Biomedical subjects

Larry Tsai

Publications and source records attributed to Larry Tsai.

6 recordsLinked to original sources

PubMed2006

Comparison of variable and conventional ventilation in a sheep saline lavage lung injury model.

OBJECTIVE: There has recently been considerable interest in alternative lung-protective ventilation strategies such as variable ventilation (VV). We aimed at testing VV in a large animal lung injury model and exploring the mechanism of improvement in gas exchange seen with VV. DESIGN: Randomized, controlled comparative ventilation study. SETTING: Research laboratory at a veterinary hospital. SUBJECTS: Female sheep weighing 59.8 +/- 10.57 kg and excised calf lungs. INTERVENTIONS: In a sheep saline lavage model of lung injury, we applied VV, whereby tidal volume (VT) and frequency (f) varied on each breath. Sheep were randomized into one of two groups (VV, n = 7; or control, n = 6) and ventilated for 4 hrs with all mean ventilation settings matched. MEASUREMENTS AND MAIN RESULTS: Gas exchange, lung mechanics, and hemodynamic measures were recorded over the 4 hrs. VV sheep showed improvement in gas exchange (i.e., oxygenation and carbon dioxide elimination) and ventilation pressures (i.e., reduced mean and peak airway pressures) but control sheep did not. VV sheep also displayed lower-lung elastance and mechanical heterogeneity in comparison with control sheep from 2 to 4 hrs of ventilation. To study the mechanism behind improvements seen with VV, we examined the time course associated with the enhanced recruitment occurring during VV in eight saline-lavaged excised calf lungs. We found that the recruitment associated with a larger VT during VV lasted over 200 secs, nearly an order of magnitude greater than the average time interval between large VT deliveries during VV. CONCLUSIONS: The application of VV in a large animal model of lung injury results in improved gas exchange and superior lung mechanics in comparison with CV that can be explained at least partially by the long-lasting effects of the recruitments occurring during VV.

Animals↗

PubMed2005

Pulmonary function tests versus computed tomography in sheep with experimental emphysema.

The authors explored the relative utility of pulmonary function tests (PFTs) and computed tomography (CT) to characterize the progression of papain induced emphysema in sheep (n = 12). PFT included plethysmography (FRC(pleth)), helium dilution (FRC(He)), and expired reserve volume (ERV). Following papain, FRC(pleth) and FRC(He) were unchanged; ERV decreased hence residual volume increased significantly (RV + 270 mL, +86%, P = .02). In contrast, FRC by CT increased in 10 of 12 sheep (+264 mL +21%, P = .008). We conclude that plethysmography was insensitive to emphysema, but the effect on ERV (i.e., trapped gas volume) and FRC by CT were very similar, and in line with the morphologic changes in this animal model.

Animals↗

PubMed2005

Pulmonary function tests fail to predict exercise intolerance in sheep with emphysema.

PURPOSE: The purpose of this study was to examine ventilatory parameters, gas exchange, and exercise tolerance in sheep undergoing cardiopulmonary exercise testing and pulmonary function testing at baseline and after induction of emphysema using nebulized papain, to improve our understanding of the contributions of parenchymal emphysema with minimal airway disease to exertional dysfunction in mild-to-moderate emphysema. METHODS: Static lung physiology (total lung capacity, residual volume, static elastance, and diffusing capacity of carbon monoxide) and lung (ZL) input impedance were measured, and cardiopulmonary exercise testing (CPET) was performed in 12 sheep before and after induction of emphysema. Papain treatment was delivered over a 12-wk period, as a single dose per week, to induce mild-to-moderate emphysema without airway disease. Static and dynamic lung physiology, as well as CPET, were then repeated. RESULTS: At the emphysema time point (EMPH), all animals were asymptomatic for emphysema at rest. There was a 60% increase in residual volume and a 57% decrease in static elastance, accompanied by a 36% reduction in diffusing capacity. Airway resistance was consistently, mildly increased, resulting in an increased expiratory time constant for all sheep at EMPH. There were no significant differences at EMPH versus baseline for any measured physiological variables during CPET (VO2peak, VCO2peak, RER, anaerobic threshold, O2 pulse, tidal volume, peak flow, peak VE/VO2, or peak VE). CONCLUSION: There is notable conservation of exercise capacity in sheep with mild-to-moderate parenchymal emphysema; this is not predicted by pulmonary function tests. In the absence of significant airway narrowing, mild-to-moderate emphysema is unlikely to result in airflow limitation.

