Diaphragm EMG measured by cervical magnetic and electrical phrenic nerve stimulation

The purpose of the study was to compareelectrical stimulation (ES) and cervical magnetic stimulation (CMS) ofthe phrenic nerves for the measurement of the diaphragm compound muscleaction potential (CMAP) and phrenic nerve conduction time. A specially designed esophageal catheter with three pairs of electrodes was used,with control of electrode positioning in 10 normal subjects. Pair A and pairB were close to the diaphragm (pairA lower than pairB); pair C waspositioned 10 cm above the diaphragm to detect the electromyogram fromextradiaphragmatic muscles. Electromyograms were also recorded fromupper and lower chest wall surface electrodes. The shape of the CMAPmeasured with CMS (CMS-CMAP) usually differed from that of the CMAPmeasured with ES (ES-CMAP). Moreover, the latency of theCMS-CMAP from pair B (5.3 ± 0.4 ms) was significantly shorter than that from pairA (7.1 ± 0.7 ms). The amplitude of the CMS-CMAP(1.00 ± 0.15 mV) was much higher than that of ES-CMAP (0.26 ± 0.15 mV) when recorded from pair C.Good-quality CMS-CMAPs could be recorded in some subjects from anelectrode positioned very low in the esophagus. The differences betweenES-CMAP and CMS-CMAP recorded either from esophageal or chest wallelectrodes make CMS unreliable for the measurement of phrenic nerveconduction time.

     

Validation of improved recording site to measure phrenic conduction from surface electrodes in humans.

Phrenic nerve stimulation, electrical (ES) or from cervical magnetic stimulation (CMS), allows one to assess the diaphragm contractile properties and the conduction time of the phrenic nerve (PNCT) through recording of an electromyographic response, traditionally by using surface electrodes. Because of the coactivation of extradiaphragmatic muscles, signal contamination can jeopardize the determination of surface PNCTs. To address this, we compared PNCTs with ES and CMS from surface and needle diaphragm electrodes in five subjects (10 phrenic nerves). At a modified recording site, lower and more anterior than usual (lowest accessible intercostal space, costochondral junction) with electrodes 2 cm apart, surface and needle PNCTs were similar (CMS: 6.0 +/- 0.25 ms surface vs. 6.2 +/- 0.13 ms needle, not significant). Electrodes recording the activity of the most likely sources of signal contamination, i.e., the serratus anterior and pectoralis major, showed distinct responses from that of the diaphragm, their earlier occurrence strongly arguing against contamination. With ES and CMS, apparently uncontaminated signals could be consistently recorded from surface electrodes.     

Putative projection of phrenic afferents to the limbic cortex in humans studied with cerebral-evoked potentials

Straus, Christian, Marc Zelter, Jean-Philippe Derenne,Bernard Pidoux, Jean-Claude Willer, and Thomas Similowski.Putative projection of phrenic afferents to the limbic cortex inhumans studied with cerebral-evoked potentials. J. Appl. Physiol. 82(2): 480-490, 1997.Respiratorysensations may rely in part on cortical integration of respiratoryafferent information. In an attempt to study such projections, werecorded evoked potentials at scalp and cervical sites in 10 normalvolunteers undergoing transcutaneous phrenic stimulation (0.1-ms squarepulses, intensity liminal for diaphragmatic activation, series of 600 shocks at 2 Hz). A negative cerebral component of peak latency(12.79 ± 0.54 ms; N13) was constant, and a negativespinal component (7.09 ± 1.04 ms; N7) could also be recorded, allresults being reproducible over time. Monitoring of cardiac frequency,skin anesthesia, and stimulation adjacent to the phrenic nerve made thephrenic origin of N7 and N13 the foremost hypothesis. Increasingstimulation frequency and comparison with median nerve stimulationprovided arguments for the neural nature of the signals and theircerebral origin. Recordings from intracerebral electrodes in a patientshowed a polarity reversal of the evoked potentials at the level of the cingulate gyrus. In conclusion, phrenic stimulation could allow one tostudy projections of phrenic afferents to the central nervous system inhumans. Their exact site and physiological meaning remain to beclarified.

