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Am. J. Respir. Crit. Care Med., Volume 156, Number 5, November 1997, 1562-1566

Recovery of PdiTwitch Following the Induction of Diaphragm Fatigue in Normal Subjects

JOHN M. TRAVALINE, SHRIVAS SUDARSHAN, and GERARD J. CRINER

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania

Low frequency diaphragm fatigue (LFF) may play a major role in the pathogenesis of ventilatory failure; however, recovery from LFF is not well studied. We measured transdiaphragmatic twitch pressure (PdiT) at FRC (using a reduction of PdiT as an index of LFF) and maximum transdiaphragmatic pressure (Pdimax) before and after the induction of diaphragm fatigue in seven normal subjects, age 31 ± 3 yr (mean ± SD). Fatigue was induced by breathing through an inspiratory resistive load. PdiT produced by bilateral transcutaneous supramaximal electrophrenic stimulation was measured at baseline, 15, 30 min, 1, 2, 3, 4 h, and then 1 to 3 times between hour 20-25 post-fatigue. Pdimax estimated by twitch occlusion was measured at baseline, 30 min, 2-3, and 20-25 h post-fatigue. Pre-fatigue values (mean ± SE) were: PdiT 23.6 ± 2.5 cm H2O. The mean ± SD time to fatigue was 25.3 ± 12.3 min. Post-fatigue PdiT was reduced to 50%, and by 3 h was 72% of the initial value; 100% by 25 h. Pdimax was reduced to 75% post-fatigue, but recovered to 87% by 3 h, and 100% by 25 h. We concluded that recovery of PdiT and Pdimax in normal subjects starts to occur within the first few hours following diaphragm fatigue, and is complete by 25 h.




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