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PubMed1992

Pulmonary function after spinal surgery for idiopathic scoliosis.

Respiratory function was assessed in 20 patients with idiopathic scoliosis undergoing spinal surgery (median age, 15 years; range, 11-34 years; median preoperative vital capacity, 67%; range, 28-109% predicted). Ten patients underwent anterior spinal surgery through a thoracotomy incision, seven of whom had posterior spinal surgery as a second-stage procedure. The other ten had posterior spinal surgery as their initial operation. Postoperatively, three patients had clinical evidence of respiratory complications. Daytime oxygen saturation was reduced throughout the first postoperative week, with no significant difference between anterior and posterior spinal surgery. Hypercapnia was unusual and generally mild. Vital capacity was reduced significantly 1 week after both anterior and posterior spinal surgery (P less than 0.05). The median vital capacity 1 week after anterior spinal surgery was 45% of preoperative values compared with 78% after posterior surgery (P less than 0.05). Inspiratory muscle strength, as assessed by sniff mouth pressure, was 56% of preoperative values 1 week after anterior spinal surgery (P less than 0.05) and 85% after posterior spinal surgery (not significant). Vital capacity, but not sniff mouth pressure, remained significantly reduced 6 weeks after surgery. Oxygen saturation should be monitored noninvasively during the first week after both anterior and posterior spinal surgery even in patients at low risk of developing respiratory complications.

Adolescent↗

PubMed1976

Extended experience in the long-term corticosteroid treatment of pulmonary sarcoidosis.

A 15-yr experience with symptomatic pulmonary parenchymal sarcoidosis treated with corticosteroids has included 250 patients. Within the past 5 yr 192 patients have been actively studied and these are reported in detail. Varied clinical observations are described. Serial measurements of vital capacity and steady-state carbon monoxide diffusing capacity were performed. All of these patients were sufficiently symptomatic and incapacitated to require treatment. Ninety-one percent were Black, 72% were female, and 72% were in the third and fourth decades. In response to treatment there was overall clinical improvement and an increase in vital capacity in 150 (83%) of 180 patients, although only a temporary increase in 12 of these patients. By contrast, only 82 (46%) showed an increase in carbon monoxide steady-state diffusing capacity and only temporarily in 19 patients. Changes in vital capacity correlate well with changes in symptoms and the radiographic appearance and are of great assistance in assessing the clinical course and need for continued treatment. The diffusing capacity is more difficult to interpret. Continued treatment was required in 74 patients (48%) because of recurrent clinical relapses as treatment was withdrawn. Such relapses were observed in 70% of the patients. Improvement and discontinuation of treatment was achieved in 66 patients (42%). In the 44 in whom there was no observed relapse, 34 were treated for less than 2.5 yr. In the total group, longer periods of treatment, 2.5-10 yr or more, were required in 104 patients (54%). In this series of 192 patients there were 7 deaths, with 22 deaths in the total 15-yr series of 250 patients. Of these, 18 were directly attributed to the sarcoidosis. Clinical improvement coincident with corticosteroid treatment and the frequency of relapse as treatment is withdrawn strongly support the benefits of corticosteroid treatment for symptomatic pulmonary sarcoidosis. When relapses occur and recur, retreatment is necessary and often long-term maintenance doses of prednisone (10-15 mg daily) are required for many years. The relatively infrequent problems related to this treatment are greatly exceeded by the clinical benefits.

Adrenal Cortex Hormones↗

PubMed2001

Physiological changes and clinical correlations of dyspnea in cancer outpatients.

The purposes of this cross-sectional study of 75 outpatients of a general oncology clinic were to assess the subjective and objective factors associated with dyspnea in cancer patients and to characterize factors that might contribute to respiratory muscle weakness demonstrated in a previous study. Patients with moderate to severe shortness of breath completed visual analogue scales (VAS) of shortness of breath (SOB) and anxiety; other data were acquired from pulmonary function tests, including maximum inspiratory pressure (MIP) and expiratory pressures; chest radiography; arterial blood gases; measurement of hemoglobin, serum potassium, phosphate, calcium, albumin, and magnesium; and ultrasound study of the diaphragm for thickness and excursion. The correlation coefficient between SOB VAS and anxiety VAS was 0.26 (P = 0.03). In stepwise multiple regression analyses, only the regression coefficient for anxiety remained significant at P < 0.05 in the multivariate model with SOB VAS as the dependent variable. The multivariate model using MIP (a measure of respiratory muscle strength) as the dependent variable, found significance for total diaphragmatic excursion, hemoglobin, phosphate, residual volume over total lung volume, vital capacity, percent predicted total lung capacity, oxygen saturation, and forced vital capacity. The regression coefficients for these variables were significant at P < 0.05 and the model accounted for 58% of the variance of MIP.

