Asynchronism of the respiratory movements in lobar pneumonia

Abstract

Asynchronism of the respiratory movements occurs in many severe cases of lobar pneumonia. The phenomenon was first observed by the author some twenty years ago. A careful search of the literature has yielded only two references to the phenomenon, one by Grocco in 1904, the other by Grocco's pupil, Frugoni, in 1910.

The phenomenon consists in the separation of the contractions of the diaphragm and intercostal muscles by a definite, though variable, time-interval. As far as has been observed, the movement of the abdomen precedes that of the thorax. In well-developed types of the phenomenon the abdominal wall may have reached the expiratory phase before the intercostal muscles begin to contract. In other instances, the lower intercostal muscles take up the movement of the abdomen and the contraction spreads as a wave over the thorax.

Asynchronism of the respiratory movements has so far been observed only in lobar pneumonia. It possesses grave prognostic significance. Nearly all patients who develop it die. Usually it appears late in the disease. Though generally associated with other indications of severity, it may give the first intimation that the disease is likely to be fatal.