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1.
Immediate effects of diaphragmatic myofascial release on the physical and functional outcomes in sedentary women: A randomized placebo-controlled trial.
Marizeiro, DF, Florêncio, ACL, Nunes, ACL, Campos, NG, Lima, POP
Journal of bodywork and movement therapies. 2018;(4):924-929
Abstract
BACKGROUND Although diaphragmatic myofascial release techniques are widely used in clinical practice, few studies have evaluated the simultaneous acute effects of these techniques on the respiratory and musculoskeletal systems. OBJECTIVE To evaluate the immediate effects of diaphragmatic myofascial release in sedentary women on the posterior chain muscle flexibility; lumbar spine range of motion; respiratory muscle strength; and chest wall mobility. DESIGN A randomized placebo-controlled trial with concealed allocation, intention-to-treat analysis, and blinding of assessors and participants. PARTICIPANTS Seventy-five sedentary women aged between 18 and 35 years. INTERVENTION The sample was randomly allocated into one of two groups; the experimental group received two diaphragmatic myofascial release techniques in a single session, and the control group received two placebo techniques following the same regimen. OUTCOMES MEASURES The primary outcome was chest wall mobility, which was analyzed using cirtometry. The secondary outcomes were flexibility, lumbar spine range of motion, and respiratory muscle strength. Outcomes were measured before and immediately after treatment. RESULTS The manual diaphragm release techniques significantly improved chest wall mobility immediately after intervention, with a between-group difference of 0.61 cm (95% CI, 0.12-1.1) for the axillary region, 0.49 cm (95% CI, 0.03-0.94) for the xiphoid region, and 1.44 (95% CI, 0.88-2.00) for the basal region. The techniques also significantly improved the posterior chain muscle flexibility, with a between-group difference of 5.80 cm (95% CI, 1.69-9.90). All movements except flexion of the lumbar spine significantly increased. The effects on respiratory muscle strength were non-significant. CONCLUSION The diaphragmatic myofascial release techniques improve chest wall mobility, posterior chain muscle flexibility, and some movements of the lumbar spine in sedentary women. These techniques could be considered in the management of people with reduced chest wall and lumbar mobility. TRIAL REGISTRATION NCT03065283.
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Topical Ice Slush Adversely Affects Sniff Nasal Inspiratory Force After Coronary Bypass Surgery.
Nazer, RI, Albarrati, AM
Heart, lung & circulation. 2018;(3):371-376
Abstract
BACKGROUND Topical cooling with ice slush as an adjunct for myocardial protection during cardiac surgery has been shown to cause freezing injury of the phrenic nerves. This can cause diaphragmatic dysfunction and respiratory complications. METHODS Twenty (n=20) male patients between the ages of 40 and 60 years were equally randomised to undergo elective coronary artery bypass grafting (CABG) with either cold cardioplegic arrest with topical ice slush cooling or cold cardioplegic arrest without the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to compare inspiratory muscle strength. RESULTS There was no difference in the preoperative SNIF in the two randomised groups. In the immediate postoperative period, the ice slush group had worse SNIF (33.5±9.6cm H2O versus 47.8±12.2cm H2O; p=0.009). The pre-home discharge SNIF was still significantly lower for the ice slush group despite a noted improvement in SNIF recovery in both groups (38.3±10.6cm H2O versus 53.5±13.2cm H2O; p=0.011). Two patients in the ice slush group had left diaphragmatic dysfunction with none in the control group. CONCLUSION The use of topical ice slush is associated with freezing injury of the phrenic nerves. This will adversely affect the inspiratory muscle force which may lead to respiratory complications after surgery.
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3.
Diaphragm and Lung Ultrasound to Predict Weaning Outcome: Systematic Review and Meta-Analysis.
