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Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm

BACKGROUND: Most patients with unilateral diaphragm paralysis (UDP) have unexplained dyspnea, exercise limitations, and reduction in inspiratory muscle capacity. We aimed to evaluate the generation of pressure in each hemidiaphragm separately and its contribution to overall inspiratory strength. MET...

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Autores principales: Caleffi-Pereira, Mayra, Pletsch-Assunção, Renata, Cardenas, Letícia Zumpano, Santana, Pauliane Vieira, Ferreira, Jeferson George, Iamonti, Vinícius Carlos, Caruso, Pedro, Fernandez, Angelo, de Carvalho, Carlos Roberto Ribeiro, Albuquerque, André Luís Pereira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090915/
https://www.ncbi.nlm.nih.gov/pubmed/30068327
http://dx.doi.org/10.1186/s12890-018-0698-1
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author Caleffi-Pereira, Mayra
Pletsch-Assunção, Renata
Cardenas, Letícia Zumpano
Santana, Pauliane Vieira
Ferreira, Jeferson George
Iamonti, Vinícius Carlos
Caruso, Pedro
Fernandez, Angelo
de Carvalho, Carlos Roberto Ribeiro
Albuquerque, André Luís Pereira
author_facet Caleffi-Pereira, Mayra
Pletsch-Assunção, Renata
Cardenas, Letícia Zumpano
Santana, Pauliane Vieira
Ferreira, Jeferson George
Iamonti, Vinícius Carlos
Caruso, Pedro
Fernandez, Angelo
de Carvalho, Carlos Roberto Ribeiro
Albuquerque, André Luís Pereira
author_sort Caleffi-Pereira, Mayra
collection PubMed
description BACKGROUND: Most patients with unilateral diaphragm paralysis (UDP) have unexplained dyspnea, exercise limitations, and reduction in inspiratory muscle capacity. We aimed to evaluate the generation of pressure in each hemidiaphragm separately and its contribution to overall inspiratory strength. METHODS: Twenty-seven patients, 9 in right paralysis group (RP) and 18 in left paralysis group (LP), with forced vital capacity (FVC) < 80% pred, and 20 healthy controls (CG), with forced expiratory volume in 1 s (FEV(1)) > 80% pred and FVC > 80% pred, were evaluated for lung function, maximal inspiratory (MIP) and expiratory (MEP) pressure measurements, diaphragm ultrasound, and transdiaphragmatic pressure during magnetic phrenic nerve stimulation (Pdi(Tw)). RESULTS: RP and LP had significant inspiratory muscle weakness compared to controls, detected by MIP (− 57.4 ± 16.9 for RP; − 67.1 ± 28.5 for LP and − 103.1 ± 30.4 cmH(2)O for CG) and also by Pdi(TW) (5.7 ± 4 for RP; 4.8 ± 2.3 for LP and 15.3 ± 5.7 cmH(2)O for CG). The Pdi(Tw) was reduced even when the non-paralyzed hemidiaphragm was stimulated, mainly due to the low contribution of gastric pressure (around 30%), regardless of whether the paralysis was in the right or left hemidiaphragm. On the other hand, in CG, esophagic and gastric pressures had similar contribution to the overall Pdi (around 50%). Comparing both paralyzed and non-paralyzed hemidiaphragms, the mobility during quiet and deep breathing, and thickness at functional residual capacity (FRC) and total lung capacity (TLC), were significantly reduced in paralyzed hemidiaphragm. In addition, thickness fraction was extremely diminished when contrasted with the non-paralyzed hemidiaphragm. CONCLUSIONS: In symptomatic patients with UDP, global inspiratory strength is reduced not only due to weakness in the paralyzed hemidiaphragm but also to impairment in the pressure generated by the non-paralyzed hemidiaphragm.
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spelling pubmed-60909152018-08-17 Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm Caleffi-Pereira, Mayra Pletsch-Assunção, Renata Cardenas, Letícia Zumpano Santana, Pauliane Vieira Ferreira, Jeferson George Iamonti, Vinícius Carlos Caruso, Pedro Fernandez, Angelo de Carvalho, Carlos Roberto Ribeiro Albuquerque, André Luís Pereira BMC Pulm Med Research Article BACKGROUND: Most patients with unilateral diaphragm paralysis (UDP) have unexplained dyspnea, exercise limitations, and reduction in inspiratory muscle capacity. We aimed to evaluate the generation of pressure in each hemidiaphragm separately and its contribution to overall inspiratory strength. METHODS: Twenty-seven patients, 9 in right paralysis group (RP) and 18 in left paralysis group (LP), with forced vital capacity (FVC) < 80% pred, and 20 healthy controls (CG), with forced expiratory volume in 1 s (FEV(1)) > 80% pred and FVC > 80% pred, were evaluated for lung function, maximal inspiratory (MIP) and expiratory (MEP) pressure measurements, diaphragm ultrasound, and transdiaphragmatic pressure during magnetic phrenic nerve stimulation (Pdi(Tw)). RESULTS: RP and LP had significant inspiratory muscle weakness compared to controls, detected by MIP (− 57.4 ± 16.9 for RP; − 67.1 ± 28.5 for LP and − 103.1 ± 30.4 cmH(2)O for CG) and also by Pdi(TW) (5.7 ± 4 for RP; 4.8 ± 2.3 for LP and 15.3 ± 5.7 cmH(2)O for CG). The Pdi(Tw) was reduced even when the non-paralyzed hemidiaphragm was stimulated, mainly due to the low contribution of gastric pressure (around 30%), regardless of whether the paralysis was in the right or left hemidiaphragm. On the other hand, in CG, esophagic and gastric pressures had similar contribution to the overall Pdi (around 50%). Comparing both paralyzed and non-paralyzed hemidiaphragms, the mobility during quiet and deep breathing, and thickness at functional residual capacity (FRC) and total lung capacity (TLC), were significantly reduced in paralyzed hemidiaphragm. In addition, thickness fraction was extremely diminished when contrasted with the non-paralyzed hemidiaphragm. CONCLUSIONS: In symptomatic patients with UDP, global inspiratory strength is reduced not only due to weakness in the paralyzed hemidiaphragm but also to impairment in the pressure generated by the non-paralyzed hemidiaphragm. BioMed Central 2018-08-02 /pmc/articles/PMC6090915/ /pubmed/30068327 http://dx.doi.org/10.1186/s12890-018-0698-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Caleffi-Pereira, Mayra
Pletsch-Assunção, Renata
Cardenas, Letícia Zumpano
Santana, Pauliane Vieira
Ferreira, Jeferson George
Iamonti, Vinícius Carlos
Caruso, Pedro
Fernandez, Angelo
de Carvalho, Carlos Roberto Ribeiro
Albuquerque, André Luís Pereira
Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm
title Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm
title_full Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm
title_fullStr Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm
title_full_unstemmed Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm
title_short Unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm
title_sort unilateral diaphragm paralysis: a dysfunction restricted not just to one hemidiaphragm
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090915/
https://www.ncbi.nlm.nih.gov/pubmed/30068327
http://dx.doi.org/10.1186/s12890-018-0698-1
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