Document Detail

Recovery of diaphragmatic function in awake sheep after two approaches to thoracic surgery.
MedLine Citation:
PMID:  9375345     Owner:  NLM     Status:  MEDLINE    
Video-assisted thoracoscopic surgery (VATS) is replacing thoracotomy, but no study has addressed the extent or duration of VATS-induced diaphragmatic alteration. We hypothesized that VATS would impair diaphragmatic function less and return diaphragmatic function faster than thoracotomy. In eight sheep, sonomicrometers were randomly implanted on the right costal diaphragm via VATS or thoracotomy. Diaphragmatic resting length, shortening fraction, and respiratory function were measured weekly during quiet breathing (QB) and CO2 rebreathing for 4 wk. For VATS, shortening fraction was smallest on postoperative days 1 (POD 1) (6.4 +/- 3.4 and 12.9 +/- 8.7% during QB and 10% CO2 rebreathing, respectively) and 7 (6.3 +/- 3.4 and 16.9 +/- 4.0% during QB and 10% CO2 rebreathing, respectively) and recovered by 3 wk (13.2 +/- 1.8 and 28.9 +/- 8.0% during QB and 10% CO2 rebreathing, respectively). For thoracotomy, shortening fraction at 10% CO2 rebreathing was smaller on PODs 1, 7, 14 (15.9 +/- 7.1, 13.6 +/- 5.4, and 19.0 +/- 6.9%) than on POD 28 (29.9 +/- 8.2%), but not during QB on POD 1 or 7 (7.5 +/- 3.8 and 3.4 +/- 2.6%) compared with POD 28 (10.7 +/- 8.7%). Shortening fraction did not differ between surgeries. There was no group difference in minute ventilation, respiratory rate, transdiaphragmatic pressure, or esophageal and gastric pressures. In conclusion, although shortening fraction recovered faster for VATS, this translated into insignificant functional differences.
H Imanaka; W R Kimball; J C Wain; M Nishimura; K Okubo; D Hess; R M Kacmarek
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  83     ISSN:  8750-7587     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1997-12-30     Completed Date:  1997-12-30     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1733-40     Citation Subset:  IM    
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, USA.
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MeSH Terms
Carbon Dioxide / blood
Diaphragm / physiology*
Muscle Contraction / physiology
Muscle Fibers, Skeletal / physiology
Phrenic Nerve / physiology
Respiratory Mechanics / physiology
Thoracic Surgical Procedures*
Reg. No./Substance:
124-38-9/Carbon Dioxide

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