A. Detroyer et al., NEURAL DRIVE TO THE DIAPHRAGM IN PATIENTS WITH SEVERE COPD, American journal of respiratory and critical care medicine, 155(4), 1997, pp. 1335-1340
Citations number
30
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
Patients with severe chronic obstructive pulmonary disease (COPD) have
a greater neural drive to the parasternal intercostal and scalene mus
cles and greater inspiratory expansion of the rib cage than do healthy
individuals. However, such patients also have a reduced outward displ
acement or a paradoxical inward displacement of the ventral abdominal
wall during inspiration. This has led to the suggestion that they may
have less use of the diaphragm, possibly secondary to chronic muscle f
atigue. To assess the effect of COPD on the neural drive to the diaphr
agm, we inserted needle electrodes into the costal part of the right h
emidiaphragm in eight patients with severe disease (mean [+/- SD] FEV(
1): 0.82 [+/- 0.27] L) and six control subjects of similar age, and me
asured the discharge frequencies of single motor units during resting
breathing. A total of 115 diaphragmatic motor units were recorded in t
he control subjects and 122 in the patients. All motor units discharge
d rhythmically in phase with inspiration. However, whereas 95% of the
units in the control subjects had a peak discharge frequency between 7
and 14 Hz, 79% of the units in the COPD patients had a peak discharge
frequency greater than 15 Hz. As a result, the discharge frequency of
all units averaged 10.5 [+/- 2.4] Hz in the control subjects, but 17.
9 [+/- 4.3] Hz in the patients (p < 0.001). These observations indicat
e that patients with severe COPD have an increased neural drive not on
ly to the rib cage inspiratory muscles, but also to the diaphragm. Con
sequently, the reduced inspiratory expansion of the abdomen in severe
COPD results from mechanical factors alone.