Effect of diaphragm fatigue on neural respiratory drive.

To test the hypothesis that diaphragm fatigue leads to an increase in neural respiratory drive, we measured the esophageal diaphragm electromyogram (EMG) during CO(2) rebreathing before and after diaphragm fatigue in six normal subjects. The electrode catheter was positioned on the basis of the amplitude and polarity of the diaphragm compound muscle action potential recorded simultaneously from four pairs of electrodes during bilateral anterior magnetic phrenic nerve stimulation (BAMPS) at functional residual capacity. Two minutes of maximum isocapnic voluntary ventilation (MIVV) were performed in six subjects to induce diaphragm fatigue. A maximal voluntary breathing against an inspiratory resistive loading (IRL) was also performed in four subjects. The reduction of transdiaphragmatic pressure elicited by BAMPS was 22% (range 13-27%) after 2 min of MIVV and was similar, 20% (range 13-26%), after IRL. There was a linear relationship between minute ventilation (VE) and the root mean square (RMS) of the EMG during CO(2) rebreathing before and after fatigue. The mean slope of the linear regression of RMS on VE was similar before and after diaphragm fatigue: 2.80 +/- 1.31 vs. 3.29 +/- 1.40 for MIVV and 1.51 +/- 0.31 vs 1.55 +/- 0.31 for IRL, respectively. We conclude that the esophageal diaphragm EMG can be used to assess neural drive and that diaphragm fatigue of the intensity observed in this study does not affect respiratory drive.     

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.

     

Effects of hypoxia on diaphragm relaxation rate during fatigue

Van Lunteren, Erik, Augusto Torres, and Michelle Moyer.Effects of hypoxia on diaphragm relaxation rate during fatigue. J. Appl. Physiol. 82(5):1472-1478, 1997.Skeletal muscle fatigue is associated with aslowing of relaxation rate. Hypoxia may increase the rate at whichfatigue occurs, but, surprisingly, mild to moderate hypoxia has notbeen found to augment the degree of slowing of relaxation duringfatigue. The present study tested the hypothesis that severe hypoxiainteracts with fatigue in slowing the rate of muscle relaxation andthat this can be modulated by altering membranous ionic conductances.Rat diaphragm muscle strips were studied in vitro while aerated with95% O₂-5%CO₂ (normoxia) or 95%N₂-5%CO₂ (hypoxia). During continuous0.1-Hz stimulation, relaxation rate and force remained stable overtime, and relaxation rate was not slowed by hypoxia. Hypoxiaaccelerated force decline during continuous 5-Hz but not intermittent20-Hz stimulation. During both 5- and 20-Hz stimulation, relaxationrate became slower over time as force declined, the extent of which wasincreased significantly by hypoxia. The extent of hypoxia-augmentedslowing of relaxation rate during fatigue increased over time and was greater than expected for a given degree of force loss. 4-Aminopyridine did not attenuate or partially attenuated, whereas loweringextracellular Clconcentration fully attenuated, the hypoxia-induced prolongation ofrelaxation rate during repetitive stimulation. Thushypoxia slows relaxation rate to a greater extent than expected for a given degree of force decline, an effect that increases over time, isat most partially attenuated by loweringK⁺ conductance, and is fullyattenuated by lowering membranousCl conductance.

     

Effect of corticosteroids on diaphragm fatigue, SDH activity, and muscle fiber size.

The influence of dexamethasone on diaphragm (DIA) fatigue, oxidative capacity, and fiber cross-sectional areas (CSA) was determined in growing hamsters. One group received dexamethasone by daily subcutaneous injection for 21 days (D animals), while pair-weight (P) and free-eating controls (CTL) received saline subcutaneously. Isometric contractile properties of the DIA were determined in vitro by supramaximal direct muscle stimulation in the presence of curare. DIA fatigue resistance was determined through repetitive stimulation at 40 pulses/s for 2 min. A computer-based image-processing system was used to histochemically determine muscle fiber-type proportions, CSA, and succinate dehydrogenase activities. The medial gastrocnemius muscle (MG) was used as a limb muscle control, with histochemical studies being performed on both the superficial (s) and deep/red (r) portions. Dexamethasone markedly attenuated the normal increment in body weight over the 3-wk period. DIA fatigue resistance was significantly reduced in the D compared with CTL and P animals. Dexamethasone had no effect on fiber-type proportions of the DIA or MGr (MGs contained only type II fibers). In the DIA, the CSA of type II fibers was reduced 33% in D and 18.5% in P animals compared with CTL. Although no significant atrophy was noted in the type I DIA fibers of either D or P animals, a trend toward significance was noted in D animals compared with CTL. In the MGs, the CSA of type II fibers was reduced 33% in D and 16.5% in P animals compared with CTL. Significant atrophy of type I and II fibers of the MGr was noted in D animals compared with CTL (33.8 and 35% reductions, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of respiratory muscle unloading on exercise-induced diaphragm fatigue.

