Ventilatory responses to mechanical loads in cervical cord-injured humans

Abstract

Load compensation in 29 cervical cord-injured men was inferred from the difference between actual first-breath responses to graded elastic and resistive loads and those calculated assuming identical respiratory muscle pressure (Pmus) wave forms in the unloaded and loaded states (i.e., the passive prediction). At every load, respiratory frequency (f) and tidal volume (VT) responses from different individuals formed a continuum ranging from a weak VT defense coupled with an increased f to a strong VT defense coupled with a decreased f. Individual VT responses ranged from values smaller than the passive prediction to values exceeding control, suggesting that phrenic motoneuron output was not constant but decreased in some subjects and increased in others. In support of this hypothesis, 1) individual VT responses varied with inspiratory duration (TI; P less than 0.01); 2) TI responses indicated some subjects prematurely terminated their phrenic motoneuron output, whereas others prolonged it; 3) VT/TI responses suggested that some subjects modified the discharge frequency of their phrenic output; and 4) rib cage instability contributed insignificantly to these responses. These findings, which are similar to those reported for normal men, indicate that 1) afferent pathways from the rib cage and intercostal muscles are not required for the initiation of a range of ventilatory responses to loads; and 2) afferent pathways from the mouth, lung, and/or diaphragm are sufficient, by themselves, to modulate the duration, intensity, and timing of the phrenic discharge during the first loaded breath.