If the accessory respiratory muscles suddenly functioned without the diaphragm to initiate inspiration, could this generate negative pleural pressures and lead to the intrathoracic petechial hemorrhages commonly found in SIDS cases at autopsy?

In other words, let's say the diaphragm somehow, suddenly became fully and bilaterally paralyzed in a healthy, spontaneously breathing infant (one not receiving mechanical ventilation). The rising pCO2 and dropping pO2 would trigger gasping inspiratory efforts by the CNS via chemoreceptor-mediated reflexes. However, because only the accessory muscles are available and with the diaphragm being inoperative, would the inspiratory efforts be met with resistance?

Possible answers:

  • No, they could still initiate inspiration independent of the diaphragm (overcoming resisting force of lung compliance).
  • Yes. Negative pleural pressures would result; effectively a 100% airway obstruction, and lead to severe terminal gasping efforts and cause the petechiae.
  • Other
  • From the references below: In infants and young children undergoing thoracic surgery complicated by bilateral phrenic nerve injuries, postoperative hospital stays were prolonged due to the need for prolonged mechanical ventilation1,2.

    So in that situation, apnea didn't occur simply because the patients were already receiving mechanical ventilation. But what would happen if they weren't? My guess is immediate respiratory arrest, gasping, asphyxia, negative intrathoracic pressures and secondary cardiac arrest. What's yours?

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    References:

    1. Joho-Arreola AL, Bauersfeld U, Stauffer UG, Baenziger O, Bernet V. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children. Eur J Cardiothorac Surg. 2005 Jan;27(1):53-7. doi: 10.1016/j.ejcts.2004.10.002. PMID: 15621471.

    2. De Leeuw M, Williams JM, Freedom RM, Williams WG, Shemie SD, McCrindle BW. Impact of diaphragmatic paralysis after cardiothoracic surgery in children. J Thorac Cardiovasc Surg. 1999 Sep;118(3):510-7. doi: 10.1016/S0022-5223(99)70190-X. PMID: 10469969.

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