Modifications of Diaphragmatic Activity Induced by Midline Laparotomy and Changes in Abdominal Wall Compliance |
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| Authors: | Joaquim Gea Juan Bautista Gáldiz Norman Comtois Ercheng Zhu Igor Salazkin José antonio Fiz Alejandro Grassino |
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| Affiliation: | 1. Hôpital de Notre-Dame, Université de Montréal, Montréal, Québec, Canada;2. Meakins-Christie Laboratories, McGill University, Montréal, Québec, Canada;4. Servicio de Neumología, Hospital de Cruces, Barakaldo, Universidad del País Vasco, Vizcaya, Spain;5. Servei de Pneumologia, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain;1. Thoracic Surgery Department, Quirónsalud-Madrid University Hospital, Madrid, Spain;2. Istituto Nazionale Tumori, IRCCS, Pascale Foundation, Naples, Italy;1. Université de Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France;2. Service d’électronique, Université de Technologie de Compiègne, Compiègne, France;3. Unité 1179 INSERM, Montigny-le-Bretonneux, France;4. Service de Physiologie-Explorations Fonctionnelles, Hôpital Ambroise Paré, Groupe Hospitalier Paris Ile-de-France Ouest, Boulogne-Billancourt, France;1. Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288, Matsushima, Kurashiki City, 701-0193, Japan;2. Master''s Program in Rehabilitation, Kawasaki University of Medical Welfare, 288, Matsushima, Kurashiki City, 701-0193, Japan;1. The State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, China;2. Bioengineering Center, Wayne State University, Detroit, MI, USA |
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| Abstract: | Introduction and ObjectiveDiaphragmatic activity varies with the initial length of the muscle. Our objective was to evaluate the influence of surgery and changes in abdominal wall compliance on diaphragmatic activity.MethodsBoth phrenic nerves in 7 mongrel dogs were stimulated electrically with single supramaximal pulses (twitch). The gastric (Pga) and transdiaphragmatic (Pdi) pressures generated and muscle shortening (sonomicrometry) were used to evaluate diaphragmatic activity, which was determined at baseline, after midline laparotomy, with an elastic abdominal bandage, and with a rigid circular cast. Abdominal pressure was then gradually increased in order to induce progressive lengthening of the diaphragm.ResultsAfter laparotomy, the pressures were somewhat lower (by 12%) than at baseline. The elastic bandage produced a slight increase in the pressure generated by the diaphragm (mean [SE] values: Pga, from 4.2 [0.3] cm H2O to 6.3 [0.9] cm H2O, P<.01; Pdi, from 12.1 [2.0] cm H2O to 15.4 [1.8] cm H2O, P<.05]), and these values increased even further with the rigid cast (Pga, to 12.6 [1.5] cm H2O; Pdi, to 20.2 [2.3] cm H2O; P<.01 for both comparisons); this occurred despite smaller degrees of muscle shortening: by 57% [5%] of the initial length at functional residual capacity at baseline, by 49% [5%] with the bandage (P<.05), and by 39% [6%] with the cast (P<.01). With progressive lengthening of the muscle, its contractile efficacy increased up to a certain point (105% of the length at functional residual capacity), after which it began to decline.ConclusionsAbdominal wall compliance plays an important role in the diaphragmatic response to stimulation. This appears to be due mainly to changes in its length at rest. |
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