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Diaphragm Dysfunction

Alain Boussuges, Fabienne Brégeon, Philippe Blanc, Jean-Marie Gil, Laurent Poirette
BACKGROUND: M-mode ultrasonography might be useful for detecting hemidiaphragm paralysis. The objective of the present study was to describe the motion recorded by M-mode ultrasonography of both diaphragmatic leaves in patients with a pre-established diagnosis of hemidiaphragm paralysis. METHODS: A study was conducted in 26 patients (18 men, 8 women) with unilateral diaphragmatic paralysis. They were referred to two different rehabilitation centres after thoracic surgery in 23 cases and cardiac interventional procedures in three cases...
October 16, 2018: Clinical Physiology and Functional Imaging
Víctor Lago Leal, Luis Martínez Cortés, Carlos Seco Del Cacho
Congenital high airway obstruction syndrome (CHAOS) is a rare sequence due to a complete obstruction of the fetal airway that blocks the larynx or trachea, either intrinsic atresia or extrinsic compression (e.g., congenital neck mass). Despite the true incidence of CHAOS is unknown, an incidence of 1 per 50,000 newborns is described. If any obstruction occurs in the tracheobronchial airway, this secretion cannot be extricated. Because of this situation, a knock-on effect starts: the enlargement of the lungs squeezes the heart and great veins, what results in a replacement of the heart to the center of the chest becoming small and dysfunctional...
July 2018: Indian Journal of Radiology & Imaging
Thomas Breuer, Christian S Bruells, Klemens Horst, Christoph Thiele, Frank Hildebrand, Stephan Linnartz, Tom Siegberg, Nadine Frank, Ghislaine Gayan-Ramirez, Lukas Martin, Dirk H Ostareck, Gernot Marx, Tim-Philipp Simon
INTRODUCTION: Mechanical ventilation is known to activate oxidative stress and proteolytic pathways in the diaphragm. Trauma by inducing inflammation and activating proteolytic pathways may potentiate the effects of mechanical ventilation on the diaphragm. In a blunt chest trauma with concomitant injuries we tested the hypothesis that trauma via inflammation further activates the proteolytic pathways and worsens atrophy in the diaphragm. MATERIAL AND METHODS: Piglets were separated into 2 groups and underwent 72hrs of mechanical ventilation...
October 8, 2018: Shock
Hannah Horris, Barton E Anderson, R Curtis Bay, Kellie C Huxel Bliven
CONTEXT: Altered diaphragm function is linked to decreased core stabilization, postural changes, and decreased function. Two clinical tests used to assess breathing are the hi-lo and lateral rib expansion (LRE) tests. It is currently unknown how breathing classification based on these tests differ, and how their results are affected by varying test positions. OBJECTIVE: To compare results of breathing tests when conducted in varying test positions. DESIGN: Prospective cross-sectional study...
October 9, 2018: Journal of Sport Rehabilitation
Pia Sjöberg, Johannes Töger, Erik Hedström, Per Martin Arvidsson, Einar Heiberg, Hakan Arheden, Ronny Gustafsson, Shahab Nozohoor, Marcus Carlsson
Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in repaired tetralogy of Fallot (rToF) patients to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and PR>20% (n=18) and healthy controls (n=15) underwent magnetic resonance imaging (MRI) including 4D-flow. A subset of patients (n=8) underwent PVR and MRI after surgery...
September 28, 2018: American Journal of Physiology. Heart and Circulatory Physiology
Diana Jansen, Annemijn H Jonkman, Lisanne Roesthuis, Suvarna Gadgil, Johannes G van der Hoeven, Gert-Jan J Scheffer, Armand Girbes, Jonne Doorduin, Christer S Sinderby, Leo M A Heunks
BACKGROUND: Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure...
September 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Bruno Bordoni, Bruno Morabito
Irritable bowel syndrome (IBS) is one of the most debilitating and common gastrointestinal disorders; nevertheless, its pathophysiology is still unclear. It affects 11% of the world's population, and is characterized by alternating periods of pain and/or motility disorders with periods of remission and without any evidence of any structural and functional organic variation. It has been recently proposed that an altered contractile ability of the diaphragm muscle might adversely influence intestinal motility...
July 23, 2018: Curēus
M A Mukhamedyarov, P N Grigor'ev, E A Ushanova, T L Zefirov, A V Leushina, A L Zefirov
The function of synaptic transmission and presynaptic vesicular cycle in the neuromuscular synapses of the diaphragm was studied in transgenic APP/PS1 mice (Alzheimer's disease model). The decrease in the quantal content of end-plate potential, intense depression of the amplitude of terminal plate potentials under conditions of lasting high frequency stimulation (50 Hz), a drastic prolongation of the synaptic vesicle recycling time in APP/PS1 mice in comparison with wild type mice were detected. Manifest dysfunction of the neuromuscular synapses, caused by disordered neurosecretion and recycling of the synaptic vesicles in the presynaptic nerve endings, was detected in the Alzheimer's disease model on transgenic APP/PS1 mice...
