4. Discussion
ventilatory insufficiency, chronic respiratory failure
MULTIPLE SCLEROSIS, RECRUITMENT, SYNDROME, CHRONIC RESPIRATORY FAILURE
The present study evaluated the impact of a four-week LVR maneuver on restrictive syndrome in individuals with MS, specifically investigating whether daily LVR application could alter respiratory function parameters. In our study, implementing a daily LVR protocol over a short term did not result in a significant increase in FVC or PCF; however, there was a notable improvement in MIC in the study group, compared to the control group that did not undergo the protocol (MIC, on the other hand, is a parameter describing passive lung capacity and thoraco-pulmonary compliance, independent of muscle strength. We have seen how in MS patients, ventilatory insufficiency originates from the progressive decrease in respiratory muscle strength, which, over time, leads to a decrease in thoraco-pulmonary compliance, which, in turn, causes micro-atelectasis in the lung parenchyma. This mechanism consequently establishes a vicious circle whereby the decrease in compliance leads to an increase in respiratory work, which further strains the already deficient respiratory muscles [The results of this study, in fact, provide information on the mechanisms through which the incentive of alveolar recruitment can help to improve and preserve the distensibility of the chest wall, acting on the range of motion of the cost-sternal and costovertebral joints, on the elasticity of the respiratory musculature, and on the elastic properties of the lung parenchyma. In addition, a small increase in MIC was found in patients performing LVR [To date, the optimal frequency of alveolar recruitment in the management of chronic respiratory failure remains an area of uncertainty and variability within medical literature. Some authors advocate for a once-daily approach [Our preliminary observations suggest that participants generally showed a favorable reception of the maneuvers. Over a prolonged period, in a specific cohort of individuals diagnosed with multiple sclerosis, the use of lung volume recruitment techniques correlated with a lower rate of deterioration in lung function and PCF [