TY - JOUR
T1 - Efficacy of positive vs negative pressure ventilation in unloading the respiratory muscles
AU - Belman, M. J.
AU - Soo Hoo, G. W.
AU - Kuei, J. H.
AU - Shadmehr, R.
N1 - Funding Information:
Supported by a grant from the American Lung Association of Los Angeles County and from the Parker Francis Foundation.
PY - 1990
Y1 - 1990
N2 - We compared the efficacy of positive pressure ventilation (PPV) vs negative pressure ventilation (NPV) in providing ventilatory muscle rest for five normal subjects and six patients with chronic obstructive pulmonary disease (COPD). All participants underwent measurement of transdiaphragmatic pressure (Pdi), pressure time integral of the diaphragm (PTI), integrated diaphragmatic electromyogram (iEMG), minute ventilation (V̇E), tidal volume (VT), and end-tidal CO2 (etCO2) during 15 minutes of PPV and NPV. For each subject, ventilator adjustments were made to obtain V̇E similar to levels measured during quiet breathing (QB). We found that the iEMG, Pdi, PTI, and average coefficient of variation of the tidal volume (CV-VT) were consistently lower during PPV as compared with NPV (p=0.01). The iEMG normalized for V̇E and VT was also significantly lower during PPV (p=0.01). During PPV, subjects were mildly hyperventilated (lower etCO2 and higher V̇E) compared with QB and NPV, but no significant correlation was noted between the change in etCO2 and the change in iEMG. The change in PTI was significantly correlated with the change in iEMG (p<0.01). We conclude that in the short term, PPV is more effective than NPV in reducing diaphragmatic activity. Positive pressure ventilation may be the preferred method of assisted ventilation in future studies of ventilatory muscle rest therapy.
AB - We compared the efficacy of positive pressure ventilation (PPV) vs negative pressure ventilation (NPV) in providing ventilatory muscle rest for five normal subjects and six patients with chronic obstructive pulmonary disease (COPD). All participants underwent measurement of transdiaphragmatic pressure (Pdi), pressure time integral of the diaphragm (PTI), integrated diaphragmatic electromyogram (iEMG), minute ventilation (V̇E), tidal volume (VT), and end-tidal CO2 (etCO2) during 15 minutes of PPV and NPV. For each subject, ventilator adjustments were made to obtain V̇E similar to levels measured during quiet breathing (QB). We found that the iEMG, Pdi, PTI, and average coefficient of variation of the tidal volume (CV-VT) were consistently lower during PPV as compared with NPV (p=0.01). The iEMG normalized for V̇E and VT was also significantly lower during PPV (p=0.01). During PPV, subjects were mildly hyperventilated (lower etCO2 and higher V̇E) compared with QB and NPV, but no significant correlation was noted between the change in etCO2 and the change in iEMG. The change in PTI was significantly correlated with the change in iEMG (p<0.01). We conclude that in the short term, PPV is more effective than NPV in reducing diaphragmatic activity. Positive pressure ventilation may be the preferred method of assisted ventilation in future studies of ventilatory muscle rest therapy.
UR - http://www.scopus.com/inward/record.url?scp=0025080728&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025080728&partnerID=8YFLogxK
U2 - 10.1378/chest.98.4.850
DO - 10.1378/chest.98.4.850
M3 - Article
C2 - 2119950
AN - SCOPUS:0025080728
SN - 0012-3692
VL - 98
SP - 850
EP - 856
JO - CHEST
JF - CHEST
IS - 4
ER -