Chest
Clinical InvestigationsPulmonary FunctionInfluence of Immersion in Water on Muscle Function and Breathing Pattern in Patients With Severe Diaphragm Weakness
Section snippets
Patients
Seven consecutive patients referred to the Krankenhaus Kloster Grafschaft for consideration of noninvasive ventilatory support were recruited for this study. The protocol was approved by our ethical review committee, and all subjects gave written informed consent to participate. Patients with bulbar paralysis and consequent weakness of the facial muscles were excluded. Clinical diagnoses are shown in Table 1. Identical procedures were applied to seven healthy members of the local community of
Anthropometric Data, Lung and Muscle Function
Diagnosis, spirometric, and clinical data are shown in Table 1. Respiratory muscle strength data of the patients are shown in Table 2. All patients had severe bilateral diaphragm weakness (patients 1, 3, 4, and 6) or paresis (patients 2, 5, and 7), as judged by phrenic nerve stimulation and, in all but one patient (patient 2), expiratory muscle weakness. The control subjects were assumed to be free of neurologic and respiratory disease. Their mean Pimax was 60.3 cm H2O, compared with 37 cm H2O
DISCUSSION
Although dyspnea in water is recognized as a symptom suggestive of diaphragm paralysis or weakness, no previous study has systematically investigated the underlying mechanisms. Moreover, in only one of the few cases so far described in the literature was diaphragm paralysis confirmed by phrenic nerve stimulation.2 Our data show that there was a substantial reduction in VC without significant reduction in tidal volume. Nevertheless, the patient's complaint of dyspnea was consistent with the
ACKNOWLEDGMENT
The authors thank Sven Wallstein and Patrick Appelhans for technical assistance with land-based and water-based measurements.
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