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Neural Drive to the Diaphragm After Lung Volume Reduction Surgery^*

^* From the Neurological Department Kaiser Franz Josef Hospital, Vienna (Dr. Lahrmann), Ludwig Boltzmann Institute for Environmental Pneumology, Lainz Hospital, Vienna (Drs. Wild, Wanke, and Zwick), Clinic of Anesthesiology (Dr. Tschernko) and Clinic of Surgery, University Vienna (Drs. Wisser and Klepetko), Austria.

Correspondence to: Heinz Lahrmann, MD, Msc, Neurological Department, Kaiser Franz Josef Hospital, Kundratstraße 3, A-1100 Vienna, Austria.

Study objectives: The aim of this study was to investigate prospectively the changes in neural drive to the diaphragm in the first year after lung volume reduction surgery (LVRS) in patients with COPD.

Patients and methods: In 14 patients with severe emphysema (mean ± SD; age, 53.7 ± 8.3 years; FEV₁, 0.64 ± 0.18 L; residual volume [RV], 5.33 ± 1.25 L; PaO₂, 62.3 ± 9.0 mm Hg; PaCO₂, 39.0 ± 6.0 mm Hg), we assessed lung function, arterial blood gases, maximal exercise capacity (Wmax), and oxygen uptake (O₂max); intrinsic positive end-expiratory pressure (PEEPi); diaphragmatic strength (transdiaphragmatic pressure, Pdisniff) and endurance capacity (tlim); central diaphragmatic drive assessed by root mean square analysis of the esophageal electromyogram (rmsdia); and isotime dyspnea during loaded breathing tests (BS).

Results: Despite a significant increase (expressed as a percentage of baseline) in FEV₁ (40.6%) and a decrease in RV (30.0%) and PEEPi (75.7%) 1 month after LVRS, the improvements in Wmax (31.2%) and O₂max (13.7%); Pdisniff (25.4%) and tlim (64.9%); rmsdia (34.6%); and BS (21.7%) did not reach statistical significance (p < 0.05) until 6 months after LVRS. Arterial blood gases did not change significantly. Significant correlations were found between decrease in rmsdia and changes in PEEPi (r = 0.69), Wmax (r = -0.56), Pdisniff (r = -0.65), tlim (r = -0.59), and BS (r = 0.71) 6 months after LVRS.

Conclusions: Our results show that LVRS is able to increase the efficacy of the respiratory pump and by this way reduce ventilatory drive and respiratory effort sensation.

Key Words: diaphragm • dyspnea • electromyography • lung volume reduction surgery • neural drive

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