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PubMed1984

Nighttime ventilation improves respiratory failure in secondary kyphoscoliosis.

Four patients with cardiorespiratory failure caused by secondary kyphoscoliosis were studied. Polycythemia, cor pulmonale, restrictive lung pattern (functional residual capacity (FRC), 17 to 27% predicted; vital capacity (VC), 11 to 23% predicted), and abnormal arterial blood gases, primarily hypoventilation (PaO2, 31 to 44 mm Hg; PaCO2, 52 to 73 mm Hg), were seen in all. Supplementary oxygen, digoxin, diuretics, 15 min of intermittent positive-pressure breathing with inspired pressure (PI) 25 cm H2O 4 times daily, and tracheostomy failed to produce improvement. However, 12 h of nighttime ventilation (NTV) with PI 28 to 35 cm H2O through a permanent tracheostomy proved effective. Within 72 h, dyspnea at rest, restless sleep, and frequent waking resolved. Within 8 to 22 days, the PaO2 was approximately 58 mmHg and the PaCO2 was approximately 41 mm Hg while breathing 21% oxygen spontaneously during the day. The right heart failure resolved within 2 to 7 wk, and the hemoglobin count decreased to approximately 165 g/L within 2 to 6 months. There was a mean increase of 700 ml (72%) in functional residual capacity and 430 ml (49%) in vital capacity. The patients were discharged 2 days to 5 wk after NTV commenced. Daytime activity increased, approaching a normal life style. The improvement was sustained over a mean follow-up period of 3.4 yr. Problems included recurrent episodes of tracheobronchitis, mild self-limiting hemoptysis, and speech modification. Nighttime ventilation may be an effective alternative for long-term treatment of cardiorespiratory failure caused by secondary kyphoscoliosis.

Adult↗
PubMed2002

Partial liquid ventilation: Effect of initial dose and redosing strategy in acute lung injury.

OBJECTIVE: Partial liquid ventilation (PLV) with perfluorochemicals has been shown to be effective in treating acute respiratory failure in animal studies and human trials. To determine the influences of perfluorochemicals on initial dose and redosing strategy, we studied their effects on gas exchange, pulmonary mechanics, and lung architecture. DESIGN: After lung injury was induced by repeated warm saline lavages, the animals were instilled endotracheally with different doses of perflubron during 5-10 mins in PLV-treated groups. The animals were randomized to five groups: PLV-12S (12 mL/kg perflubron, single dose), PLV-12M (12 mL/kg perflubron, multiple replacement doses), PLV-18S (18 mL/kg perflubron, single dose), PLV-18M (18 mL/kg perflubron, multiple replacement doses), and the control group (conventional mechanical ventilation only). Ventilator settings were kept constant during the 4-hr experiment. SETTING: An animal laboratory affiliated with Temple University School of Medicine. SUBJECTS: Twenty-eight New Zealand White juvenile rabbits (weight, 1.96 +/- 0.03 kg). INTERVENTIONS: Physiologic data were recorded every 30 mins. A constant volume (1.3 mL/kg/hr) of perflubron was replaced hourly in the PLV-12M and PLV-18M groups. The perflubron in the expired gas was measured with a thermal detector device. The hourly evaporative loss rate and the estimated residual perfluorochemical amount were calculated and analyzed. Histologic examinations of the lungs were performed. MEASUREMENTS AND MAIN RESULTS: All animals in the PLV-treated groups (PLV-12S, n = 4; PLV-12M, n = 5, PLV-18S, n = 5; PLV-18M, n = 4) demonstrated improvements in gas exchange and respiratory compliance that were significantly (p <.05) better than the control group (n = 8). However, the PLV-12S group demonstrated progressive deterioration after the initial improvement. The loss rate of perflubron did not differ among the PLV-treated groups (1.17 +/- 0.03 mL/kg/hr), but the residual perfluorochemical volume in the lungs decreased progressively and significantly in the PLV-12S and PLV-18S groups as a function of time (p <.05). Histologic examination showed good alveolar protection in the PLV-12M, PLV-18S, and PLV-18M groups. CONCLUSIONS: We conclude that the low initial dose (12 mL/kg, about two thirds the functional residual capacity volume of rabbits) of perflubron required hourly replacement to maintain the effects of PLV. With a high initial dose of 18 mL/kg perflubron (equal to a full functional residual capacity volume in rabbits), the responses are potentiated in both single and multiple dosing groups up to 4 hrs.

