Name: investigation into deep breathing through measurement of ventilatory parameters and observation of breathing patterns
Uploaded: 2019-09-16T13:30:00.000+00:00
Duration: 8 min 34 s
Description: Watch this Scientific Journal Video about Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns at JoVE.com

The authors thank Dr. Shimpachiro Ogiwara, former Professor at the University of Kanazawa, and Mrs. Sandra M. Ogiwara, CSP (UK), BScPT (C), for English editing of the manuscript.

This protocol was in accordance with the ethical principles of the Declaration of Helsinki. The procedure was explained to all participants before commencement of the study.
1. Participant screening
<ol>
	<li>Recruit 15 healthy women in their twenties through convenience sampling. Check medical history verbally. Exclude participants with cardiopulmonary disease.</li>
	<li>Explain the procedure to the participant.</li>
	<li>Ask the participant to refrain from eating and drinking 2 h prior to the commencement of the measurement and to bring a tight-fitting black shirt.</li>
</ol>
2. Procedure
<ol>
	<li>Preparation for the procedure
	<ol>
		<li>Calibrate the gas analyzer that has integrated components of a pneumotachograph and oxygen/carbon dioxide concentration meters 15 &#8211; 30 min before the measurement. Follow manufacturer&#39;s protocols.</li>
		<li>Attach a video camera to a tripod at a distance of 1.5 m from the chair the participant will sit on. Prepare to record a lateral view of the sitting participant in a range from the top of the&#160;cranium to the seat of the chair.</li>
		<li>Instruct the waiting participant to put on the tight-fitting black shirt in a cubicle, and when ready, stand by the side of the chair in the laboratory.</li>
		<li>Place three electrodes (positive, negative&#160;and ground) on the skin of the chest in standing, each with a wire to connect to a transmitter that relays to the electrocardiograph.</li>
		<li>Seat the participant comfortably for 5 min in a chair with a back support at an angle of 70&#176; and, if necessary, insert a small cushion in the neck and/or&#160;lumbar region.</li>
		<li>Explain to the participant deep breathing with a natural breathing (NB) pattern of slow and deep breaths, breathing in through the nose and blowing out through the mouth with no consideration or knowledge given on specific movement of the chest.</li>
		<li>Ask the participant to take a natural deep breath without any guidance. Prepare to begin measurement if the investigator is satisfied with breathing performance. Observe the participant&#39;s thoracoabdominal movement during inspiration and expiration.</li>
	</ol>
	</li>
	<li>Measurement of deep breathing with the NB pattern
	<ol>
		<li>Fit the participant with a sampling mask over the mouth and nose for measurement of the expired gas. Perform a seal test: close the hole for the sampling tube of the mask with a finger and ask the participant to breathe out gently and confirm whether air leaks from the mask. Connect a sampling tube to the mask for measurement of the ventilatory parameters.</li>
		<li>Ask the participant to refrain from talking during the procedure.</li>
		<li>Instruct the participant to rest for 5 min, and simultaneously begin recording the expired gas and heart rate, together with video capture. After the 5 min rest phase, instruct the participant to begin deep breathing for 5 min with NB pattern. On termination, instruct the participant to rest for 5 min.</li>
		<li>Continue recording and measuring throughout the three phases.</li>
		<li>Perform only one three-phase trial for each participant.</li>
	</ol>
	</li>
	<li>Rest phase
	<ol>
		<li>Inform the participant that the experimenter will take off the mask and allow her a 10 min intermission phase.</li>
		<li>Instruct the participant that she may sit and talk in the laboratory, but not drink. Begin timing the intermission phase with a stopwatch at the moment of taking off the mask.</li>
	</ol>
	</li>
	<li>Measurement of deep breathing with the diaphragmatic breathing (DB) pattern
	<ol>
		<li>Seat the participant as in step 2.1.5.</li>
		<li>Explain to the participant deep breathing with a diaphragmatic breathing (DB) pattern. Ask the participant to lace her fingers, place them on her abdomen and take a deep breath in through the nose, expanding the abdomen under the hands and then blowing out through the mouth and gently retracting the abdomen.</li>
		<li>Instruct the participant to practice this deep breathing with the DB pattern until the investigator is satisfied.&#160;Observe that thoracoabdominal expansion takes place during inspiration followed by its contraction on expiration.</li>
		<li>Fit the participant with a sampling mask over the mouth and nose for measurement of the expired gas. Perform a seal test: close the hole for the sampling tube of the mask with a finger and ask the participant to breathe out gently and confirm whether air leaks from the mask. Connect a sampling tube to the mask for measurement of the ventilatory parameters.</li>
		<li>Ask the participant to refrain from talking during the measurement.</li>
		<li>Instruct the participant to rest for 5 min, and simultaneously begin recording the expired gas and heart rate, together with video capture. After the 5 min rest phase, instruct the participant to begin deep breathing for 5 min with the DB pattern. On termination, instruct the participant to rest for 5 min. Continue recording and measuring throughout the three phases.</li>
		<li>Take the mask off the participant following the 5 min rest phase.</li>
		<li>Ask the participant immediately which of the two deep breathing techniques was more comfortable. Record the participant&#8217;s response on a spreadsheet.</li>
		<li>Remove the electrodes, leads and transmitter from the participant and let her leave.</li>
		<li>Perform only one three-phase trial for each participant.</li>
	</ol>
	</li>
</ol>
3. Measurement of the Ventilatory Parameters
<ol>
	<li>Sample the breath-by-breath expired gas using a&#160;gas analyzer (see Table of Materials and Figure 2).
	<ol>
		<li>Measure the following ventilatory parameters: oxygen uptake (VO2), carbon dioxide output (VCO2), expired minute ventilation (VE), respiratory rate (f), tidal volume (VT), expiratory time (Te), and inspiratory time (Ti).</li>
		<li>Measure the heart rate using a medical telemetry sensor for the electrocardiograph (see Table of Materials and Figure 2), which is connected to the gas analyzer. 
		NOTE: The&#160;gas analyzer is operated using computer software provided by the manufacturer (Table of Materials).</li>
	</ol>
	</li>
	<li>Collect the data for each 5 min phase of rest and deep breathing for NB and DB patterns. Save the data on the ventilatory parameters in CSV format using computer software (see Table of Materials and Figure 3,4).
	<ol>
		<li>Collect mean data for each 5 min phase of this protocol. Average data for the optionally set phase is obtained on a breath-by-breath basis.</li>
	</ol>
	</li>
	<li>Enter the data for each participant into the spreadsheet program (see Table of Materials and Figure 5) and determine the mean and standard deviation (SD) for the initial rest and deep breathing phases for NB and DB.</li>
</ol>
4. Assessment of the Breathing Pattern
<ol>
	<li>Record thoracoabdominal movement from a lateral view of the participant using a video camera (Table of Materials).</li>
	<li>Make sure that the background color is in sharp contrast to the participant&#8217;s silhouette.</li>
	<li>Record the video image at 1/30 s per frame, which is the standard speed for the video camera used.</li>
	<li>Upload the motion-images into a personal computer using video editing software 1 (Table of Materials).</li>
	<li>Observe 5 min video images of the deep breathing phases at double speed under visual assessment and classify the breathing patterns as upper costal, diaphragmatic or thoracoabdominal. Use video editing software 2 (Table of Materials). 
	NOTE: Video images are analyzed by a cardiopulmonary physical therapist (MY).</li>
</ol>
5. Participants&#8217; preferred pattern for deep breathing
<ol>
	<li>Prepare a spreadsheet for the participant&#39;s response.</li>
	<li>Ask the participant which of the two deep breathing techniques is more comfortable following the measurement of the DB pattern.</li>
	<li>Fill in the spreadsheet with the participant&#39;s response.</li>
	<li>Be ready to listen to the participant if she wants to talk about the procedure. Do not include the participant&#8217;s comments in the analysis.</li>
</ol>
6. Statistical Analysis
NOTE: Perform statistical analysis using commercial computer software (Table of Materials), and then provide all the button clicks.
<ol>
	<li>Ventilatory parameters
	<ol>
		<li>Do not analyze the 5 min rest phase following the two deep breathing phases in this protocol.</li>
		<li>Determine the mean and SD for the initial rest phases and deep breathing phases for each parameter.</li>
		<li>Employ two-way repeated-measures analysis of variance (2-way ANOVA) to evaluate the ventilatory parameters and heart rate for the initial rest phases and two deep breathing phases. 
		NOTE: Factor &#34;instruction&#34;&#160;includes two levels NB and DB, and factor &#34;phase&#34;&#160;has two levels rest phase and deep breathing phase.</li>
		<li>Using the Bonferroni method, evaluate between each factor for parameter measurement, yielding significant interaction following 2-way ANOVA.</li>
	</ol>
	</li>
	<li>Classification of breathing patterns exhibited by the participants including their preferred pattern for deep breathing.
	<ol>
		<li>Categorize the number of participants according to their breathing pattern in upper costal, diaphragmatic or thoracoabdominal breathing.</li>
		<li>Compile from the spreadsheet the number of participants according to their preferred pattern of deep breathing.</li>
	</ol>
	</li>
</ol>

