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Pulmonary Division, Department of Medicine, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio 44109
Lower thoracic spinal cord stimulation (SCS)
results in the generation of large positive airway pressures (Paw) and
may be a useful method of restoring cough in patients with spinal cord injury. The purpose of the present study was to assess the mechanical contribution of individual respiratory muscles to pressure generation during SCS. In anesthetized dogs, SCS was applied at different spinal
cord levels by using a 15-lead multicontact electrode before and after
sequential ablation of the external and internal obliques, transversus
abdominis (TA), rectus abdominis, and internal intercostal muscles. Paw
was monitored after tracheal occlusion. SCS at the T9 spinal cord level resulted in
maximal changes in Paw (60 ± 3 cmH2O). Section of the oblique
muscles resulted in a fall in Paw to 29 ± 2 cmH2O. After subsequent section of
the rectus abdominis and TA, Paw fell to 25 ± 2 and 12 ± 1 cmH2O respectively. There was a
small remaining Paw (4 ± 1 cmH2O) after section of the
internal intercostal nerves. Stimulation with a two-electrode lead
system (T9 + T13) resulted in significantly
greater pressure generation compared with a single-electrode lead due
to increased contributions from the obliques and transversus muscles.
In a separate group of animals, Paw generation was monitored after
section of the abdominal muscles and again after section of the
external intercostal and levator costae muscles. These studies
demonstrated that inspiratory intercostal muscle stimulation resulted
in only a small opposing inspiratory action (
3
cmH2O). We conclude that, during
SCS, 1) contraction of the obliques
and TA muscles makes the largest contribution to changes in Paw, and
2) stimulation with a two-electrode
lead system results in more complete abdominal muscle activation and enhanced mechanical actions of the obliques and transversus muscles.
electrical stimulation; mechanical action; airway pressure; dogs
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