Explore the vast range of titles available.

The diaphragm is well known for its role as the principal muscle of respiration. However, according to previous studies, its role is multifactorial, from breathing through pain perception, regulation of emotional sphere, collaborating in gastroesophageal functions, facilitating the venous and lymphatic return, to an essential role in the maintenance of lumbar spine stability. The purpose of the study was to examine whether diaphragm function parameters (thickness and range of motion) are associated with static balance maintenance. A total of 142 participants were examined and divided into three groups: G1-patients qualified for lung resection due to cancer; G2 -patients after lobe resection; G3 -healthy subjects. Diaphragm thickness and excursion was measured using ultrasonography. Stabilometric parameters of balance were assessed by Zebris FDM-S platform. Greater diaphragm thickening during active breathing and diaphragm thickness fraction were associated with better static balance parameters. Limitation of diaphragm motion during quiet breathing and deep breathing was linked to balance disorders. There was no correlation between diaphragm muscle excursion during sniff maneuvers and balance parameters. Deterioration of diaphragm function observed after thoracic surgery was closely related with deterioration of balance maintenance. Impairment of diaphragm function manifested by decrease of muscle thickness and movement restriction is strongly associated with balance disorders in a clinical sample and among healthy subjects.

To analyze diaphragmatic thickness, at end-inspiration and end-expiration, diaphragmatic thickening index and mobility via US under two different modalities of inspiratory muscle loading, in two different modalities of inspiratory muscle loading and different load intensities at full-vital capacity maneuvers and the relationship between diaphragmatic thickness with pulmonary function tests in participants with HF. This randomized crossover trial, enrolled with 17 HF subjects, evaluated diaphragm thickness (Tdi, mm), fractional thickness (TFdi, %), and mobility (mm) US during low and high intensities (30% and 60% of maximal inspiratory pressure-MIP) with two modalities of inspiratory muscle loading mechanical threshold loading (MTL) and tapered flow-resistive loading (TFRL). Both MTL and TFRL produced a increase in Tdi, but only with high intensity loading compared to baseline-2.21 (0.26) vs. 2.68 (0.33) and 2.73 (0.44) mm; p = .01. TFdi was greater than baseline under all conditions, except during low intensity of TFRL. Diaphragm mobility was greater than baseline under all conditions, and high intensity of TFRL elicited greater mobility compared to all other conditions. Additionally, baseline Tdi was moderately correlated with pulmonary function tests. MTL and TFRL modalities elicit similar increases in diaphragm thickness at loads, but only during high intensity loading it was greater than baseline. Diaphragm mobility was significantly greater than baseline under both loads and devices, and at high intensity compared to low intensity, although TFRL produced greater mobility compared to modalities of inspiratory muscle loading. There is an association between diaphragm thickness and pulmonary function tests.

Stroke is associated with diaphragmatic weakness and impaired respiratory function as well as balance impairment. The role of inspiratory muscle training (IMT) on improvement of respiratory muscle strength in people after stroke has been reported. However, the training intensity associated with optimal diaphragm recruitment and the relationship between the effect of IMT and other functions in this population remains uncertain. This randomized controlled trial (RCT) aims to explore the effects of a 4-week IMT program with training intensity at 50% maximum inspiratory pressure (MIP) (previously shown to be associated with maximal diaphragm contraction), on respiratory function, balance control, exercise capacity and quality of life (QOL) in people after stroke. This is a patient- and assessor-blinded RCT. Eligible participants will be randomly allocated to the targeted-IMT group (with 50% MIP as the training intensity) or sham-IMT group (with 10% MIP as the training intensity). Both groups will also receive the same standardised hospital-based physical-rehabilitation protocol. All interventions will be implemented 5 days/week for 4 weeks. The primary outcome is the change of diaphragmatic thickness. Secondary outcomes are spirometry respiratory function, balance control, exercise capacity and QOL. Assessment will be conducted at baseline, post-intervention, and at 12th week follow-up. Data will be primarily analysed using repeated-measures ANOVA α=0.05. Results of this study will primarily inform the effect of IMT on lung function, balance control, exercise capacity and QOL in addition to physical rehabilitation, further the interplay between the change in diaphragm thickness, balance and QOL will be analysed in detail.