Journal Article↗
PubMed1976

Lung volumes and compliance in myasthenia gravis and reversible airway obstruction.

A patient with myasthenia gravis, reversible airway obstruction, and a vertical chest wall pressure-volume curve was shown to inflate his lungs to 12 liter during the night. During the day, either spontaneously or after isoproterenol, his functional residual capacity decreased by more than 2 liter. The large lung volume changes occurred without a change in slope of the static pressure-volume curve of the lung above functional residual capacity. The changes in the position of this curve might be due to the the very slow filling and emptying of bullae or to unexplained alterations in the length-tension characteristics of the alveoli. The vertical pressure-volume curve of the chest wall suggested that, unlike other patients who have normal or decreased chest wall compliance, this patient's chest wal was not a factor that limited ventilation at high lung volumes.

Airway Obstruction↗
PubMed1977

A rebreathing method for measuring carbon monoxide diffusing capacity. A supplement to the single-breath method.

A rebreathing method for measuring carbon monoxide diffusing capacity is described. The method can be used in patients whose vital capacity is too small, or whose cooperation is inadequate, for the single-breath method. The apparatus is simple and the same gas mixtures are used as for the single-breath method. The results obtained by the rebreathing method are similar to those by the single-breath method (80% of the results by the rebreathing method lie within 20% of the value by the single-breath method). The rebreathing method also provides a measurement of the functional residual capacity.

Carbon Monoxide↗
PubMed1988

Sustained inflation during HFOV improves pulmonary mechanics and oxygenation.

Effective use of high-frequency oscillatory ventilation (HFOV) may require maintenance of adequate lung volume to optimize gas exchange. To determine the impact of inflation during HFOV, sustained inflation was applied at pressures of 5, 10, and 15 cmH2O above mean airway pressure for 3, 10, and 30 s to 15 intubated, paralyzed, anesthetized rabbits after saline lavage to induce surfactant deficiency. Arterial blood gases were recorded in all rabbits while static compliance, resistance, time constant, and changes in functional residual capacity were recorded using the interrupter technique and plethysmograph in seven rabbits. Parameters were recorded before and 2 min after sustained inflation. Arterial PO2, compliance of the respiratory system, and functional residual capacity increased after sustained inflation at pressure levels of at least 10 cmH2O and 10-s duration. As the presence or duration of a sustained inflation was increased, oxygenation improved (P less than or equal to 0.01), but arterial PCO2 increased as longer sustained inflations were used (P less than or equal to 0.005). Sustained inflations of 5 cmH2O above mean airway pressure or of 3-s duration were ineffective. We conclude that either a critical pressure or duration of sustained inflation is needed to improve oxygenation and pulmonary mechanics during HFOV.

Animals↗
PubMed1997

Respiratory system mechanics in sedated, paralyzed, morbidly obese patients.

