Supramaximal inflation improves lung compliance in subjects with amyotrophic lateral sclerosis

Research output: Contribution to journalArticle

Abstract

Rationale: Lung compliance has been found to be low in patients with chronic diaphragmatic weakness or paralysis but has not been well-studied in patients with amyotrpphic lateral sclerosis (ALS). Noninvasive positive-pressure ventilation (NPPV) prolongs survival in ALS patients but may also have additional beneficial effects. Objectives: This study evaluated static expiratory lung compliance (CL) in subjects with ALS and determined the effect of lung inflation with supramaximal inflation on CL. Design: This was a prospective trial comparing CL before and after supramaximal lung inflation via mouthpiece-delivered positive pressure. Setting: A single university medical center with an multidisciplinary ALS center. Participants: Fourteen subjects with ALS were compared to 4 healthy volunteers. Interventions: Subjects underwent a battery of pulmonary function tests including for CL. Then they used positive pressure administered via a mouthpiece set to 10 cm H2O above their maximal static recoil pressure for 5 min. The CL measurement was then repeated. Results: The mean (± SD) baseline CL was reduced (164.1 ± 82.1 mL/cm H2O) in subjects with ALS and was significantly lower than that in healthy volunteers (237.5 mL/cm H2O; p = 0.04). CL increased significantly in subjects with evidence of diaphragm weakness (change in CL, 11.3 ± 16.7 mL/cm H2O; p = 0.03). Healthy volunteers did not have an increase in CL. Conclusions: Patients with ALS and diaphragmatic weakness have reduced CL, and brief supramaximal inflation increases CL. These findings suggest that atelectasis or increased alveolar surface forces are present in ALS patients and that these patients will have increased work of breathing. Some of the beneficial effects demonstrated with NPPV therapy may be through its effects on CL and the work of breathing.

Original languageEnglish (US)
Pages (from-to)1322-1329
Number of pages8
JournalCHEST
Volume129
Issue number5
DOIs
StatePublished - May 2006

Keywords

  • Neuromuscular disease
  • Noninvasive ventilation
  • Pulmonary mechanics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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