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Section of Respiratory Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada R3A 1R8
Increasing inspiratory flow (
)
has been shown to shorten neural inspiratory time
(TIn) in normal subjects breathing on a mechanical ventilator, but the effect of
on respiratory motor output before inspiratory termination has not previously been studied
in humans. While breathing spontaneously on a mechanical ventilator, eight normal subjects were intermittently exposed to
200-ms-duration positive pressure pulses of different amplitudes at the
onset of inspiration. Based on the increase in
above control breaths (
), trials were grouped into small,
medium, and large groups (mean 
: 0.51, 1.11, and 1.65 l/s,
respectively). We measured TIn,
transdiaphragmatic pressure (Pdi), and electrical activity
(electromyogram) of the diaphragm (EMGdi). Transient increases in
caused shortening of TIn from 1.34 to
1.10 (not significant), 1.55 to 1.11 (P < 0.005), and
1.58 to 1.17 s (P < 0.005) in the small, medium,
and large 
groups, respectively. EMGdi measured at end
TIn of the pulse breaths was 131 (P < 0.05), 142, and 155% (P < 0.05)
of the EMGdi of the control breaths at an identical time point in the
small, medium, and large trials, respectively. The latency of the
excitation was 126 ± 42 (SD) ms, consistent with a reflex effect.
Increasing
had two countervailing effects on Pdi: 1)
a depressant mechanical effect due primarily to the force-length (11.2 cmH2O/l) relation of the diaphragm, and 2) an
increase in diaphragm activation. For the eight subjects, mean peak Pdi
did not change significantly, but there was significant intersubject
variability, reflecting variability in the strength of the excitation
reflex. We conclude that increasing inspiratory
causes a graded
facilitation of EMGdi, which serves to counteract the negative effect
of the force-length relation on Pdi.
mechanical ventilation; diaphragm force-length relation; reflex control
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