Original Article
Modifications of Diaphragmatic Activity Induced by Midline Laparotomy and Changes in Abdominal Wall Compliance
Modificaciones en la actividad del diafragma inducidas por laparotomía media y cambios en la rigidez de la pared abdominal
Joaquim Geaa,
, Juan Bautista Gáldizb,d, Norman Comtoisa, Ercheng Zhua, Igor Salazkina, José antonio Fiza,e, Alejandro Grassinoa,e
Corresponding author
a Hôpital de Notre-Dame, Université de Montréal, Montréal, Québec, Canada
b Meakins-Christie Laboratories, McGill University, Montréal, Québec, Canada
d Servicio de Neumología, Hospital de Cruces, Barakaldo, Universidad del País Vasco, Vizcaya, Spain
e Servei de Pneumologia, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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"identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Juan Bautista" "apellidos" => "Gáldiz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff3" ] ] ] 2 => array:3 [ "nombre" => "Norman" "apellidos" => "Comtois" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Ercheng" "apellidos" => "Zhu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Igor" "apellidos" => "Salazkin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 5 => 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"entidad" => "Servicio de Neumología, Hospital de Cruces, Barakaldo, Universidad del País Vasco, Vizcaya, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Servei de Pneumologia, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modificaciones en la actividad del diafragma inducidas por laparotomía media y cambios en la rigidez de la pared abdominal" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-10-17" "fechaAceptado" => "2008-02-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec155439" "palabras" => array:4 [ 0 => "Diaphragm" 1 => "Abdominal surgery" 2 => "Abdominal cast" 3 => "Muscle length" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155438" "palabras" => array:4 [ 0 => "Diafragma" 1 => "Cirugía abdominal" 2 => "Prótesis abdominal" 3 => "Longitud muscular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction and Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Diaphragmatic activity varies with the initial length of the muscle. Our objective was to evaluate the influence of surgery and changes in abdominal wall compliance on diaphragmatic activity.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Both phrenic nerves in 7 mongrel dogs were stimulated electrically with single supramaximal pulses (twitch). The gastric (Pga) and transdiaphragmatic (Pdi) pressures generated and muscle shortening (sonomicrometry) were used to evaluate diaphragmatic activity, which was determined at baseline, after midline laparotomy, with an elastic abdominal bandage, and with a rigid circular cast. Abdominal pressure was then gradually increased in order to induce progressive lengthening of the diaphragm.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">After laparotomy, the pressures were somewhat lower (by 12%) than at baseline. The elastic bandage produced a slight increase in the pressure generated by the diaphragm (mean [SE] values: Pga, from 4.2 [0.3] cm H<span class="elsevierStyleInf">2</span>O to 6.3 [0.9] cm H<span class="elsevierStyleInf">2</span>O, <span class="elsevierStyleItalic">P</span><.01; Pdi, from 12.1 [2.0] cm H<span class="elsevierStyleInf">2</span>O to 15.4 [1.8] cm H<span class="elsevierStyleInf">2</span>O, <span class="elsevierStyleItalic">P</span><.05]), and these values increased even further with the rigid cast (Pga, to 12.6 [1.5] cm H<span class="elsevierStyleInf">2</span>O; Pdi, to 20.2 [2.3] cm H<span class="elsevierStyleInf">2</span>O; <span class="elsevierStyleItalic">P</span><.01 for both comparisons); this occurred despite smaller degrees of muscle shortening: by 57% [5%] of the initial length at functional residual capacity at baseline, by 49% [5%] with the bandage (<span class="elsevierStyleItalic">P</span><.05), and by 39% [6%] with the cast (<span class="elsevierStyleItalic">P</span><.01). With progressive lengthening of the muscle, its contractile efficacy increased up to a certain point (105% of the length at functional residual capacity), after which it began to decline.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Abdominal wall compliance plays an important role in the diaphragmatic response to stimulation. This appears to be due mainly to changes in its length at rest.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción y objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">La actividad del diafragma puede verse modificada por su longitud inicial. Nuestro objetivo ha sido evaluar la influencia de la cirugía y los cambios en la rigidez de la pared abdominal sobre la actividad del músculo.