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Lung function of children treated for malignant extrapulmonary tumors.

Lung function was studied in 29 children suffering from extrapulmonary tumors of varying etiology (Wilm's tumor, n = 7; bone malignancy, n = 17; nasopharyngeal epithelioma, n = 5). Lung volume: vital capacity (VC) and functional residual capacity (FRC), lung mechanics: lung resistance (RL), dynamic lung compliance (CLdyn) and static lung compliance (CLstat) and lung transfer factor for CO (TLCO), and blood gases were determined at different stages of therapy: at t0, before any aggressive treatment for respiratory function; at t1, after the initiation of polychemotherapy with or without local tumoral treatment (surgery or local irradiation); at t2, less than 6 months after onset of thoracopulmonary irradiation (whole lung irradiation at 20 grays) (group I), or local thoracopulmonary irradiation at high exposure greater than 40 grays (group II); at t3 after more than 6 months following irradiation with chemotherapy maintained; at t4, after cessation of all treatment (mean: 25 months +/- 14 after cessation of treatment). At t0, lung function data in children without pulmonary metastases did not deviate from predicted values. At t1, group I showed a significant decrease in CLdyn, which could be due to chemotherapy and for 5 children to consequences of abdominal surgery. In group II, only two children had a low CLdyn and also a significant decrease in VC (possibly due to the site of the tumor). After irradiation (at t2), FRC, TLCO and CLdyn were significantly lower than the predicted values and lower than at t1 in both groups (p greater than 0.01). At t3, functional parameters did not show any change compared to t2. At t4, FRC and TLCO were within normal limits in both groups but CLdyn, CLstat and the CLdyn/FRC ratio remained significantly decreased. It is suggested that these functional abnormalities are due to inadequate alveolar growth.

Adolescent↗

Habituation of phasic total respiratory resistance responses.

We examined the effects of repetitious stimulation on phasic respiratory resistance responses of 30 healthy adult males. Individuals were told either that they would inhale a substance which would cause bronchoconstriction or that they would inhale a substance which would cause no breathing changes. All subjects completed four inhalation trials. During each trial a lamp was turned on to indicate the presence of the inhalant; in reality, the subjects inhaled no substances. Respiratory resistance and functional residual capacity were measured just before and during the time the lamp was on. Regardless of the type of instruction, the response to the inhalation task was predominantly an increase in respiratory resistance. During Trials 1, 2, and 3, the number of subjects who increased respiratory resistance was greater than the number of subjects who decreased respiratory resistance. The number of subjects who increased respiratory resistance was not different from the number of subjects who decreased respiratory resistance during Trial 4. Changes in functional residual capacity did not affect changes in respiratory resistance; functional residual capacity changed neither within nor between trials. Given a progressive decrease in the number of subjects who increased their respiratory resistance on successive trials, the results were consistent with a response habituation model.

Adolescent↗

Effect of three different surgical prone positions on lung volumes in healthy volunteers.

Ten healthy volunteers were placed in three different surgical prone positions (knee-chest, Eschmann frame and two supports, one each for the thorax and pelvis); the normal prone position without any supports was used as a control. Lung volumes using helium dilution and spirometry were calculated for each volunteer in each position. Compared with the control position, functional residual capacity, expiratory reserve volume, residual volume and total lung capacity were significantly higher in the knee-chest position. Functional residual capacity and expiratory reserve volume were significantly higher in the frame position. No advantage was gained with the use of the two supports position. We conclude that, of these three prone positions in awake volunteers, the knee-chest position causes least respiratory restriction.

Adult↗

Human chest wall function during epidural anesthesia.