Llamas-Álvarez, AM, Tenza-Lozano, EM, Latour-Pérez, J
Chest. 2017;(6):1140-1150
Abstract
BACKGROUND Deciding the optimal timing for extubation in patients who are mechanically ventilated can be challenging, and traditional weaning predictor tools are not very accurate. The aim of this systematic review and meta-analysis was to assess the accuracy of lung and diaphragm ultrasound for predicting weaning outcomes in critically ill adults. METHODS MEDLINE, the Cochrane Library, Web of Science, Scopus, LILACS, Teseo, Tesis Doctorales en Red, and OpenGrey were searched, and the bibliographies of relevant studies were reviewed. Two researchers independently selected studies that met the inclusion criteria and assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The summary receiver-operating characteristic curve and pooled diagnostic OR (DOR) were estimated by using a bivariate random effects analysis. Sources of heterogeneity were explored by using predefined subgroup analyses and bivariate meta-regression. RESULTS Nineteen studies involving 1,071 people were included in the study. For diaphragm thickening fraction, the area under the summary receiver-operating characteristic curve was 0.87, and DOR was 21 (95% CI, 11-40). Regarding diaphragmatic excursion, pooled sensitivity was 75% (95% CI, 65-85); pooled specificity, 75% (95% CI, 60-85); and DOR, 10 (95% CI, 4-24). For lung ultrasound, the area under the summary receiver-operating characteristic curve was 0.77, and DOR was 38 (95% CI, 7-198). Based on bivariate meta-regression analysis, a significantly higher specificity for diaphragm thickening fraction and higher sensitivity for diaphragmatic excursion was detected in studies with applicability concerns. CONCLUSIONS Lung and diaphragm ultrasound can help predict weaning outcome, but its accuracy may vary depending on the patient subpopulation.
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Impact of feeding method on diaphragm electrical activity and central apnea in preterm infants (FEAdi study).
Ng, E, Schurr, P, Reilly, M, Dunn, M, Beck, J
Early human development. 2016;:33-7
Abstract
BACKGROUND In preterm infants, it is unknown whether feeding affects neural breathing pattern. OBJECTIVES By measuring the diaphragm electrical activity (Edi) waveform, we evaluated the effect of enteral feeding and compared the effects of feeding methods on neural breathing pattern and central apnea in very low birth weight preterm infants. METHODS In a prospective, randomized, crossover study, ten non-ventilated preterm infants with birth weights<1250g and tolerating full feeds were randomized to either bolus feeding (BF) or slow infusion feeding (SF) over 90min, followed by crossover to the other method at the next feed. Edi was continuously measured by a feeding catheter with miniaturized sensors. Five 15-min epochs were chosen [Baseline (BL), first 15min and 90min after BF/SF started] for breath-by-breath analyses of neural breathing pattern, including Edi peak, Edi min (end-expiratory), neural inspiratory and expiratory times, neural respiratory rate, and central apnea. Primary outcome was change in Edi min with feed. Secondary outcomes include change in Edi peak, frequency and duration of central apnea with feeding. RESULTS Although intrasubject coefficient of variation was not significantly different, individual responses to feeding and feeding method were variable. No significant difference in Edi timing, Edi min, Edi peak, or apnea was observed for the different epochs. CONCLUSIONS In this study cohort, neural breathing pattern does not appear to be consistently affected by enteral feeding or the feeding method. Compared with BF, SF does not appear to reduce the number or duration of apneas.
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The Effect of Caffeine on Diaphragmatic Activity and Tidal Volume in Preterm Infants.
Kraaijenga, JV, Hutten, GJ, de Jongh, FH, van Kaam, AH
The Journal of pediatrics. 2015;(1):70-5
Abstract
OBJECTIVE To determine the effect of caffeine on diaphragmatic activity, tidal volume (Vt), and end-expiratory lung volume (EELV) in preterm infants. STUDY DESIGN Using transcutaneous electromyography of the diaphragm (dEMG), we measured diaphragmatic activity from 30 minutes before (baseline) to 3 hours after administration of an intravenous caffeine-base loading dose in 30 spontaneously breathing preterm infants (mean gestational age, 29.1 ± 1.3 weeks), most of whom were on noninvasive respiratory support. Diaphragmatic activity was expressed as the percentage change in dEMG amplitude, area under the curve, respiratory rate, and inspiratory and expiratory times. Using respiratory inductive plethysmography, we measured changes in Vt and EELV from baseline. These outcome variables were calculated at 8 fixed time points after caffeine administration (5, 15, 30, 60, 90, 120, 150, and 180 minutes) and compared with baseline. RESULTS Caffeine administration resulted in rapid (within 5 minutes) increases in dEMG amplitude (median, 43%; IQR, 24%-63%; P < .001) and area under the curve (median, 28%; IQR, 14%-48%; P < .001). Vt also increased by a median of 30% (IQR, 7%-48%), and this change was significantly correlated with the change in dEMG amplitude (r = 0.67; P < .001). These effects were relatively stable until 120 minutes after caffeine administration. Caffeine did not consistently impact EELV, respiratory rate, or inspiratory and expiratory times. CONCLUSION Caffeine treatment results in a rapid and sustained increase in diaphragmatic activity and Vt in preterm infants.
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Unaffected contractility of diaphragm muscle fibers in humans on mechanical ventilation.
