PubMed · 7059492
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D G Shaw. 1982. Fleischner's lines-a model?. https://pubmed.ncbi.nlm.nih.gov/7059492/
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The monitoring of the development of respiratory function in low-birth-weight or sick neonates is important in its overall treatment. The most direct approach to obtaining information on respiratory function is to monitor the activity of the diaphragmatic muscular system rather than measure the resultant change in lung volume or ventilator output, which cannot be guaranteed to be directly related to the neonate's own respiratory activity. The system was designed to assess the feasibility of monitoring respiratory activity in such neonates by measuring the diaphragmatic electromyograph. It is hoped that this system can be used to monitor the development of lung function and possibly, if reliability proves adequate, the synchronisation and control of ventilator assistance. To monitor the EMG, the dominant effect of the ECG was removed using a digital processor. Initial clinical measurements indicate that neonatal respiratory activity can be monitored by measuring the diaphragmatic EMG. Comparative measurements show the EMG method is faster in detecting the inspiratory phase of a breath. Measurements on ventilated neonates showed the presence of intermittent respiratory activity. It also is proposed that clinically relevant information may be deduced from the analysis of the morphology of the detected EMG waveform.
This review examines approaches to evaluation of the respiratory muscles and describes new techniques that may be more quantitative, less effort dependent, and less invasive than conventional methods. To evaluate strength of the respiratory muscles, maximum inspiratory and expiratory pressures remain useful measures. Potential methodologic errors, however, necessitate careful technique. Evaluation of the twitch response to direct phrenic nerve stimulation may ultimately prove more quantitative and less effort dependent than measurements of maximum pressure. Many techniques are also available to measure endurance of respiratory muscles, but most are less than satisfactory outside the research environment because of poor reproducibility and other procedural difficulties. The maximum incremental resistive loading test, however, has proven to be practical and well tolerated. There is little substitute for careful clinical observation of respiratory muscle coordination and movement, particularly in the patient with suspected respiratory muscle weakness or chest wall distortion. In conclusion, though the respiratory muscles are difficult to evaluate, techniques are available that can be quite helpful for assessment, particularly in response to interventions such as rehabilitation.