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D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+diaphragmatic+breathing+in+persons+with+chronic+obstructive+pulmonary+disease:+A+review+of+the+literature.">Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease: A review of the literature.</a> Journal of Cardiopulmonary Rehabilitation. 22, 7-21 (2002).</li><li>Sackner, M. A., Gonzalez, H. F., Jenouri, G., Rodriguez, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+abdominal+and+thoracic+breathing+on+breathing+pattern+components+in+normal+subjects+and+in+patients+with+chronic+obstructive+pulmonary+disease.">Effects of abdominal and thoracic breathing on breathing pattern components in normal subjects and in patients with chronic obstructive pulmonary disease.</a> The American Review of Respiratory Disease. 130, 584-587 (1984).</li><li>Gosselink, R. A., Wagenaar, R. C., Rijswijk, H., Sargeant, A. J., Decramer, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diaphragmatic+breathing+reduces+efficiency+of+breathing+in+patients+with+chronic+obstructive+pulmonary+disease.">Diaphragmatic breathing reduces efficiency of breathing in patients with chronic obstructive pulmonary disease.</a> American Journal of Respiratory and Critical Care Medicine. 151, 1138-1142 (1995).</li><li>Adachi, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiopulmonary+Exercise+Test.">Cardiopulmonary Exercise Test.</a> International Heart Journal. 58, 654-665 (2017).</li><li>Guazzi, M., Bandera, F., Ozemek, C., Systrom, D., Arena, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiopulmonary+Exercise+Testing:+What+Is+Its+Value.">Cardiopulmonary Exercise Testing: What Is Its Value.</a> Journal of the American College of Cardiology. 70, 1618-1636 (2017).</li><li>Jones, A. 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The authors declare that they have no competing financial interests.