Adult↗

PubMed2003

Daily comparison of respiratory functions between on-pump and off-pump patients undergoing CABG.

OBJECTIVE: Widespread application of on-pump revascularization procedures is increasing due to the thought of elimination of untoward effects of cardiopulmonary circuit. Thus, whether off-pump coronary artery surgery eliminates side effects especially related to respiratory functions is still controversial. Although many previous studies have evaluated these respiratory functions, daily comparison of 12 parameters was not included in any of the studies. The aim of our prospective study was to ascertain whether off-pump coronary operation improves pulmonary functions and postoperative recovery period when compared with on-pump technique and whether early discharge of patients with off-pump surgery is the result of respiratory improvement. METHODS: Eighteen patients in each group were included: on-pump group underwent coronary revascularization with cardiopulmonary bypass and off-pump with stabilization. Respiratory function tests and arterial blood gas analyses were performed preoperatively and daily after operation function tests included forced expiratory volume (FEV) in 1s, forced vital capacity (FVC), expiratory reserve volume, vital capacity, quotient of FEV in 1s to FVC, maximal voluntary ventilation (MVV), tidal volume, and forced midexpiratory flow. Blood gas analyses included partial arterial oxygen and carbon dioxide pressure, arterial pH and hematocrit (Hct). RESULTS: Preoperative pulmonary functions and arterial blood gases were not statistically significant between groups except MVV and partial arterial oxygen pressure. MVV was slightly higher in on-pump group and partial arterial oxygen pressure was slightly lower in on-pump group. During postoperative first day Hct (P=0.004) and FEV in 1s (P=0.049) values and third day partial arterial oxygen pressure (P=0.011) and Hct (P=0.011) values were lower in on-pump group. Mean extubation, duration in postoperative suit and hospital discharge times, mean blood loss were not statistically significant between groups postoperatively. CONCLUSION: Pulmonary functions and arterial blood gases were not improved in off-pump patients when compared with on-pump patients. Patients going to be surgically revascularized should not be altered to off-pump surgery merely with the hope of improving respiratory functions with off-pump technique. As the postoperative stay times at surgical theatre and hospital is not different and the extubation times were similar, early discharge of patients with off-pump surgery cannot be related merely to better preservation of respiratory functions.

Analysis of Variance↗

PubMed1993

Prediction of pulmonary function in wheelchair users.

As a result of the improved medical treatment of infectious diseases, these formerly leading causes of mortality in the United States have been supplanted in rank by chronic events as the major causes of death. The major causes include coronary artery disease, respiratory disease, and cancer. Static and dynamic pulmonary functions in the apparently healthy wheelchair user population were measured and then modelled using stepwise regression. One hundred and nine wheelchair users (97 males, 12 females) with paraplegia (n = 77) or quadriplegia (n = 32) gave informed consent and participated in this study. Subjects ranged from being Olympic caliber wheelchair marathon racers to those who live sedentary life styles. Subjects performed three slow vital capacity (SVC) tests, three forced vital capacity (FVC) tests, and three maximal voluntary ventilation (MVV) tests while seated in their standard wheelchair. The order of the pulmonary function tests was randomized. Subjects also completed two functional residual capacity (FRC) measurements. Analysis of variance revealed significant differences in several pulmonary functions based on gender (FEVC, p = 0.0001, FEV1, p = 0.0001, FEVC 25-75%, p = 0.005, PEF, p = 0.002, FIVC, p = 0.002, RV, p = 0.0001, MVV, p = 0.0001, SVC, p = 0.001). The women's unforced prediction equations using age, height, weight did yield some significant correlations with predictions based upon ambulatory subjects. The men's unforced adapted prediction equations did reveal significant correlations with the validation group for FEVC (r = 0.66, p = 0.007), FEV1 (r = 0.62, p = 0.015), PIF (r = 0.95, p = 0.015), MVV (r = 0.57, p = 0.067), SVC (r = 0.69, p = 0.019), and RV (r = 0.67, p = 0.009). Pulmonary function in male wheelchair users should be predicted using equations which incorporate years with disability and level of impairment. Additional study is required to make any recommendations regarding women wheelchair users. However, study of pulmonary function in women should be made a priority. Pulmonary function is affected by the extent of physical impairment, and tends to decline as years with disability increase.

Adolescent↗

PubMed1996

Head position and its effect on pulmonary function in tetraplegic patients.

