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Evaluation of ins and expiratory muscles in respiratory diseases

Grant number: 12/23886-1
Support Opportunities:Scholarships in Brazil - Doctorate (Direct)
Effective date (Start): January 01, 2013
Effective date (End): December 31, 2016
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal Investigator:Carlos Roberto Ribeiro de Carvalho
Grantee:Letícia Zumpano Cardenas
Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
Associated research grant:10/08947-9 - Evaluation of INS and expiratory muscles in respiratory diseases, AP.TEM

Abstract

The evaluation of the kinematic of the respiratory muscles (ins and expiratory) and their functional and clinical contributions to respiratory diseases are outstanding in the scientific context. Previous studies have confirmed that chronic obstructive pulmonary disease (COPD) and lung fibrosis may lead to disadvantageous conformation for some respiratory muscles even at rest. While the diaphragm can be flattened in COPD patients, in the other hand it can be extremely shortened in lung fibrosis. As a consequence, its ability to generate strength in these two extreme situations based on force-length graph (principle of Frank-Starling) is severely impaired. This disadvantage of the diaphragm in association with a greater recruitment of inspiratory-accessory muscles are believed to contribute substantially for a higher breathlessness. Regarding the respiratory mechanics yet, the ventilatory muscles will have important influence on other diseases too. A typical situation is the failure of weaning from the mechanical ventilator because of weakness or fatigue from the diaphragm. Other illustrative condition represents the intense breathlessness referred by the individuals with diaphragm paralysis, where this symptom can reflect exactly the inability of the diaphragm to generate strength sufficiently for the inspiration. This dysfunction of the diaphragm, however, is likely not the only mechanism of the dyspnea in this disease, since some patients maintain the symptom after surgical correction of the diaphragmatic insertion. Therefore, it's clear the importance of future studies about the respiratory mechanics, specifically focused on ventilatory muscles, in diverse respiratory diseases. Taking also account the importance of having centers of reference linking to this field in our country, we proposed the current study comprised of four investigations: (1) with COPD, (2) lung fibrosis, (3) weaning of mechanical ventilation, (4) and paralysis of diaphragm. Novel and recognizable diagnostic techniques will be applied, as maximal magnetic stimulation of phrenic nerve, transdiaphragmatic pressure measurement, electromyogram of accessory muscles for ventilation, and synchrony of thoracic subcompartments during respirations, with all measurements being done at rest and during cardiopulmonary exercise as well. Our objective is the human and diagnostic development about the knowledge of dysfunctions of the ventilatory muscles and its repercussions, making possible a comprehensive understanding of the pathophysiology and, in this way, new design of future interventions for these respiratory diseases. (AU)

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