     

Conduction velocity of the human phrenic nerve in the neck

PurposeTo measure phrenic nerve conduction velocity in the neck in humans.ScopeWe studied 15 healthy subjects (9 men, 32.4 ± 6.7). We performed bipolar electrical phrenic stimulation in the neck, from a distal and a proximal stimulation site, and recorded diaphragm electromyographic responses on the surface of the chest. The ratio of the between-site distance to the latency difference provided phrenic velocities. Ulnar motor velocity was assessed similarly. In addition, five homogeneous patients with Charcot-Marie-Tooth disease type 1A (CMT1A) were studied for validation purposes. We obtained diaphragmatic responses from the two stimulation sites in all cases. The distal latencies (anterior axillary line recording) were 6.51 ± 0.63 ms (right) and 6.13 ± 0.64 ms (left). The minimal between site distance was 39 mm. Phrenic motor velocity was 55.2 ± 6.3 m s^?1 (right) and 56.3 ± 7.2 m s^?1 (left). In CMT1A, phrenic velocities were 17.1 ± 8.1 m s^?1 (from 7 to 32 m s^?1) and were similar to ulnar and median velocities.ConclusionsPhrenic nerve velocities can be estimated in humans and compare with upper limb motor conduction velocities. This should refine the investigation of phrenic function in peripheral neuropathies.     

Pathogenesis of nitrofen-induced congenital diaphragmatic hernia in fetal rats

Allan, Douglas W., and John J. Greer. Pathogenesis ofnitrofen-induced congenital diaphragmatic hernia in fetal rats. J. Appl. Physiol. 83(2): 338-347, 1997.Congenital diaphragmatic hernia (CDH) is a developmental anomalycharacterized by the malformation of the diaphragm and impaired lungdevelopment. In the present study, we tested several hypothesesregarding the pathogenesis of CDH, including those suggesting that theprimary defect is due to abnormal 1)lung development, 2) phrenic nerveformation, 3) developmentalprocesses underlying diaphragmatic myotube formation, 4) pleuroperitoneal canal closure,or 5) formation of the primordial diaphragm within the pleuroperitoneal fold. The2,4-dichloro-phenyl-p-nitrophenyl ether (nitrofen)-induced CDH rat model was used for thisstudy. The following parameters were compared between normal andherniated fetal rats at various stages of development:1) weight, protein, and DNA contentof lungs; 2) phrenic nerve diameter,axonal number, and motoneuron distribution;3) formation of the phrenic nerve intramuscular branching pattern and diaphragmatic myotube formation; and 4) formation of the precursor ofthe diaphragmatic musculature, the pleuroperitoneal fold. Wedemonstrated that previously proposed theories regarding the primaryrole of the lung, phrenic nerve, myotube formation, and the closure ofpleuroperitoneal canal in the pathogenesis of CDH are incorrect.Rather, the primary defect associated with CDH, at least in thenitrofen rat model, occurs at the earliest stage of diaphragmdevelopment, the formation of the pleuroperitoneal fold.

     

Attenuation of phrenic motor discharge by phrenic nerve afferents

Short latency phrenic motor responses to phrenic nerve stimulation were studied in anesthetized, paralyzed cats. Electrical stimulation (0.2 ms, 0.01-10 mA, 2 Hz) of the right C5 phrenic rootlet during inspiration consistently elicited a transient reduction in the phrenic motor discharge. This attenuation occurred bilaterally with an onset latency of 8-12 ms and a duration of 8-30 ms. Section of the ipsilateral C4-C6 dorsal roots abolished the response to stimulation, thereby confirming the involvement of phrenic nerve afferent activity. Stimulation of the left C5 phrenic rootlet or the right thoracic phrenic nerve usually elicited similar inhibitory responses. The difference in onset latency of responses to cervical vs. thoracic phrenic nerve stimulation indicates activation of group III afferents with a peripheral conduction velocity of approximately 10 m/s. A much shorter latency response (5 ms) was evoked ipsilaterally by thoracic phrenic nerve stimulation. Section of either the C5 or C6 dorsal root altered the ipsilateral response so that it resembled the longer latency contralateral response. The low-stimulus threshold and short latency for the ipsilateral response to thoracic phrenic nerve stimulation suggest that it involves larger diameter fibers. Decerebration, decerebellation, and transection of the dorsal columns at C2 do not abolish the inhibitory phrenic-to-phrenic reflex.     