Background Ventilator-induced diaphragmatic dysfunction (VIDD) occurs in up to 60% of mechanically ventilated patients and prolongs ventilatory dependance. The consequences of VIDD are muscle atrophy, reduction of strength, and injury of muscle fibers. Atrophy and contractile activity of the diaphragm can be estimated by ultrasound muscle thickness and thickening fraction. Prior experience demonstrates invasive electrical stimulation of the diaphragm helps preserve muscle thickness. This is the first study on a non-invasive phrenic nerve stimulator that aims to assess its feasibility, safety, and usefulness in preserving diaphragm thickness. Methods A multi-center randomized clinical trial will be performed in four intensive care units (ICUs) in the United States of America and Canada. Inclusion criteria include patients older than 21 years, in the first 48 h of mechanical ventilation (MV) and predicted to remain on the ventilator for at least 48 h. Patients with contraindications for phrenic nerve stimulation, severe chronic pulmonary diseases, or impossibility to measure diaphragm thickness with ultrasound will be excluded. Patients enrolled will be randomized to standard care (control) or 30-min daily non-invasive phrenic nerve stimulation up to 10 days after enrollment (intervention). The primary effectiveness endpoint is the change in diaphragm thickness on day 10, extubation, or death whichever occurs first. Secondary endpoints include change in diaphragm thickness on day 4, maximal inspiratory pressure before extubation, and time-to rapid shallow breathing index (RSBI) <105. Safety objectives include the proportion of device- or procedure-related adverse events (SAE). The estimated sample size will be 40 patients (20 per group). Discussion The STIMIT ACTIVATOR trial is a randomized multi-center study powered to elucidate whether non-invasive phrenic nerve stimulation is feasible, safe, and preserves diaphragm thickness. Meeting the primary endpoint will demonstrate its applicability in clinical practice to prevent diaphragmatic atrophy in ventilated patients. Trial registration ClinicalTrials.gov: NCT05883163, August 29, 2023.

To evaluate the improvement effect of graded exercise rehabilitation on diaphragm function, exercise function, and respiratory performance in AECOPD patients. 68 AECOPD patients admitted to the Respiratory and Critical Care Department of a tertiary hospital in Zunyi City. Patients were randomly divided into a study group and a control group (each group 34 patients), and then according to the grading criteria, patients in each group were divided into 3 levels, for a total of 6 groups. The control group used conventional rehabilitation, while the study group used graded exercise rehabilitation. Bedside ultrasound was used to monitor the changes in diaphragm function (DE, DTei, DTee, DTF), 6MWT, CAT score, mMRC questionnaire, non-invasive mechanical ventilation time, and hospital stay between two groups of patients before and after rehabilitation. Compared with before the rehabilitation intervention, the study group showed significant improvement in diaphragm movement compared to the control group ( P  < 0.05). The end-inspiratory, end-expiratory, and diaphragm thickening scores all improved compared to before, and the differences were statistically significant ( P  < 0.05); The 6MWT and CAT scores of the study group were significantly higher than those of the control group after the intervention, and the difference was statistically significant ( P  < 0.05); Compared with the control group, the study group had significantly less mechanical ventilation time and hospitalization time, and the difference was statistically significant (both P  < 0.05); The total incidence of MV related complications in the study group was lower than that in the control group, and the difference was statistically significant ( P  < 0.05). There were no actual compression injuries, aspiration, deep vein thrombosis, atelectasis, etc. in either group; The mMRC questionnaire did not show statistical significance ( P  > 0.05), but there was improvement before the intervention. Graded exercise rehabilitation can effectively improve the overall diaphragm function of patients, and has a positive effect on enhancing exercise quality and endurance; Bedside ultrasound can dynamically and real-time observe the diaphragm movement status of AECOPD patients, objectively and directly evaluate the recovery of respiratory muscle function, and has important clinical value.

Diaphragm dysfunction, a prevalent complication in mechanically ventilated patients, is strongly associated with prolonged weaning periods and increased mortality rates. Neurally adjusted ventilatory assist (NAVA), which synchronizes ventilator support with neural respiratory drive through diaphragmatic electromyography monitoring, has demonstrated efficacy in preserving diaphragm contractility. Complementary to this, the external diaphragmatic pacing (EDP) mitigates ventilation-induced diaphragmatic atrophy through targeted phrenic nerve stimulation. However, the synergistic potential of the NAVA + EDP combination therapy in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains unexplored. This prospective randomized trial enrolled 60 mechanically ventilated patients with AECOPD, who were equally allocated into three groups ( n  = 20 per group): conventional pressure support ventilation (PSV), neurally adjusted ventilatory assist (NAVA), and NAVA combined with external diaphragm pacing (NAVA + EDP). The primary outcome was diaphragmatic function, assessed using two ultrasonographic parameters: diaphragmatic excursion (DE) and diaphragm thickness fraction (DTF). Secondary outcomes included the following: (a) respiratory mechanics parameters, including electrical activity of the diaphragm (EAdi), plateau pressure (Pplat), static lung compliance (Cst), and airway resistance (Raw); (b) gas exchange indices, such as partial pressure of arterial carbon dioxide (PaCO 2 ) and PaO 2 /FiO 2 ratio; and (c) clinical outcomes, namely duration of mechanical ventilation (DMV) and intensive care unit length of stay (ILOS). Compared to the PSV group, the NAVA group exhibited significantly higher DE and DTF values at 72 h and 96 h (all P  < 0.05). Furthermore, the NAVA + EDP group demonstrated increased DE levels at 48 h, 72 h, and 96 h, along with elevated DTF values at 72 h and 96 h (all P  < 0.05). Additionally, the NAVA group showed significantly shorter durations of DMV and ILOS compared to the PSV group, while the NAVA + EDP group further reduced both DMV and ILOS durations relative to the NAVA group (all P  < 0.05). NAVA + EDP treatment exhibited effectively in reducing DMV and improving clinical outcomes for mechanically ventilated patients with AECOPD.