By the use of this protocol, effective instruction for deep breathing can be examined through oxygen consumption, ventilatory parameters, and chest wall excursion. The participants had a mean age of 21.6 years, mean body mass of 51.9 kg, mean height of 159.3 cm and a body mass index of 20.5 kg/m2. No incentives were offered to partake in this protocol. There are three critical steps within the protocol. First, concerning the control of food intake, the&#160;ratio of carbon dioxide output to oxygen uptake provides information about the nutrient mixture catabolized for energy10. Food intake in lower physical activity has a greater effect compared to higher physical activity on VO2 measured in expired gas11. The result for VO2 (Table 1) demonstrates a lower physical activity during deep breathing. Consequently, it is imperative to set conditions for food intake prior to measurement. Second, the participants are required to refrain from talking during measurement so as not to influence expired gas data. Third, to avoid possible learning effects of the DB pattern on the NB pattern, the execution of the breathing pattern sequence for the measurement is important (Figure 1).
In general, breathing exercise takes 3-5 min to execute. Therefore, the investigators allocated a 5 min deep breathing phase sandwiched between the two rest phases. The participants carried out only one trial for NB and DB&#160;deep breathing phase, for this protocol was designed to simulate initial instruction in a clinical setting of a 5-min breathing exercise. However, participants did not have an ideal diaphragmatic breathing pattern when carrying it out for the first time in this protocol (Table 2). Modification of this protocol may require further instruction time and practice for learning diaphragmatic breathing to compare the two breathing methods.
For the measurement of the expired gas on a breath-by-breath basis, the number of samples per min for the ventilatory parameters is equal to the respiratory rate per min. The number of samples per min is known to increase during vigorous physical activity, but that for the ventilatory parameters decreases during deep breathing as was shown in this protocol. Considering the above fact, the average time for data collection should be determined.
By the use of a video camera, it is possible for one investigator to carry out this protocol. In addition, a breathing pattern can be easily judged by fast-forwarding the motion-images. During the preliminary testing for this protocol, markers were placed on the sternum and abdomen, followed by videotaping. However, these markers were of no assistance for the visual judgment. Consequently, it was decided to have the participant wear a tight-fitting black shirt. Furthermore, it may be easier to observe the thoracoabdominal excursion if the color of the shirt is in contrast to that of the background. In this protocol, the wall&#8217;s background color is white beige in contrast to the black shirt. The investigators recommend the use of different protocol(s)12,13 if one intends to study breathing patterns particularly with attention to the kinematics of the thorax.
As for the sample size used&#160;this protocol, calculation by post-hoc power analysis14 yielded 0.75. To satisfy statistical power of 0.8 defined by Cohen14, a minimum sample size of 17 participants would have been required for this protocol, which meant that it had a shortage of two participants. Further, the distribution of pulmonary ventilation could not be assessed, as would have been possible with electrical impedance tomography15.
Ventilatory parameters obtained in this protocol include mechanism of intervention and energy cost in a systematic review of breathing control2. Alternative method for this procedure would be to analyze the ventilatory parameters in the rest phase following deep breathing, consequently determining the effect on ventilatory parameters immediately following deep breathing. Further, we could compare the ventilatory parameters pre- and post-deep breathing exercise. This may result in a change in the ventilatory parameters if participants become proficient in the two patterns of deep breathing. Henceforth, the investigators would like to explore how ventilatory parameters in the elderly and individuals in supine and/or side lying would differ from those in this study.

The cardiopulmonary physical therapist normally treats the patient according to the individual&#39;s needs and requirements. However, in general, the patient is left to carry out preoperative deep breathing exercise by him/herself. Therefore, it is imperative to find a simple and effective instruction method for the patient to carry out deep breathing exercises1.
Diaphragmatic breathing is such a breathing exercise and one method of breathing control2,3. The therapeutic outcome of this method includes a reduction in work of breathing and improvement in efficiency of breathing2,3, and this brings about an increase in tidal volume, resulting in a reduction in respiratory rate. However, some researchers have pointed out that diaphragmatic breathing exercise may cause asynchronous and paradoxical motion of the rib cage due to abdominal excursions in some patients4,5. In such cases, the use of a patient&#39;s natural breathing pattern may be efficacious. Regarding the question of deep breathing being effective as a means of a reduction in the mechanical work of breathing and improvement of ventilatory efficiency, it may be useful to quantify ventilatory parameters by the use of a&#160;gas analyzer.
It is well known that cardiopulmonary exercise testing is carried out using a gas analyzer6,7. Some investigators8,9 have reported measurement for diaphragmatic breathing with a gas analyzer in&#160;patients with chronic obstructive pulmonary disease. Jones et al.8 compared diaphragmatic breathing, pursed-lip breathing, and a combination of both, with that of spontaneous breathing. During these three methods of breathing, oxygen consumption (VO2) and respiratory rate (f) were measured, which showed that a&#160; higher resting VO2 may be explained by the increased mechanical work of breathing8. Ito et al.9 examined the immediate effect of diaphragmatic breathing or respiratory muscle stretch on VO2, f and tidal volume (VT). We may expect from the results of the aforementioned studies that similar evidence could be obtained by application of similar breathing exercises to confirm an effective deep breathing method of instruction.
This protocol describes the method for measurement of ventilatory parameters and chest wall excursion in deep breathing with two breathing patterns, together with their results and analysis. Continuous and quantitative sampling of ventilatory parameters can measure breathing precisely compared to alternative techniques. VO2 obtained in this protocol can be regarded as an indicator of work of breathing8. Further, f, VT, and minute ventilation are related to ventilatory efficiency.&#160;Information on breathing pattern can also be obtained from these ventilator parameters plus inspiratory and expiratory time. This protocol also involves assessment of chest wall excursion through video capture, which corresponds to observation by a physical therapist of the patient&#39;s chest wall excursion during breathing exercise. The overall goal of this study was to find a viable and efficient method of deep breathing exercise based on analysis of oxygen consumption, ventilatory parameters, and chest wall excursion.

<table><tbody><tr><td>Expired gas analyzer</td><td>Minato Medical Science, Osaka, Japan</td><td>AE-300S</td><td></td></tr><tr><td>Expired gas analyzing software</td><td>Minato Medical Science, Osaka, Japan</td><td>AT for Windows</td><td></td></tr><tr><td>Medical telemetry sensor for electrocardiograph</td><td>Nihon Kohden, Tokyo, Japan</td><td>BSM-2401</td><td></td></tr><tr><td>Spreadsheet program</td><td>Microsoft, https://www.microsoft.com/ja-jp</td><td>Excel</td><td></td></tr><tr><td>SPSS Statistical Software</td><td>IBM, https://www.ibm.com/jp-ja/analytics/spss-statistics-software</td><td>Version 23.0</td><td></td></tr><tr><td>Video camera</td><td>Sony, Tokyo, Japan</td><td>DCR-SR 100</td><td></td></tr><tr><td>Video editing software 1</td><td>Sony, Tokyo, Japan</td><td>PlayMemories Home</td><td></td></tr><tr><td>Video editing software 2</td><td>Adobe, https://www.adobe.com/jp/</td><td>Premiere Elements 11</td><td></td></tr></tbody></table>

investigation into deep breathing through measurement of ventilatory parameters and observation of breathing patterns

