Am. J. Respir. Crit. Care Med., Vol 153, No. 6, 06 1996, 1897-1901.
Respiratory muscle response to flail chest
M Cappello, C Yuehua and A De Troyer
Laboratory of Cardiorespiratory Physiology, Brussels School of Medicine, Belgium.
We have previously shown that flail chest in the dog causes an inspiratory
inward displacement of the ribs and an increased inspiratory activity in
the external intercostal muscles, and we have speculated that this
increased activity is due to an increased spindle afferent activity. The
present studies were designed to test this hypothesis. Twenty-nine supine
anesthetized dogs were studied, and flail was produced surgically by
fracturing ventrally and dorsally two to four contiguous ribs on the right
side of the chest. Although flail elicited an increased inspiratory
activity in the external intercostal and levator costae muscles in the
disconnected segment of the rib cage, it did not alter the inspiratory
activity in the diaphragm and parasternal intercostals. Expiratory activity
in the triangularis sterni, internal intercostals, and transversus
abdominis remained unchanged also, as did the inspiratory activity in the
external intercostals on the left side of the chest. After flail, the
normal inspiratory shortening of the external intercostal muscles in the
disconnected segment was also reversed into an inspiratory muscle
lengthening. However, when the fractured ribs were connected to the
adjacent ribs so that the external intercostals were prevented from
lengthening during inspiration, external intercostal and levator costae
inspiratory activity was unaltered. These observations support the
hypothesis that the increased external intercostal muscle activity seen in
flail chest results primarily from an increased activation of the muscle
spindles.