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Plethysmographic estimation of thoracic gas volume in apneic mice.

Electrical stimulation of intercostal muscles was employed to measure thoracic gas volume (TGV) during airway occlusion in the absence of respiratory effort at different levels of lung inflation. In 15 tracheostomized and mechanically ventilated CBA/Ca mice, the value of TGV obtained from the spontaneous breathing effort available in the early phase of the experiments (TGVsp) was compared with those resulting from muscle stimulation (TGVst) at transrespiratory pressures of 0, 10, and 20 cmH2O. A very strong correlation (r2= 0.97) was found, although with a systematically (approximately 16%) higher estimation of TGVst relative to TGVsp, attributable to the different durations of the stimulated (approximately 50 ms) and spontaneous (approximately 200 ms) contractions. Measurements of TGVst before and after injections of 0.2, 0.4, and 0.6 ml of nitrogen into the lungs in six mice resulted in good agreement between the change in TGVst and the injected volume (r2= 0.98). In four mice, TGVsp and TGVst were compared at end expiration with air or a helium-oxygen mixture to confirm the validity of isothermal compression in the alveolar gas. The TGVst values measured at zero transrespiratory pressure in all CBA/Ca mice [0.29 +/- 0.05 (SD) ml] and in C57BL/6 (N = 6; 0.34 +/- 0.08 ml) and BALB/c (N = 6; 0.28 +/- 0.06 ml) mice were in agreement with functional residual capacity values from previous studies in which different techniques were used. This method is particularly useful when TGV is to be determined in the absence of breathing activity, when it must be known at any level of lung inflation or under non-steady-state conditions, such as during pharmaceutical interventions.

Animals↗

[Functional status of the bronchial tree in infants with gastroesophageal reflux].

Airway resistance (Raw) and functional residual capacity (FRC pl) were determined by plethysmography in 17 children aged 3 to 12 months. Gastroesophageal reflux was diagnosed on the ground of longterm monitoring of esophageal pH or the X-ray examination of the stomach. No elevated airway resistance was found. In 41% of the cases FRC (per kg of body weight) was increased. This indirectly indicates the diminished small airways patency.

Airway Resistance↗

Lung volume and pleural pressure in the anesthetized hamster.

Lung volumes and respiratory pressures were measured in anesthetized male hamsters weighing an average 117 g. In 16 supine animals functional residual capacity (FRC) determined by body plethysmograph was 1.12 +/- 0.23 (SD) ml (about 20% total lung capacity, TLC) slightly and significantly larger than the FRC measured by saline displacement, 1.01 +/- 0.15 ml. Similar results were found in six prone animals. Paralysis did not significantly alter supine FRC. Contrary to published reports, pleural pressure (Ppl) estimated from esophageal pressure was negative at FRC. The fact that lung volume decreased by 0.2 ml (about 4% TLC) when the chest was opened at FRC provided additional evidence of negative Ppl at FRC. No consistent changes in the lung pressure-volume curve were found after the chest was opened. Deflation chest wall compliance just above FRC was about twice lung compliance. The vital capacity and reserve volumes in this study agreed with values reported in the literature. However, absolute lung volumes (TLC, FRC, and residual volume) were lower by about 1.4 ml, possibly because of earlier overestimates of box FRC.

Animals↗

[Influence of pulmonary recruitment on exogenous surfactant effects].

An experimental model was devised to study the effects of a sustained insufflation maneuver on the immediate response to exogenous surfactant administration and the effects of baseline pulmonary volume subsequently used in 20 adult albino rats. Lung-injury was induced by repeated lavages with saline solution. Gas exchange, hemodynamic status, lung mechanics and histopathology were assessed. The rats were divided into four experimental groups. Group 1 was delivered 30 cm H2O sustained insufflation over 15 seconds prior to the surfactant. It was subsequently ventilated at positive end-expiratory pressure (PEEP) of 10 cm H2O. Group 2 did not receive sustained insufflation and was ventilated at PEEP of 10 cm H2O. Group 3 was delivered sustained insufflation and was ventilated with PEEP of 4 cm H2O; and group 4 did not receive sustained insufflation and was ventilated with PEEP of 4 cm H2O. The surfactant immediate effect was not modified by previous sustained insufflation administration. Increased PaO2 associated to high functional residual capacity (FRC) (Group 1 p = 0.0001; Group 2 p = 0.0001), regardless of sustained insufflation, was observed. The use of sustained insufflation prior to surfactant administration along with high FRC ventilation was associated with polymorphonuclear infiltrates beneath the bronchiolar epithelium (p = 0.008). Our results do not advocate the use of sustained insufflation prior to the administration of exogenous surfactant.