In this protocol, two deep breathing patterns were shown to 15 participants to determine an easy yet effective method of breathing exercise for future application in a clinical setting. The women in their twenties were seated comfortably in a chair with back support. They were fitted with an airtight mask connected to a&#160;gas analyzer. Three electrodes were placed on the chest connected to a wireless transmitter for relaying to the electrocardiograph. They executed a 5 min rest phase, followed by 5 min of deep breathing with a natural breathing pattern, terminating with a 5 min rest phase. This was followed by a 10 min intermission before commencing the second instruction phase of substituting the natural breathing pattern with the diaphragmatic breathing pattern. Simultaneously, the following took place: a) continuous collection, measurement and analysis of the expired gas to assess the ventilatory parameters on a breath-by-breath basis; b) measurement of the heart rate by an electrocardiograph; and c) videotaping of the participant&#8217;s thoracoabdominal movement from a lateral aspect. From the video capture, the investigators carried out visual observation of the fast-forward motion-images followed by classification of the breathing patterns, confirming that the participants had carried out the method of deep breathing as instructed. The amount of oxygen uptake revealed that, during deep breathing, the work of breathing decreased. The results from the expired minute ventilation, respiration rate and tidal volume confirmed increased ventilatory efficiency for deep breathing with the natural breathing pattern compared to that with the diaphragmatic breathing pattern. This protocol suggests a suitable method of instruction for assessing deep breathing exercises on the basis of oxygen consumption, ventilatory parameters, and chest wall excursion.

The Ventilatory Parameters and Heart Rate 
Based on the data (Figure 5), the NB and DB patterns were analyzed statistically (Figure 6 and Table 1). The f, VT and Te were found to have a significant interaction (p&#60;0.05, respectively). A significant decrease in the f was found for both the NB and DB patterns during deep breathing compared to the initial rest phases (p&#60;0.05, respectively), and, during deep breathing with the NB pattern, the f decreased to a greater extent compared to that for the DB pattern (Figure 6 and Table 1). The VT and Te revealed a significant increase during deep breathing compared to the initial rest phases for the NB and DB patterns, and, those for both deep breathing with the NB pattern were greater compared to those for the DB pattern (Figure 6). All of the parameters except VE and HR revealed main effect for the &#34;phase&#34;&#160;factor (Table 1).
A reduction in the work of breathing was reflected in a decrease in VO2, and, during deep breathing with the NB and DB patterns, the VO2 decreased with&#160;reduced work of breathing (Table 1). The improvement in ventilatory efficiency is reflected in an increase in VT and a decrease in f or VE. Deep breathing with the NB pattern was superior in ventilatory efficiency compared to that with the DB pattern. Generally, the relationship between VE and alveolar ventilation (VA) is calculated by the formula: VE= VT &#215; f and VA = (VT- anatomic dead space) &#215; f. Assuming that VE is a constant, a decreased respiratory rate and an increased VT indicate an improvement in VA. As VE yielded no significant interaction and main effect following 2-way ANOVA (Table 1), VE for deep breathing with both breathing patterns appeared to be equal. The respiratory rate during deep breathing with the NB pattern was significantly smaller compared to the DB pattern, but, for VT during deep breathing, it was significantly greater&#160;compared to that for the DB pattern (Figure 6 and Table 1). In other words, the alveolar ventilation or gas exchange during deep breathing with the NB pattern appears more efficient than for that during deep breathing with the DB pattern.
Breathing Patterns and Participants&#39;&#160;Preference 
Shown is the result of the visual assessment for thoracoabdominal movement during deep breathing with two methods of instructions (Table 2). For the NB pattern,The majority of the participants presented an upper costal or thoracoabdominal movement. During deep breathing with the DB pattern, all but one participant showed a thoracoabdominal or diaphragmatic movement. This result shows that the participants were able to carry out deep breathing as instructed. Thirteen out of the 15 participants expressed that they found the NB pattern easier to carry out than the DB pattern.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/60062/60062fig01.jpg" /> 
Figure 1. Flow chart for the protocol. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60062/60062fig01large.jpg" targe="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/60062/60062fig02v2.jpg" /> 
Figure 2. Ventilatory parameters as were seen displayed on the screen. 
Left, Natural breathing pattern; Right, Diaphragmatic breathing pattern. Display shows a sample of individual data for each of the breath-by-breath samples for the ventilatory parameters and heart rate. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60062/60062fig02v2large.jpg" targe="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/60062/60062fig03.jpg" /> 
Figure 3. CSV format for ventilatory parameters during deep breathing with a natural breathing pattern. 
The spreadsheet shows a sample of ventilatory parameters and heart rate following measurement. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60062/60062fig03large.jpg" targe="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/60062/60062fig04.jpg" /> 
Figure 4. CSV format for ventilatory parameters during deep breathing with a diaphragmatic breathing pattern. 
The spreadsheet shows a sample of ventilatory parameters and heart rate following measurement. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60062/60062fig04large.jpg" targe="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/60062/60062fig05.jpg" /> 
Figure 5. Raw data for all participants, which was converted from CSV data. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60062/60062fig05large.jpg" targe="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/60062/60062fig06.jpg" /> 
Figure 6. Significant interaction between ventilatory parameters. 
Solid blue circle, deep breathing with natural breathing pattern; White circle, deep breathing with diaphragmatic breathing pattern. (A) shows the f, respiratory rate, (B) shows the VT, tidal volume, and (C) shows the Te, expiratory time. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60062/60062fig06large.jpg" targe="_blank">Please click here to view a larger version of this figure.</a>
<table fo:keep-together.within-page="1">
	<tbody>
		<tr>
			<td rowspan="2"></td>
			<td colspan="2">Natural Breathing Pattern</td>
			<td colspan="2">Diaphragmatic Breathing Pattern</td>
			<td colspan="3">2-way ANOVA</td>
		</tr>
		<tr>
			<td>Rest</td>
			<td>Deep breathing</td>
			<td>Rest</td>
			<td>Deep breathing</td>
			<td>Instruction</td>
			<td>Phase</td>
			<td>Interaction</td>
		</tr>
		<tr>
			<td>VO2 (L/min)</td>
			<td>0.20&#177;0.02</td>
			<td>0.19&#177;0.01</td>
			<td>0.20&#177;0.02</td>
			<td>0.19&#177;0.01</td>
			<td></td>
			<td>&#60;0.01</td>
			<td></td>
		</tr>
		<tr>
			<td>VCO2 (L/min)</td>
			<td>0.17&#177;0.03</td>
			<td>0.23&#177;0.07</td>
			<td>0.16&#177;0.02</td>
			<td>0.21&#177;0.07</td>
			<td></td>
			<td>&#60;0.01</td>
			<td></td>
		</tr>
		<tr>
			<td>VE (l/min)</td>
			<td>6.8&#177;1.1</td>
			<td>7.7&#177;3.6</td>
			<td>6.3&#177;1.1</td>
			<td>7.7&#177;3.9</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>f (/min)</td>
			<td>14.4&#177;3.0</td>
			<td>5.4&#177;2.3*</td>
			<td>13.6&#177;2.3</td>
			<td>7.8&#177;3.6&#8224;,&#167;</td>
			<td></td>
			<td>&#60;0.01</td>
			<td>&#60;0.05</td>
		</tr>
		<tr>
			<td>VT (/ml)</td>
			<td>483&#177;76</td>
			<td>1507&#177;579*</td>
			<td>464&#177;61</td>
			<td>1057&#177;509&#8224;,&#167;</td>
			<td>&#60;0.05</td>
			<td>&#60;0.01</td>
			<td>&#60;0.05</td>
		</tr>
		<tr>
			<td>Te (s)</td>
			<td>2.79&#177;0.92</td>
			<td>8.37&#177;4.00*</td>
			<td>2.82&#177;0.53</td>
			<td>5.25&#177;2.31&#8224;,&#167;</td>
			<td>&#60;0.05</td>
			<td>&#60;0.01</td>
			<td>&#60;0.05</td>
		</tr>
		<tr>
			<td>Ti (s)</td>
			<td>1.63&#177;0.43</td>
			<td>4.51&#177;1.70</td>
			<td>1.69&#177;0.33</td>
			<td>3.67&#177;1.08</td>
			<td></td>
			<td>&#60;0.01</td>
			<td></td>
		</tr>
		<tr>
			<td>HR (bpm)</td>
			<td>69.1&#177;7.6</td>
			<td>71.7&#177;8.9</td>
			<td>68.5&#177;7.6</td>
			<td>70.1&#177;8.5</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>
Table 1. Comparison between the two breathing patterns. VO2, oxygen uptake; VCO2, carbon dioxide output; VE, minute ventilation; f, respiratory rate; VT, tidal volume; Te, expiratory time; Ti, inspiratory time; HR, heart rate; *, p&#60;0.05 (Rest vs. Deep breathing during NB); &#8224;, p&#60;0.05 (Rest vs. Deep breathing during DB); &#167;, p&#60;0.05 (NB vs. DB during Deep breathing). This table has been modified from one published in the Journal of Physical Therapy Science, 2018.
<table fo:keep-together.within-page="1">
	<tbody>
		<tr>
			<td>Instruction</td>
			<td>Upper costal</td>
			<td>Thoracoabdominal</td>
			<td>Diaphragmatic</td>
		</tr>
		<tr>
			<td>Natural breathing pattern</td>
			<td>7</td>
			<td>6</td>
			<td>2</td>
		</tr>
		<tr>
			<td>Diaphragmatic breathing pattern</td>
			<td>1</td>
			<td>8</td>
			<td>6</td>
		</tr>
	</tbody>
</table>
Table 2. Result of the visual assessment for thoracoabdominal movement during deep breathing with two breathing patterns. This table has been modified from one published in the Journal of Physical Therapy Science, 2018.