BACKGROUND: Although epidural anesthesia (EA) can significantly disrupt the function of the respiratory system, data concerning its effects on respiratory muscle activity and the resulting motion of the chest wall are scarce. This study aimed to determine the effects of lumbar EA on human chest wall function during quiet breathing. METHODS: Six persons were studied while awake and during mid-thoracic (approximately a T6 sensory level) and high (approximately a T1 sensory level) lumbar EA produced by either 2% lidocaine (two persons) or 1.5% etidocaine (four persons) with 1:200,000 epinephrine. Respiratory muscle activity was measured using fine-wire electromyography electrodes. Chest wall configuration during high EA was determined using images of the thorax obtained by three-dimensional, fast computed tomography. The functional residual capacity was measured using a nitrogen dilution technique. RESULTS: High EA abolished activity in the parasternal intercostal muscles of every participant but one, whereas the mean phasic activity of the scalene muscles was unchanged. High EA significantly decreased the inspiratory volume displacement of the rib cage compared with intact breathing but did not have a significant effect on diaphragm displacement. Therefore, high EA decreased the percentage contribution of rib cage expansion to inspiratory increases in thoracic volume (delta Vth) (from 27 +/- 2 [MSE] to 10 +/- 11% of delta Vth). Paradoxic rib cage motion during inspiration (i.e., a net inward motion during inspiration) developed in only one participant. High EA substantially increased the functional residual capacity (by 295 +/- 89 ml), with a significant net caudad motion of the end expiratory position of the diaphragm. In addition, high EA significantly decreased the volume of liquid in the thorax at end expiration in five of the six participants, a factor that also contributed to the increase in functional residual capacity in these persons. CONCLUSIONS: Rib cage expansion continues to contribute to tidal volume during high EA in most subjects, even when most of the muscles of the rib cage are paralyzed; the mean phasic electrical activity of unblocked respiratory muscles such as scalenes does not increase in response to rib cage muscle paralysis produced by EA; and high EA increases the functional residual capacity, an increase produced in most participants by a caudad motion of the diaphragm and a decrease in intrathoracic blood volume.

Adult↗

Lung volumes and maximal respiratory pressures in collegiate swimmers and runners.

To determine whether respiratory muscle strength is related to pulmonary volume differences in athletes and nonathletes, 11 intercollegiate female swimmers, 11 female cross-country runners, and two nonathletic control groups, matched to the athletes in height and age, were evaluated for pulmonary parameters including maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax). Swimmers exhibited larger (p less than .05) vital capacities (VC), residual lung volumes (RV), inspiratory capacities (IC), and functional residual capacities (FRC) than both the runners or the controls but no difference (p greater than .05) in either PImax or inspiratory flow (FIV 25%-75%). Timed expiratory volumes (FEV 0.5 and FEV 1.0) were significantly (p less than .05) lower in the swimmers than in the controls. These data suggest that an adaptational growth may be responsible, in part, for the augmented static lung volumes demonstrated in swimmers.

Adolescent↗

Single breath N2 washout in papain-induced pulmonary emphysema.

Single breath nitrogen washout tests were analyzed in dogs (n = 8) with healthy lungs and after development of emphysema. The animals were in the supine position and studied during anaesthesia and mechanical ventilation (FiO2 = 0.4, FiN2 = 0.6). During controlled expiration with constant flow (VE = 0.15 l/s) onset of phase IV of the alveolar plateau was related to airway closure of dependent lung regions (closing volume CV). In the control state, CV accounted for 6.2 +/- 1.5% VC, and closing capacity (CC) was lower than functional residual capacity (FRC). Likewise, gas exchange was normal in all animals (PaO2 = 24.7 +/- 3.32 kPa, PaCO2 = 5.18 +/- 0.53 kPa, PA-aO2 = 2.6 +/- 0.3 kPa). Panlobular emphysema (PLE) was induced by inhalation of papain (100 mg/kg). After three weeks development of PLE was documented by measurements of lung volumes (functional residual capacity (FRC), expired vital capacity (EVC), total lung capacity (TLC), residual volume (RV], pulmonary mechanics (dynamic and static compliance (Cdyn, Cstat), mean airway resistance (Raw], gas exchange (PaO2, PaCO2, PA-aO2), and by radiomorphological analysis. In the PLE-group, FRC and RV (p less than or equal to 0.05), and Cstat (p less than or equal to 0.01) were significantly elevated. CV increased to 16.2 +/- 2.7% VC (p less than or equal to 0.01) and CC exceeded FRC by 80 ml, indicating that tidal volume breathing took place within the range of closing volume. Oxygenation was significantly impaired (PaO2 = 18.6 +/- 3.72 kPa, PA-aO2 = 6.5 +/- 1.1 kPa, p less than or equal to 0.05), but not CO2-elimination. Pathological analysis by radiomorphological means showed dissiminate parenchymal lesions compatible with emphysema of grade II severity located predominantly in subpleural areas. In dogs with papain-induced PLE, premature closure of dependent airways is enhanced, which is due to structural changes and a loss of elastic recoil in the lungs.

