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Chron Respir Dis. 2017 May;14(2):110-116. doi: 10.1177/1479972316674413. Epub 2017 Feb 24.

Short-term effect of volume recruitment-derecruitment manoeuvre on chest-wall motion in Duchenne muscular dystrophy.

Author information

1
1 Physiology, Functional Testing Department and Technological Innovations Centre, Raymond Poincaré Teaching Hospital, Garches, France.
2
2 UMR Inserm 1179, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
3
3 Laboratoire Européen Performance Santé Altitude (LEPSA: EA4604), Université de Perpignan Via Dominitia (UPVD), Font Romeu, France.

Abstract

Because progressive respiratory muscle weakness leads to decreased chest-wall motion with eventual ribcage stiffening, the purpose was to compare vital capacity (VC) and contributions of chest-wall compartments before and after volume recruitment-derecruitment manoeuvres (VRDM) in Duchenne muscular dystrophy (DMD). We studied nine patients with DMD and VC lower than 30% of predicted. VRDM was performed using 15 insufflations-exsufflations of +30 to -30 cmH2O. VC and three-dimensional chest-wall motion were measured, as well as oxygen saturation, transcutaneous partial pressure of carbon dioxide and the rapid shallow breathing index (respiratory rate/tidal volume) before (baseline) and immediately and 1 hour after VRDM. VC increased significantly immediately after VRDM (108% ± 7% of baseline, p = 0.018) but returned to baseline within 1 hour, and the rapid shallow breathing index increased significantly. The non-dominant side systematically increased immediately after VRDM ( p = 0.0077), and in the six patients with abnormal breathing asymmetry (difference >10% of VC) at baseline, this asymmetry was corrected immediately and/or 1 hour after VRDM. VRDM improved VC and reduced chest-wall motion asymmetry, but this beneficial effect waned rapidly with respiratory muscle fatigue, suggesting that VRDM may need to be repeated during the day to produce lasting benefits.

KEYWORDS:

Duchenne muscular dystrophy; lung function; mechanical insufflation–exsufflation; physiotherapy; respiratory mechanics

PMID:
27923984
PMCID:
PMC5720223
DOI:
10.1177/1479972316674413
[Indexed for MEDLINE]
Free PMC Article

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