Chest wall kinematics and Hoover's sign

ArticleinRespiratory Physiology & Neurobiology 160(3):325-33 · March 2008with9 Reads
DOI: 10.1016/j.resp.2007.10.019 · Source: PubMed
No attempt has been made to quantify the observed rib cage distortion (Hoover's sign) in terms of volume displacement. We hypothesized that Hoover's sign and hyperinflation are independent quantities. Twenty obstructed stable patients were divided into two groups according to whether or not they exhibited Hoover's sign during clinical examination while breathing quietly. We evaluated the volumes of chest wall and its compartments: the upper rib cage, the lower rib cage and the abdomen, using optoelectronic plethysmography. The volumes of upper rib cage, lower rib cage and abdomen as a percentage of absolute volume of the chest wall were similar in patients with and without Hoover's sign. In contrast, the tidal volume of the chest wall, upper rib cage, lower rib cage, their ratio and abdomen quantified Hoover's sign, but did not correlate with level of hyperinflation. Rib cage distortion and hyperinflation appear to define independently the functional condition of these patients.
    • "This, in turn, reduces the mobility of the abdominal rib cage [22]. Other studies have shown that patients with COPD who presents asynchrony often contracts the abdominal muscles during expiration [24] and the relaxation of these muscles is done gradually during inspiration [7], causing the CTI tend to retract earlier inspiration and slowing its expansion in the inspiratory phase and may be then an increase in recruitment and activation of the inspiratory muscles don't diafragmáticos to compensate for this disadvantage [21,25] mechanics, which cannot be mistakenly confused by observing the abdominal compartment contrubuição increase in this population of patients. Gorman, et al. evaluated both the zone of apposition, which was measured using ultrasonography, and ribcage diameters, which were measured using magnetometers. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To determinate by the OEP the effects of deep inspiration on physiological variables and thoracic-abdominal asynchrony in patients with COPD, compared with healthy individuals matched for age. Methods: Ten patients with COPD and 12 healthy individuals were evaluated using OEP during deep inspiration. TAA was estimated using the phase angle in a Lissajous figure for three consecutive and consistent respiratory cycles. Results: There was significant difference (p<0.01) on the phase angle between the abdominal rib cage (RCa) and the abdomen (AB) in COPD patients compared to the control (-20.7°±26.3° vs-0.3°±8.8°). Greater compartmental contribution to the tidal volume was found in the pulmonary rib cage (RCp) in both the control group (p<0.009) and the COPD group (p<0.003). The degree of obstruction was not correlated with TAA between the different compartments. Conclusion: During deep inspiration for assincroniatoracoabdominal in patients with COPD in relation to healthy, not sort of adding then to improves the respiratory pattern in this group of patients and the degree of airway obstruction of these patients correlates with the presence ATA.
    Full-text · Article · Dec 2015 · Respiratory Physiology & Neurobiology
    • "We speculate that the bony rib cage undergoes chronic adaptation to more severe emphysema in the upper lobes. The relationship between rib cage variation and COPD is controversial [5,10,11,19,31,32,33]. It was traditionally believed that patients with hyperinflation and COPD accommodate part of the increased lung volume by expanding the rib cage [5,34]. "
    [Show abstract] [Hide abstract] ABSTRACT: Factors determining the shape of the human rib cage are not completely understood. We aimed to quantify the contribution of anthropometric and COPD-related changes to rib cage variability in adult cigarette smokers. Rib cage diameters and areas (calculated from the inner surface of the rib cage) in 816 smokers with or without COPD, were evaluated at three anatomical levels using computed tomography (CT). CTs were analyzed with software, which allows quantification of total emphysema (emphysema%). The relationship between rib cage measurements and anthropometric factors, lung function indices, and %emphysema were tested using linear regression models. A model that included gender, age, BMI, emphysema%, forced expiratory volume in one second (FEV1)%, and forced vital capacity (FVC)% fit best with the rib cage measurements (R(2) = 64% for the rib cage area variation at the lower anatomical level). Gender had the biggest impact on rib cage diameter and area (105.3 cm(2); 95% CI: 111.7 to 98.8 for male lower area). Emphysema% was responsible for an increase in size of upper and middle CT areas (up to 5.4 cm(2); 95% CI: 3.0 to 7.8 for an emphysema increase of 5%). Lower rib cage areas decreased as FVC% decreased (5.1 cm(2); 95% CI: 2.5 to 7.6 for 10 percentage points of FVC variation). This study demonstrates that simple CT measurements can predict rib cage morphometric variability and also highlight relationships between rib cage morphometry and emphysema.
    Full-text · Article · Jul 2013
    • "Our findings are in accordance with other studies, which have also found a major abdominal contribution to tidal volume (60%) at rest in patients with COPD (Aliverti et al., 2009; Bianchi et al., 2004 Bianchi et al., , 2007 Romagnoli et al., 2011). On the other hand, other studies found a lower abdominal contribution to tidal volume (40%) at functional residual capacity (Binazzi et al, 2008) and during exercise (Vogiatzis et al., 2005). The ratio of the inspiratory time to total time of the respiratory cycle increased during ILB indicates more work from the inspiratory muscles (Decramer et al., 2005). "
    [Show abstract] [Hide abstract] ABSTRACT: Chest wall volumes and breathing patterns of 13 male COPD patients were evaluated at rest and during inspiratory loaded breathing (ILB). The sternocleidomastoid (SMM) and abdominal muscle activity was also evaluated. The main compartment responsible for the tidal volume at rest and during ILB was the abdomen. During ILB patients exhibited, in addition to increases in the ratio of inspiratory time to total time of the respiratory cycle and minute ventilation, increases (p<0.05) in the chest wall tidal volume by an increase in abdomen tidal volume as a result of improvement of end chest wall inspiratory volume without changing on end chest wall expiratory volume. The SMM and abdominal muscle activity increased 63.84% and 1.94% during ILB. Overall, to overcome the load imposed by ILB, COPD patients improve the tidal volume by changing the inspiratory chest wall volume without modifying the predominant mobility of the abdomen at rest and without affecting the end chest wall expiratory volume.
    Article · Apr 2013
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