Animals↗

PubMed2004

Evaluation of head-out constant volume body plethysmography for measurement of specific airway resistance in conscious, sedated sheep.

OBJECTIVE: To evaluate the use of a modified whole body plethysmograph in awake sheep. ANIMALS: 10 healthy adult sheep. PROCEDURE: Concurrent measurements of specific airway resistance (sR(aw)) and pulmonary resistance (R(L)) were obtained using a novel noninvasive head-out constant-volume plethysmograph and esophageal balloon-pneumotachography, respectively. All data were collected before and after external resistive loading with 1 and 5.6 cm H2O/L/s. Functional residual capacity (FRC) was measured by helium dilution for computation of airway resistance (R(aw)) preloading (R(aw) = sR(aw)/FRC). RESULTS: The sR(aw) and R(L) were closely correlated in 10 adult sheep. Additionally, sR(aw), and R(L) accurately reflected the magnitude of added resistance. The mean FRC was 52 mL/kg and used to calculate R(aw). At baseline, the values for R(aw) were significantly correlated with sR(aw) and R(L). CONCLUSIONS AND CLINICAL RELEVANCE: Precise measurements of sR(aw) and R(aw) at baseline and sR(aw) after external resistive loading were obtained by use of this novel noninvasive plethysmographic technology. This method should have application to veterinary patients or animals used in research in which noninvasive rapid or serial measurements of sR(aw) in the conscious state are required.

Airway Resistance↗

PubMed2003

Physiologic responses of sheep to two different methods of papain exposure.

Human emphysema is a progressive, destructive lung disease that produces morphologic and functional heterogeneity throughout its course. Consequently, the mature form of the disease is described by a broad range of anatomic, radiological, and physiologic patterns. This report describes the development and characterization of a sheep model of emphysema that represents many of the essential features of both homogeneous and heterogeneous emphysema. Emphysema was produced by two different techniques of papain exposure: (1) aerosol (75 IU/kg) given weekly for 4 treatments (HM) or (2) aerosol (75 IU/kg) weekly for 3 treatments following subsegmental intrabronchial instillations, 75 IU (in 10 saline) per lobe in 6 lobes (HT). Dexamethasone (0.06 mg/kg iv) was administered prior intrabronchial instillations only. On computed tomography, the HM group had homogeneous emphysema, the HT group gross nonuniformity of disease and bullae formation. Both groups demonstrated a significant (p < 0.05) increase in residual volume (HM, +38%; HT, +30%). There was a significant increase (p = 0.002) in total lung capacity per kilogram for the HM group. Emphysema had no effect on active or passive chest wall compliances. Diffusion capacity was significantly (p < 0.05) reduced in both groups. Both elastic (p = 0.066) and resistive (p = 0.025) components of impedance were increased in the HT, and airway resistance increased significantly in the HM groups. The HM model demonstrated gas trapping, a characteristic feature of emphysema, but failed to replicate the alterations in lung dynamics observed in the human form of this disease. The HT model demonstrated less static hyperinflation but significant frequency dependence and hence appeared to better represent the dynamic characteristics of human emphysema.

Administration, Inhalation↗

PubMed2002

Bronchoscopic lung volume reduction using tissue engineering principles.

Bronchoscopic lung volume reduction (BLVR), a minimally invasive procedure based on tissue engineering principles, was performed in six sheep with papain-induced experimental emphysema (EMPH). Physiologic measurements, at baseline, after generation of EMPH, and at 3 and 9 weeks after BLVR, included lung volumes, diffusing capacity (DL(CO)), pressure-volume relationships for the lung and chest wall, pleural pressures generated during active respiratory muscle contraction, lung resistance and dynamic elastance. The animal model displayed hyperinflation (change in total lung capacity +8%; change in residual volume +66%), reduced DL(CO) (-21%), and elevated airway resistance (+76%) that resembled advanced human EMPH. BLVR was well tolerated without complications, and it reduced lung volumes (change in total lung capacity -16%; change in residual volume -55%) in a pattern that resulted in significant improvements in vital capacity (10%). At autopsy, well-organized, peripheral scars associated with tissue contraction were observed at 33 of the 36 (91%) treated sites. There was no evidence of infection, abscess, or granuloma formation, or allergic reaction. Scar tissue, generated by BLVR, replaced hyperinflated lung, reduced overall lung volume, and improved respiratory function safely and consistently. The BLVR technology employed in this study addresses the limitations identified in our prior attempt at BLVR therapy and appears safe and effective enough to justify a trial in humans.

Airway Resistance↗