Figures
- FIGURE 1
Illustration of oesophageal (Poes), gastric (Pga), transdiaphragmatic (Pdi) pressure curves during sniff manoeuvre in a patient with unilateral diaphragm paralysis (a,b) and in a healthy control subject (c,d).
- FIGURE 2
Metabolic and respiratory variables during incremental cycling exercise in patients with unilateral diaphragmatic paralysis (paralysis group) and healthy control group (CG). a) Peak oxygen uptake (V′O2), b) Ventilation (VE), c) Tidal volume (VT), d) respiratory rate (RR), e) Borg score for dyspnoea and f) Borg score for leg effort. Dotted lines represent the peak of exercise for each group. Values represent mean±sem. *p<0.05 for paralysis group versus CG at iso-work rate or peak of exercise.
- FIGURE 3
Inspiratory oesophageal (Poes), gastric (Pga), transdiaphragmatic (Pdi) pressures (a–c) and percentage of maximal scalene (EMGsca/ EMGsca, max) and sternocleidomastoid (EMGscm/ EMGscm, max) muscle activation (d, e) during incremental cycling exercise in patients with unilateral diaphragmatic paralysis (paralysis group) and healthy control group (CG). Dotted lines represent the peak of exercise for each group. Values represent mean±sem. *p<0.05 for paralysis group versus control group at iso-work rate or peak of exercise.
- FIGURE 4
Percentage of maximal oesophageal pressure generation (Poes/Poes,max) (a); percentage of maximal scalene activation (EMGsca/ EMGsca, max) (b); transdiaphragmatic pressure (Pdi) (c); and Borg score for dyspnoea (d) during incremental cycling exercise in patients with unilateral diaphragmatic paralysis (paralysis group) and healthy control group (CG) at similar ventilation. VE: ventilation. Dotted lines represent the peak of exercise for each group. Values represent mean±sem. *: p<0.05 for paralysis group versus control group at similar VE or peak of exercise (matching symbols).
Tables
- TABLE 1
Demographic data of patients with unilateral diaphragmatic paralysis and control group
Paralysis group Control group p-value Male 17 (49) 10 (50) 0.92 Age years 55.8±9.9 (32–77) 49.8±6.4 (40–58) 0.03 Weight kg 75.5±11.8 (48–99) 78.7±9.8 (65–105) 0.32 Height m 1.63±0.1 (1.5–1.9) 1.68 ±0.1 (1.5–1.9) 0.07 BMI kg·m−2 28.4±3.4 (22.2–35.6) 27.9±2.1(22.5–29.8) 0.49 Left paralysis 22 (63) – – Cause of paralysis Idiopathic 10 (29) – – Trauma 13 (37) – – After cardiac surgery 8 (23) – – After thoracic surgery 4 (11) – – Data are presented as mean±sd (range) or n (%), unless otherwise stated. BMI: body mass index.
- TABLE 2
Lung function and dyspnoea assessment of patients with unilateral diaphragmatic paralysis and control group at rest
Paralysis group Control group p-value Lung function FEV1 sitting L (% pred) 1.8±0.6 (59±13) 2.9±0.5 (92±9) <0.001 FVC sitting L (% pred) 2.3±0.8 (62±13) 3.5±0.7 (92±8) <0.001 FEV1/ FVC % 80±11 82±5 0.24 FVC supine L (% pred) 2.0±0.7 (56±13) – – Δ FVC sitting versus supine % −12±8 – – IC L (% pred) 1.7±0.5 (64±13) 2.7±0.5 (87±14) <0.001 MVV L (% pred) 82.1±22.8 (65±13) 120.0±30.9 (85± 20) <0.001 TLC L (% pred) 4.2±0.9 (73±21) – – DLCO (% pred) 20.1±8.3 (66±38) – – DL/VA (% pred) 5.28±1.50 (107±35) – – MRC 1 11 (31) 20 (100) <0.001 2 14 (40) 0 (0) – 3 9 (26) 0 (0) – 4 1 (3) 0 (0) – 5 0 (0) 0 (0) – Data are presented as mean±sd or n (%), unless otherwise stated. FEV1: forced expiratory volume in 1 s; % pred: % predicted; FVC: forced vital capacity, IC: inspiratory capacity; MVV: maximal voluntary ventilation; TLC: total lung capacity, DLCO: carbon monoxide diffusing capacity; DL/VA: carbon monoxide diffusing capacity by alveolar ventilation coefficient; MRC: Medical Research Council Breathlessness Scale.
