Twitch transdiaphragmatic pressure depends critically on thoracoabdominal configuration

We measured the effect of thoracoabdominal configuration on twitch transdiaphragmatic pressure (Pdi, t) in response to supramaximal, transcutaneous, bilateral phrenic nerve shocks in three thin normal men. Pdi, t was measured as a function of lung volume (VL) in the relaxation configuration, at functional residual capacity (FRC), and at the same end-tidal VL 1) during relaxation; 2) with the abdomen (Ab) expanded and the rib cage (RC) in its relaxed FRC configuration; 3) with RC expanded and Ab in its relaxed FRC configuration; and 4) in configuration 3 with an active transdiaphragmatic pressure similar to that required to produce configuration 2. In increasing VL from FRC to configuration 1, Pdi,t decreased by 3.6 cmH(2)O; to configuration 2 by 14.8 cmH(2)O to configuration 3 by 3.7 cmH(2)O; and to configuration 4 by 2.7 cmH(2)O. We argue that changes in velocity of shortening and radius of curvature are unlikely to account for these effects and suggest that changes in diaphragmatic fiber length (L-di) are primarily responsible. If so, equivolume displacements of Ab and RC change L-di in a ratio of similar to 4:1. We conclude that Pdi,t is exquisitely sensitive to abdominal displacements that must be rigorously controlled if Pdi, t is to be used to assess diaphragmatic contractility.