The effects of inspiratory flow and inflation volume on the mechanical properties of the respiratory system in eight sedated and paralyzed postoperative morbidly obese patients (aged 37.6 +/- 11.8 yr who had never smoked and had normal preoperative seated spirometry) were investigated by using the technique of rapid airway occlusion during constant-flow inflation. With the patients in the supine position, we measured the interrupter resistance (Rint,rs), which in humans probably reflects airway resistance, the "additional" resistance (delta Rrs) due to viscoelastic pressure dissipation and time-constant inequalities, and static respiratory elastance (Est,rs). Intra-abdominal pressure (IAP) was measured by using a bladder catheter, and functional residual capacity was measured by the heliumdilution technique. The results were compared with a previous study on 16 normal anesthetized paralyzed humans. Compared with normal persons, we found that in obese subjects: 1) functional residual capacity was markedly lower (0.645 +/- 0.208 liter) and IAP was higher (24 +/- 2.2 cmH2O); 2) alveolar-arterial oxygenation gradient was increased (178 +/- 59 mmHg); 3) the volume-pressure curve of the respiratory system was curvilinear with an "inflection" point; 4) Est,rs, Rint,rs, and delta Rrs were higher than normal (29.3 +/- 5.04 cmH2O/l, 5.9 +/- 2.4 cmH2O.l-1.s, and 6.4 +/- 1.6 cmH2O.l-1.s, respectively); 5) Rint,rs increased with increasing inspiratory flow, Est,rs did not change, and delta Rrs decreased progressively; and 6) with increasing inflation volume, Rint,rs and Est,rs decreased, whereas delta Rrs rose progressively. Overall, our data suggest that obese subjects during sedation and paralysis are characterized by hypoxemia and marked alterations of the mechanical properties of the respiratory system, largely explained by a reduction in lung volume due to the excessive unopposed IAP.

Adult↗
PubMed2001

Alveolar recruitment promotes homogeneous surfactant distribution in a piglet model of lung injury.

Uneven distribution of exogenous surfactant contributes to a poor clinical response in animal models of respiratory distress syndrome. Alveolar recruitment at the time of surfactant administration may lead to more homogeneous distribution within the lungs and result in a superior clinical response. To investigate the effects of three different volume recruitment maneuvers on gas exchange, lung function, and homogeneity of surfactant distribution, we studied 35 newborn piglets made surfactant deficient by repeated airway lavage with warm saline. Volume recruitment was achieved by either a temporal increase in tidal volume or an increase in end-expiratory pressure during surfactant administration, yielding an increase in dynamic compliance of the respiratory system of 77% in the first group and an increase in functional residual capacity of 108% in the second group. A third group of piglets (all n = 7) received a combination of both volume recruitment maneuvers, with increases in dynamic compliance of the respiratory system of 100% and in functional residual capacity of 192%. Those animals subjected to increased tidal volume showed an improved surfactant response in terms of oxygenation, ventilation, lung volumes, lung mechanics, and homogeneity of surfactant distribution. Increased end-expiratory volume augmented the surfactant effect only to some extent. The combination of both volume recruitment maneuvers, however, needed lung volumes beyond total lung capacity (approximately 56 mL/kg), thus probably inducing early sequelae of ventilator-induced lung injury. We conclude that volume recruitment by means of increased tidal volumes at the time of surfactant administration leads to a superior surfactant effect owing to more homogeneous surfactant distribution within a collapsed lung.

Animals↗
PubMed2006

Pulmonary function assessment in an infant with Barnes syndrome: proactive evaluation for surgical intervention.

Our aim for this study was to report pulmonary mechanics in a neonate with a severe case of Barnes syndrome, a rare form of thoracolaryngopelvic dysplasia, and to use these data to guide ventilatory support and serve as a presurgical screening tool. A comprehensive pulmonary function evaluation was performed on a 36-day-old patient with Barnes syndrome who was being mechanically ventilated because of severe pulmonary distress secondary to thoracic dystrophy. The measurements consisted of respiratory volumes including functional residual capacity, ventilatory mechanics including compliance and resistance, and thoracoabdominal synchrony. Chest wall compliance was 64% below normal, and the thoracoabdominal motion was indicative of predominantly abdominal displacement during inspiratory breaths. The lungs were functioning at a low functional residual capacity, resulting in low lung compliance and increased pulmonary resistance. As a result of the evaluation, the patient was recommended for lateral thoracic expansion surgery and the ventilatory management was adjusted to focus on end-distending pressure support.

