Chest
Volume 90, Issue 4, October 1986, Pages 546-552
Journal home page for Chest

Clinical Investigations
Intermittent Positive Pressure Breathing in Patients with Respiratory Muscle Weakness: Alterations in Total Respiratory System Compliance

https://doi.org/10.1378/chest.90.4.546Get rights and content

Intermittent positive pressure ventilation (IPPB) is reported to improve lung compliance and decrease the work of breathing in subjects with kyphoscoliosis. These results suggest that IPPB may improve chest wall and lung compliance in patients with neuromuscular disease. We studied the short-term effects of IPPB on total respiratory system compliance in 14 subjects with neuromuscular disease. Seven were quadriplegics, and seven had muscular dystrophy. Vital capacity was reduced to 38±14 percent of the predicted normal values. Baseline measurements of total respiratory system compliance were 57±18 percent when compared to normal control values. After a 20 minute treatment of IPPB delivered with inspiratory pressures of 20 to 25 cm H2O that more than tripled resting tidal volume, there was no significant change in total respiratory system compliance in either group of patients. These findings indicate that patients with quadriplegia or muscular dystrophy do not derive immediate improvement in ventilatory mechanics from IPPB treatments.

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

REFERENCES (31)

  • EH Bergofsky

    Mechanism for respiratory insufficiency after cervical cord injury: a source of alveolar hypoventilation

    Ann Intern Med

    (1964)
  • W Hall

    Respiratory failure as a complication of neuromuscular disease

    Adv Neurol

    (1977)
  • JPH Derenne et al.

    The respiratory muscles: mechanics, control, and pathophysiology

    Am Rev Respir Dis

    (1978)
  • R Bellamy et al.

    Respiratory complications in traumatic quadriplegia

    J Neurosurg

    (1973)
  • L Messard et al.

    Survival after spinal cord trauma: a life table analysis

    Arch Neurol

    (1978)
  • A Haas et al.

    Impairment of respiration after spinal cord injury

    Arch Phys Med Rehabil

    (1964)
  • AC McKinley et al.

    Pulmonary function, ventilatory control, and respiratory complications in quadriplegic subjects

    Am Rev Respir Dis

    (1969)
  • BG Ferris et al.

    Pulmonary function in convalescent poliomyelitic patients: compliance of the lungs and thorax

    N Engl J Med

    (1952)
  • DJ Stone et al.

    The effect of respiratory muscular dysfunction on pulmonary function: studies in patients with spinal cord injuries

    Am Rev Respir Dis

    (1963)
  • M Estenne et al.

    Chest wall stiffness in patients with chronic respiratory muscle weakness

    Am Rev Respir Dis

    (1983)
  • GJ Gibson et al.

    Pulmonary mechanics in patients with respiratory muscle weakness

    Am Rev Respir Dis

    (1977)
  • A DeTroyer et al.

    The effects of intermittent positive pressure breathing on patients with respiratory muscle weakness

    Am Rev Respir Dis

    (1981)
  • A DeTroyer et al.

    Analysis of lung volume restriction in patients with respiratory muscle weakness

    Thorax

    (1980)
  • A DeTroyer et al.

    Respiratory mechanics in quadriplegia: the respiratory function of the intercostal muscles

    Am Rev Respir Dis

    (1980)
  • DeTroyer A, Pride NB. The respiratory system in neuromuscular disorders. In: Roussos C, Macklem PT, eds. The thorax....
  • Cited by (0)

    Manuscript received January 2; revision accepted April 10.

    View full text