Diaphragmatic Breathing and Ventilator-Induced Diaphragmatic Dysfunction: Difference between revisions

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== Evidence Based Practice : ==
== Evidence Based Practice : ==
Allison et al reported that during lumbo-pelvic motion control tests, diaphragmatic activity increases in healthy subjects(7)  O’Sullivan concluded in their case studies that lumbopelvic movements decreases in patients with diaphragmatic injuries. (8)
Allison et al reported that during lumbo-pelvic motion control tests, diaphragmatic activity increases in healthy subjects<ref>Allison G, Kendle K, Roll S, Schupelius J, Scott Q, Panizza J. [https://www.sciencedirect.com/science/article/pii/S000495141460369X The role of the diaphragm during abdominal hollowing exercises.] Australian Journal of Physiotherapy. 1998 Jan 1;44(2):95-102.</ref>  O’Sullivan concluded in their case studies that lumbopelvic movements decreases in patients with diaphragmatic injuries.<ref>O’Sullivan PB, Beales DJ. [https://www.sciencedirect.com/science/article/abs/pii/S1356689X0600083X Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series.] Manual therapy. 2007 Aug 1;12(3):209-18.</ref>


Moreover, patients with chronic lower back pain have often been reported to have defects in posture and motor control (9) (10)
Moreover, patients with chronic lower back pain have often been reported to have defects in posture and motor control.<ref>O’Sullivan P. [https://www.sciencedirect.com/science/article/abs/pii/S1356689X05001104 Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism.] Manual therapy. 2005 Nov 1;10(4):242-55.</ref><ref>Hodges PW, Moseley GL. [https://www.sciencedirect.com/science/article/abs/pii/S1050641103000427 Pain and motor control of the lumbopelvic region: effect and possible mechanisms]. Journal of electromyography and kinesiology. 2003 Aug 1;13(4):361-70.</ref>


== Effect of mechanical ventilation on diaphragm ==
== Effect of mechanical ventilation on diaphragm ==


* VIDD: Ventilator-induced diaphragmatic dysfunction: defined as loss of diaphragmatic force- generating capacity as a consequence to use of mechanical ventilation due to suppressed inspiratory effort.
* '''Ventilator-induced diaphragmatic dysfunction(VIDD):'''
* Mechanical ventilatory assistance contributes to  diaphragm muscle inactivity and unloading thus leading to diaphragmatic  atrophy and fatigue(11)
** Loss of diaphragmatic force- generating capacity as a consequence to use of mechanical ventilation due to suppressed inspiratory effort.
* Diaphragm weakness is a leading cause of difficult weaning from mechanical ventilation (12) and Loss of thickness of diaphragm muscle, however, if there is insufficient ventilatory support and diaphragm is not unloaded adequately leading to load-induced inflammation and injury. (13)
* Mechanical ventilatory assistance contributes to  diaphragm muscle inactivity and unloading thus leading to diaphragmatic  atrophy and fatigue.<ref>Vassilakopoulos T, Petrof BJ. [https://www.atsjournals.org/doi/full/10.1164/rccm.200304-489CP Ventilator-induced diaphragmatic dysfunction.] American journal of respiratory and critical care medicine. 2004 Feb 1;169(3):336-41.</ref>
* Diaphragm atrophy developing during mechanical ventilation strongly impacts clinical outcomes. Targeting an inspiratory effort level similar to that of healthy subjects at rest might accelerate liberation from ventilation.(29)
* Diaphragm weakness is a leading cause of difficult weaning from mechanical ventilation<ref>Dres M, Dubé BP, Mayaux J, Delemazure J, Reuter D, Brochard L, Similowski T, Demoule A. [https://www.atsjournals.org/doi/full/10.1164/rccm.201602-0367OC Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients.] American journal of respiratory and critical care medicine. 2017 Jan 1;195(1):57-66.</ref> and loss of thickness of diaphragm muscle, however, if there is insufficient ventilatory support and diaphragm is not unloaded adequately leading to load-induced inflammation and injury.<ref>Orozco-Levi M, Lloreta J, Minguella J, Serrano S, Broquetas JM, Gea J. [https://www.atsjournals.org/doi/full/10.1164/ajrccm.164.9.2011150 Injury of the human diaphragm associated with exertion and chronic obstructive pulmonary disease.] American journal of respiratory and critical care medicine. 2001 Nov 1;164(9):1734-9.</ref>
* Diaphragm atrophy developing during mechanical ventilation strongly impacts clinical outcomes. Targeting an inspiratory effort level similar to that of healthy subjects at rest might accelerate liberation from ventilation.<ref>Lipson DA, Barnacle H, Birk R, Brealey N, Locantore N, Lomas DA, Ludwig-Sengpiel A, Mohindra R, Tabberer M, Zhu CQ, Pascoe SJ. [https://www.atsjournals.org/doi/full/10.1164/rccm.201703-0449OC FULFIL trial: once-daily triple therapy for patients with chronic obstructive pulmonary disease.] American journal of respiratory and critical care medicine. 2017 Aug 15;196(4):438-46.</ref>