Activation of thalamic ventroposteriolateral neurons by phrenic nerve afferents in cats and rats.

It has been demonstrated that phrenic nerve afferents project to somatosensory cortex, yet the sensory pathways are still poorly understood. This study investigated the neural responses in the thalamic ventroposteriolateral (VPL) nucleus after phrenic afferent stimulation in cats and rats. Activation of VPL neurons was observed after electrical stimulation of the contralateral phrenic nerve. Direct mechanical stimulation of the diaphragm also elicited increased activity in the same VPL neurons that were activated by electrical stimulation of the phrenic nerve. Some VPL neurons responded to both phrenic afferent stimulation and shoulder probing. In rats, VPL neurons activated by inspiratory occlusion also responded to stimulation on phrenic afferents. These results demonstrate that phrenic afferents can reach the VPL thalamus under physiological conditions and support the hypothesis that the thalamic VPL nucleus functions as a relay for the conduction of proprioceptive information from the diaphragm to the contralateral somatosensory cortex.     

Cervical magnetic stimulation as a method to discriminate between diaphragm and rib cage muscle fatigue

Inspiratory muscle fatigue can probablydetermine hypercapnic respiratory failure. Diaphragm fatigue isdetected by electrical phrenic stimulation (ELS), but there is nosimple tool to assess rib cage muscle (RCM) fatigue. Cervical magneticstimulation (CMS) costimulates the phrenic nerves and RCM. We reasonedthat changes in transdiaphragmatic pressure twitch (Pdi,tw) with CMSand ELS should be different after selective diaphragm vs. RCM fatigue. Five volunteers performed inspiratory resistive tasks while voluntarily uncoupling diaphragm and RCM. BaselinePdi,tw_ELS andPdi,tw_CMS were 28.57 ± 1.68 and 32.83 ± 2.92 cmH₂O. Afterselective diaphragm loading,Pdi,tw_ELS andPdi,tw_CMS were reduced by 39 and26%, with comparable decreases in gastric pressure twitch (Pga,tw).Esophageal pressure twitch (Pes,tw) was better preserved with CMS.Therefore Pes,tw/Pga,tw was lower with ELS than CMS (1.24 ± 0.16 vs. 1.73 ± 0.11, P = 0.05). After selectiveRCM loading, there was no diaphragm fatigue, butPes,tw_CMS was significantlyreduced (30%). These findings support the role of rib cagestiffening by CMS-related RCM contraction in the ELS-CMSdifferences and suggest that CMS can be used to assess RCM fatigue.

     

Long-term facilitation of upper airway muscle activities in vagotomized and vagally intact cats

Mateika, J. H., and R. F. Fregosi. Long-termfacilitation of upper airway muscle activities in vagotomized andvagally intact cats. J. Appl. Physiol.82(2): 419-425, 1997.The primary purpose of the presentinvestigation was to determine whether long-term facilitation (LTF) ofupper airway muscle activities occurs in vagotomized and vagally intactcats. Tidal volume and diaphragm, genioglossus, and nasal dilatormuscle activities were recorded before, during, and after one carotidsinus nerve was stimulated five times with 2-min trains of constantcurrent. Sixty minutes after stimulation, nasal dilator andgenioglossus muscle activities were significantly greater than controlin the vagotomized cats but not in the vagally intact cats. Tidalvolume recorded from the vagotomized and vagally intact cats wassignificantly greater than control during the poststimulation period.In contrast, diaphragm activities were not significantly elevated inthe poststimulation period in either group of animals. We conclude that1) LTF of genioglossus and nasaldilator muscle activities can be evoked in vagotomized cats;2) vagal mechanisms inhibit LTF inupper airway muscles; and 3) LTF canbe evoked in accessory inspiratory muscles because LTF of inspiredtidal volume was greater than LTF of diaphragm activity.

