randomized Clinical Trial

2021 ◽  
Vol 17 ◽  
Author(s):  
Samara Sousa Vasconcelos Gouveia ◽  
Guilherme Pertinni de Morais Gouveia ◽  
Leydnaya Maria Souza ◽  
Bruno Cunha da Costa ◽  
Gustavo Henrique Melo Sousa ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Muscle Strength ◽  
Normal Distribution ◽  
Randomized Clinical Trial ◽  
Respiratory Muscle ◽  
Control Group ◽  
Respiratory Muscle Strength

Purpose: This study aimed to analyze the effect of a Pilates protocol on respiratory muscle strength and heart rate variability (HRV) in patients with type 2 diabetes. Method: A randomized clinical trial (RBR-2gc2qj) was conducted with a type 2 diabetic target population. Patients practiced the Pilates protocol for 8 weeks, with two visits per week. The variables tested were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and HRV (time and frequency domains). All variables were tested for normal distribution. Using SPSS 21.0, analysis of variance was performed for variables with normal distribution, and the Wilcoxon and Friedman tests were used for variables that did not show a normal distribution, with a 5% significance level. Results: Forty-four participants were included in the study (intervention group: 22; control group: 22; mean age: 61.23 ± 8.49 years), most of whom were female (77.3%), married or in a consensual union (59.1%), had complete literacy (31.8%), and had an average body mass index of 26.96 ± 4.35 kg/m2. There were no significant differences in MIP and MEP before and after the protocol between the intervention and control groups. Regarding HRV, there were significant differences in autonomic modulation, especially between the moments before and during exercise and between the moments during and after exercise; however, it was not possible to determine which system (sympathetic or parasympathetic) is most involved in these changes. Conclusion: The exercise protocol based on the Pilates method did not alter respiratory muscle strength but promoted changes in HRV, especially between the moments before and during exercise and during and after exercise.

Abstract 222: Nerve Conduction Study in Postural Orthostatic Tachycardia Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Samreen F Asghar ◽  
Sadaf Syed ◽  
Amna A Butt ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Tibial Nerve ◽  
Sensory Nerves ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Medical Diagnostic

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. The aim of this study is to demonstrate median, ulnar, peroneal, tibial nerve conduction results POTS patients. Methods: 177 patients were selected randomly from our clinic with POTS. Nerve conduction results of median, ulnar, peroneal, tibial nerves were reviewed from electronic medical records. Results: Out of 177 patients, 151 patients are females (85%, n=151, age 32.07±11.10), 26 patients are males (15%, n=26, age 29.08±17.40).Median nerve conduction results are 57.83 m/sec ±7.58 m/sec, Ulnar nerve conduction results are 56.62 m/sec ±6.85 m/sec, Peroneal nerve conduction results are 49.96 m/sec ±6.85 m/sec, Tibial nerve conduction results are 50.70 m/sec ±6.86 m/sec. Conclusion: The nerve conduction velocities tend to be within normal range in Postural Orthostatic Tachycardia Syndrome (POTS) patients.

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