The diaphragm acts as a brake during expiration to prevent lung collapse

American Journal of Respiratory and Critical Care Medicine

Volumn 195, Issue 12, 2017, Pages 1608-1616

  Pellegrini, Mariangela ^a,b   Hedenstierna, Göran ^a   Roneus, Agneta ^a   Segelsjö, Monica ^a   Larsson, Anders ^a   Perchiazzi, Gaetano ^a,b  

^a UPPSALA UNIVERSITY   (Sweden)

^b UNIVERSITY OF BARI   (Italy)

Author keywords

Assisted mechanical ventilation; Computed tomography imaging; Lung collapse; Mild acute respiratory distress syndrome; Spontaneous breathing

Indexed keywords

ADULT RESPIRATORY DISTRESS SYNDROME; ANIMAL EXPERIMENT; ANIMAL MODEL; ARTICLE; ATELECTASIS; BREATHING MECHANICS; COMPARATIVE STUDY; COMPUTER ASSISTED TOMOGRAPHY; CONTROLLED STUDY; DIAPHRAGM; EXCITATION CONTRACTION COUPLING; EXPIRED AIR; IMAGE ANALYSIS; LUNG PRESSURE; LUNG VOLUME; NONHUMAN; PARALYSIS; POSITIVE END EXPIRATORY PRESSURE; PRIORITY JOURNAL; RESPIRATORY AIRFLOW; YORKSHIRE PIG; ANIMAL; ARTIFICIAL VENTILATION; DIAGNOSTIC IMAGING; DISEASE MODEL; EXHALATION; LUNG; PATHOPHYSIOLOGY; PHYSIOLOGY; PIG; PULMONARY ATELECTASIS; X-RAY COMPUTED TOMOGRAPHY;

ANIMALS; DIAPHRAGM; DISEASE MODELS, ANIMAL; EXHALATION; LUNG; PULMONARY ATELECTASIS; RESPIRATION, ARTIFICIAL; RESPIRATORY DISTRESS SYNDROME, ADULT; SWINE; TOMOGRAPHY, X-RAY COMPUTED;

EID: 85014689998     PISSN: 1073449X     EISSN: 15354970     Source Type: Journal    
DOI: 10.1164/rccm.201605-0992OC     Document Type: Article

References (42)