Background and objective Traumatic spinal cord injury (TSCI) often leads to respiratory dysfunction, in which the impaired diaphragm function is one of the main causes. Respiratory muscle rehabilitation training can be used to improve respiratory function, but its effect on diaphragm function has not been deeply investigated. This study employed ultrasound monitoring to assess how respiratory muscle rehabilitation training affects diaphragmatic function in TSCI patients. Methods In this prospective randomized controlled trial (RCT) study, 56 patients with spinal cord injury were randomly divided into experimental group and control group, 28 cases in each group. The experimental group received respiratory muscle rehabilitation training twice a day for 15 min each time; and the control group received only the usual care. The diaphragm thickness, diaphragm movement and diaphragm contraction speed of the two groups were measured by ultrasound before and after training. Results Compared to the control group, the experimental group had significant improvements. Diaphragm thickness increased from 2.05 ± 0.25 mm to 2.38 ± 0.30 mm in the experimental group ( P  < 0.001), while the control group changed minimally from 2.02 ± 0.22 mm to 2.05 ± 0.23 mm ( P  = 0.338). Diaphragm movement increased from 1.52 ± 0.20 mm to 1.85 ± 0.25 mm in the experimental group ( P  < 0.001), versus a small change from 1.50 ± 0.18 mm to 1.53 ± 0.20 mm in the control group ( P  = 0.315). Diaphragm contraction speed accelerated from 1.20 ± 0.15 cm/s to 1.45 ± 0.20 cm/s in the experimental group ( P  < 0.001), while the control group changed slightly from 1.18 ± 0.13 cm/s to 1.20 ± 0.15 cm/s ( P  = 0.380). Respiratory frequency decreased from 20.3 ± 3.4 times/min to 16.0 ± 2.5 times/min in the experimental group ( P  < 0.001), and the control group changed less from 19.5 ± 2.1 times/min to 18.2 ± 2.3 times/min ( P  = 0.070). Ventilator removal time was significantly reduced in the experimental group (14.1 ± 1.5 days) compared to the control group (20.2 ± 2.0 days, P  = 0.002). Conclusion Respiratory muscle rehabilitation significantly enhances diaphragm function and respiratory parameters in spinal cord injury patients. Ultrasound monitoring effectively evaluates these improvements, providing a valuable, novel clinical approach for TSCI rehabilitation. While this preliminary RCT demonstrates positive outcomes, the sample size limitation ( n  = 56) and absence of long-term follow-up should be acknowledged. These aspects will be addressed through larger sample sizes and extended observation periods in subsequent research.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with respiratory muscle weakness and respiratory failure. Non-invasive ventilation alleviates respiratory symptoms and prolongs life, but is a palliative intervention. Slowing the deterioration of diaphragm function before respiratory failure would be desirable. We aimed to assess whether early diaphragm pacing could slow down diaphragm deterioration and would therefore delay the need for non-invasive ventilation. We did a multicentre, randomised, controlled, triple-blind trial in patients with probable or definite ALS in 12 ALS centres in France. The main inclusion criterion was moderate respiratory involvement (forced vital capacity 60–80% predicted). Other key eligibility criteria were age older than 18 years and bilateral responses of the diaphragm to diagnostic phrenic stimulation. All patients were operated laparoscopically and received phrenic stimulators. Clinicians randomly assigned patients (1:1) to receive either active or sham stimulation with a central web-based randomisation system (computer-generated list). Investigators, patients, and an external outcome allocation committee were masked to treatment. The primary outcome was non-invasive ventilation-free survival, analysed in the intention-to-treat population. Safety outcomes were also assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01583088. Between Sept 27, 2012, and July 8, 2015, 74 participants were randomly assigned to receive either active (n=37) or sham (n=37) stimulation. On July 16, 2015, an unplanned masked analysis was done after another trial showed excess mortality with diaphragm pacing in patients with hypoventilation (DiPALS, ISRCTN 53817913). In view of this finding, we analysed mortality in our study and found excess mortality (death from any cause) in our active stimulation group. We therefore terminated the study on July, 16, 2015. Median non-invasive ventilation-free survival was 6·0 months (95% CI 3·6–8·7) in the active stimulation group versus 8·8 months (4·2–not reached) in the control (sham stimulation) group (hazard ratio 1·96 [95% CI 1·08–3·56], p=0·02). Serious adverse events (mainly capnothorax or pneumothorax, acute respiratory failure, venous thromboembolism, and gastrostomy) were frequent (24 [65%] patients in the active stimulation group vs 22 [59%] patients in the control group). No treatment-related death was reported. Early diaphragm pacing in patients with ALS and incipient respiratory involvement did not delay non-invasive ventilation and was associated with decreased survival. Diaphragm pacing is not indicated at the early stage of the ALS-related respiratory involvement. Hospital Program for Clinical Research, French Ministry of Health; French Patients' Association for ALS Research (Association pour la Recherche sur la Sclérose Latérale Amyotrophique); and Thierry de Latran Foundation.