Animals↗

[Weaning postoperative artificial respiration in cardiac surgery patients, CPAP versus ZEEP].

Pulmonary lesions following extracorporeal circulation (ECC) are said to be responsible for decreased functional residual capacity (FRC). Weaning from controlled mechanical ventilation (CMV) in the postoperative period is commonly performed by a CPAP system in order to restore the impaired oxygen exchange. Testing the superiority of CPAP against insufflation at atmospheric pressure (ZEEP), 33 patients after coronary bypass grafting (CABG) underwent from the end of CMV till extubation either CPAP or ZEEP in a randomized distribution. Data sampling included respiratory rate, paO2, paCO2 and AaDO2-Quotient (gas exchange), as well as HR, MAP, CVP and LAP (hemodynamics). None of the obtained data showed statistical significant differences between the CPAP and the ZEEP group. Therefore there appears to be no necessity for CPAP when weaning CABG patients, due to the absence of previous lung damage and the short time range of intubation and CMV.

Air Pressure↗

The influence of lung volume reduction surgery on exercise in patients with COPD.

Although the influence of lung volume reduction surgery (LVRS) on incremental- and constant-power exercise is important in the evaluation of this procedure for patients with chronic obstructive pulmonary disease (COPD), it is rarely reported even in large randomised controlled trials. This report describes 39 patients with severe COPD ((mean +/- SE) forced expiratory volume in one second 32 +/- 2% pred, functional residual capacity 195 +/- 6% pred) who participated in a randomised controlled trial of LVRS and who completed incremental exercise tests at 6 months as well as endurance tests (constant power of 25 +/- 1 W) at 3, 9 and 12 months. Peak oxygen uptake (V'O2,pk) was similar between the treatment (n = 19) and control groups (n = 20) at baseline. After LVRS, the treatment group had a significantly greater V'O2,pk (mean difference (95% CI) 1.28 (0.07-2.50) mL x kg x min(-1)) and power (13 (6-20) W). The treatment group achieved a significantly greater minute ventilation (7.1 (2.9-11.3) L x min(-1)) with a greater tidal volume (0.16 (0.04-0.28) L). Baseline endurance was similar between groups. After surgery, there were significant between-group differences in endurance time, which were maintained at 12 months (7.3 (3.9-10.8) min). Lung volume reduction surgery is associated with an increase in exercise capacity and endurance, as compared with conventional medical treatment.

Aged↗

Pulmonary function tests in preschool children with asthma.

Pulmonary function tests are seldom performed in preschool children with asthma. The aim of this multicenter study was to compare pulmonary function in 74 preschool children with asthma (height of 90-130 cm) and 84 healthy control subjects. Functional residual capacity (helium dilution technique) and expiratory interrupter resistance (interrupter technique) were measured. As compared with control children, children with asthma had a significantly higher resistance (0.77 +/- 0.20 vs. 0.92 +/- 0.22 kPa. L-1. second, p < 0.001) and significantly lower specific expiratory interrupter conductance (p < 0.005) values. Resistance values were significantly higher in children with asthma with than without symptoms on exertion (p < 0.05). The effect of bronchodilator administration, expressed as the percentage of baseline and predicted resistance values, was significantly greater in children with asthma than in control subjects (-18.6 +/- 13.6% vs. -11.2 +/- 15.2%, p </= 0.001, and -23.2 +/- 19.2% vs. -12.6 +/- 17.8%, p < 0.001), respectively. A 35% decrease in resistance after bronchodilation expressed as the percentage of predicted values had a likelihood ratio of 3 for separating the bronchodilator response in children with asthma from that in healthy control subjects. Pulmonary function tests that do not require active cooperation may help in the management and follow-up of preschool children with asthma who are unable to perform forced expiratory maneuvers.

Asthma↗

Role of vagus nerves in resiniferatoxin-induced bronchoconstriction of guinea pigs.

