Inspiratory Resistance Breathing Research Articles

Cerebral Blood Flow and Cerebral Tissue Oxygen Responses to Inspiratory Resistance Breathing During Hypoxia

Increasing resistance to inspiration further decreases intrathoracic and intracranial pressures, leading to increases in venous return, stroke volume, and consequently, arterial pressure and cerebral perfusion pressure. Accordingly, inspiratory resistance breathing may be of therapeutic interest for clinical conditions associated with decreased delivery of blood and oxygen to the brain. Previous studies in healthy humans have investigated the effect of inspiratory resistance breathing on the cerebral circulation, by studying blood velocity within intracranial vessels (via transcranial Doppler (TCD) ultrasound), with equivocal results. The aim of this study was to investigate the effect of inspiratory resistance breathing on blood flow through the internal carotid artery (ICA), and cerebral tissue oxygenation during hypoxia. We hypothesized that inspiratory resistance breathing would increase ICA blood flow, and improve cerebral tissue oxygenation during a mild hypoxic stimulus.MethodsSix healthy human subjects (5M/1F) completed two 10‐min protocols in randomized order: 1) breathing a hypoxic gas mix (16% O2, balance N2), and 2) breathing a hypoxic gas mix (16% O2, balance N2) with inspiratory resistance of −7 cmH2O. ICA blood flow was derived from simultaneous measurements of blood velocity and diameter measured by duplex ultrasound, middle cerebral artery velocity (MCAv) was recorded continuously by TCD ultrasound, and cerebral tissue oxygenation (ScO2) was recorded by near‐infrared spectroscopy. Arterial oxygen saturation (SpO2) was measured by pulse oximetry, and end‐tidal O2 (etO2) was measured by a gas analyzer. Data were analyzed from the last 1‐min of baseline and each protocol with a linear mixed model.ResultsThe hypoxic stimulus decreased SpO2 and etO2 (P<0.0001), and inspiratory resistance breathing did not protect against these responses (P≥0.21). ICA diameter increased with hypoxia under both conditions (P=0.002), regardless of resistance breathing (P=0.56). ICA velocity (23.6 ± 1.6 cm/s vs. 25.7 ± 1.1 cm/s) and flow (298.8 ± 36.6 ml/min vs. 328.8 ± 39.5 ml/min) were lower with hypoxia and inspiratory resistance breathing compared with hypoxia alone (P≤0.07), while mean MCAv was not affected by either hypoxia or resistance breathing (P≥0.15). ScO2 decreased under both conditions (P=0.0009; hypoxia: −2.7 ± 0.9 %; hypoxia + resistance breathing: −3.6 ± 0.8 %), with no effect of inspiratory resistance breathing (P=0.90).ConclusionThese preliminary data demonstrate that, contrary to our hypothesis, inspiratory resistance breathing did not increase ICA blood flow, nor improve cerebral tissue oxygenation during a mild hypoxic stimulus. Rather, ICA blood flow decreased with inspiratory resistance breathing during hypoxia, primarily due to a reduction in ICA blood velocity. Further studies are required to elucidate whether inspiratory resistance breathing may be of therapeutic interest for clinical conditions affecting cerebral blood flow and tissue oxygenation.

Tolerance to a haemorrhagic challenge during heat stress is improved with inspiratory resistance breathing.

What is the central question of this study? Does inspiratory resistance breathing improve tolerance to simulated haemorrhage in individuals with elevated internal temperatures? What is the main finding and its importance? The main finding of this study is that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress. These findings demonstrate a scenario in which exploitation of the respiratory pump can ameliorate serious conditions related to systemic hypotension. Heat exposure impairs human blood pressure control and markedly reduces tolerance to a simulated haemorrhagic challenge. Inspiratory resistance breathing enhances blood pressure control and improves tolerance during simulated haemorrhage in normothermic individuals. However, it is unknown whether similar improvements occur with this manoeuvre in heat stress conditions. In this study, we tested the hypothesis that inspiratory resistance breathing improves tolerance to simulated haemorrhage in individuals with elevated internal temperatures. On two separate days, eight subjects performed a simulated haemorrhage challenge [lower-body negative pressure (LBNP)] to presyncope after an increase in internal temperature of 1.3±0.1°C. During one trial, subjects breathed through an inspiratory impedance device set at 0cmH2 O of resistance (Sham), whereas on a subsequent day the device was set at -7cmH2 O of resistance (ITD). Tolerance was quantified as the cumulative stress index. Subjects were more tolerant to the LBNP challenge during the ITD protocol, as indicated by a>30% larger cumulative stress index (Sham, 520±306mmHgmin; ITD, 682±324mmHgmin; P<0.01). These data indicate that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress.

Cerebral oxygenation and regional cerebral perfusion responses with resistance breathing during central hypovolemia.