Watch this Scientific Journal Video about Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns at JoVE.com

Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns

Here, we present a protocol to assess two deep breathing patterns of natural and diaphragmatic breathing for their effectiveness and ease of execution. Fifteen participants were selected, utilizing an electrocardiograph and expired gas analyzer for measurement of the ventilatory parameters, together with visual assessment by video capture of thoracoabdominal movement.

In this protocol, two deep breathing patterns were shown to 15 participants to determine an easy yet effective method of breathing exercise for future ...

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Nanyang Technological University

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Unit 1

The Respiratory System

Vital Signs: Respiration

SCIENTISTS IN ACTION

11.5K Views.  Kanazawa University. Ons protocol is belangrijk omdat het een efficiënt ademmethode biedt die onafhankelijk door het individu kan worden uitgevoerd. Het voordeel van deze techniek is dat het continue en kwantitatieve beademingsparameters kan beoordelen. In vergelijking met andere methoden, die meten hoeveelheid ademhalingen als expiratoire.Deze techniek kan worden uitgebreid naar de instructie van ademhalingsoefening of het werken op een patiënt of in onze ervaring, patiënten hebben een probleem bij het...

Video: Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns

Quantitative Autonomic Testing

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be invaluable tool for evaluation of these disorders, both in clinic and research. There are number of autonomic tests, however, only few were validated clinically or are quantitative. Here, fully quantitative and clinically validated protocol for testing of autonomic functions is presented. As a bare minimum the clinical autonomic laboratory should have a tilt table, ECG monitor, continuous noninvasive blood pressure monitor, respiratory monitor and a mean for evaluation of sudomotor domain. The software for recording and evaluation of autonomic tests is critical for correct evaluation of data. The presented protocol evaluates 3 major autonomic domains: cardiovagal, adrenergic and sudomotor. The tests include deep breathing, Valsalva maneuver, head-up tilt, and quantitative sudomotor axon test (QSART). The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores (CASS). Detailed protocol is provided highlighting essential aspects of testing with emphasis on proper data acquisition, obtaining the relevant parameters and unbiased evaluation of autonomic signals. The normative data and CASS algorithm for interpretation of results are provided as well.

Standardized, comprehensive and fully quantitative testing of autonomic functions is described. The autonomic tests consist of evaluation of all three major autonomic domains including cardiovagal, adrenergic and sudomotor. The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores.

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be ...