     

Effects of DAP on diaphragm force and fatigue, including fatigue due to neurotransmission failure

Van Lunteren, Erik, and Michelle Moyer. Effects of DAPon diaphragm force and fatigue, including fatigue due toneurotransmission failure. J. Appl.Physiol. 81(5): 2214-2220, 1996.Among theaminopyridines, 3,4-diaminopyridine (DAP) is a more effectiveK⁺ channel blocker than is4-aminopyridine (4-AP), and, furthermore, DAP enhances neuromusculartransmission. Because 4-AP improves muscle contractility, wehypothesized that DAP would also increase force and, in addition,ameliorate fatigue and improve the neurotransmission failure componentof fatigue. Rat diaphragm strips were studied in vitro (37°C). Infield-stimulated muscle, 0.3 mM DAP significantly increased diaphragmtwitch force, prolonged contraction time, and shifted theforce-frequency relationship to the left without altering peak tetanicforce, resulting in increased force at stimulation frequencies 50 Hz.During 20-Hz intermittent stimulation, DAP increased diaphragm peakforce compared with control during a 150-s fatigue run and,furthermore, significantly improved maintenance of intratrain force.The relative contribution of neurotransmission failure to fatigue wasestimated by comparing the force generated by phrenic nerve-stimulatedmuscles with that generated by curare-treated field-stimulated muscles.DAP significantly increased force in nerve-stimulated muscles and, inaddition, reduced the neurotransmission failure contribution todiaphragm fatigue. Thus DAP increases muscle force atlow-to-intermediate stimulation frequencies, improves overall force andintratrain fatigue during 20-Hz intermittent stimulation, and reducesneurotransmission failure.

     

Task failure with lack of diaphragm fatigue during inspiratory resistive loading in human subjects

McKenzie, D. K., G. M. Allen, J. E. Butler, and S. C. Gandevia. Task failure with lack of diaphragm fatigue during inspiratory resistive loading in human subjects. J. Appl. Physiol. 82(6): 2011-2019, 1997.Taskfailure during inspiratory resistive loading is thought to beaccompanied by substantial peripheral fatigue of the inspiratorymuscles. Six healthy subjects performed eight resistive breathingtrials with loads of 35, 50, 75 and 90% of maximal inspiratorypressure (MIP) with and without supplemental oxygen. MIP measuredbefore, after, and at every minute during the trial increased slightlyduring the trials, even when corrected for lung volume (e.g., for 24 trials breathing air, 12.5% increase, P < 0.05). In some trials, taskfailure occurred before 20 min (end point of trial), and in thesetrials there was an increase in end-tidalPCO₂(P < 0.01), despite the absence of peripheral muscle fatigue. In four subjects (6 trials with task failure), there was no decline in twitch amplitude with bilateral phrenic stimulation or in voluntary activation of the diaphragm, eventhough end-tidal PCO₂ rose by 1.6 ± 0.9%. These results suggest that hypoventilation,CO₂ retention, and ultimate taskfailure during resistive breathing are not simply dependent on impairedforce-generating capacity of the diaphragm or impaired voluntaryactivation of the diaphragm.

     

Spiral nerve cuff electrode for recordings of respiratory output

Sahin, Mesut, Musa A. Haxhiu, Dominique M. Durand, andIsmail A. Dreshaj. Spiral nerve cuff electrode for recordings ofrespiratory output. J. Appl. Physiol.83(1): 317-322, 1997.The feasibility of using the spiral nervecuff electrode design for recordings of respiratory output from thehypoglossal (HG) and phrenic nerves is demonstrated in anesthetized,paralyzed, and artificially ventilated cats. Raw neural discharges ofthe HG nerve were analyzed in terms of signal-to-noise ratios andfrequency spectra. The rectified and integrated moving average activity of the HG nerve had a peak value of 1.74 ± 0.21 µV and a baseline value of 0.72 ± 0.11 µV at elevated respiratory drive induced byincreases in CO₂ or oxygendeprivation when recorded with 10-mm-long cuffs. The frequency contentof the HG electroneurogram extended from several hundred hertz to 6 kHz. Spiral nerve cuff recordings without desheathing of the nerveprovided large enough signal-to-noise ratios that allowed them to beused as a measure of respiratory output and had much wider frequencybandwidths than the hook electrode preparations. A major advantage ofthe cuff electrode over the hook electrode was its mechanicalstability, which significantly improved the reproducibility of therecordings both in terms of signal amplitudes and frequency contents.

