The Effect of Posture on Diaphragmatic Movement and Vital Capacity in Normal Subjects

Wade, O. L.; Gilson, J. C.

doi:10.1136/thx.6.2.103

Cited by 92 publications

(15 citation statements)

References 31 publications

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“…Many workers, Dally (1908), Keith (1909) and Wade & Gilson (1951), have reported that the diaphragmatic movement in quiet respiration is about 1-2 cm and this is here confirmed. Herxheimer's (1949) assumption that the diaphragm moves more in the erect posture than in the supine during quiet respiration has not been confirmed.…”

Section: Discussionsupporting

confidence: 79%

“…Herxheimer has suggested that there is dissociation of the movements of the chest and diaphragm and that at different phases of deep respiration first one and then the other plays the predominant part in ventilating the lungs. Wade & Gilson (1951) described a method of measuring diaphragmatic movement and showed that with changes of posture the extent of diaphragmatic movement in both quiet and deep respiration varied little, but the resting level of the diaphragm at the end of a quiet respiration changed greatly and the pattern of diaphragmatic movement in relationship to this resting level showed great changes. These authors realized, however, that some of their measurements of diaphragmatic movement were unreliable because vertical movements of the thoracic cage that occurred with respiration * Part of a thesis accepted for the doctorate of medicine by the University of Cambridge.…”

mentioning

confidence: 99%

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Movements of the thoracic cage and diaphragm in respiration*

Wade¹

1954

The Journal of Physiology

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262

102

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Section: Discussionsupporting

confidence: 79%

mentioning

confidence: 99%

Movements of the thoracic cage and diaphragm in respiration*

Wade¹

1954

The Journal of Physiology

Self Cite

262

102

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“…Standing and sitting have been shown to lead to the highest lung volumes [ 72 , 73 ]. At higher lung volumes the elastic recoil of the lungs and the chest wall is greater.…”

Section: Discussionmentioning

confidence: 99%

The effect of body position on pulmonary function: a systematic review

et al. 2018

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BackgroundPulmonary function tests (PFTs) are routinely performed in the upright position due to measurement devices and patient comfort. This systematic review investigated the influence of body position on lung function in healthy persons and specific patient groups.MethodsA search to identify English-language papers published from 1/1998–12/2017 was conducted using MEDLINE and Google Scholar with key words: body position, lung function, lung mechanics, lung volume, position change, positioning, posture, pulmonary function testing, sitting, standing, supine, ventilation, and ventilatory change. Studies that were quasi-experimental, pre-post intervention; compared ≥2 positions, including sitting or standing; and assessed lung function in non-mechanically ventilated subjects aged ≥18 years were included. Primary outcome measures were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC, FEV1/FVC), vital capacity (VC), functional residual capacity (FRC), maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), peak expiratory flow (PEF), total lung capacity (TLC), residual volume (RV), and diffusing capacity of the lungs for carbon monoxide (DLCO). Standing, sitting, supine, and right- and left-side lying positions were studied.ResultsForty-three studies met inclusion criteria. The study populations included healthy subjects (29 studies), lung disease (nine), heart disease (four), spinal cord injury (SCI, seven), neuromuscular diseases (three), and obesity (four). In most studies involving healthy subjects or patients with lung, heart, neuromuscular disease, or obesity, FEV1, FVC, FRC, PEmax, PImax, and/or PEF values were higher in more erect positions. For subjects with tetraplegic SCI, FVC and FEV1 were higher in supine vs. sitting. In healthy subjects, DLCO was higher in the supine vs. sitting, and in sitting vs. side-lying positions. In patients with chronic heart failure, the effect of position on DLCO varied.ConclusionsBody position influences the results of PFTs, but the optimal position and magnitude of the benefit varies between study populations. PFTs are routinely performed in the sitting position. We recommend the supine position should be considered in addition to sitting for PFTs in patients with SCI and neuromuscular disease. When treating patients with heart, lung, SCI, neuromuscular disease, or obesity, one should take into consideration that pulmonary physiology and function are influenced by body position.Electronic supplementary materialThe online version of this article (10.1186/s12890-018-0723-4) contains supplementary material, which is available to authorized users.

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“…For pump failure patients, ventilatory insufficiency is initially nocturnal only. Normally VC does not decrease by more than 7.5% when going from sitting to supine [ 13 ]. Larger decreases that often result in orthopnea are caused by diaphragm dysfunction.…”

Section: Pathophysiologymentioning

confidence: 99%

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Bach

2017

Ann Rehabil Med

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This review article describes definitive noninvasive respiratory management of respiratory muscle dysfunction to eliminate need to resort to tracheotomy. In 2010 clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis users of noninvasive ventilatory support (NVS) of whom 760 required it continuously (CNVS). The CNVS sustained their lives by over 3,000 patient-years without resort to indwelling tracheostomy tubes. These centers have now extubated at least 74 consecutive ventilator unweanable patients with DMD, over 95% of CNVS-dependent patients with SMA1, and hundreds of others with advanced neuromuscular disorders (NMDs) without resort to tracheotomy. Two centers reported a 99% success rate at extubating 258 ventilator unweanable patients without resort to tracheotomy. Patients with myopathic or lower motor neuron disorders can be managed noninvasively by up to CNVS, indefinitely, despite having little or no measurable vital capacity, with the use of physical medicine respiratory muscle aids. Ventilator-dependent patients can be decannulated of their tracheostomy tubes.

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The Effect of Posture on Diaphragmatic Movement and Vital Capacity in Normal Subjects

Cited by 92 publications

References 31 publications

Movements of the thoracic cage and diaphragm in respiration*

Movements of the thoracic cage and diaphragm in respiration*

The effect of body position on pulmonary function: a systematic review

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

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