September 2018: Bulletin of Experimental Biology and Medicine
Heather A Ballard, Olga S Leavitt, Anthony C Chin, Rashmi Kabre, Debra E Weese-Mayer, John Hajduk, Narasimhan Jagannathan
BACKGROUND: Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation are rare neurocristopathies characterized by autonomic dysregulation including bradyarrhythmias, abnormal temperature control, and most significantly, abnormal control of breathing leading to tracheostomy and ventilator dependence as life support. Surgical advancements have made phrenic nerve-diaphragm pacemakers available, to eliminate the tether to a mechanical ventilator for 12-15 hours each day...
September 24, 2018: Paediatric Anaesthesia
Z H Lu, F Guo, G Zhang, H Q Ge, L L Xu, Y L Chen
Objective: To investigate the prevalence of diaphragmatic dysfunction in mechanical ventilated subjects with sepsis and the relationship between diaphragmatic dysfunction and clinical outcomes. Methods: Newly intubated patients with sepsis diagnosed according to "Sepsis-3" were enrolled from January 2017 to October 2017 in Intensive Care Unit (ICU) of Sir Run Run Shaw Hospital. Diaphragm thickness was recorded ultrasonographically at end-inspiration and end-expiration when the patients' spontaneous breathing recovered...
September 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
F Barutta, S Bellini, R Mastrocola, R Gambino, F Piscitelli, V di Marzo, B Corbetta, K Vemuri, A Makriyannis, L Annaratone, G Bruno, G Gruden
BACKGROUND AND PURPOSE: The endocannabinoid (EC) system has been implicated in the pathogenesis of diabetic nephropathy (DN). We investigated the effects of peripheral blockade of the endocannabinoid receptor of type 1 (CB1R) as add-on treatment to ACE-inhibition in type 1 diabetic (DM) mice with established albuminuria. EXPERIMENTAL APPROACH: Renal functional parameters (albumin excretion rate, creatinine clearance), tubular injury, renal structure, both EC and EC receptor levels, and markers of podocyte dysfunction, fibrosis and inflammation were studied in streptozotocin-induced DM mice treated for 14 weeks with vehicle, the ACE-inhibitor perindopril (2 mg/Kg/die), the peripheral restricted CB1R antagonist AM6545 (10 mg/Kg/die) or both...
September 5, 2018: British Journal of Pharmacology
David P Burns, Leonie Canavan, Jane Rowland, Robin O'Flaherty, Molly Brannock, Sarah E Drummond, Dervla O'Malley, Deirdre Edge, Ken D O'Halloran
KEY POINTS: Impaired ventilatory capacity and diaphragm muscle weakness are prominent features of Duchenne muscular dystrophy, with strong evidence of attendant systemic and muscle inflammation. We performed a 2-week intervention in young wild-type and mdx mice, consisting of either injection of saline or co-administration of a neutralizing interleukin-6 receptor antibody (xIL-6R) and urocortin-2 (Ucn2), a corticotrophin releasing factor receptor 2 agonist. We examined breathing and diaphragm muscle form and function...
August 30, 2018: Journal of Physiology
Yong Song, MarJanna Dahl, Wendy Leavitt, Jeremy Alvord, Calan Y Bradford, Kurt H Albertine, J Jane Pillow
Background: Preterm infants are deficient in vitamin A, which is essential for growth and development of the diaphragm. Preterm infants often require mechanical ventilation (MV) for respiratory distress. In adults, MV is associated with the development of ventilation-induced diaphragm dysfunction and difficulty weaning from the ventilator. We assessed the impact of MV on the preterm diaphragm and the protective effect of vitamin A during MV. Methods: Preterm lambs delivered operatively at ∼131 days gestation (full gestation: 150 days) received respiratory support by synchronized intermittent mandatory ventilation for 3 days...
2018: Frontiers in Physiology
Basil J Petrof
The diaphragm is the primary muscle of inspiration. Its capacity to respond to the load imposed by pulmonary disease is a major determining factor both in the onset of ventilatory failure and in the ability to successfully separate patients from ventilator support. It has recently been established that a very large proportion of critically ill patients exhibit major weakness of the diaphragm, which is associated with poor clinical outcomes. The two greatest risk factors for the development of diaphragm weakness in critical illness are the use of mechanical ventilation and the presence of sepsis...
