Respiratory pressure partitioning during quiet inspiration in unilateral and bilateral diaphragmatic weakness

To compensate for diaphragmatic weakness, intercostal/accessory muscles may be recruited in inspiration and/or abdominal muscles in expiration with relaxation during subsequent inspiration. As a consequence, for a given decrease in pleural pressure (Ppl) during quiet inspiration (qi), abdominal pressure (Pab) should either undergo a smaller increase than normal or, in severe cases, decrease. If so, the ratio of change in Pab to Ppl during qi (delta Pab/delta Ppl(qi], which is normally less than -1 when upright, should increase, approaching +1 in profound diaphragmatic weakness. To examine the relationship between degree of diaphragmatic weakness and delta Pab/delta Ppl(qi), we measured (erect and supine) anteroposterior rib cage and abdominal motion, Pab, Ppl, and transdiaphragmatic pressure (Pdi) during qi, maximal inspiration (Pdi(max)mi) and maximal inspiratory effort at FRC (Pdi(max)FRC) in 10 patients with bilateral and 8 with unilateral diaphragmatic weakness. Pdi(max)mi and Pdi(max)FRC were low in all patients. delta Pab/delta Ppl(qi) (erect) was increased in all patients (0.28 +/- 0.7; mean +/- SD) and correlated closely with both Pdi(max)mi (r = -0.89, p less than 0.001) and Pdi(max)FRC (r = -0.76, p less than 0.001). There was extensive overlap in the data between unilateral and bilateral diaphragmatic weakness. The ratio of delta Pdi during qi to Pdi(max)FRC was less than 0.31 in all patients. The results suggest that delta Pab/delta Ppl(qi) is a useful index of the degree of diaphragmatic weakness and that the functional consequences of unilateral and bilateral weakness are not rigidly separable.(ABSTRACT TRUNCATED AT 250 WORDS)