- TABLE 3
Respiratory muscle strength of patients with unilateral diaphragmatic paralysis and control group
Paralysis group Control group p-value Volitional inspiratory muscle strength PImax cmH2O (% pred) −67±25 (55±23) −103±30 (100±21) <0.001 SNIP cmH2O (% pred) 57±18 (58±15) 96±20 (89±28) <0.001 Sniff Poes cmH2O −44±13 −66±26 0.001 Sniff Pga cmH2O −10±9 36±14 <0.001 Sniff Pdi cmH2O 34±17 102±26 <0.001 Nonvolitional inspiratory muscle strength Twitch Pdi (bilateral) cmH2O 5.3±2.7 15.3±5.7 <0.001 Twitch Pdi cmH2O Unaffected hemidiaphragm/right for control group 3.5±1.3 7.4±2.7 <0.001 Twitch Pdi cmH2O Affected hemidiaphragm/left for control group 2.5±1.1 8.9±3.4 <0.001 Data are presented as mean±sd, unless otherwise stated. PImax: maximal static inspiratory pressure; SNIP: sniff nasal inspiratory pressure; Sniff Poes: oesophageal pressure during sniff manoeuvre; Sniff Pga: gastric pressure during sniff manoeuvre; Sniff Pdi: transdiaphragmatic pressure during sniff manoeuvre; Twitch Pdi: transdiaphragmatic pressure during phrenic nerve magnetic stimulation.
- TABLE 4
Metabolic, respiratory, and cardiovascular parameters recorded at peak of incremental cardiopulmonary exercise testing (CPET) in patients with unilateral diaphragmatic paralysis and control group
Paralysis group Control group p-value CPET performance Work rate W (% pred) 83.9±38.5 (54±26) 152.3±55.2 (90±41) <0.001 V′O2 mL·kg−1·min−1 (% pred) 18.7±5.5 (90.2±20.1) 25.3±9.5 (106.7±21.8) 0.01 RER 0.99±0.13 1.09±0.09 0.01 Ventilation and gas exchange VT L 1.3±0.5 1.9±0.4 <0.001 VT/IC % 72±11 72±8 0.93 VE L·min−1 51.5±16.9 74.7±23.7 0.001 RR bpm 42±9 39±9 0.24 VE/MVV 0.6±0.3 0.6±0.2 0.44 IC L 1.6±0.4 2.8±0.5 <0.001 Δ IC (peak-rest) L 0.0±0.2 0.6±1 0.03 VE/VCO2 36±5 35±3 0.86 SpO2 % 93±3 95±1 0.06 Cardiovascular HR bpm (% pred) 138±22 (85±12) 157±19 (93±10) 0.003 O2 pulse mL·bpm−1 (% pred) 14±3 (82±21) 15±5 (89±28) 0.15 Symptoms Borg modified (dyspnoea) 9 (7–10) 5 (3.25–9) 0.001 Borg modified (legs effort) 9 (7–10) 7 (5–8.75) 0.02 Data are presented as mean±sd and median (25th–75th percentile), unless otherwise stated. V′O2: maximal oxygen consumption; RER: respiratory exchange ratio; VT: tidal volume; VE: pulmonary ventilation; RR: respiratory rate; MVV: maximum voluntary ventilation; IC: inspiratory capacity; VCO2: CO2 production; SpO2: peripheral oxygen saturation; HR: heart rate.
