Respiratory-related evoked potential elicited in tracheostomised lung transplant patients

The present study investigated the role of removal of upper airway and lung vagal afferents in the respiratory-related evoked potential (RREP) response to inspiratory occlusions in two patients with a tracheostomy, who had undergone double lung transplantation (DLT). The patients were 1.5 and 3 months post-DLT and surgical placement of the tracheostomy. RREP recordings in response to inspiratory occlusions were obtained under four conditions: mouth breathing ignore trial; mouth breathing attend trial; tracheostomy breathing attend trial; and tracheostomy breathing ignore trial. The RREP peak components, Nf, P1 and N1, were present in both mouth and tracheostomy ignore breathing trials. The P300 was present in both mouth and tracheostomy attend trials. RREP peak latencies were similar between conditions. The peak amplitudes were greater with mouth breathing due to greater occlusion-related inspiratory pressure. These results demonstrate that the respiratory-related evoked potential can be elicited with inspiratory occlusion in the absence of mouth, upper airway and lung vagal afferent input. This suggests that inspiratory occlusion can elicit cortical activity with activation of inspiratory pump mechanoreceptors.