Abnormalities, Multiple↗
PubMed2003

[Pulmonary function test before and after operation of coronary artery by-pass surgery].

Respiratory complications after successful CABG operation continuous to have on influence on the immediate recovery of a patient. It was reported that the mortality risk of the CABG patients increased, proportional to the reduction of pulmonary function tests (PFT). In the present study we aimed to investigate PFT values (vital capacity: VC, total lung capacity: TLC, residual volume: RV, functional residual capacity: FRC, force expiratory volume first second: FEV1, force mid expiratory flow: FEF25-75, duration force expiratory flow in vital capacity 25%: FEF25, duration force expiratory flow in vital capacity 50%: FEF50, duration force expiratory flow in vital capacity 75%: FEF75, peak expiratory flow: PEF, RV/TLC, FEF/FIF, FEV1/FVC) and arterial blood gases (pH, PaCO2, PaO2, SaO2) pre- and postoperatively which undergo CABG. The PFT and arterial blood gases values of 20 patients, age between 39-74 years, were measured that were undergo CABG operation before a week and three months after.The measured PFT values of 20 patients were recorded by system 2400 computerized and sensor medix 6200 and arterial blood gases analysed by radiometer ABL 300. The results were compared by the time and periods of before and after CABG operation, statistically evaluated the pearson's correlation and Student's t-test. In the results the postoperative PFT values were significantly decreased (p< 0.05, p< 0.001). But the RV, RV% and RV/TLC values were not changed significantly. In arterial blood gases values were not significantly changes. To avoid the postoperative complications we suggested that should be done the PFT and arterial blood gases measurement preoperatively.

Adult↗
PubMed1982

Respiratory mechanics of a small carnivore: the ferret.

The ferret, Mustela putorius furo, is a small relatively inexpensive carnivore with minimal housing requirements. Measurements were made from anesthetized tracheotomized supine males. Values obtained during tidal breathing for six animals (576 +/- 12 g) were as follows: tidal volume, 6.06 +/- 0.30 ml; respiratory frequency, 26.7 +/- 3.9 breaths min-1; dynamic lung compliance, 2.48 +/- 0.21 ml cmH2O-1; pulmonary resistance, 22.56 +/- 1.61 cmH2O . l-1 . s. Pressure-volume curves from nine ferrets revealed almost infinitely compliant chest walls so that lung and total respiratory system curves were essentially the same. Total lung capacity (TLC, 89 +/- 5 ml) and functional residual capacity (17.8 +/- 2.0 ml) were determined by gas freeing the lungs in vivo. The TLC of these ferrets is about the same as in 2.5-kg rabbits. Maximum expiratory flow-volume curves showed peak flows of 10.1 vital capacities (VC) . s-1 at 75% VC and flows of 8.4 and 5.4 VC . s-1 at 50 and 25% VC.

Animals↗
PubMed1982

3-methylindole-induced pulmonary toxicosis in ponies.

In unanesthetized ponies, arterial blood gas tensions, pulmonary mechanics, and lung volumes were determined before and 24 to 48 hours after oral administration of 500 ml of corn oil or 100 mg of 3-methylindole (3MI)/kg of body weight in 500 ml of corn oil. In the latter group, variables were also measured after bilateral cervical vagotomy. Respiratory rate and minute ventilation were increased by 3MI treatment and decreased after vagotomy, suggesting that the tachypnea induced by 3MI was vagally mediated. The arterial O2 tension (PaO2) was unaffected but arterial CO2 tension (PaCO2) decreased below base line after 3 MI and vagotomy. Specific respiratory conductance and dynamic compliance wee decreased by 3MI. Specific conductance increased again after vagotomy. Functional residual capacity, which increased after 3MI, was unaffected by vagotomy. Total lung capacity and quasistatic compliance were unaffected by either treatment. Minimal volume was larger in 3MI-treated ponies than in untreated ponies. Decreased dynamic compliance and specific respiratory conductance and increased functional residual capacity and minimal volume are all compatible with small airway obstruction produced by the necrotizing bronchiolitis and bronchiolar obstruction observed histologically in 3MI-treated ponies.