== References ==
== References ==
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6.Diaphragm Deep Breathing. <nowiki>https://www.eugeneor.gov/DocumentCenter/View/14142/Diaphagmatic_breathing?bidId=</nowiki>.
6.Diaphragm Deep Breathing. <nowiki>https://www.eugeneor.gov/DocumentCenter/View/14142/Diaphagmatic_breathing?bidId=</nowiki>.


7. Allison GT, Kendle K, Roll S, Schupelius J, Scott Q, Panizza J. Aust J Physiother. 1998; 44(2):95-102
8. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series.O'Sullivan PB, Beales DJ, Man Ther. 2007 Aug; 12(3):209-18
9. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. Hodges PW, Moseley GL. J Electromyogr Kinesiol. 2003 Aug; 13(4):361-70.
10. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. O'Sullivan P. Man Ther. 2005 Nov; 10(4):242-55)
11. Vassilakopoulos T, Petrof BJ. Ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2004;169(3):336-341.
12. Dres M, Dubé B-P, Mayaux J, Delemazure J, Reuter D, Brochard L,et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med 2017;195:57–66
13. Orozco-Levi M, Lloreta J, Minguella J, Serrano S, Broquetas JM, Gea J. Injury of the human diaphragm associated with exertion and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164:1734–1739
29.  Goligher E, Dres M, Fan E, Rubenfeld G. Mechanical Ventilation–induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes | American Journal of Respiratory and Critical Care Medicine. Atsjournals.org. <nowiki>https://www.atsjournals.org/doi/10.1164/rccm.201703-0536OC</nowiki>. Published 2017.
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[[Category:Course Pages]]
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[[Category:Physioplus Content]]
[[Category:Respiratory System - Assessment and Examination]]
[[Category:Respiratory System - Assessment and Examination]]

Revision as of 08:09, 15 September 2021

Original Editor - Carin Hunter based on the course by Rina Pandya
Top Contributors - Ewa Jaraczewska, Carin Hunter, Jess Bell, Kim Jackson and Wanda van Niekerk

Effects of diaphragmatic breathing(6)[edit | edit source]