Resistance breathing improves tolerance to central hypovolemia induced by lower body negative pressure (LBNP), but this is not related to protection of anterior cerebral blood flow [indexed by mean middle cerebral artery velocity (MCAv)]. We hypothesized that inspiratory resistance breathing improves tolerance to central hypovolemia by maintaining cerebral oxygenation (ScO2), and protecting cerebral blood flow in the posterior cerebral circulation [indexed by posterior cerebral artery velocity (PCAv)]. Eight subjects (4 male/4 female) completed two experimental sessions of a presyncopal-limited LBNP protocol (3 mmHg/min onset rate) with and without (Control) resistance breathing via an impedance threshold device (ITD). ScO2 (via near-infrared spectroscopy), MCAv and PCAv (both via transcranial Doppler ultrasound), and arterial pressure (via finger photoplethysmography) were measured continuously. Hemodynamic responses were analyzed between the Control and ITD condition at baseline (T1) and the time representing 10 s before presyncope in the Control condition (T2). While breathing on the ITD increased LBNP tolerance from 1,506 ± 75 s to 1,704 ± 88 s (P = 0.003), both mean MCAv and mean PCAv were similar between conditions at T2 (P ≥ 0.46), and decreased by the same magnitude with and without ITD breathing (P ≥ 0.53). ScO2 also decreased by ~9% with or without ITD breathing at T2 (P = 0.97), and there were also no differences in deoxygenated (dHb) or oxygenated hemoglobin (HbO2) between conditions at T2 (P ≥ 0.43). There was no evidence that protection of regional cerebral blood velocity (i.e., anterior or posterior cerebral circulation) nor cerebral oxygen extraction played a key role in the determination of tolerance to central hypovolemia with resistance breathing.

Tolerance to a hemorrhagic challenge during heat stress is improved with inspiratory resistance breathing

The mechanism(s) by which heat stress alters blood pressure control and tolerance to a simulated hemorrhagic challenge is multifaceted; however, heat‐induced reductions in central blood volume play a key role. Inspiratory resistance breathing improves blood pressure control and tolerance during simulated hemorrhage in normothermic individuals. It is unknown if similar improvements occur with this maneuver in heat stress conditions. This study tested the hypothesis that inspiratory resistance breathing improves tolerance to simulated hemorrhage in individuals with elevated internal temperatures. On 2 separate days, 8 subjects performed a simulated hemorrhage challenge (lower body negative pressure, LBNP) to pre‐syncope following an increase in internal temperature of 1.5 °C. During one trial subjects breathed through an inspiratory impedance device set at 0 cmH20 of resistance (Sham) while on the other day the device was set at −7 cmH20 of resistance (Experimental). Tolerance was quantified as cumulative stress index (CSI). Subjects were more tolerant to the LBNP challenge during the Experimental protocol as indexed by a larger CSI (Sham: 520±306 mmHg × min; Experimental: 682±324 mmHg × min, P&lt;0.01). These data indicate that inspiratory resistance breathing modestly improves tolerance to a simulated hemorrhagic challenge during heat stress.Support NIH‐HL61388 &amp; HL84072

Respiratory abdominal muscle recruitment and chest wall motion in myotonic muscular dystrophy.

Abdominal muscles are selectively active in normal subjects during stress and may increase the potential energy for inspiration by reducing the end-expiratory lung volume (EELV). We hypothesized that a similar process would occur in subjects with myotonic muscular dystrophy (MMD), but would be less effective, because of to their weakness and altered chest wall mechanics. Fine-wire electromyography (EMG) of the transversus abdominis (TA), internal oblique (IO), external oblique, and rectus abdominis was recorded in 10 MMD and 10 control subjects. EMG activity, respiratory inductive plethysmography, and gastric pressure were recorded during static pressure measurement and at increasing levels of inspiratory resistance breathing. EELV was reduced and chest wall motion was synchronous only in controls. Although the TA and IO were selectively recruited in both groups, EMG activity of the MMD group was twice that of controls at the same inspiratory pressure. In MMD subjects with mildly reduced forced vital capacity, significant differences can be seen in abdominal muscle recruitment, wall motion, work of breathing, and ventilatory parameters.

