Chest
Clinical InvestigationsIntermittent Positive Pressure Breathing in Patients with Respiratory Muscle Weakness: Alterations in Total Respiratory System Compliance
Section snippets
Patient Characteristics
Fourteen patients with chest wall muscle weakness were studied (Table 1). All patients gave written informed consent. The group included seven quadriplegics and seven patients with muscular dystrophy. Patients 2 and 4 in Table 1 carry the diagnosis of myotonic dystrophy. Because their physiologic abnormalities were similar to the patients with muscular dystrophy, their data are included in the group diagnosed as having muscular dystrophy. Patients were selected from a neurology and a
PROTOCOL
All 14 patients underwent routine pulmonary function testing and measurements of total respiratory system compliance. Lung compliance was then measured in four of the muscular dystrophic and in five of the quadriplegic subjects who agreed to placement of an esophageal balloon. After the above measurements, each subject received 20 minutes of IPPB using a Bennett PR-2 device delivering 20 to 30 cm H2O pressure. Tidal volumes during IPPB were at least triple the resting tidal volume (Table 3).
RESULTS
The effects of IPPB on CRS in the seven muscular dystrophic and seven quadriplegic subjects are shown in Figures 1 and 2. There were no significant alterations in CRS during the 90-minute observation period following IPPB in either group. Five of the subjects (1, 6, 8, II, and 14) had tidal volumes on IPPB that. exceeded inspiratory capacity. Despite this large inflation volume, there were no consistent differences in changes of respiratory system compliance when compared to the other subjects.
DISCUSSION
Sinha and Bergofsky18 demonstrated that IPPB increased CL and decreased the work of breathing for up to three hours in patients with kyphoscoliosis. To determine if similar improvements in CL could be achieved in muscular dystrophy, DeTroyer and Deisser12 measured static CL in ten subjects, but they found no alteration in CL following IPPB. However, their study did not include quadriplegic subjects nor did it evaluate the effects of IPPB on the chest wall. The latter is particularly important
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Manuscript received January 2; revision accepted April 10.