     

Role of phrenic nerve afferents in the control of breathing

A long-held belief is that respiratory-related reflexes mediated by afferents in the diaphragm are weak or absent. However, recent data suggest that diaphragmatic afferents are capable of altering ventilatory motor drive as well as influencing perception of added inspiratory loads in humans. This review describes the sensory elements of the diaphragm, their central projections, and their functional significance in the control of respiratory muscle activation. The reflexes elicited by electrical stimulation of phrenic nerve afferents and the contribution of diaphragmatic afferents in respiratory load compensation and perception are considered. There is growing evidence that phrenic nerve afferents are activated under a variety of conditions. However, the significance of this input to the central nervous system is yet to be discerned.     

Diaphragmatic relaxation rate after voluntary contractions and uni- and bilateral phrenic stimulation

We compared the rate of relaxation of the diaphragm (RRdi) after unilateral phrenic nerve stimulation, bilateral phrenic nerve stimulations, and short sharp voluntary contractions (sniffs). RRdi was measured as the maximum rate of decline in transdiaphragmatic pressure (Pdi) corrected for the change in Pdi [maximum relaxation rate (MRR)/delta Pdi], the time constant (tau) of the later exponential decline in Pdi, and the time to half relaxation (1/2 RT). In five subjects there was no difference in mean RRdi apart from a smaller MRR/delta Pdi (P less than 0.05) for left unilateral compared with either right unilateral or bilateral needle stimulation. However, RRdi varied unpredictably between unilateral and bilateral stimulation of the phrenic nerve in individual subjects. In the same five subjects, sniffs were found to have a slower RRdi than bilateral stimulations (MRR/delta Pdi 0.0064 +/- 0.0007 vs. 0.0074 +/- 0.0018/ms, tau 57.2 +/- 8.7 vs. 48.2 +/- 7.4 ms, 1/2 RT 108.9 +/- 10.9 vs. 73.9 +/- 6.0 ms; all P less than 0.05). The application and inflation of an abdominal binder to an external pressure of 60 mmHg resulted in a decrease in functional residual capacity (-710 +/- 70 ml), but there was no effect on relaxation parameters. Our findings suggest that in the evaluation of RRdi 1) unilateral hemidiaphragmatic stimulations may not accurately reflect the in vivo contractile properties of the diaphragm, 2) sniff maneuvers are not voluntary equivalents of phrenic nerve stimulations, and 3) RRdi is not affected by abdominal binder inflation up to 60 mmHg.     

Motor innervation of the cricopharyngeus muscle by the recurrent laryngeal nerve

Hammond, Carol Smith, Paul W. Davenport, Alastair Hutchison,and Randall A. Otto. Motor innervation of thecricopharyngeus muscle by the recurrent laryngeal nerve.J. Appl. Physiol. 83(1): 89-94, 1997.Patients with recurrent laryngeal nerve (RLN) paresis demonstrate impaired function of laryngeal muscles and swallowing. Thecricopharyngeus muscle (CPM) is a major component of the upper esophageal sphincter. It was hypothesized that the RLN innervates thismuscle. A nerve branch leading from the RLN to the CPM was found in adult sheep by anatomic dissection. Electrical stimulation ofthe RLN elicited a muscle action potential recorded by electrodes placed in the ipsilateral CPM. Swallowing was investigated by mechanical stimulation of oropharynx pre- and postsectioning of theRLN. Severing of the RLN resulted in a loss of the early phases ofswallow-related CPM electromyographic activity; however,late-phase CPM electromyographic activity persisted. The RLN providesmotor innervation of the CPM, which also has innervation from thepharyngeal plexus.

     

Time course of recovery from nerve injury in skeletal muscle: energy state and local circulation

Hayashi, Yoshihiro, Takaaki Ikata, Hiroaki Takai, ShinjiroTakata, Takayuki Sogabe, and Keiko Koga. Time course of recoveryfrom nerve injury in skeletal muscle: energy state and localcirculation. J. Appl. Physiol. 82(3):732-737, 1997.This study examined the time course of recoveryfrom nerve injury on energy state assessed by phosphorus-31 magneticresonance spectroscopy and local circulation dynamics by fluorine-19magnetic resonance spectroscopy in skeletal muscles ofrats. The hindlimb muscles that had undergone unilateralsciatic nerve compression for 2 wk (CN) were compared withsham-operated (SO) muscles and with muscles that had the compressionremoved after 2 wk and were allowed to recover for 4 wk (R4) or for 6 wk (R6). The energy state and local circulation dynamics of CN muscleswere less than those of SO muscles (P < 0.01). The energy state of R4 muscles remained at levels similar toCN muscles, whereas the local circulation dynamics improved but notback to SO values. In R6 muscles, both parameters returned to SOvalues. These results showed that the recovery processes of circulationprecede those of energy state in skeletal muscles.