1. Reber A, Nylund U, Hedenstierna G. Position and shape of the diaphragm: implications for atelectasis formation. Anaesthesia 1998;53:1054-1061.
2. Krayer S, Rehder K, Vettermann J, Didier EP, Ritman EL. Position and motion of the human diaphragm during anesthesia-paralysis. Anesthesiology 1989;70:891-898.
3. Hering E, Breuer J. Die Selbststeuerung der Atmung durch den Nervus vagus. Sitzung Akad Wiss Wien 1968;57:672-677.
4. Campbell EJM. The respiratory muscles and the mechanics of breathing. London: Lloyd-Luke; 1957.
5. Grimby G, Hedenstierna G, Löfström B. Chest wall mechanics during artificial ventilation. J Appl Physiol 1975;38:576-580.
6. Roussos CS, Fukuchi Y, Macklem PT, Engel LA. Influence of diaphragmatic contraction on ventilation distribution in horizontal man. J Appl Physiol 1976;40:417-424.
7. Guyton A, Hall J. Pulmonary ventilation. In: Hall J, editor. Textbook of medical physiology, 13th ed. Philadelphia, PA: Elsevier; 2016. pp. 497-508.
8. Easton PA, Katagiri M, Kieser TM, Platt RS. Postinspiratory activity of costal and crural diaphragm. J Appl Physiol (1985) 1999;87:582-589.
9. Muller N, Volgyesi G, Becker L, Bryan MH, Bryan AC. Diaphragmatic muscle tone. J Appl Physiol 1979;47:279-284.
10. Meessen NE, van der Grinten CP, Luijendijk SC, Folgering HT. Continuous negative airway pressure increases tonic activity in diaphragm and intercostal muscles in humans. J Appl Physiol (1985) 1994;77:1256-1262.
11. Allo J-C, Beck JC, Brander L, Brunet F, Slutsky AS, Sinderby CA. Influence of neurally adjusted ventilatory assist and positive endexpiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med 2006;34:2997-3004.
12. Emeriaud G, Beck J, Tucci M, Lacroix J, Sinderby C. Diaphragm electrical activity during expiration in mechanically ventilated infants. Pediatr Res 2006;59:705-710.
13. Muller N, Bryan AC, Zamel N. Tonic inspiratory muscle activity as a cause of hyperinflation in histamine-induced asthma. J Appl Physiol 1980;49:869-874.
14. Larouche A, Massicotte E, Constantin G, Ducharme-Crevier L, Essouri S, Sinderby C, Beck J, Emeriaud G. Tonic diaphragmatic activity in critically ill children with and without ventilatory support. Pediatr Pulmonol 2015;50:1304-1312.
15. Slutsky AS. History of mechanical ventilation: from vesalius to ventilator-induced lung injury. Am J Respir Crit Care Med 2015;191:1106-1115.
16. Doorduin J, van Hees HWH, van der Hoeven JG, Heunks LMA. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med 2013;187:20-27.
17. Putensen C, Muders T, Varelmann D, Wrigge H. The impact of spontaneous breathing during mechanical ventilation. Curr Opin Crit Care 2006;12:13-18.
18. Yoshida T, Fujino Y, Amato MB, Kavanagh BP. Spontaneous breathing during mechanical ventilation: risks, mechanisms & management. Am J Respir Crit Care Med 2017;195:985-992.
19. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967;2:319-323.
20. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS; ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-2533.
21. Decramer M, Vogelmeier C. Global strategy for the diagnosis, management and prevention of COPD; 2016 [accessed 2016 Oct. 20]. Available from: www.goldcopd.org/gold-reports
22. Yanai M, Sekizawa K, Ohrui T, Sasaki H, Takishima T. Site of airway obstruction in pulmonary disease: direct measurement of intrabronchial pressure. J Appl Physiol (1985) 1992;72:1016-1023.
23. Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, et al.; ACURASYS Study Investigators. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010;363:1107-1116.
24. Pellegrini M, Ronéus A, Fiore T, Hedenstierna G, Larsson A, Perchiazzi G. Can expiratory electrical diaphragmatic activity guide setting of positive end-expiratory pressure during spontaneous breathing in acute respiratory failure? [abstract]. Am J Respir Crit Care Med 2015;191:A1200.
25. Pellegrini M, Hedenstierna G, Roneus A, Segelsjö M, Larsson A, Perchiazzi G. The diaphragm has an expiratory braking effect in spontaneously breathing lung injured animals as shown by electrical diaphragmatic activity [abstract]. Intensive Care Med Exp 2015;3:A572.
26. Pellegrini M, Hedenstierna G, Roneus A, Segelsjö M, Vestito MC, Larsson A, Perchiazzi G. Spontaneous breathing compared with mechanical ventilation improves lung aeration and reduces lung collapse in experimental mild acute respiratory distress syndrome [abstract]. Intensive Care Med Exp 2016;679.
27. Hedenstierna G, Pellegrini M, Roneus A, SegelsjöM, Larsson A, Perchiazzi G. Expiratory diaphragm activity reduces atelectasis formation [abstract]. FASEB J 2016;30:1261.9.
28. Pellegrini M, Hedenstierna G, Roneus A, SegelsjöM, Larsson A, Perchiazzi G. Expiratory diaphragm activity reduces atelectasis formation [abstract]. Am J Respir Crit Care Med 2016;193:A7646.
29. Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, Sinderby C. Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 2001;164:419-424.
30. Juan G, Calverley P, Talamo C, Schnader J, Roussos C. Effect of carbon dioxide on diaphragmatic function in human beings. N Engl J Med 1984;310:874-879.
31. Laghi F, Shaikh HS, Morales D, Sinderby C, Jubran A, Tobin MJ. Diaphragmatic neuromechanical coupling and mechanisms of hypercapnia during inspiratory loading. Respir Physiol Neurobiol 2014;198:32-41.
32. Beck J, Sinderby C, Lindström L, Grassino A. Effects of lung volume on diaphragm EMG signal strength during voluntary contractions. J Appl Physiol (1985) 1998;85:1123-1134.
33. Bellani G, Mauri T, Coppadoro A, Grasselli G, Patroniti N, Spadaro S, Sala V, Foti G, Pesenti A. Estimation of patient's inspiratory effort from the electrical activity of the diaphragm. Crit Care Med 2013;41:1483-1491.
34. Stenqvist O, Gattinoni L, Hedenstierna G. What's new in respiratory physiology? The expanding chest wall revisited! Intensive Care Med 2015;41:1110-1113.
35. Ballantyne D, Richter DW. The non-uniform character of expiratory synaptic activity in expiratory bulbospinal neurones of the cat. J Physiol 1986;370:433-456.
36. Beck J, Brander L, Slutsky AS, Reilly MC, Dunn MS, Sinderby C. Noninvasive neurally adjusted ventilatory assist in rabbits with acute lung injury. Intensive Care Med 2008;34:316-323.
37. Appelberg J, Pavlenko T, Bergman H, Rothen HU, Hedenstierna G. Lung aeration during sleep. Chest 2007;131:122-129.
38. Badier M, Jammes Y, Romero-Colomer P, Lemerre C. Tonic activity in inspiratory motoneurons by stimulation muscles and phrenic of vagal afferents. J Appl Physiol (1985) 1989;66:1613-1619.
39. Wrigge H, Zinserling J, Neumann P, Defosse J, Magnusson A, Putensen C, Hedenstierna G. Spontaneous breathing improves lung aeration in oleic acid-induced lung injury. Anesthesiology 2003;99:376-384.
40. Vimlati L, Kawati R, Hedenstierna G, Larsson A, Lichtwarck-Aschoff M. Spontaneous breathing improves shunt fraction and oxygenation in comparison with controlled ventilation at a similar amount of lung collapse. Anesth Analg 2011;113:1089-1095.
41. Schellekens W-JM, van Hees HWH, Doorduin J, Roesthuis LH, Scheffer GJ, van der Hoeven JG, Heunks LMA. Strategies to optimize respiratory muscle function in ICU patients. Crit Care 2016;20:103.
42. Liu L, Takahashi D, Qui H, Slutsky AS, Sinderby C, Beck J. Feasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental lung injury. BMC Anesthesiol 2015;15:124.