Chest
Volume 110, Issue 2, August 1996, Pages 454-461
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Clinical Investigations: Miscellaneous
Thoracoabdominal Pattern of Breathing in Neuromuscular Disorders

https://doi.org/10.1378/chest.110.2.454Get rights and content

Study objective

To assess abnormalities in thoracoabdominal pattern of breathing (TAPB) in neuromuscular disorders during spontaneous breathing, intermittent positive pressure ventilation (IPPV) with and without abdominal (AB) binder, and immediately after IPPV.

Design

Repeated measures design: Pre-IPPV spontaneous breathing, IPPV, IPPV with AB binder, and post-IPPV spontaneous breathing. In protocol 1, ventilator pressure was held constant at the individual value habitually adopted in sessions of IPPV. In protocol 2, it was increased stepwise from 5 to 30 cm H2O.

Setting

University hospital, Department of Pediatrics, Intensive Care, and Neuro-Ventilatory Rehabilitation.

Patients

Thirty-one patients with spinal muscular atrophy (SMA) and 19 patients with myopathy, mean age (±SD) 9.7±3 years.

Measurements

Tidal volume (VT), percent thoracic contribution to VT (%RC), the phase angle between the thoracic and the AB volume changes and the labored breathing index, which is an index of asynchrony taking into account both the phase relationships and relative volumes of rib cage and AB compartments.

Results

We observed marked abnormalities in TAPB during spontaneous breathing, especially in the SMA group. %RC, labored breathing index, and phase angle displayed nearly normal values during IPPV. IPPV pressures of 25 to 30 cm H2O were necessary to increase %RC above 80%. AB binding decreased VT, but led to larger thoracic volumes, especially in patients with SMA. Thoracic contribution to VT and thoracic volume after IPPV were higher than baseline levels.

Conclusions

The quantitative assessment of TAPB enhances the ability to estimate pulmonary function in neuromuscular disorders, and the efficiency of mechanical ventilation.

Section snippets

Subjects

Fifty subjects (24 boys, 26 girls), mean age 9.7±3.1 y, mean height 123.8±16.9 cm, mean weight 21.6±8.6 kg with spinal muscular atrophy—or myopathy—participated in this study. Patient characteristics for each of the two protocols are given in Table 1. The diagnoses were based on clinical and laboratory examinations including nerve conduction studies, electromyograms, and muscle biopsies. All the patients underwent one or two 30-min daily sessions of IPPV for several years. Volume values were

Baseline Values

The subjects displayed high levels of LBI and phase angle during spontaneous breathing (Fig 1). The %RC during spontaneous breathing was low in patients with SMA, and within normal limits in patients with myopathy. However, this and all the remaining differences between groups were nonsignificant.

Breathing Pattern During IPPV Without Binding

The %RC increased up to 58% in the SMA group, and 65% in the myopathy group. The thoracic volume rose to 400 mL in patients with SMA and 300 mL in patients with myopathy. During IPPV, LBI and phase

DISCUSSION

The purpose of this study was to quantitatively assess the abnormalities in the TAPB during spontaneous breathing or mechanical ventilation in subjects with SMA or myopathy. The first protocol reproduced their habitual IPPV session, whereas in the second protocol, IPPV pressure was manipulated. In fact, these two protocols yielded similar results. Accordingly, the observations of the second protocol may be generalized to the normal IPPV sessions with constant pressure. We observed that the

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    This work was supported by the Association Française contre les Myopathies.

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