To study the role of vagal afferent C-fibers in resiniferatoxin (RTX)-induced bronchoconstriction in vivo, 30 guinea pigs weighing 347 +/- 28 g were evenly and randomly divided into five groups: Group 1, control; 2, chronic vagotomy; 3, local capsaicin (acute); 4, local capsaicin (chronic); and 5, systemic capsaicin. Each animal was anesthetized with pentobarbital sodium, cannulated with a tracheal cannula and venous catheter, paralyzed with gallamine triethiodide, and artificially ventilated. All animals were pretreated with atropine and phenoxybenzamine. Immediately after RTX was intravenously injected, each animal in the control group exhibited profound decreases in maximal expiratory flow, dynamic respiratory compliance, and total lung capacity, as well as an increase in functional residual capacity, indicating severe airway constriction. Animals in Groups 2-4 exhibited partial abolishment, while those in Group 5 showed complete abolishment of the RTX-induced bronchoconstriction. In 12 additional animals (6 animals each in control and chronic vagotomy groups), chronic vagotomy caused also suppressive effects on capsaicin-induced airway constriction. At one min, our data demonstrate that 36-51% of noncholinergic bronchoconstriction is due to the vagal component while the remaining constriction is due to the nonvagal component. Thus, the nonvagal component plays a significant role in this type of tachykinin-mediated airway constriction.

Afferent Pathways↗

Pulmonary function of guinea pigs exposed to freshly generated ultrafine zinc oxide with and without spike concentrations.

Exposure of guinea pigs 3 hr/day for 5 consecutive days to freshly formed ultrafine zinc oxide (ZnO) (count median diameter: 0.05 micron; geometric standard deviation: 2.0) at a concentration of 7 mg/m3 produced a gradual decrease in total lung capacity and vital capacity over the course of the exposure period. The carbon monoxide (CO) diffusing capacity (DLCO) was not affected until the fourth day, when it dropped abruptly to 30% below control levels. Wet-lung weight/body weight ratios and wet-lung/dry-lung weight ratios increased, indicating the presence of edema. Exposures to 2.7 mg/m3 ZnO, using the same 3 hr/day, 5 day time frame, did not alter any parameters measured. In 2 experiments a single high peak of ZnO (25-34 mg/m3) occurred. In one experiment exposure was stopped, but pulmonary function measurements were made as scheduled; in the other case, exposures to ZnO were continued. In both, lung volumes were decreased abruptly and to a greater extent than when peaks were absent. Continued exposure caused greater decrements in total lung capacity (TLC) and vital capacity (VC) as well as decrements in functional residual capacity (FRC) and residual volume (RV) than were observed when exposure was stopped. Peak exposures reduced DLCO to 45%-60% below control. These values rose to 25%-30% below control with or without continued exposure. Airway resistance increased and compliance decreased following peak exposures. When exposure was stopped, these changes were reversible; with continued exposure they still were different from control levels on the fifth day.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗

Effects of water immersion to the neck on pulmonary circulation and tissue volume in man.

Utilizing the rebreathing of a gas mixture containing C2H2, C180, He O2, and N2, we obtained serial measurements of the pulmonary capillary blood flow (Qc), diffusing capacity per unit of alveolar volume (DL/VA), functional residual capacity (FRC), pulmonary tissue plus capillary blood volume (VTPC), and O2 comsumption (VO2) in five normal subjects under the following conditions: 1) 6 h of sitting, 2) 4 h of sitting while immersed in thermoneutral water to the neck, and 3) 4 h of lying in thermoneutral water to the neck. Water immersion (NI) was preceded and followed by 1-h prestudy and 1-h recovery periods. The measurements were made at 30-min intervals. Seated NI produced a fourfold increase in sodium excretion (UNaV), a 25-36% increase in Qc, a 45-59% increase in DL/VA, and a 30-36% decrease in FRC. This occurred as early as the 1st h of NI and persisted throughout the 4-h period of study. Throughout the seated control and NI periods, VO2, heart rate, and VTPC remained constant. During supine NI, Qc, HR, DL/VA, FRC, and VO2 did not differ significantly from supine prestudy. These date demonstrate that seated NI causes a significant increase of Qc and DL/VA which persists throughout the immersion period. Furthermore, the lack of change of VTPC suggests that the central vascular engorgement induced by seated NI is not accompanied by extravasation of fluid into the pulmonary interstitial space.

Adolescent↗

Pulmonary function in insulin-dependent diabetes mellitus with limited joint mobility.