     

Cervical magnetic stimulation: a new painless method for bilateral phrenic nerve stimulation in conscious humans

Assessing diaphragmatic contractility is a common goal in various situations. This assessment is mainly based on static or dynamic maximal voluntary maneuvers and twitch transdiaphragmatic pressures (Pdi) obtained by stimulation of the phrenic nerves (PS). PS eliminates the central components of diaphragmatic activation, but the available techniques of PS remain subject to some limitations. Transcutaneous PS is painful, and needle PS is potentially dangerous. Time-varying magnetic fields can stimulate nervous structures without pain and without adverse effects. In six subjects, we have studied cervical magnetic stimulation (CMS) as a method of PS. We have compared the stimulated Pdi (Pdistim) with the maximal Pdi obtained during static combined expulsive-Mueller maneuver (Pdimax) and with the Pdi generated during a sniff test (Pdisniff). CMS produced twitch Pdi averaging 33.4 +/- 9.7 cmH2O. Pdistim/Pdimax and Pdistim/Pdisniff were 24 +/- 6 and 41 +/- 14%, respectively. These values are comparable to those obtained in other studies with transcutaneous PS. They were highly reproducible in all the subjects. Electromyographic data provided evidence of bilateral maximal stimulation. CMS is a nonspecific method and may stimulate various nervous structures. However, diaphragmatic contraction was elicited by stimulation of the phrenic trunk, since the phrenicodiaphragmatic latencies (less than 7 ms) were in the range of values reported with direct stimulation of the trunk. Cocontraction of neck muscles, including the sternomastoid, was present, but its influence in the CMS-induced Pdi seems minimal. We conclude that magnetic stimulation is an easy, well-tolerated, reproducible safe, and valuable method to assess phrenic conduction and diaphragmatic twitch response.     

Inputs from upper airway affect firing of respiratory-associated midbrain neurons

Chen, Zibin, and Frederic L. Eldridge. Inputs fromupper airway affect firing of respiratory-associated midbrain neurons. J. Appl. Physiol. 83(1): 196-203, 1997.In 16 decerebrated unanesthetized cats, we studied effects ofneural inputs from upper airway on firing of 62 mesencephalic neuronsthat also developed respiratory-associated (RA) rhythmic firing whenrespiratory drive was high [Z. Chen, F. L. Eldridge, and P.G.Wagner. J. Physiol. (Lond.) 437:305-325, 1991] and on firing of 16 neurons that did notdevelop the rhythmic firing (non-RA neurons). Activity in RA neuronsincreased after mechanical expansion of pharynx (45% of those tested)or larynx (68%) and after stimulation of glossopharyngeal (50%) orsuperior laryngeal nerves (77%). The increased neuronal firingoccurred despite decreases or abolition of respiratory activity(expressed in phrenic nerve). Neuronal firing also increased aftermechanical stimulation of nasal mucosa (66%) or by jetsof air directed into the nares (48%) and after lightbrushing of nasal skin (~40%). Most stimuli led to decreased firingin a smaller number of neurons, and some neurons showed no response.None of the non-RA neurons developed an increase of firing after any ofthe stimuli, although one had decreased firing after stimulation of thesuperior laryngeal nerve. We conclude that inputs from the upper airwayand nasal skin have independent modulatory effects on the samemesencephalic neurons that are stimulated by ascending rhythmic RAinput from the medulla. These findings may have relevance to generationof the sensation of dyspnea.