Animals↗

Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema.

STUDY OBJECTIVE: To explore mechanisms of relief of exertional breathlessness following surgery to reduce thoracic gas volume in patients with emphysema. MATERIALS AND METHODS: We studied 8 patients with emphysema (FEV1 = 39 +/- 3% predicted; residual volume [RV] = 234 +/- 12% predicted; mean +/- SEM) who were severely breathless despite optimal pharmacotherapy and who underwent unilateral bullectomy for giant bullae (greater than one third hemithorax); 4 of these also had ipsilateral lung reduction (pneumectomy). Pulmonary function and cycle exercise performance (n = 6) were evaluated before and 13 +/- 3 weeks after surgery. Chronic breathlessness was measured with the Baseline Dyspnea Index and the Medical Research Council dyspnea scale. Exertional breathlessness was measured using Borg ratings at a standardized work rate (BorgSTD). RESULTS: FEV1, FVC, and maximal inspiratory pressures increased postsurgery by 29 +/- 7% (p < 0.05), 24 +/- 10% (p = 0.06), and 39 +/- 12% (p < 0.01), respectively. Plethysmographic total lung capacity, RV, and functional residual capacity fell by 14 +/- 2%, 30 +/- 4%, and 18 +/- 3%, respectively (p < 0.001). All measures of chronic breathlessness improved significantly (p < 0.05). During exercise at a standardized work rate, BorgSTD fell 45% (p < 0.05), end-expiratory lung volume (EELV) fell 22% (p < 0.01), and breathing frequency (F) fell 25% (p = 0.08). By multiple stepwise regression analysis, 99% (p = 0.007) of the variance in symptom relief (delta BorgSTD) was explained by the combination of decreased ratio of the end-expiratory lung volume to total lung capacity, decreased F, and diminished mechanical constraints on tidal volume (tidal volume to vital capacity ratio). CONCLUSION: Reduced exertional breathlessness at a given workload after volume reduction surgery was attributed to a combination of reduced thoracic hyperinflation, reduced F, and reduced mechanical constraints on lung volume expansion.

Dyspnea↗

Physiologic growth and development of the lung during the first year of life.

Pulmonary function tests were performed on a total of 125 healthy infants younger than 25 postconception (pc) months of age. Maximal expiratory flow at functional residual capacity (VmaxFRC) was measured from partial expiratory flow-volume curves, and functional residual capacity (FRC) was measured by the helium dilution technique. There was a highly significant (p less than 0.01) linear regression for both VmaxFRC and FRC with increasing body length. The highest size-corrected flows (VmaxFRC/FRC) were obtained in the healthy premature (2.7 FRC/s, n = 6) and full-term (2.5 FRC/s, n = 5) infants, and there was a relatively constant value between 13 and 25 pc months of age (1.2 FRC/s), which was similar to those reported in older children and adults. In an age-matched group of infants 10 to 16 pc months of age, females had both higher absolute flows (126 versus 102 ml/s, p less than 0.03) and size-corrected flows (1.4 versus 1.0 FRC/s, p less than 0.001) than did males. These physiologic data support the concepts that neonates have proportionately larger airways relative to their lung volume at FRC, infants have size-corrected flows similar to those in older children and adults, and female infants have proportionately larger airways relative to their lung size than do male infants.