Patients with insulin dependent diabetes mellitus (IDDM) and limited joint mobility (LJM) were studied to determine if altered respiratory mechanics were another manifestation of a generalized disturbance in collagen metabolism. Lung volumes and maximal expiratory flow volume curves were measured in 23 patients with IDDM. Patients were divided into 2 groups: (1) 11 without LJM, and (2) 12 with severe LJM. The groups were matched for age, sex, and glycemic control but not for duration of IDDM. In patients with severe LJM, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were significantly decreased (p less than 0.05). Total lung capacity (TLC), thoracic gas volume (TGV) at functional residual capacity (FRC) and residual volume (RV) were also significantly lower (p less than 0.05) in the severe LJM group. There was no evidence of air-flow obstruction in either group. Our results demonstrate an association between severe LJM and a significant decrease in lung volumes. This could be due to decreased lung compliance or restriction of chest wall expansion.

Adolescent↗

Airway response of asthmatics to carbachol and to deep inspiration.

Dose-response curves were established in asthmatics by using graded doses of aerosolized carbachol and specific airway conductance (SGaw) measurements. After carbachol inhalation, we evaluated the influence on SGaw of a deep inspiration to total lung capacity followed by a passive expiration to functional residual capacity. When SGaw had returned to its pre-deep-inspiration value, forced expiratory volume in one second (FEV1) was obtained. Two groups of patients were selected according to the effect of deep inspiration on SGaw: group A (22 patients) with a less than 25% SGaw increase after deep inspiration, and group B (21 patients) with a more than 75% SGaw increase. Both groups were comparable in age and initial SGaw and FEV1 values. Carbachol inhalation induced a similar SGaw decrease in both groups, whereas FEV1 decreased more (p less than 0.05) in group A than in group B. The two groups did not differ significantly regarding the dose of carbachol causing a 25% SGaw decrease and in the slope of the dose-response curve. We conclude that, in asthmatic patients, airway response to an inhaled broncho-constrictor agent is not related to the airway response to deep inspiration. This suggests that previous studies of airway response to bronchoconstrictor agents which have been performed by using only FEV1 measurements, may need to be reassessed.

Adult↗

Effect of expiratory resistive loading on the noninvasive tension-time index in COPD.

Expiratory resistive loading (ERL) is used by chronic obstructive pulmonary disease (COPD) patients to improve respiratory function. We, therefore, used a noninvasive tension-time index of the inspiratory muscles (TT(mus) = I/PI(max) x TI/TT, where I is mean inspiratory pressure estimated from the mouth occlusion pressure, PI(max) is maximal inspiratory pressure, TI is inspiratory time, and TT is total respiratory cycle time) to better define the effect of ERL on COPD patients. To accomplish this, we measured airway pressures, mouth occlusion pressure, respiratory cycle flow rates, and functional residual capacity (FRC) in 14 COPD patients and 10 normal subjects with and without the application of ERL. TT(mus) was then calculated and found to drop in both COPD and normal subjects (P<0.05). The decline in TT(mus) in both groups resulted solely from a prolongation of expiratory time with ERL (P<0.001 for COPD, P<0.05 for normal subjects). In contrast to the COPD patients, normal subjects had an elevation in I and FRC, thus minimizing the decline in TT(mus). In conclusion, ERL reduces the potential for inspiratory muscle fatigue in COPD by reducing TI/TT without affecting FRC and I.

Aged↗

[Effects of different levels of PEEP on PaO2, PaCO2, shunt and static compliance in A.R.D.S. (author's transl)].

This study points out that in acute respiratory distress syndrome, the positive end-expiratory pressure (PEEP) had in every case the same action on functional residual capacity and static lung compliance. However its results on PaO2, PaCO2 and circulation are often different from patient to patient according also to the different levels of PEEP. The level of optimal PEEP is that which opens the largest number of alveoli; it is better defined by the value of PaO2 on 100% oxygen than by static compliance.

Carbon Dioxide↗

Inspiratory muscle training improves lung function and exercise capacity in adults with cystic fibrosis.

