Assessment of thoraco-abdominal asynchrony

doi:10.1016/j.prrv.2009.02.004

Paediatric Respiratory Reviews

Volume 10, Issue 2, June 2009, Pages 75-80

https://doi.org/10.1016/j.prrv.2009.02.004 Get rights and content

Summary

Thoraco-abdominal asynchrony is often observed in many respiratory disorders and/or respiratory muscle dysfunctions and clinically assessed as a sign of respiratory distress and increased work of breathing. This review describes the assessment of thoraco-abdominal asynchrony by respiratory inductance plethysmography. Visual inspection of the Konno-Mead plot yields information about the relative contribution of the RC and the ABD to respiration and about respiratory muscle dysfunction in selected patients. The monitoring of thoraco-abdominal asynchrony is a useful, non-invasive indicator of respiratory muscle load or respiratory muscle dysfunction and can be used to determine response to therapy in individual patients. The technique is limited by the fact that it does not detect respiratory muscle fatigue and that the occurrence of TAA does not always correspond to a clinically relevant respiratory problem, especially in the neonatal period.

Section snippets

Physiological and pathophysiological nuts and bolts

Excursions of the rib cage (RC) and the abdomen (ABD) occur nearly simultaneously and in synchrony during quiet tidal breathing in healthy children. While it is evident that contraction of the diaphragm causes expansion of the abdominal compartment, the explanation for the expansion of the RC during normal inspiration is less straightforward. Expansion of the RC is achieved by several mechanisms: (1) intercostal muscle contraction elevates the upper eight ribs and stabilizes the RC against the

Assessment of thoraco-abdominal asynchrony

It is often possible to assess the degree of TAA qualitatively simply by visual inspection or palpation of RC and ABD movements with respiration. Correct interpretation of breathing pattern observations often allows detecting impending respiratory failure or significant pulmonary dysfunction in children without the need for more invasive examinations.

More precise quantification of TAA is possible by technical means such as respiratory inductance plethysmography (RIP) which measures respiration

Clinical and research applications

The continuous assessment of TAA seems a clinically useful non-invasive technique for quantitatively assessing respiratory diseases in small children, especially for assessing acute inspiratory airflow obstruction. It has, however, never become part of standard routine monitoring in intensive care units. This may be partly related to the fact that TAA is affected by many factors such as the type and severity of respiratory disease, patient's age, neuromuscular disorders affecting respiratory

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Cited by (66)