Medicine

Method to Obtain Pattern of Breathing in Senescent Mice through Unrestrained Barometric Plethysmography

Unrestrained barometric plethysmography (UBP) is a method for quantifying the pattern of breathing in mice, where breathing frequency, tidal volume, and minute ventilation are routinely reported. Moreover, information can be collected regarding the neural output of breathing, including the existence of central apneas and augmented breaths. An important consideration for UBP is obtaining a breathing segment with a minimal impact of anxious or active behaviors, to elucidate the response to breathing challenges. Here, we present a protocol that allows for short, quiet baselines to be obtained in aged mice, comparable to waiting for longer bouts of quiet breathing. The use of shorter time segments is valuable, as some strains of mice may be increasingly excitable or anxious, and longer periods of quiet breathing may not be achieved within a reasonable timeframe. We placed 22 month-old mice in a UBP chamber and compared four 15 s quiet breathing segments between minutes 60&#8211;120 to a longer 10 min quiet breathing period that took&#160;2&#8211;3 h to acquire. We also obtained counts of central apneas and augmented breaths prior to the quiet breathing segments, following a 30 min familiarization period. We show that 10 min of quiet breathing is comparable to using a much shorter 15 s duration. Additionally, the time leading up to these 15 s quiet breathing segments can be used to gather data regarding apneas of central origin. This protocol allows investigators to collect pattern-of-breathing data in a set amount of time and makes quiet baseline measures feasible for mice that may exhibit increased amounts of excitable behavior. The UBP methodology itself provides a useful and noninvasive way to collect pattern-of-breathing data and allows for mice to be tested over several time points.

Unrestrained barometric plethysmography is used to quantify the pattern of breathing in awake mice. We show that 15 s segments under a standardized protocol display similar values to an extended duration of quiet breathing. This methodology also allows for the quantification of apnea and augmented breaths during the first hour in the chamber.

Unrestrained barometric plethysmography (UBP) is a method for quantifying the pattern of breathing in mice, where breathing frequency, tidal volume, and ...

Intraperitoneal Glucose Tolerance Test, Measurement of Lung Function, and Fixation of the Lung to Study the Impact of Obesity and Impaired Metabolism on Pulmonary Outcomes

Obesity and respiratory disorders are major health problems. Obesity is becoming an emerging epidemic with an expected number of over 1 billion obese individuals worldwide by 2030, thus representing a growing socioeconomic burden. Simultaneously, obesity-related comorbidities, including diabetes as well as heart and chronic lung diseases, are continuously on the rise. Although obesity has been associated with increased risk for asthma exacerbations, worsening of respiratory symptoms, and poor control, the functional role of obesity and perturbed metabolism in the pathogenesis of chronic lung disease is often underestimated, and underlying molecular mechanisms remain elusive. This article aims to present methods to assess the effect of obesity on metabolism, as well as lung structure and function. Here, we describe three techniques for mice studies: (1) assessment of intraperitoneal glucose tolerance (ipGTT) to analyze the effect of obesity on glucose metabolism; (2) measurement of airway resistance (Res) and respiratory system compliance (Cdyn) to analyze the effect of obesity on lung function; and (3) preparation and fixation of the lung for subsequent quantitative histological assessment. Obesity-related lung diseases are probably multifactorial, stemming from systemic inflammatory and metabolic dysregulation that potentially adversely influence lung function and the response to therapy. Therefore, a standardized methodology to study molecular mechanisms and the effect of novel treatments is essential.

The incidence of obesity is rising and increases the risk of chronic lung diseases. To establish the underlying mechanisms and preventive strategies, well-defined animal models are needed. Here, we provide three methods (glucose-tolerance-test, body plethysmography, and lung fixation) to study the effect of obesity on pulmonary outcomes in mice.

Obesity and respiratory disorders are major health problems. Obesity is becoming an emerging epidemic with an expected number of over 1 billion obese ...

Immunology and Infection

Assessment of Respiratory Function in Conscious Mice by Double-chamber Plethysmography

Air volume changes created by a conscious subject breathing spontaneously within a body box are at the basis of plethysmography, a technique used to non-invasively assess some features of the respiratory function in humans as well as in laboratory animals. The present article focuses on the application of the double-chamber plethysmography (DCP) in small animals. It provides background information on the methodology as well as a detailed step-by-step procedure to successfully assess respiratory function in conscious, spontaneously breathing animals in a non-invasive manner. The DCP can be used to monitor the respiratory function of multiple animals in parallel, as well as to identify changes induced by aerosolized substances over a chosen time period and in a repeated manner. Experiments on control and allergic mice are used herein to demonstrate the utility of the technique, explain the associated outcome parameters, as well as to discuss the related advantages and shortcomings. Overall, the DCP provides valid and theoretically sound readouts that can be trusted to evaluate the respiratory function of conscious small animals both at baseline and after challenges with aerosolized substances.

The objective of the present article is to provide a detailed description of the recommended procedures to evaluate respiratory function in conscious mice by double-chamber plethysmography.

Air volume changes created by a conscious subject breathing spontaneously within a body box are at the basis of plethysmography, a technique used to ...

Combining Volumetric Capnography And Barometric Plethysmography To Measure The Lung Structure-function Relationship

Tools to measure lung and airways volume are critical for pulmonary researchers interested in evaluating the impact of disease or novel therapies on the lung. Barometric plethysmography is a classic technique to evaluate the lung volume with a long history of clinical use. Volumetric capnography utilizes the profile of exhaled carbon dioxide to determine the volume of the conducting airways, or dead space, and provides an index of airways homogeneity. These techniques may be used independently, or in combination to evaluate the dependence of airways volume and homogeneity on lung volume. This paper provides detailed technical instructions to replicate these techniques and our representative data demonstrates that the airways volume and homogeneity are highly correlated to lung volume. We also provide a macro for the analysis of capnographic data, which can be modified or adapted to fit different experimental designs. The advantage of these measures is that their advantages and limitations are supported by decades of experimental data, and they can be made repeatedly in the same subject without expensive imaging equipment or technically advanced analysis algorithms. These methods may be particularly useful for investigators interested in perturbations that change both the functional residual capacity of the lung and airways volume.

Here, we describe two measures of pulmonary function &#8211; barometric plethysmography, which allows the measurement of lung volume, and volumetric capnography, a tool to measure the anatomic dead space and airways uniformity. These techniques may be used independently or combined to assess airways function at different lung volumes.

Tools to measure lung and airways volume are critical for pulmonary researchers interested in evaluating the impact of disease or novel therapies on the ...