Exercise performance during inspiratory resistance breathing under exhaustive constant load work

The purpose of this study was to determine the effects of different inspiratory resistances on exercise performance and to describe physiological and subjective responses during constant load work of an intensity that elicits the maximum sensitivity to respiratory factors of respirator wear. Nine subjects (mean age 25·8±4·8 years) performed exhaustive treadmill exercise during constant load work of 80% of maximal aerobic capacity while inspiring against one of five randomly assigned inspiratory resistance conditions. For inspiratory resistances of 0·20 kPa (R1), 0·29 kPa (R2), 0·39 kPa (R3), and 0·49 kPa (R4), measured at a steady air flow rate of 85 L min-1, average performance times were 84, 75, 54, and 30% of the control condition. Performance time reductions were significant for R3 and R4 trials. Results also indicated a significantly reduced mean respiration rate, minute ventilation, and oxygen ventilatory equivalent (VE/VO2 ) for the R4 condition at exercise breakpoint compared to control. For resistances R1-R4, mean VE/VO2 were significantly reduced from control by approximately 12, 17, 19, and 31%. At breakpoint, mean ratings of perceived exertion were similar for control, R1, R2, and R3 conditions but were significantly lower for R4. These findings suggest that the impact of the respiratory limitations of versus control. Breathing comfort did not differ significantly between resistances below the R3 level, but discomfort was significantly greater for conditions R3 and respirators can be diminished by employing respirators with inspiratory resistances below the R3 level.

Poster 79 Recruitment patterns of abdominal muscles during inspiratory resistance breathing: Eileen H. Breslin, RN, DNSc (University of California Davis Medical Center/Center for Nursing Research, Sacramento, CA); Viviane Ugalde, MD; H. William Bonekat, DO; Sandra A. Walsh, BS; Sylvia J. Horasek, BA; Michael Cronin, RT, DMS

Poster 79 Recruitment patterns of abdominal muscles during inspiratory resistance breathing: Eileen H. Breslin, RN, DNSc (University of California Davis Medical Center/Center for Nursing Research, Sacramento, CA); Viviane Ugalde, MD; H. William Bonekat, DO; Sandra A. Walsh, BS; Sylvia J. Horasek, BA; Michael Cronin, RT, DMS

Correlations between Dyspnea, Diaphragm and Sternomastoid Recruitment during Inspiratory Resistance Breathing in Normal Subjects

The purpose of this study was to determine the relationship between recruitment of the DI and SM muscles measured as EMG signal amplitudes, the pattern of respiratory muscle recruitment measured with inductive plethysmography, and the intensity of the sensation of dyspnea, measured with 100 mm VAS. Eighteen normal subjects between the ages of 33 and 47 breathed under two conditions: normal controlled breathing and breathing against an inspiratory resistance at 60 percent of their maximal inspiratory pressure (MIP). The PM, RR, duty cycle (TI/TTOT, and VT were held constant. During resistance breathing, VAS dyspnea was increased when EMG-DI decreased; EMG-SM increased in association with the sensation of dyspnea. During inspiratory resistance breathing, dyspnea markedly increased and rib cage and accessory muscle recruitment was the predominant pattern of breathing. These data suggest that dyspnea may be associated with the recruitment of the accessory respiratory muscles rather than the recruitment of the diaphragm.

Respiratory muscle oxygen consumption estimated by the diaphragm pressure-time index.

The O2 consumption of the respiratory muscles (VO2resp), work of breathing, and the time integral of the transdiaphragmatic pressure (TTdi) were measured in four normal subjects breathing against inspiratory resistance. A total of 39 runs were performed at mean tidal transdiaphragmatic pressures (Pdi) ranging from 15 to 53 cmH2O, respiratory frequencies from 3.5 to 22 breaths/min, and inspiratory time durations (TI) from 32 to 76% of the total breath duration. Each run was maintained from 8 to 17 min and the above parameters were kept constant by the subject via visual feedback of Pdi and TI with an oscilloscope. Most of the runs (36 of 39) were performed at TTdi values below those known to produce respiratory muscle fatigue. We found a strong linear correlation between the VO2resp and the TTdi (r = 0.74, P less than 0.001) and a weaker correlation between VO2resp and W (r = 0.31, P less than 0.05). These data suggest that TTdi is a good estimator of VO2resp over a wide range of respiratory patterns during inspiratory resistance breathing. The high variability seen in respiratory muscle efficiency during resistive breathing may be due to W not being a good indicator of the energy consumed by the respiratory muscles.

Evidence for cardiac volume-receptor regulation of feline jejunal blood flow and fluid transport.

The aim of the study was to investigate the role of cardiac mechanoreceptors in the reflex regulation of intestinal blood flow and fluid transport. Feline cardiac mechanoreceptor activity was modified with two noninvasive techniques: positive-pressure ventilation (PPV) and inspiratory resistance breathing (IRB). A jejunal segment with intact vascular and nervous supply was isolated and exposed to cholera toxin as a model for intestinal secretion. The results revealed that PPV induced a pronounced intestinal vasoconstriction and a marked inhibition of choleraic secretion. IRB had the opposite effects. The responses were well correlated with changes in central blood volume and either markedly reduced or abolished by vagotomy, intestinal alpha-adrenoreceptor blockade, or postganglionic mesenteric denervation. The results indicate that cardiac mechanoreceptors with vagal afferents may mediate the observed reflex responses, and hence this receptor station may be of importance in the normal reflex control of intestinal hemodynamics and fluid transport.