</p> <span class="elsevierStyleSectionTitle">Método</span><p class="elsevierStyleSimplePara elsevierViewall">En 7 perros mestizos se estimularon eléctricamente ambos nervios frénicos con pulsos únicos supramáximos (<span class="elsevierStyleItalic">twitch</span>). Para evaluar la actividad del diafragma se determinaron las presiones generadas - gástrica (Pga<span class="elsevierStyleInf">tw</span>) y transdiafragmática (Pdi<span class="elsevierStyleInf">tw</span>)– y el acortamiento muscular (sonomicrometría). La respuesta diafragmática se obtuvo en situación basal, tras laparotomía media, con venda abdominal elástica y con prótesis rígida circular. A continuación se incrementó ligera y progresivamente la presión abdominal para conseguir el alargamiento sucesivo del diafragma.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Tras la laparotomía, las presiones fueron algo inferiores a las basales (12%). La banda elástica provocó un leve aumento de la presión generada por el diafragma (valores medios ± error estándar. Pgatw: 4,2 ± 0,3 a 6,3 ± 0,9 cmH<span class="elsevierStyleInf">2</span>O, p < 0,01; Pdi<span class="elsevierStyleInf">tw</span>: 12,1 ± 2,0 a 15,4 ± 1,8 cm H<span class="elsevierStyleInf">2</span>O, p < 0,05), que se incrementó aún más con la prótesis rígida (Pga=: 12,6 ± 1,5 cmH<span class="elsevierStyleInf">2</span>O; Pdi<span class="elsevierStyleInf">tw</span>: 20,2 ± 2,3 cmH<span class="elsevierStyleInf">2</span>O; p < 0,01 para ambas), a pesar de valores de acortamiento inferiores -un 57 ± 5% de la longitud inicial a capacidad funcional residual en situación basal, un 49 ± 5% con banda (p < 0,05) y un 39 ± 6% con prótesis (p < 0,01)–. Al alargar progresivamente el músculo, su efectividad contráctil aumentó hasta un punto (un 105% de la longitud a capacidad funcional residual) a partir del cual comenzó a declinar.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p class="elsevierStyleSimplePara elsevierViewall">La rigidez de la pared abdominal desempeña un papel importante en la respuesta del diafragma a la estimulación. Esto parece deberse fundamentalmente a cambios en su longitud de reposo.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedades del diafragma y de los músculos ventilatorios" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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| 2020 March | 23 | 16 | 39 |
| 2020 February | 18 | 17 | 35 |
| 2020 January | 24 | 13 | 37 |
| 2019 December | 13 | 13 | 26 |
| 2019 November | 19 | 16 | 35 |
| 2019 October | 10 | 10 | 20 |
| 2019 September | 12 | 10 | 22 |
| 2019 August | 14 | 12 | 26 |
| 2019 July | 18 | 21 | 39 |
| 2019 June | 11 | 14 | 25 |
| 2019 May | 15 | 18 | 33 |
| 2019 April | 14 | 31 | 45 |
| 2019 March | 19 | 22 | 41 |
| 2019 February | 12 | 9 | 21 |
| 2019 January | 9 | 13 | 22 |
| 2018 December | 14 | 15 | 29 |
| 2018 November | 20 | 16 | 36 |
| 2018 October | 30 | 15 | 45 |
| 2018 September | 17 | 9 | 26 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 12 | 7 | 19 |
| 2018 March | 5 | 5 | 10 |
| 2018 February | 9 | 10 | 19 |
| 2018 January | 15 | 9 | 24 |
| 2017 December | 11 | 9 | 20 |
| 2017 November | 8 | 5 | 13 |
| 2017 October | 15 | 11 | 26 |
| 2017 September | 11 | 9 | 20 |
| 2017 August | 10 | 10 | 20 |
| 2017 July | 7 | 5 | 12 |
| 2017 June | 21 | 13 | 34 |
| 2017 May | 8 | 4 | 12 |
| 2017 April | 8 | 3 | 11 |
| 2017 March | 10 | 6 | 16 |
| 2017 February | 7 | 8 | 15 |
| 2017 January | 6 | 6 | 12 |
| 2016 December | 4 | 2 | 6 |
| 2016 November | 10 | 6 | 16 |
| 2016 October | 15 | 7 | 22 |
| 2016 September | 15 | 9 | 24 |
| 2016 August | 10 | 3 | 13 |
| 2016 July | 8 | 0 | 8 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 45 | 6 | 51 |
| 2015 September | 51 | 8 | 59 |
| 2015 August | 34 | 8 | 42 |
| 2015 July | 44 | 3 | 47 |
| 2015 June | 32 | 4 | 36 |
| 2015 May | 45 | 12 | 57 |
| 2015 April | 34 | 9 | 43 |
| 2015 March | 42 | 7 | 49 |
| 2015 February | 22 | 2 | 24 |
| 2015 January | 59 | 5 | 64 |
| 2014 December | 64 | 6 | 70 |
| 2014 November | 36 | 5 | 41 |
| 2014 October | 58 | 8 | 66 |
| 2014 September | 45 | 8 | 53 |
| 2014 August | 31 | 11 | 42 |
| 2014 July | 27 | 7 | 34 |
| 2014 June | 47 | 8 | 55 |
| 2014 May | 43 | 8 | 51 |
| 2014 April | 68 | 7 | 75 |
| 2014 March | 60 | 10 | 70 |
| 2014 February | 47 | 8 | 55 |
| 2014 January | 33 | 4 | 37 |
| 2013 December | 40 | 9 | 49 |
| 2013 November | 22 | 3 | 25 |
| 2013 October | 34 | 9 | 43 |
| 2013 September | 36 | 14 | 50 |
| 2013 August | 28 | 10 | 38 |
| 2013 July | 50 | 15 | 65 |
| 2013 June | 61 | 6 | 67 |
| 2013 May | 35 | 6 | 41 |
| 2013 April | 21 | 7 | 28 |
| 2013 March | 8 | 1 | 9 |
Show all