We previously compared the effects of increased respiratory muscle work during whole body exercise and at rest on diaphragmatic fatigue and showed that the amount of diaphragmatic force output required to cause fatigue was reduced significantly during exercise (Babcock et al., J Appl Physiol 78: 1710, 1995). In this study, we use positive-pressure proportional assist ventilation (PAV) to unload the respiratory muscles during exercise to determine the effects of respiratory muscle work, per se, on exercise-induced diaphragmatic fatigue. After 8-13 min of exercise to exhaustion under control conditions at 80-85% maximal oxygen consumption, bilateral phrenic nerve stimulation using single-twitch stimuli (1 Hz) and paired stimuli (10-100 Hz) showed that diaphragmatic pressure was reduced by 20-30% for up to 60 min after exercise. Usage of PAV during heavy exercise reduced the work of breathing by 40-50% and oxygen consumption by 10-15% below control. PAV prevented exercise-induced diaphragmatic fatigue as determined by bilateral phrenic nerve stimulation at all frequencies and times postexercise. Our study has confirmed that high- and low-frequency diaphragmatic fatigue result from heavy-intensity whole body exercise to exhaustion; furthermore, the data show that the workload endured by the respiratory muscles is a critical determinant of this exercise-induced diaphragmatic fatigue.     

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.

     

Power fatigue of the rat diaphragm muscle.

We hypothesized that decrements in maximum power output (W(max)) of the rat diaphragm (Dia) muscle with repetitive activation are due to a disproportionate reduction in force (force fatigue) compared with a slowing of shortening velocity (velocity fatigue). Segments of midcostal Dia muscle were mounted in vitro (26 degrees C) and stimulated directly at 75 Hz in 400-ms-duration trains repeated each second (duty cycle = 0.4) for 120 s. A novel technique was used to monitor instantaneous reductions in maximum specific force (P(o)) and W(max) during fatigue. During each stimulus train, activation was isometric for the initial 360 ms during which P(o) was measured; the muscle was then allowed to shorten at a constant velocity (30% V(max)) for the final 40 ms, and W(max) was determined. Compared with initial values, after 120 s of repetitive activation, P(o) and W(max) decreased by 75 and 73%, respectively. Maximum shortening velocity was measured in two ways: by extrapolation of the force-velocity relationship (V(max)) and using the slack test [maximum unloaded shortening velocity (V(o))]. After 120 s of repetitive activation, V(max) slowed by 44%, whereas V(o) slowed by 22%. Thus the decrease in W(max) with repetitive activation was dominated by force fatigue, with velocity fatigue playing a secondary role. On the basis of a greater slowing of V(max) vs. V(o), we also conclude that force and power fatigue cannot be attributed simply to the total inactivation of the most fatigable fiber types.     

Relative contribution of neurotransmission failure to diaphragm fatigue

Two procedures were used to estimate the relative contribution of neurotransmission failure (NF) to fatigue of the rat diaphragm at different rates of phrenic nerve stimulation. In one, direct muscle stimulation was intermittently superimposed on neural stimulation of the diaphragm, and the relative contribution of NF was estimated by the difference in generated tension. In a second procedure, diaphragm fatigue was induced by using either direct muscle stimulation (with complete blockade of the neuromuscular junction by d-tubocurare) or phrenic nerve stimulation. The relative contribution of NF to diaphragm fatigue was then estimated by comparing the force loss during these two modes of stimulation. With both procedures, it was observed that 1) the relative contribution of NF to diaphragm fatigue was less than 45% at each frequency of phrenic nerve stimulation; 2) the relative contribution of NF to diaphragm fatigue increased at higher rates of phrenic stimulation, reaching a maximum at 75 pulses/s; and 3) the relative contribution of NF to diaphragm fatigue reached a plateau after 2 min of repetitive stimulation.     