Chloral Hydrate↗

Oxygen desaturation during sleep in infants and young children with congenital heart disease.

Oxygen saturation (SaO2) during sleep and pulmonary functions were evaluated in 19 infants with congenital heart disease, aged 6 +/- 4 months, and in 11 normal infants, aged 8 +/- 5 months, to determine whether infants with congenital heart disease have more frequent oxygen desaturation during sleep and, if so, its relationship to underlying pulmonary function. Infants with congenital heart disease were classified as acyanotic (n = 11) or cyanotic (n = 8) on the basis of their aortic SaO2 at the time of cardiac catheterization (greater or less than 90% SaO2). Pulmonary function tests included respiratory rate, functional residual capacity, total respiratory system compliance, and maximal flows at functional residual capacity. Significant differences were found in the values for the lowest SaO2 of each 5-minute epoch (SaO2L) averaged during the entire sleep time (normal 94% +/- 2%, acyanotic 90% +/- 3%, and cyanotic 74% +/- 4%; p less than 0.01). The three groups also differed significantly in frequency distributions of percentage of total sleep time with SaO2L less than 90% (SaO2%T) (normal 10% +/- 17%, acyanotic 36% +/- 34%, and cyanotic 97% +/- 4%; p less than 0.05). Compared with the control group, the acyanotic group had a higher respiratory rate (66 +/- 19 breaths/min vs 35 +/- 6 breaths/min; p less than 0.01), a lower tidal volume (65% +/- 29% predicted vs 105% +/- 18% predicted; p less than 0.01), and a lower total respiratory compliance (59% +/- 18% predicted vs 106% +/- 30% predicted; p less than 0.01). A negative correlation existed between SaO2%T and aortic SaO2 (R2 = 0.64; p less than 0.01). We conclude that oxygen desaturation occurs during sleep in infants with congenital heart disease; the presence of desaturation appears to be related to the initial degree of hypoxemia and the presence of abnormal pulmonary function.

Cyanosis↗

Evaluation of human diaphragm contractility using mouth pressure twitches.

Mouth (PmT), esophageal (PesT), and transdiaphragmatic pressure twitches (PdiT) in response to single supramaximal bilateral phrenic nerve shocks were recorded during relaxation between total lung capacity (TLC) and functional residual capacity (FRC) in five normal volunteers. The PmT versus PesT or PmT versus PdiT relationships, which were linearly correlated (all r greater than 0.76), were not affected by diaphragm fatigue and were reproducible on repeated determinations over a period exceeding 1 yr. The PmT versus lung volume relationship was also linear (all r greater than 0.72) and reproducible, and its changes following diaphragm fatigue reliably reflected the changes in diaphragm contractility. We conclude that PmT is a reliable measure of diaphragm pressure-generating capacity in normal individuals and has the potential of providing similar information in patients.

Adult↗

Hyperinflation: control of functional residual lung capacity.

Hyperinflation is the consequence of a dysbalance of static forces (determining the relaxation volume) and/or of the dynamic components. The relaxation volume is determined by an equilibrium between the elastic recoil of the lungs and of the chest walls. The dynamic components include the pattern of breathing, upper airway resistance and postinspiratory activity of inspiratory muscles. The respiratory and laryngeal muscles are under control and thus both static and dynamic hyperinflation can be secured. Our knowledge of the mechanism of increased FRC is based on clinical observations and on experiments. The most frequent stimuli leading to a dynamic increase of functional residual lung capacity (FRC) include hypoxia and vagus afferentation. Regulation of FRC is still and undetermined concept. The controlled increase of FRC, hyperinflation, participates in a number of lung diseases.

Animals↗

Pulmonary diffusing capacity in lambs during the early neonatal period.