Pulmonary pathophysiology of neuromuscular disease
2023, Pulmonary Assessment and Management of Patients with Pediatric Neuromuscular Disease
Patients with neuromuscular weakness have a high risk of developing significant respiratory morbidity throughout life. Respiratory failure is recognized as the main cause of mortality in these conditions. Nevertheless, the prevalence, severity, and progression of respiratory impairment may vary significantly across specific neuromuscular conditions. This is due to the combination of skeletal muscle weakness, disease-specific respiratory muscle involvement, and the variable severity of comorbidities affecting respiratory function such as kyphoscoliosis, axial/truncal weakness, and bulbar involvement.
Associations of respiratory mechanic instability with respiratory parameters in pediatric patients with obstructive sleep apnea syndrome
2022, International Journal of Pediatric Otorhinolaryngology
This study aimed to identify the effectiveness of respiratory mechanic instability (RMI) in the diagnosis of pediatric obstructive sleep apnea syndrome (OSAS). We sought to evaluate the correlations of RMI with sleep-related parameters and determine the effectiveness of using RMI for diagnosing OSAS in children.
Children who underwent polysomnography (PSG) for various reasons were enrolled in this study. Patients' clinical and PSG data at two university hospitals were reviewed retrospectively. During PSG, RMI parameters were automatically calculated according to the phase relationship between thoracic and abdominal movement signals.
Among 263 children who underwent PSG, 183 (70.4%) were diagnosed with OSAS (apnea-hypopnea index [AHI] ≥ 1). RMI parameters were higher in the OSAS group than in the control group. They also tended to increase with disease severity. RMI scores were well correlated with respiratory parameters, showing a stronger correlation in those with moderate or severe OSAS without central apnea. Areas under the receiver operating characteristics curves (AUROCs) of RMI indicators were over 0.65. The percentage of RMI in stage duration showed the highest value of the AUROCs.
Paradoxical thoraco-abdominal movement assessed by RMI provides additional information. It may be useful in diagnosing OSAS in children.
Synchronized Nasal Intermittent Positive Pressure Ventilation
2021, Clinics in Perinatology
Relationship between thoracoabdominal mobility and hours of life in infants: A cross-sectional study
2021, Respiratory Physiology and Neurobiology
Citation Excerpt :
Moreover, the higher the RR, the greater the abdominal mobility of this population. Due to the immaturity of their muscular and respiratory systems, in addition to rib cage complacency, NBs exhibited a significant biomechanical disadvantage during the breathing process (Barlow et al., 2018; Hammer and Newth, 2009). This culminates in asynchronous breathing movements, and an increase in work of breathing (Hammer and Newth, 2009), often displaying energy expenditure (Oliveira et al., 2009).
Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility.
The Respiratory Fluctuation Index: A global metric of nasal airflow or thoracoabdominal wall movement time series to diagnose obstructive sleep apnea
2019, Biomedical Signal Processing and Control
Polysomnography (PSG) recordings provide comprehensive physiological data to diagnose obstructive sleep apnea (OSA), a common breathing disorder. OSA severity is usually diagnosed using the apnea hypopnea index (AHI), the frequency of episodes of breathing cessation or reduction. This study proposes a new global measure, the Respiratory Fluctuation Index (RFI), which accurately characterizes the distribution of respiratory drops in a PSG time series without the need for hand-counting episodes. We test two approaches: linear regression models to estimate the hand-scored AHI from one or more RFIs, and threshold detection models to diagnose OSA severity based on a single RFI. Based on PSG data recorded from 60 adults, we find very good agreement between both types of models and the ground truth. Regression models based on the RFI derived from nasal airflow had the best agreement with manually scored AHIs, visualized with Bland-Altman plots. In addition, threshold detection models based on the RFI of nasal airflow achieved the highest sensitivities (78.97%, 87.50% and 92.31%) and specificities (78.26%, 86.46% and 91.82%) in detecting OSA with AHI ≥ 5, AHI ≥ 15 and AHI ≥ 30, respectively. The strong performance of the models demonstrates the efficacy of the proposed RFI metric for OSA assessment.
Age-related ranges of respiratory inductance plethysmography (RIP) reference values for infants and children
2019, Paediatric Respiratory Reviews
Citation Excerpt :
The RIP parameters also assist in identifying TAA, paradoxical breathing, and the onset of respiratory muscle fatigue, which are often observed in infants and children with respiratory disorders [8]. Various studies have used this method to evaluate pulmonary disorders such as parenchymal processes, obstructive airways (asthma, chronic obstructive pulmonary disease), and musculoskeletal and neuromuscular diseases [3,4,8–16]. The need for normative data from healthy subjects without pulmonary complications for WOB parameters such as RR, Φ, % RC, and LBI for all ages is critical for the usefulness of this method.
The current noninvasive method for respiratory monitoring is respiratory inductance plethysmography (RIP); two bands are connected, one each to the chest and the abdomen, to measure the breathing pattern. RIP requires post hoc analysis to calculate indices such as respiratory rate, phase angle, labored breathing index, and percent of rib cage contribution to breathing. Clinical studies have provided patient RIP values and age-matched normal values, but they lack global evaluation of normative data for a wide age range of pediatric subjects. Herein, we compiled normative RIP indices from numerous studies for a large range of pediatric ages.
From these data, we derived regression equations useful for computing normal RIP parameters as a function of age.
The presented review will provide caregivers the ability to compare RIP data of pediatric patients against the regression analysis. This comparison will help identify patients with pulmonary complications and aid in guiding respiratory therapy.

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ReviewAssessment of thoraco-abdominal asynchrony

Summary

Section snippets

Physiological and pathophysiological nuts and bolts

Assessment of thoraco-abdominal asynchrony

Clinical and research applications

Chest

Chest

Chest

Paradoxical inward rib cage motion during rapid eye movement sleep in infants and young children

J Dev Physiol

Changes in the contribution of the rib cage to tidal breathing during infancy

Am Rev Respir Dis

Asynchronous breathing during sleep

Arch Dis Child

Measurements of thoraco-abdominal asynchrony and work of breathing in children

Interaction between chest wall motion and lung mechanics in normal infants and infants with bronchopulmonary dysplasia

Pediatr Pulmonol

Chest wall motion before and during mechanical ventilation in children with neuromuscular disease

Pediatr Pulmonol

Motion of the rib cage and the abdomen in tetraplegic patients

Clin Sci Mol Med

Respiratory mechanics in quadriplegia. The respiratory function of the intercostal muscles

Am Rev Respir Dis

Abdominal wall movement in normals and patients with hemidiaphragmatic and bilateral diaphragmatic palsy

Thorax

Thoracoabdominal motion in chronic obstructive pulmonary disease

Am Rev Respir Dis

The respiratory inductive plethysmograph: a new non-invasive monitor of respiration

Bull Eur Physiopathol Respir

Inductive plethysmography–a new respiratory transducer [proceedings]

J Physiol

Deformation of the chest wall during breathing efforts

J Appl Physiol

Measurement of the separate volume changes of rib cage and abdomen during breathing

J Appl Physiol

Validation of the phase angle technique as an objective measure of upper airway obstruction

Pediatr Pulmonol

Asynchronous chest wall movements during non-rapid eye movement and rapid eye movement sleep in children with bronchopulmonary dysplasia

Am Rev Respir Dis

Review
Assessment of thoraco-abdominal asynchrony