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction

Oxygenation-sensitive cardiac magnetic resonance imaging (OS-CMR) is a diagnostic technique that uses the inherent paramagnetic properties of deoxyhemoglobin as an endogenous source of tissue contrast. Used in combination with standardized vasoactive breathing maneuvers (hyperventilation and apnea) as a potent non-pharmacologic vasomotor stimulus, OS-CMR can monitor changes in myocardial oxygenation. Quantifying such changes during the cardiac cycle and throughout vasoactive maneuvers can provide markers for coronary macro- and microvascular function and thereby circumvent the need for any extrinsic, intravenous contrast or pharmacologic stress agents.
OS-CMR uses the well-known sensitivity of T2*-weighted images to blood oxygenation. Oxygenation-sensitive images can be acquired on any cardiac MRI scanner using a modified standard clinical steady-state free precession (SSFP) cine sequence, making this technique vendor-agnostic and easily implemented. As a vasoactive breathing maneuver, we apply a 4-min breathing protocol of 120 s of free breathing, 60 s of paced hyperventilation, followed by an expiratory breath-hold of at least 30 s. The regional and global response of myocardial tissue oxygenation to this maneuver can be assessed by tracking the signal intensity change. The change over the initial 30 s of the post-hyperventilation breath-hold, referred to as the breathing-induced myocardial oxygenation reserve (B-MORE) has been studied in healthy people and various pathologies. A detailed protocol for performing oxygen-sensitive CMR scans with vasoactive maneuvers is provided.
As demonstrated in patients with microvascular dysfunction in yet incompletely understood conditions, such as inducible ischemia with no obstructive coronary artery stenosis (INOCA), heart failure with preserved ejection fraction (HFpEF), or microvascular dysfunction after heart transplantation, this approach provides unique, clinically important, and complementary information on coronary vascular function.

The assessment of microvascular function by oxygenation-sensitive cardiac magnetic resonance imaging in combination with vasoactive breathing maneuvers is unique in its ability to assess rapid dynamic changes in myocardial oxygenation in vivo and, thus, may serve as a critically important diagnostic technique for coronary vascular function.

Oxygenation-sensitive cardiac magnetic resonance imaging (OS-CMR) is a diagnostic technique that uses the inherent paramagnetic properties of ...

Electrical Impedance Tomography: Enhancing Pulmonary Health and Treatment

Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit

Electrical Impedance Tomography (EIT) is a groundbreaking, non-invasive, and radiation-free imaging technique for continuous, real-time ventilation monitoring. It also has an application in pulmonary perfusion monitoring. EIT quantifies ventilation and perfusion patterns across the lung from the measurement and processing of impedance changes in the thorax. It is a powerful tool for clinicians to visualize breath-by-breath changes in pulmonary function. 
An innovative application of EIT is its ability to assess pulmonary perfusion using the kinetic analysis of a hypertonic solution injection during a breath-hold. The solution generates an impedance change in the thorax as it circulates through the pulmonary vasculature. This indirect method allows for the estimation of perfusion patterns, contributing significantly to our understanding of pulmonary blood flow dynamics at the bedside.
EIT is not just a tool for monitoring but also can be critical for the diagnosis of respiratory pathologies such as pneumothorax and bronchial intubation. It can help identify the etiology of ventilation/perfusion (V/Q) mismatch in patients receiving invasive mechanical ventilation, which is not possible with other diagnostic tools. Moreover, EIT can assist in the individual optimization of ventilator settings, such as Positive End-Expiratory Pressure (PEEP) titration and tidal volume improving oxygenation and lung health in critical care.
In summary, EIT represents a paradigm shift in bedside pulmonary monitoring and diagnostics. Its non-invasive nature and immediacy of data make EIT an indispensable tool in modern respiratory medicine. With its growing applications, EIT will be pivotal in advancing our understanding of and approach to respiratory care, particularly in intensive care settings.

Electrical Impedance Tomography is a non-invasive, radiation-free, real-time pulmonary ventilation monitoring tool. By measuring impedance changes in the thorax, it can visualize the distribution of air on a breath-by-breath basis. Initially intended for ventilation monitoring, electrical impedance tomography can also measure perfusion via intravenous injection of a saline solution.

Electrical Impedance Tomography (EIT) is a groundbreaking, non-invasive, and radiation-free imaging technique for continuous, real-time ventilation ...

Physical Assessment of the Respiratory Tract II: Inspection

Physical assessment of the respiratory tract through inspection is a crucial step in understanding the patient&#39;s respiratory health. It provides insights into the functioning of the respiratory system, the musculoskeletal structure, and even the patient&#39;s nutritional status. This comprehensive approach involves observing several vital aspects: chest configuration, breathing patterns, respiratory rates, skin color, and use of accessory muscles.
Chest Configuration
The chest configuration can reveal a lot about the patient&#39;s respiratory health. Typically, the ratio of the anteroposterior diameter to the lateral diameter is 1:2. However, certain deformities associated with respiratory diseases can alter this relationship. These include the barrel chest, funnel chest (pectus excavatum), pigeon chest (pectus carinatum), and kyphoscoliosis.
Barrel chest, characterized by an increased anteroposterior diameter due to lung overinflation, is often seen in patients with emphysema and COPD. A funnel chest is a depression in the lower portion of the sternum that can compress the heart and great vessels, possibly leading to murmurs. The pigeon chest is an anterior sternum displacement, increasing the anteroposterior diameter. Kyphoscoliosis is defined by an elevated scapula and an S-shaped spine, limiting lung expansion.
When inspecting the posterior chest, any spinal curvatures such as kyphosis, scoliosis, and kyphoscoliosis should be noted, as they can affect breathing.
Breathing Patterns and Respiratory Rates
Breathing patterns and respiratory rates provide vital information about a patient&#39;s respiratory health. The average adult at rest takes 12 to 20 breaths per minute. In older adults, it is between 16 to 25 breaths/minute. The length of inspiration should be half as long as expiration (a ratio of 1:2). However, pathologic conditions may alter these patterns. For example, wheezing is common in patients with asthma, while irregular breathing patterns can indicate Kussmaul, Cheyne-Stokes, or Biot&#39;s respirations.
<ul>
	<li>&#8226; Kussmaul Respiration: Characterized by deep, rapid breathing, often seen in diabetic ketoacidosis or severe metabolic acidosis. It helps the body expel carbon dioxide to reduce acidosis.</li>
</ul>
<ul>
	<li>&#8226; Cheyne-Stokes Respiration: Involves a cycle of increasing and decreasing breathing depth, leading to temporary apnea, and can indicate heart failure, stroke, or brain injury.</li>
</ul>
<ul>
	<li>&#8226; Biot&#39;s Respiration: Marked by quick, shallow breaths followed by periods of apnea, often associated with medulla oblongata damage, stroke, or opioid use.</li>
</ul>
Skin Color
The color of the patient&#39;s skin can provide clues about their respiratory status. Cyanosis, a late sign of hypoxemia, is best observed in the conjunctivae, lips, palms, and under the tongue. It can be caused by hypoxemia or decreased cardiac output. Long-standing hypoxemia may lead to nail clubbing, which increases the angle between the base of the nail and its tip to 180 degrees or more.
Use of Accessory Muscles
During periods of exertion or specific disease conditions, accessory muscles like the sternocleidomastoid, scalene, and trapezius during inspiration, and the abdominal and internal intercostal muscles during expiration, can provide additional support to assist the breathing effort. Observing how the patient uses these muscles can provide important information about the patient&#39;s respiratory health.
In conclusion, physical assessment of the respiratory tract through inspection is a comprehensive approach that provides vital insights into a patient&#39;s respiratory health. By carefully observing the chest configuration, breathing patterns and rates, skin color, and use of accessory muscles, healthcare professionals can more effectively diagnose and treat respiratory diseases.