A rebreathing method was used to make 53 measurements of pulmonary diffusing capacity (DLco) and functional residual capacity (FRC) in 17 newborn lambs during the first 2 days of life. DLco, FRC, and DLco/FRC all increased in studies made at 24--48 hr of age compared to those at 2--4 hr of age: DLco 0.86 +/- 0.18 to 1.52 +/- 0.09 ml/min/torr; FRC 37 +/- 10 to 60 +/- 8 ml and DLco/FRC 2.52 +/- 0.75 to 2.89 +/- 0.37 ml/min/torr/ml X 10(-2). DLco measured using 0.005% CO in the test gas was not different than that measured using 0.5% CO.

Animals↗

Serial determination of lung volume in small animals by nitrogen washout.

This report describes the design of an apparatus and the procedures used to serially measure the total lung capacity and the functional residual capacity of small animals utilizing the N2-washout technique. The calibration data indicate that the technique is accurate to within 1 ml and has a variance of less than 5%. The in vivo lung volume measurements of rats were validated by comparing them with values obtained with a water-displacement technique; the means were within 0.3 ml. Examples of the precision and changes in lung volume of animals during studies are included to demonstrate the reliability and usefulness of the technique.

Animals↗

Localized compliance of small airways in excised rat lungs using microfocal X-ray computed tomography.

Airway compliance is a key factor in understanding lung mechanics and is used as a clinical diagnostic index. Understanding such mechanics in small airways physiologically and clinically is critical. We have determined the "morphometric change" and "localized compliance" of small airways under "near"-physiological conditions; namely, the airways were embedded in parenchyma without dehydration and fixation. Previously, we developed a two-step method to visualize small airways in detail by staining the lung tissue with a radiopaque solution and then visualizing the tissue with a cone-beam microfocal X-ray computed tomography system (Sera et al. J Biomech 36: 1587-1594, 2003). In this study, we used this technique to analyze changes in diameter and length of the same small airways ( approximately 150 microm ID) and then evaluated the localized compliance as a function of airway generation (Z). For smaller (<300-microm-diameter) airways, diameter was 36% larger at end-tidal inspiration and 89% larger at total lung capacity; length was 18% larger at end-tidal inspiration and 43% larger at total lung capacity than at functional residual capacity. Diameter, especially at smaller airways, did not behave linearly with V(1/3) (where V is volume). With increasing lung pressure, diameter changed dramatically at a particular pressure and length changed approximately linearly during inflation and deflation. Percentage of airway volume for smaller airways did not behave linearly with that of lung volume. Smaller airways were generally more compliant than larger airways with increasing Z and exhibited hysteresis in their diameter behavior. Airways at higher Z deformed at a lower pressure than those at lower Z. These results indicated that smaller airways did not behave homogeneously.

Animals↗

Critical evaluation of computerised x ray planimetry for the measurement of lung volumes.

BACKGROUND: Computerised x-ray planimetry has been advocated as an alternative to body plethysmography and helium dilution for measuring static lung volumes. The accuracy and reproducibility of this method has been assessed in comparison with these standard methods. METHODS: Plethysmographic and planimetric measurements of total lung capacity (TLC) and functional residual capacity (FRC) were made in 10 normal subjects and in 12 patients with chronic obstructive pulmonary disease (COPD), with additional helium dilution measurements in the latter 12 patients. RESULTS: Mean lung volumes (TLC and FRC) for groups of subjects measured by planimetry and by plethysmography were similar in both groups and larger than the helium dilution measurement in patients with COPD. Intraindividual agreement between planimetry and plethysmography was poor, however, with a wide confidence interval (-2.2 to +2.31). The planimeter did not measure reliably changes in volume from TLC to FRC in individuals. CONCLUSIONS: Mean lung volumes measured by planimetry in a group of patients probably reflect a regression to the mean of the computer algorithm rather than accurate TLC estimation. The technique is not yet robust enough to replace the established techniques of helium dilution or plethysmography.

Adult↗

Lung volumes 24 h after laparoscopic cholecystectomy--justification for early discharge.