Animals↗
PubMed1997

Kinematics and mechanics of midcostal diaphragm of dog.

Radiopaque markers were attached to the peritoneal surface of three neighboring muscle bundles in the midcostal diaphragm of four dogs, and the locations of the markers were tracked by biplanar video fluoroscopy during quiet spontaneous breathing and during inspiratory efforts against an occluded airway at three lung volumes from functional residual capacity to total lung capacity in both the prone and supine postures. Length and curvature of the muscle bundles were determined from the data on marker location. Muscle lengths for the inspiratory states, as a fraction of length at functional residual capacity, ranged from 0.89 +/- 0.04 at end inspiration during spontaneous breathing down to 0.68 +/- 0.07 during inspiratory efforts at total lung capacity. The muscle bundles were found to have the shape of circular arcs, with the three bundles forming a section of a right circular cylinder. With increasing lung volume and diaphragm displacement, the circular arcs rotate around the line of insertion on the chest wall, the arcs shorten, but the radius of curvature remains nearly constant. Maximal transdiaphragmatic pressure was calculated from muscle curvature and maximal tension-length data from the literature. The calculated maximal transdiaphragmatic pressure-length curve agrees well with the data of Road et al. (J. Appl. Physiol. 60: 63-67, 1986).

Animals↗
PubMed1976

Esophageal elastance in awake and anesthetized recumbent dogs.

Esophageal elastance was measured in trained dogs placed in the prone, supine, and left lateral postures before and during sodium thiopental anesthesia. Esophageal elastance was measured from static pressure-volume curves and during spontaneous breathing at functional residual capacity. There was a significant decrease in esophageal elastance, estimated from the pressure-volume curves, during anesthesia in both prone and lateral positions but not in the supine posture. Changes in vagal tone produced by stimulation of the vagal nerves did not alter esophageal elastance. Therefore, underlying mechanisms for these changes in esophageal elastance are not fully understood. There was an increase in esophageal elastance when lung volumes increased from 55 to 80% total lung capacity. However, we did not find a significant change in esophageal elastance between awake and anesthetized conditions or between positions during spontaneous breathing at functional residual capacity.

Anesthesia↗
PubMed1975

A comparative study of atropine sulfate and isoproterenol hydrochloride in chronic bronchitis.

Fifteen subjects with chronic bronchitis were treated with inhaled atropine sulfate, isoproterenol hydrochloride, or placebo in a double blind crossover trial. Each drug was inhaled 4 times per day for 3 weeks. Baseline forced expiratory flows, specific airway conductance, airway resistnace, and functional residual capacity were measured weekly. These measurements were repeated 15 min and 60 min after laboratory inhalation of each agent, using a separate double blind protocol. No significant differences were observed among the mean baseline function studies during the 3 treatment periods. There were no significant differences in sputum production, sputum thickness, dyspnea, or mouth dryness among the 3 treatment periods. Side effects were mild; isoproterenol treatment was associated with an increased frequency of palpitations, and atropine treatment was associated with difficulty in voiding. Significant increases in lung function were apparent in the measurements made 15 min and 60 min after inhalation of atropine or isoproterenol. Mean values of flow and specific airway conductance increased, and mean values of airway resistance and functional residual capacity decreased after inhalation of either drug. There was no significant difference between the effects of atropine and isoproterenol on lung function, although both differed significantly from the effects of placebo (P less than 0.001). Inhaled atropine sulfate was as effective a bronchodilator as inhaled isoproterenol hydrochloride, and was well tolerated during the 3-week trial of daily therapy.

