Actions of the inspiratory intercostal muscles in flail chest

We have previously shown in dogs that the ribs in flail chest move paradoxically inward during inspiration but continue to move cranially. We have also shown that flail elicits, probably via an increased activation of the muscle spindles, a threefold to fourfold increase in external intercostal inspiratory EMG activity without inducing any changes in parasternal intercostal activity. Therefore, the present studies were undertaken to test the hypothesis that the persistent cranial motion of the fractured ribs resulted primarily from the action of the external intercostals. A flail was induced in seven supine anesthetized animals by fracturing both dorsally and ventrally ribs 3 to 6 on the right side of the chest, after which the external intercostal muscles in interspaces 1 to 7 were severed. Severing the external intercostals caused a small increase in the inspiratory inward displacement of the fractured ribs, from 2.76 +/- 0.31 to 3.25 +/- 0.38 mm (p < 0.05), but it did not affect the parasternal intercostal EMG activity or the cranial rib displacement (before, 3.61 +/- 1.03 mm; after, 3.22 +/- 1.43 mm; NS). However, when the parasternal intercostals in interspaces 1 to 7 were also denervated, the inspiratory inward displacement of the ribs increased markedly to 5.95 +/- 0.48 mm (p < 0.01), and their inspiratory cranial displacement was reversed into a 1.05 +/- 0.58 mm inspiratory caudal displacement (p < 0.01). We conclude, therefore, that in dogs with flail chest the respiratory displacements of the ribs are still primarily determined, besides pleural pressure, by the action of the parasternal intercostals. These observations also suggest that in anesthetized dogs, spindle-induced excitation of the external intercostals has little impact on the mechanical behavior of the ribs.