OBJECTIVE: To compare lung volumes after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). DESIGN: Prospective study with matched historical controls. SETTING: Referral teaching hospital. SUBJECTS: Twenty-six healthy female subjects (age 20 to 40 years), 13 of whom had LC. MAIN OUTCOME MEASURES: Vital capacity (VC, % predicted), functional residual capacity (FRC, % predicted) and analgesic frequency (mean +/- SD) over the first 24 h. RESULTS: Immediately after operation, FRC was similarly depressed to 80.4 +/- 1.8% in the OC group and 80.8 +/- 2.3% in the LC group. After 24 h FRC fell to 70.5 +/- 1.9% in the OC group and increased to 91.3 +/- 2.4% in the LC group. VC fell immediately postoperation to 41.4 +/- 4.8% in the OC group but to only 62.2 +/- 1.9% in the LC group. By 24 h, VC improved slightly to 52.5 +/- 2.7% in the OC group but returned to normal, 99.0 +/- 3.2%, in the LC group. Postoperative analgesic frequency over 24 h was less in the LC group, 3.3 +/- 0.8 versus 5.0 +/- 0.8. CONCLUSION: Depression in lung volume is less with LC. A VC that returned to normal and a FRC level not usually associated with pulmonary complications support the practice of discharging LC patients by 24 h postoperation.

Adult↗

Effect of pneumococcal lobar pneumonia on canine lung mechanics.

We produced left lower lobe (LLL) pneumococcal pneumonia in seven dogs and measured lung volumes and pulmonary mechanics before (day 1) and 48 h after (day 3) development of the infection. Compared with seven control dogs, total lung capacity (TLC) and functional residual capacity (FRC) decreased 550 and 140 ml, respectively, representing a 15% reduction from the initial value in both cases. Compliance measured during tidal breathing decreased by 30%, and even when corrected for the smaller FRC on day 3, specific compliance (CLsp) was reduced. At autopsy, the infected LLL had an excess weight of 89 g, and its 50% reduction in gas volume accounted for the decrease in TLC from day 1 to day 3. Compared with control dogs, there were no changes in the deflation pressure-volume curves of the noninfected lung of the pneumonia dogs. These results indicate that the reduction in TLC in bacterial lobar pneumonia was small and resulted from the reduced gas volume of the infected lobe. Assuming that the increased weight gain in the LLL represented 89 ml of exudate that filled alveoli, we propose that bacterial pneumonia reduced gas volume at FRC by filling alveoli with inflammatory exudate and further decreased TLC by preventing these alveoli from inflating. The reduced CLsp suggested nonventilation of air spaces in addition to those that were liquid filled and was consistent with nonventilation of the entire LLL.

Animals↗

Influence of posture and sustained loss of lung volume on pulmonary function in awake asthmatic subjects.

Nocturnal worsening occurs commonly in the asthmatic patient population and contributes substantially to the morbidity and even mortality of asthma. However, no physiologic process has yet been identified as the major contributor to this pattern. Sleep is typically associated with both the supine posture and substantial decrements in lung volume, and both have been proposed to have a role in the pattern of nocturnal worsening. To assess the effects of posture and sleep-associated reductions in functional residual capacity on pulmonary function, eight asthmatic patients were first monitored overnight in a horizontal volume-displacement body plethysmograph to determine mean FRC during sleep for each subject. We then compared, during wakefulness, the effects on FEV1 and methacholine responsiveness from chest wall and abdomen strapping (to maintain FRC at mean sleep levels) for 6 h in the supine and upright postures. FEV1 was significantly decreased after strapping in the supine posture (2.54 +/- 0.36 versus 3.38 +/- 0.29 L on control day, p = 0.0001) but was not affected by strapping in the upright posture (3.07 +/- 0.30 versus 3.34 +/- 0.31 L on control day, not significant, NS). Bronchial responsiveness to methacholine was not altered after strapping in either posture. These observations suggest that the supine posture, in conjunction with the reduction in lung volume associated with sleep, may contribute to the nocturnal worsening of asthma.

Adult↗