Hooijman, PE, Paul, MA, Stienen, GJ, Beishuizen, A, Van Hees, HW, Singhal, S, Bashir, M, Budak, MT, Morgen, J, Barsotti, RJ, et al
American journal of physiology. Lung cellular and molecular physiology. 2014;(6):L460-70
Abstract
Several studies have indicated that diaphragm dysfunction develops in patients on mechanical ventilation (MV). Here, we tested the hypothesis that the contractility of sarcomeres, i.e., the smallest contractile unit in muscle, is affected in humans on MV. To this end, we compared diaphragm muscle fibers of nine brain-dead organ donors (cases) that had been on MV for 26 ± 5 h with diaphragm muscle fibers from nine patients (controls) undergoing surgery for lung cancer that had been on MV for less than 2 h. In each diaphragm specimen we determined 1) muscle fiber cross-sectional area in cryosections by immunohistochemical methods and 2) the contractile performance of permeabilized single muscle fibers by means of maximum specific force, kinetics of cross-bridge cycling by rate of tension redevelopment, myosin heavy chain content and concentration, and calcium sensitivity of force of slow-twitch and fast-twitch muscle fibers. In case subjects, we noted no statistically significant decrease in outcomes compared with controls in slow-twitch or fast-twitch muscle fibers. These observations indicate that 26 h of MV of humans is not invariably associated with changes in the contractile performance of sarcomeres in the diaphragm.
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The calcium sensitizer levosimendan improves human diaphragm function.
Doorduin, J, Sinderby, CA, Beck, J, Stegeman, DF, van Hees, HW, van der Hoeven, JG, Heunks, LM
American journal of respiratory and critical care medicine. 2012;(1):90-5
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Abstract
RATIONALE Acquired diaphragm muscle weakness is a key feature in several chronic conditions, including chronic obstructive pulmonary disease, congestive heart failure, and difficult weaning from mechanical ventilation. No drugs are available to improve respiratory muscle function in these patients. Recently, we have shown that the calcium sensitizer levosimendan enhances the force-generating capacity of isolated diaphragm fibers. OBJECTIVES To investigate the effects of the calcium sensitizer levosimendan on in vivo human diaphragm function. METHODS In a double-blind, randomized, crossover design, 30 healthy subjects performed two identical inspiratory loading tasks. After the first loading task, subjects received levosimendan (40 μg/kg bolus followed by 0.1/0.2 μg/kg/min continuous infusion) or placebo. Transdiaphragmatic pressure, diaphragm electrical activity, and their relationship (neuromechanical efficiency) were measured during loading. Magnetic phrenic nerve stimulation was performed before the first loading task and after bolus administration to assess twitch contractility. Center frequency of diaphragm electrical activity was evaluated to study the effects of levosimendan on muscle fiber conduction velocity. MEASUREMENTS AND MAIN RESULTS The placebo group showed a 9% (P=0.01) loss of twitch contractility after loaded breathing, whereas no loss in contractility was observed in the levosimendan group. Neuro-mechanical efficiency of the diaphragm during loading improved by 21% (P<0.05) in the levosimendan group. Baseline center frequency of diaphragm electrical activity was reduced after levosimendan administration (P<0.05). CONCLUSIONS The calcium sensitizer levosimendan improves neuromechanical efficiency and contractile function of the human diaphragm. Our findings suggest a new therapeutic approach to improve respiratory muscle function in patients with respiratory failure.
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[Effect of shenmai injection on diaphragmatic fatigue in children with respiratory failure].
Yan, CX, Yang, YG, Zhang, ZX
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine. 2002;(6):426-8
Abstract
OBJECTIVE To study the effect of Shenmai injection (SMI) on diaphragmatic fatigue in children with respiratory failure. METHODS Thirty-five cases of children respiratory failure with diaphragmatic fatigue were divided into two groups. The control group was treated with comprehensive therapy including anti-infection, oxygen inhalation and parenteral nutrition, etc. The SMI group was treated with SMI intravenously, besides the comprehensive therapy as in the control group. Taking electrical impedance respirogram (IRG) as criterion of therapeutic effect, the effective cases after 30 min medication, time for diaphragmatic fatigue disappearance, as well as arterial blood gas analysis before and after treatment were analyzed. RESULTS (1) In 30 min after medication, the effective cases in the SMI group (15/18) were more than that in the control group (4/17, P < 0.01); (2) Blood pH increased and PaCO2 decreased in both groups after treatment, but the decrease of PaCO2 was more significant in the SMI group (P < 0.05); (3) Time of diaphragmatic fatigue disappearance in the SMI group was shorter than that in the control group (P < 0.01). CONCLUSION SMI is an effective drug for treatment of diaphragmatic fatigue in children with less adverse effect, and worthwhile for spreading in clinical practice.