Objective To explore the effects of pelvic floor muscle (PFM) combined with pulmonary rehabilitation training on diaphragm function and lung function in elderly patients with intertrochanteric fracture. Methods This study was conducted by a randomized controlled single-blind method, 50 elderly patients with intertrochanteric fracture in Beijing Xiaotangshan Hospital were selected and divided into the combined training group (Experimental group, n  = 25) and the lung function training group (Control group, n  = 25) by the random number table method. Patients in the combined training group received pelvic floor muscle training combined with lung rehabilitation training, and patients in the lung function training group received lung rehabilitation training. Forced vital capacity (FVC), forced expiratory volume in the first second/FVC (FEV1/FVC) and peak expiratory flow (PEF) were evaluated before and after intervention to analyze the improvement of lung function. Diaphragm thickening fraction (DTF) and diaphragm excursion (DE) were used to observe the improvement of diaphragm function. Results After 4 weeks of intervention, there were significant differences in lung function and diaphragm function between the two groups compared with the improvement before the intervention, but patients in the combined training group had more significant improvements in FVC, FEV1/FVC, PEF, DTF, and DE. Conclusion Pelvic floor muscle combined with lung function training can improve the diaphragm function more significantly in elderly patients with intertrochanteric fracture after operation, and thus affect the lung function of patients.

IntroductionRespiratory dysfunction is a notable complication in stroke patients, in which the diaphragm, as the primary respiratory muscle, directly influences lung function. Repetitive peripheral magnetic stimulation (rPMS) is a new, non-invasive approach that is used to treat brain and nerve problems. Few studies have examined the effect of magnetic stimulation on the phrenic nerve, breathing and diaphragm in stroke patients. This study aims to assess the effect of magnetic phrenic nerve stimulation on respiratory muscle function and lung function in adults with stroke. The results of this study may provide a promising approach to managing respiratory dysfunction in stroke patients.Methods and analysisThis randomised controlled trial is designed to compare the effectiveness of bilateral magnetic phrenic nerve stimulation (rPMS) and conventional rehabilitation training in enhancing respiratory muscle strength, lung function indicators, diaphragmatic excursion and diaphragm thickness in patients with respiratory muscle weakness. Thirty patients admitted to the First Hospital of Fujian Medical University will be included in this study. Participants in the intervention group will undergo daily bilateral magnetic phrenic nerve stimulation for 2 weeks. Stimulation will be administered at a frequency of 25 Hz, with a pulse duration of 1.1 s and an inter-pulse interval of 5.9 s, for 5 days each week. Primary outcome measures will be assessed at baseline and after 2 weeks (end of the intervention) to evaluate the efficacy of rPMS compared with conventional rehabilitation techniques.Ethics and disseminationBefore commencing the study, all participants will receive a comprehensive explanation of the study procedures, including the assessments. They will also be provided informed consent forms for review, completion and signing. This study was approved by the Ethics Committee for Research at the First Affiliated Hospital of Fujian Medical University (No.: MRCTA, ECFAH of FMU [2021]641, dated 10 November 2023) (Appendix Ⅰ & Ⅱ). The trial protocol will strictly adhere to the Uniform Standards for Reporting of Trials (CONSORT) statement. The trial has been registered with the Chinese Clinical Trial Registry.Dissemination of individual findings for each participant will be available at the end of the study. The findings will be disseminated to different interest groups, participants or other patients with respiratory dysfunction through journal papers and/or conference presentations. The results of the primary trial will be submitted for publication in a peer-reviewed journal.RegistrationChiCTR2300075669, registered on 12 September 2023.