Changes in diaphragm motor unit EMG during fatigue

Fatigue-related changes in the waveform and root-mean-square (rms) values of evoked motor unit electromyographic (EMG) responses were studied in the right sternocostal region of the cat diaphragm. Motor units were isolated by microdissection and stimulation of C5 ventral root filaments and then classified as fast-twitch fatigable (FF), fast-twitch fatigue intermediate (FInt), fast-twitch fatigue resistant (FR), or slow-twitch (S) based on standard physiological criteria. The evoked EMG responses of S and FR units showed very little change during the fatigue test. The evoked EMG waveform and rms values of FF and FInt units displayed variable changes during the fatigue test. When changes were observed, they typically included a prolongation of the EMG waveform, a decrease in peak amplitude, and a decrease in rms value. The changes in EMG amplitude and rms values were not correlated. In more fatigable units, the decrease in force during the fatigue test generally exceeded the decrease in EMG rms values. Changes in the evoked force and EMG responses of multiple units innervated by C5 or C6 ventral roots were also examined during the fatigue test. The decrease in diaphragm force during the fatigue test closely matched the force decline predicted by the proportionate contribution of different motor unit types. However, the observed reduction in diaphragm EMG rms values during the fatigue test exceeded that predicted based on the aggregate contribution of different motor unit types. It was concluded that changes in EMG do not reflect the extent of diaphragm fatigue.     

Interaction of fatigue and hypercapnia in the canine diaphragm

We studied 10 open-chest dogs and measured the pressure across the diaphragm (Pdi) in each period of the protocol during stimulation at frequencies of 1, 20, 50, and 80 Hz. Three ranges of arterial PCO2 (PaCO2) were examined: less than or equal to 26, 36-50, and greater than or equal to 89 Torr. The diaphragm was fatigued with repetitive phrenic stimulation (30 Hz). During the fatiguing activity, five of the animals were subjected to hypercapnia and the other five to hypocapnia. A frequency-Pdi curve was generated for each period in the protocol. The data show that 1) fatiguing to 50% of the initial Pdi value during hypercapnia was significantly more rapid than during hypocapnia; 2) both the prefatigue and postfatigue mean Pdi values over all interactions of frequency, fatigue, and PaCO2 were unaffected by the fatiguing environment (hypercapnia vs. hypocapnia); 3) the percent reduction of Pdi by hypercapnia was the same at all four frequencies; 4) hypocapnia did not alter either the pre- or postfatigue frequency-Pdi curve; and 5) one-half relaxation time, unaffected by PaCO2, was prolonged by fatigue. We conclude that the hypercapnic diaphragm has less endurance than the hypocapnic diaphragm and that although both fatigue and hypercapnia decrease Pdi, they appear to be separate entities working through different mechanisms.     

Temperature dependence of rat diaphragm muscle contractility and fatigue

The diaphragm is a skeletal muscle of mixed fiber type that is unique in its requirement to maintain contractile function and fatigue resistance across a wide range of temperatures to sustain alveolar ventilation under conditions of hypo- or hyperthermia. The direct effect of temperature (15-41 degrees C) on rat diaphragm isometric contractility and fatigue was determined in vitro. As temperature decreased from 37 to 15 degrees C, contraction and relaxation times increased, and there was a left shift of the diaphragm's force-frequency curve, with decreased contractility at 41 and 15 degrees C. Fatigue was induced by 10 min of stimulation with 30 trains/min of 5 Hz at a train duration of 900 ms. Compared with 37 degrees C, fatigue resistance was enhanced at 25 degrees C, but no difference in fatigue indexes was evident at extreme hypothermia (15 degrees C) or hyperthermia (41 degrees C). Only when the fatigue program was adjusted to account for hypothermia-induced increases in tension-time indexes was fatigue resistance evident at 15 degrees C. These findings indicate that despite the diaphragm's unique location as a core structure, necessitating exposure to in vivo temperatures higher than found in limb muscle, the temperature dependence of rat diaphragm muscle contractility and fatigue is similar to that reported for limb muscle of mixed fiber type.