     

Almitrine and doxapram decrease fatigue and increase subsequent recovery in isolated rat diaphragm

McGuire, Michelle, Michael F. Carey, and John J. O'Connor.Almitrine and doxapram decrease fatigue and increase subsequent recovery in isolated rat diaphragm. J. Appl.Physiol. 83(1): 52-58, 1997.The effects ofalmitrine bimesylate and doxapram HCl on isometric force produced by invitro rat diaphragm were studied during direct muscle activation at37°C. Doxapram and almitrine ameliorate respiratory failureclinically by indirectly increasing phrenic nerve activity. This studywas carried out to investigate possible direct actions of these agentson the diaphragm before and after fatigue of the fibers. Two age groupsof animals were chosen [6-14 wk (group1) and 50-55 wk (group2)] because it is known that increasing agedecreases a muscle fiber's resistance to fatigue. Muscle strips wereisolated from both group 1 and group 2 and directly stimulated (2-mspulse duration, 5-15 V) to produce twitch tensions of 1.3 and 2.1 N/cm², respectively. At lowconcentrations, doxapram (20 µg/ml) and almitrine (12 µg/ml)had no effect on twitch contraction or 100-Hz tetanic tension. However,40 µg/ml doxapram and 30 µg/ml almitrine increased twitch tensionby 9.0 ± 1.4 and 11.6 ± 1.9%, respectively, in animals ofgroup 2 (n = 5). A fatigue protocol consistingof low-frequency stimulation (30-Hz trains, 250-ms duration every 2 sfor 5 min) caused a reduction of twitch tension in animals ofgroup 1 (48 ± 4% ofcontrol) and group 2 (28 ± 4% ofcontrol). At 90 min postfatigue, the twitch tension recovered to 72 ± 3 and 42 ± 2% of control values ingroup 1 and group2, respectively. In the presence of doxapram (20 µg/ml), there was a significant increase in the recovery of twitchtension at 90 min in group 1 andgroup 2 (84.5 ± 3.2 and 80.1 ± 2.8%, respectively) compared with controls at 90 min postfatigue. Inthe presence of almitrine (12 µg/ml), there was a full recovery fromfatigue in group 1 animals (100% ofcontrol) and a recovery to 95.6 ± 2.1% of control ingroup 2 animals at 90 min. Theseresults demonstrate a significant improvement in the rapidity andmagnitude of recovery from fatigue in the rat diaphragm muscle in thepresence of both doxapram and, especially, almitrine. These effects maybe due to changes in intracellular calcium, ADP/ATP ratios, or oxygenfree radical scavenging.

     

Aerobic fitness effects on exercise-induced low-frequency diaphragm fatigue

Babcock, Mark A., David F. Pegelow, Bruce D. Johnson, andJerome A. Dempsey. Aerobic fitness effects on exercise-induced low-frequency diaphragm fatigue. J. Appl.Physiol. 81(5): 2156-2164, 1996.We usedbilateral phrenic nerve stimulation (BPNS; at 1, 10, and 20 Hz atfunctional residual capacity) to compare the amount of exercise-induceddiaphragm fatigue between two groups of healthy subjects, a high-fitgroup [maximal O₂consumption (O_{2 max}) = 69.0 ± 1.8 ml ^· kg^{1 ·} min¹,n = 11] and a fit group(O_{2 max} = 50.4 ± 1.7 ml ^· kg^{1 ·} min¹,n = 13). Both groups exercised at88-92% O_{2 max}for about the same duration (15.2 ± 1.7 and 17.9 ± 2.6 min forhigh-fit and fit subjects, respectively,P > 0.05). The supramaximal BPNS test showed a significant reduction (P < 0.01) in the BPNS transdiaphragmatic pressure (Pdi) immediatelyafter exercise of 23.1 ± 3.1% for the high-fit group and23.1 ± 3.8% (P > 0.05)for the fit group. Recovery of the BPNS Pdi took 60 min in both groups.The high-fit group exercised at a higher absolute workload, whichresulted in a higher CO₂production (+26%), a greater ventilatory demand (+16%) throughout theexercise, and an increased diaphragm force output (+28%) over theinitial 60% of the exercise period. Thereafter, diaphragm force outputdeclined, despite a rising minute ventilation, and it was not differentbetween most of the high-fit and fit subjects. In summary, the high-fitsubjects showed diaphragm fatigue as a result of heavy enduranceexercise but were also partially protected from excessive fatigue,despite high ventilatory requirements, because their hyperventilatoryresponse to endurance exercise was reduced, their diaphragm wasutilized less in providing the total ventilatory response, and possiblytheir diaphragm aerobic capacity was greater.