Inspection is the initial step in assessing the respiratory system. It involves observing the following components.
Initially, the chest configuration is ...

Medical-Surgical Nursing

An Overview of the Respiratory System: Anatomy, Physiology, Assessment, and Abnormalities

KEY TERMS AND CONCEPTS

Assessment of Ventilation I: Respiratory Rate

Assessment of Ventilation
A Ventilation assessment is critical for monitoring a patient&#39;s health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
<ol>
	<li>Unobtrusive Observation: Maintaining accuracy in ventilation assessment is paramount. Observing the patient&#39;s breathing without their knowledge is crucial to achieve this. This approach helps to avoid any alteration in breathing patterns that might occur due to the patient&#39;s awareness of being watched, thereby ensuring a more accurate assessment.</li>
	<li>Comprehensive Evaluation: Consider the patient&#39;s usual ventilatory rate, the influence of any diseases or conditions on their respiratory function, the interplay between respiratory and cardiovascular functions, and the impact of ongoing therapies.</li>
	<li>Objective Measurements: In respiratory rate assessment, the focus should be on the rate, depth, and breathing rhythm. These objective measurements are crucial for accurately assessing the patient&#39;s respiratory status. They provide precise and measurable data essential for effective patient care.</li>
</ol>
Respiratory Rate Assessment:
<ul>
	<li>&#8226; Normal Rates: The average range of respiratory rate in adults is typically between 12 and 18 breaths per minute. Expiration lasts about twice as long as inspiration. However, these rates vary with age and generally decline over a person&#39;s lifetime.</li>
	<li>&#8226;&#160;Signs of Distress: A deviation from the patient&#39;s average respiratory rate by as little as 3 to 5 breaths per minute can indicate respiratory distress. A respiratory rate exceeding 24 breaths per minute demands regular observations and close monitoring, particularly if accompanied by other physiological changes.</li>
	<li>&#8226;&#160;Critical Rates: Patients with respiratory rates higher than 27 breaths per minute or lower than eight require immediate medical attention.</li>
</ul>
Using Technology: An apnea monitor can help assess the respiratory rate by sensing chest wall movement. Lack of movement triggers an apnea alarm, which is particularly useful in monitoring infants for prolonged apneic events in hospitals and at home.
Best Practices: To measure respiratory rate effectively, observe and palpate the chest wall movement; estimating respirations can lead to inaccuracies. Always consider all variables when changes in respiration occur to ensure the most accurate assessment.
Conclusion: Accurate ventilation assessment is essential for detecting early signs of respiratory compromise and ensuring effective patient care. By understanding the nuances of respiratory rate assessment and committing to these guidelines, healthcare providers can better manage patient outcomes and respond promptly to emerging health concerns.

Assessment of Ventilation
A Ventilation assessment is critical for monitoring a patient&#39;s health status. Respiration, one of the most accessible vital ...

Assessment of Ventilation II: Respiratory Depth and Rhythm

Respiratory Depth
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
<ul>
	<li>&#8226; Deep Respiration: Involves full lung expansion and complete exhalation, significantly increasing air intake.</li>
	<li>&#8226;&#160;Shallow Respiration: Characterized by minimal air passage through the lungs, making it less noticeable.</li>
</ul>
Specific clinical terms related to respiratory depth include:
<ul>
	<li>&#8226;&#160;Apnea: A cessation of breathing that, if sustained beyond 4 to 6 minutes, can lead to brain damage or death.</li>
	<li>&#8226;&#160;Dyspnea: Difficult or labored breathing, often rapid and shallow, where the patient may appear anxious. Dyspneic individuals usually find breathing easier when sitting upright, a condition known as orthopnea.</li>
</ul>
Respiratory Rhythm
Respiratory rhythm refers to the pattern of breathing, encompassing timing, regularity, and effort:
<ul>
	<li>&#8226;&#160;Diaphragmatic Breathing: Characterized by the contraction and relaxation of the diaphragm, this type of breathing is often seen in healthy men and children and is best observed by watching abdominal movements.</li>
	<li>&#8226;&#160;Thoracic Breathing: More common in women, this involves using thoracic muscles and is visible through movements in the upper chest.</li>
</ul>
Labored respirations may involve the use of accessory muscles in the neck. Signs of obstructed air movement, such as foreign body interference, include:
<ul>
	<li>&#8226;&#160;Retraction of Intercostal Spaces: Visible during inspiration when air movement is restricted.</li>
	<li>&#8226;&#160;Prolonged Exhalation is typical in conditions like COPD or asthma, where there is an obstruction to the outward flow of air.</li>
</ul>
Conclusion
Assessing the depth and rhythm of a patient&#39;s respiration is not just about identifying potential issues early. It&#39;s about tailoring interventions accordingly, ensuring that changes in respiratory patterns are promptly addressed. This thorough approach enhances patient care and outcomes and is a testament to your commitment to professional development and patient well-being.

Respiratory Depth
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains ...

Investigation into Deep Breathing through Measurement of Ventilatory Parameters and Observation of Breathing Patterns

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