STUDY OBJECTIVES: To investigate the effects of high-intensity inspiratory muscle training (IMT) on inspiratory muscle function (IMF), diaphragm thickness, lung function, physical work capacity (PWC), and psychosocial status in patients with cystic fibrosis (CF). DESIGN: Twenty-nine adult patients with CF were randomly assigned to three groups. Two groups were required to complete an 8-week program of IMT in which the training intensity was set at either 80% of maximal effort (group 1; 9 patients) or 20% of maximal effort (group 2; 10 patients). A third group of patients did not participate in any form of training and acted as a control group (group 3; 10 patients). INTERVENTIONS: In all patients, baseline and postintervention measures of IMF were determined by maximal inspiratory pressure (Pimax), and sustained Pimax (SPimax); pulmonary function, body composition, and physical activity status were also determined. In addition, diaphragm thickness was measured at functional residual capacity (FRC) and total lung capacity (TLC) [TDIcont], and the diaphragm thickening ratio (TR) was calculated (TR = thickness during Pimax at FRC/mean thickness at FRC). Subjects also completed an incremental cycle ergometer test to exhaustion and two symptom-related questionnaires, prior to and following training. RESULTS: Following training, significant increases in Pimax and SPimax (p < 0.05), TDIcont (p < 0.05), TR (p < 0.05), vital capacity (p < 0.05), TLC (p < 0.05), and PWC (p < 0.05) were identified, and decreases in anxiety scores (p < 0.05) and depression scores (p < 0.01) were noted in group 1 patients compared to group 3 patients. Group 2 patients significantly improved Pimax and SPimax (both p < 0.05) only with respect to group 3 patients. No significant differences were observed in group 3 patients. CONCLUSION: An 8-week program of high-intensity IMT resulted in significant benefits for CF patients, which included increased IMF and thickness of the diaphragm (during contraction), improved lung volumes, increased PWC, and improved psychosocial status.

Adult↗

Pathophysiologic studies of infectious bovine rhinotracheitis in the Holstein-Friesian calf.

Pulmonary function changes in 6 Holstein-Friesian calves, 4 to 8 weeks of age, were studied for 10 to 11 days following experimental inoculation with infectious bovine rhinotracheitis (IBR) virus. Calves had no demonstrable antibody titer against IBR virus before inoculation, and all calves responded to the virus by postinoculation day 3 with high fever (greater than 40.6 C) and rapid, shallow breathing. Analysis of blood gases demonstrated a progressive rise in PaCO2 but no change in PaO2. Acid-base state remained normal. Tidal volume decreased with time; conversely, minute ventilation functional residual capacity, O2 consumption, and CO2 production increased. Alveolar ventilation failed to increase as much as predicted. Studies of respiratory mechanics showed a progressive increased in total pulmonary resistance but without change in dynamic pulmonary compliance. A steady-state N2 washout test was used with these calves, and results suggested impairment of intrapulmonary gas mixing as the disease progressed. Microbiologic, pathologic, and histopathologic analyses were consistent with the picture of acute IBR. This study demonstrated our ability to measure pulmonary function changes in nonanesthetized large animals suffering from respiratory tract disease. We characterized the pathophysiologic features of acute IBR infection in the bovine species as an obstructive lung disease resulting in increased resistance to breathing, retention of CO2, and increased resting lung volume.

Airway Resistance↗

[Functional respiratory disorders in children with left-to-right shunt].

The respiratory function of 19 children aged from 2 months to 9 years old with a cardiac lesion giving a left-to-right shunt was studied and analysed with respect to the hemodynamic disturbance. Respiratory function tests (RFTs) included measurement of functional residual capacity (FRC), the partial pressure in oxygen (Pa 02) on arterialised blood taken from the ear lobe, dynamic pulmonary compliance (CI dyn.) and total pulmonary resistance (RI). FRC and RI were not significantly modified. On the other hand, CI. dyn. was low (-31.2 +/- 22.9%, p less than 0,001) as were the CI. dyn. CFR ratio (-25.5 +/- 20.9%, p less than 0.001) and the Pa 02 (-7.6 +/- 12.7% p less than 0.02). There was a significant correlation between the reduction of CI. dyn. and mean pulmonary arterial pressure (PAP) and the increase in the pulmonary blood flow. In addition, a significant correlation was also found between the reduction in Pa 02 and the PAP and increase in pulmonary blood flow. These results show that cardiac lesions with left-to-right shunts give rise to diffuse changes in respiratory function and are discussed in the light of the abnormalities in pulmonary development previously described in pulmonary biopsy of patients with left-to-right shunts. The value of RFTs in the surveillance of patients with left-to-right shunts is underlined.

Airway Resistance↗

Prospective study of lung volumes in young asthmatic children.

In a 9-y prospective study, the occurrence and duration of lung volume abnormalities in 21 young asthmatic children (median age at recruitment 4 y, range 3-8 y) was determined. The median functional residual capacity (FRC) at recruitment was 135% of that predicted for height (range 79-187%) and 13 children were hyperinflated. The median FRC decreased significantly after 3 y of follow-up and by 9 y only one child remained hyperinflated. We conclude that persistent elevation of lung volume in young asthmatic children appears to be uncommon.

Age Distribution↗