title: Depression of diaphragm motor cortex excitability during mechanical ventilation.
abstract: The effect of mechanical ventilation on the diaphragm motor cortex remains unknown. We assessed the effect of mechanical ventilation on diaphragm motor cortex excitability by measuring the costal and crural diaphragm motor-evoked potential (MEP) elicited by single and paired transcranial magnetic stimulation. In six healthy subjects, MEP recruitment curves of the costal and crural diaphragms were assessed at relaxed end expiration during spontaneous breathing [baseline tidal volume (Vt(baseline))] and isocapnic volume cycled ventilation delivered noninvasively (NIV) at three different levels of tidal volume (Vt(baseline), Vt(baseline) + 5 ml/kg liters, and Vt(baseline) + 10 ml/kg liters). The costal and crural diaphragm response to peripheral stimulation of the right phrenic nerve was not reduced by NIV. NIV reduced the costal and crural MEP amplitude during NIV (P < 0.0001) with the maximal reduction at Vt(baseline) + 5 ml/kg. Response to paired TMS showed that NIV (Vt(baseline) + 5 ml/kg) significantly increased the sensitivity of the cortical motoneurons to facilitatory (>9 ms) interstimulus intervals (P = 0.002), suggesting that the diaphragm MEP amplitude depression during NIV is related to neuromechanical inhibition at the level of motor cortex. Our results demonstrate that mechanical ventilation directly inhibits central projections to the diaphragm.
authors.affiliation: Respiratory Muscle Laboratory, Royal Brompton Hospital, Sydney St, London SW3 6NP UK.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.forename: Ewen T
authors.initials: ET
authors.lastname: Ross
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hopkinson
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Annabel H
authors.initials: AH
authors.lastname: Nickol
authors.forename: Sophie
authors.initials: S
authors.lastname: Jonville
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Dayer
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
authors.forename: John
authors.initials: J
authors.lastname: Moxham
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
authors.forename: Michael I
authors.initials: MI
authors.lastname: Polkey
mesh_terms: D000005:Abdomen / Q000502:physiology; D000328:Adult; D003964:Diaphragm / Q000294:innervation* / Q000502:physiology; D004558:Electric Stimulation; D004574:Electromagnetic Fields; D019054:Evoked Potentials, Motor / Q000502:physiology; D005246:Feedback / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009046:Motor Neurons / Q000502:physiology; D009434:Neural Pathways / Q000502:physiology; D010791:Phrenic Nerve / Q000502:physiology; D011999:Recruitment, Neurophysiological / Q000502:physiology; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology; D013990:Tidal Volume / Q000502:physiology