August 23, 2018: Chest
Leila Costa Volpon, Paulo Roberto Barbosa Evora, Gisele Douradinho Teixeira, Maurício Godinho, Sandro Scarpelini, Fabio Carmona, Ana Paula de Carvalho Panzeri Carlotti
BACKGROUND: Methylene blue (MB) has been advocated for the treatment of shock refractory to standard measures. MB is proposed to increase blood pressure in shock by interfering with guanylate cyclase and nitric oxide synthase (NOS) activity. Several studies have evaluated the vasoconstrictive and positive inotropic effects of MB in septic shock patients. However, there is a paucity of studies involving trauma patients. CASE REPORT: A 4-year-old boy was hit by a truck while riding his bicycle and was treated with fluid resuscitation at the emergency department and then taken to the operating room for damage-control surgery...
October 2018: Journal of Emergency Medicine
Lukas Schroeder, Heiko Reutter, Ullrich Gembruch, Christoph Berg, Andreas Mueller, Florian Kipfmueller
INTRODUCTION: Infants after surgical correction of congenital diaphragmatic hernia are at high risk for extubation failure, but little is known about contributing factors. Therefore, our study aimed to analyze clinical and echocardiographic parameters. MATERIALS AND METHODS: Data of 34 infants with congenital diaphragmatic hernia treated at our department (July 2013-December 2015) were analyzed. Inclusion criteria were: presence of congenital diaphragmatic hernia and echocardiography performed within 48 hours before the first, and, in case of reintubation, the final extubation attempt...
August 16, 2018: Paediatric Anaesthesia
Sunamita de Carvalho Lima, Lucas de Carvalho Porta, Álvaro da Costa Lima, Joana D'Arc Campeiro, Ywlliane Meurer, Nathália Bernardes Teixeira, Thiago Duarte, Eduardo Brandt Oliveira, Gisele Picolo, Rosely Oliveira Godinho, Regina Helena Silva, Mirian Akemi Furuie Hayashi
The high medical importance of Crotalus snakes is unquestionable, as this genus is the second in frequency of ophidian accidents in many countries, including Brazil. With a relative less complex composition compared to other genera venoms, as those from the Bothrops genus, the Crotalus genus venom from South America is composed basically by the neurotoxin crotoxin (a phospholipase A2), the thrombin-like gyroxin (a serinoprotease), a very potent aggregating protein convulxin, and a myotoxic polypeptide named crotamine...
August 2018: PLoS Neglected Tropical Diseases
Yoshiharu Kinugasa, Mari Miyagi, Takeshi Sota, Kensaku Yamada, Takuya Ishisugi, Masayuki Hirai, Kiyotaka Yanagihara, Nobuhiko Haruki, Koichi Matsubara, Masahiko Kato, Kazuhiro Yamamoto
No abstract text is available yet for this article.
August 6, 2018: European Journal of Preventive Cardiology
Matthieu Le Dinh, Serge Carreira, Julie Obert, Ghislaine Gayan-Ramirez, Bruno Riou, Maud Beuvin, Thomas Similowski, Catherine Coirault, Alexandre Demoule
BACKGROUND: Short-term mechanical ventilation (MV) protects against sepsis-induced diaphragmatic dysfunction. Prolonged MV induces diaphragmatic dysfunction in non-septic animals, but few reports describe the effects of prolonged MV in sepsis. We hypothesized that prolonged MV is not protective but worsens the diaphragmatic dysfunction induced by a mild sepsis, because MV and sepsis share key signaling mechanisms, such as cytokine upregulation. METHOD: We studied the impact of prolonged MV (12 h) in four groups (n = 8) of male Wistar rats: 1) endotoxemia induced by intraperitoneal injection of Escherichia coli lipopolysaccharide, 2) MV without endotoxemia, 3) combination of endotoxemia and MV and 4) sham control...
2018: PloS One
Nens van Alfen, Jonne Doorduin, Marieke H J van Rosmalen, Jeroen J J van Eijk, Yvonne Heijdra, Andrea J Boon, Michael A Gaytant, Ries J M van den Biggelaar, Roy T M Sprooten, Peter J Wijkstra, Jan T Groothuis
OBJECTIVE: To describe the clinical phenotype and recovery of diaphragm dysfunction caused by neuralgic amyotrophy in a large cohort of patients, to improve accurate awareness of this entity, and to encourage adoption of a standardized approach for diagnosis and treatment. METHODS: This observational cohort study recruited adult patients with neuralgic amyotrophy and symptoms of idiopathic phrenic neuropathy from the database of the Dutch expert center for neuralgic amyotrophy and the Dutch centers for home mechanical ventilation...
August 28, 2018: Neurology
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