Adult↗
PubMed1995

Pulmonary sympathetic denervation does not increase airway resistance in patients with chronic obstructive pulmonary disease (COPD).

Whether or not neural blockade of pulmonary sympathetic innervation is of relevance for airway resistance in patients with chronic obstructive pulmonary disease (COPD) is unknown. Accordingly we evaluated airway resistance during sympathetic blockade by high thoracic epidural anaesthesia in patients with COPD. Before and 45 min after thoracic epidural injection of bupivacaine 0.75% (6-8 ml; n = 10) total respiratory resistance (oscillometry, ROS), vital capacity (VC), forced expiratory vital capacity in 1 s (FEV1, [%VC]), functional residual capacity (FRC; helium dilution method), and arterial blood gases were measured. Three additional patients received bupivacaine intravenously (1.2 mg.min-1 for 45 min), another three received saline epidurally. Sensory blockade covered segment C5 through T8. As an indicator of widespread sympathetic blockade including the lungs, skin temperature increased significantly on thumb and little toe. Despite pulmonary sympathetic denervation ROS, FEV1, and FRC remained unchanged, while VC decreased slightly, probably due to intercostal muscle blockade. Blood gases remained constant. Neither intravenous bupivacaine nor epidural saline evoked directional changes. Since, in contrast to beta-adrenoceptor blockade, pulmonary sympathetic denervation did not increase airway resistance in patients with COPD, neural sympathetic blockade seems to be of no relevance for airway resistance in these patients.

Airway Resistance↗
PubMed1975

Mechanical properties of the lungs and experimental asthma in conscious allergic dogs.

Three allergic dogs were trained to swallow an esophageal balloon, breathe through a tracheostomy tube, and stand quietly in a wooden stall. The mechanical properties of their lungs were measured reproducibly over many months. Average values were: pulmonary resistance 1.33 cmH2O/l per s, static lung compliance 104 ml/cmH2O, and functional residual capacity 982 ml. In two dogs inhalation of histamine aerosol caused a 374% increase in resistance; inhalation of Ascaris suum aerosol caused a 307% increase in resistance. The increased resistance was associated with mild-to-moderate respiratory distress and slightly increased functional residual capacity. Aerosols of isoproterenol or atropine sulfate inhibited the increased resistance. We conclude that the conscious allergic dog is a suitable subject for the long-term study of asthma. Our present results are consistent with our earlier findings in anesthetized dogs, that a vagal reflex is involved in acute bronchomotor responses to inhalation of histamine as well as specific antigen.

Airway Resistance↗
PubMed1982

Pulmonary effects of intravenous histamine in the conscious pony: dose-response relationships and reproducibility.

In standing sedated ponies, we measured dynamic lung compliance (Cdyn) and pulmonary resistance (RL) during IV infusion of various doses of histamine; this was done in a given pony 3 times at 1-week intervals between experiments. Histamine doses causing a decrease in Cdyn of 50% and 75% and an increase in RL of 300% and 600% (ED50Cdyn, ED75Cdyn, ED300RL and ED600RL, respectively) were interpolated from the histamine dose-response curves. We also measured respiratory frequency, tidal volume, minute ventilation, functional residual capacity, arterial oxygen tension, arterial carbon dioxide tension, arterial oxygen tension, arterial blood pressure before and after infusion of histamine sufficient to cause a decrease in Cdyn of at least 75% and at least a 600% increase in RL. Histamine decreased arterial oxygen tension and functional residual capacity, but did not alter arterial carbon dioxide tension, pH, respiratory frequency, tidal volume, minute ventilation, and mean arterial blood pressure. There was at least a 6-fold variability in ED50Cdyn, ED75Cdyn, ED300RL, and ED600RL between ponies, but these values were very reproducible for each individual. The ED50Cdyn, ED75Cdyn, ED300RL, and ED600RL all decreased with increasing age.

Airway Resistance↗