  1. Detoxifies and Releases Toxins:
    • Our body is designed to release 70% of its toxins through breathing. At least 3x times per day for 39 seconds
  2. Anti-stress:
    • Brain releases cortisol, the “stress hormone” under stress and anxiety.
    • By taking deep breaths, heart rate slows, more oxygen enters the blood stream and ultimately communicates with the brain to relax.
    • Deep breathing increases the endorphins.
  3. Relaxation and mood elevation:
    • Diaphragmatic breathing stimulates vagus nerve which is parasympathetic, thus inducing relaxation.
  4. Deep Breathing Relieves Pain:
    • Breathing into pain will increase circulation to that specific area, relieves tension and increase oxygenation. This triggers the release of endorphins, thus effecting pain relief.
  5. Deep Breathing Enhances the Immune System:
    • Deep breathing enhances the body’s ability to metabolize nutrients and vitamins. Deep breathing aids in digestion which helps strengthen the immunity.
  6. Lowers blood pressure:
    • With relaxation blood vessels dilate, which improves circulation and lowers blood pressure. Deep breathing also slows and regulates the heart rate, which also helps with lowering BP.
  7. Deep Breathing Improves Cellular Regeneration:
    • With deep breathing the body is better oxygenated and has better circulation which enhances the body’s efforts of cellular regeneration.
  8. Helps support correct posture.
    • Inspiration lengthens the spine, facilitates lumbopelvic movements, activates core muscles.

Evidence Based Practice :[edit | edit source]

Allison et al reported that during lumbo-pelvic motion control tests, diaphragmatic activity increases in healthy subjects[1]  O’Sullivan concluded in their case studies that lumbopelvic movements decreases in patients with diaphragmatic injuries.[2]

Moreover, patients with chronic lower back pain have often been reported to have defects in posture and motor control.[3][4]

Effect of mechanical ventilation on diaphragm[edit | edit source]

  • Ventilator-induced diaphragmatic dysfunction(VIDD):
    • Loss of diaphragmatic force- generating capacity as a consequence to use of mechanical ventilation due to suppressed inspiratory effort.
  • Mechanical ventilatory assistance contributes to  diaphragm muscle inactivity and unloading thus leading to diaphragmatic  atrophy and fatigue.[5]
  • Diaphragm weakness is a leading cause of difficult weaning from mechanical ventilation[6] and loss of thickness of diaphragm muscle, however, if there is insufficient ventilatory support and diaphragm is not unloaded adequately leading to load-induced inflammation and injury.[7]
  • Diaphragm atrophy developing during mechanical ventilation strongly impacts clinical outcomes. Targeting an inspiratory effort level similar to that of healthy subjects at rest might accelerate liberation from ventilation.[8]

References[edit | edit source]

5. McCool FD, Manzoor K, Minami T. Disorders of the Diaphragm. Clin. Chest Med. 2018 Jun;39(2):345-360

6.Diaphragm Deep Breathing. https://www.eugeneor.gov/DocumentCenter/View/14142/Diaphagmatic_breathing?bidId=.

  1. ↑ Allison G, Kendle K, Roll S, Schupelius J, Scott Q, Panizza J. The role of the diaphragm during abdominal hollowing exercises. Australian Journal of Physiotherapy. 1998 Jan 1;44(2):95-102.
  2. ↑ O’Sullivan PB, Beales DJ. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series. Manual therapy. 2007 Aug 1;12(3):209-18.
  3. ↑ O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Manual therapy. 2005 Nov 1;10(4):242-55.
  4. ↑ Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. Journal of electromyography and kinesiology. 2003 Aug 1;13(4):361-70.
  5. ↑ Vassilakopoulos T, Petrof BJ. Ventilator-induced diaphragmatic dysfunction. American journal of respiratory and critical care medicine. 2004 Feb 1;169(3):336-41.
  6. ↑ Dres M, Dubé BP, Mayaux J, Delemazure J, Reuter D, Brochard L, Similowski T, Demoule A. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. American journal of respiratory and critical care medicine. 2017 Jan 1;195(1):57-66.
  7. ↑ Orozco-Levi M, Lloreta J, Minguella J, Serrano S, Broquetas JM, Gea J. Injury of the human diaphragm associated with exertion and chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine. 2001 Nov 1;164(9):1734-9.
  8. ↑ Lipson DA, Barnacle H, Birk R, Brealey N, Locantore N, Lomas DA, Ludwig-Sengpiel A, Mohindra R, Tabberer M, Zhu CQ, Pascoe SJ. FULFIL trial: once-daily triple therapy for patients with chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine. 2017 Aug 15;196(4):438-46.
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