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Laboratoire de Physiopathologie Respiratoire, Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris cedex 13, France
Inspiratory muscle fatigue can probably
determine hypercapnic respiratory failure. Diaphragm fatigue is
detected by electrical phrenic stimulation (ELS), but there is no
simple tool to assess rib cage muscle (RCM) fatigue. Cervical magnetic
stimulation (CMS) costimulates the phrenic nerves and RCM. We reasoned
that changes in transdiaphragmatic pressure twitch (Pdi,tw) with CMS
and ELS should be different after selective diaphragm vs. RCM fatigue. Five volunteers performed inspiratory resistive tasks while voluntarily uncoupling diaphragm and RCM. Baseline
Pdi,twELS and
Pdi,twCMS were 28.57 ± 1.68 and 32.83 ± 2.92 cmH2O. After
selective diaphragm loading,
Pdi,twELS and
Pdi,twCMS were reduced by 39 and
26%, with comparable decreases in gastric pressure twitch (Pga,tw).
Esophageal pressure twitch (Pes,tw) was better preserved with CMS.
Therefore Pes,tw/Pga,tw was lower with ELS than CMS (
1.24 ± 0.16 vs. 1.73 ± 0.11, P = 0.05). After selective
RCM loading, there was no diaphragm fatigue, but
Pes,twCMS was significantly
reduced (30%). These findings support the role of rib cage
stiffening by CMS-related RCM contraction in the ELS-CMS
differences and suggest that CMS can be used to assess RCM fatigue.
respiratory muscles; phrenic nerve stimulation
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