To test the influence of head position on pulmonary function in tetraplegic individuals 15 subjects with chronic C4-C7 injuries participated in a one group pre-post test comparing the relationship between orthostatic position of the head (OPH) and standard pulmonary function tests (PFTs). Twelve subjects with habitual forward head posture and three with non-forward head posture performed PFTs in (1) their habitual posture, and (2) an experimental posture imposed by placement of thoracic and/or lumbar rolls behind their back. Results showed that changing head posture did not alter mid-forced expiratory flow or forced inspiratory vital capacity, but significantly affected forced vital capacity (t = 2.83; P < 0.05) and 12 s maximum voluntary ventilation (t = 2.07; P < 0.05). In cases where pulmonary function was altered by head position, the resulting performance was best in the subject's habitual posture, although no differences in resting pulmonary tests were observed between subjects with and without forward head position. These data show that temporary postural alterations affecting OPH, if not allowing sufficient time for muscular adaptation, adversely affect pulmonary function in tetraplegic patients.

Adolescent↗

PubMed2001

The body weight-walking distance product as related to lung function, anaerobic threshold and peak VO2 in COPD patients.

The product of walking distance and body weight (D x W) mimics the work of walking. We hypothesized the superiority of D x W to walking distance (D) alone in any correlation with lung function, anaerobic threshold (AT) and maximal oxygen uptake (VO2max). We further hypothesized that the D x W product for a 6-min walk test (6 MWT) would correlate with the AT and VO2max because all three are markers of exercise ability. Thirty-three male chronic obstructive pulmonary disease (COPD) patients with mean forced expiratory volume in 1 sec (FEV1) of 1.2+/-0.4 l (range 0.58-1.86 l) were enrolled. Six patients were excluded due to inability to achieve a maximal test. Lung function and self-assessed every-day activities using a oxygen-cost diagram were evaluated before entry of the study. A maximal effort ramp-pattern cardiopulmonary exercise test (CPET) and a 6 MWT were conducted in random order. Borg score, heart rate, and O2 saturation with pulse oximetry (SpO2) were measured during both exercise tests. VO2 AT and minute ventilation were also measured during the CPET. Correlations were sought between the distance covered in the 6 MWT, and the D x W product with AT, VO2max and other variables. The average D and D x W were 456 m and 27.5 kg km(-1), respectively. D x W was superior to D alone when correlated with the VO2max and AT determined from the CPET, while modestly correlated with the change (delta) in Borg score and delta SpO2 in the 6 MWT and self-assessed every-day activities. Distance x weight product was correlated with the AT and VO2max. In addition, D x W was better correlated with diffusing capacity for carbon monoxide and vital capacity than D alone. We conclude that D x W mimics the work of walking better than D and is suggested as a parameter for evaluation of patients' fitness if gas exchange measurements are not available.

Activities of Daily Living↗

PubMedDate not supplied

The effect of hemodialysis on lung function, gas exchange, and response to carbon dioxide stimulation in chronic uremia.

Little is known of the effect of chronic hemodialysis on lung function. In six patients with chronic uremia, we performed pulmonary function tests, sampled arterial blood, and measured the ventilatory response to carbon dioxide inhalation before and after routine hemodialysis. Patients were in the seated position throughout the study period. Routine pulmonary function was normal in all but one patient; a restrictive ventilatory defect was seen in a patient with prior pleuropericarditis and this was independent of fluid status. All patients showed improvement after dialysis in maximum flow rate at 25 per cent vital capacity corrected for changes in vital capacity (V max 25% VC/VC) supporting reversible obstruction of small airways. Hypoxemia was not precipitated by dialysis and all patients showed a small improvement in alveolar-arterial oxygen gradient. Although resting hyperventilation was documented in these patients, the ventilatory response to carbon dioxide inhalation was not consistently enhanced before or after hemodialysis.

Adult↗

PubMed1976

Effect of modification of the smoking habit on lung function.

The effect of smoking cessation or modification on lung function was determined during a 48-week period. In a large number of the cigarette smokers, a disturbance of lung function was not revealed by conventional tests, such as the 1-sec forced expiratory volume; however, an abnormality was often demonstrable in tests that may reflect alterations in small airways, such as closing volume and Phase III of the single-breath expired N2 curve. There was no relation between the degree of abnormality of lung function and the presence of respiratory symptoms, but there appeared to be a relationship to lifetime smoking history, the heaviest smokers having the poorest function. Cessation, or more than 25 per cent decrease in the number of cigarettes smoked, was attened by improvement in the slope of Phase III of the N2 washout curve, closing volume, and closing capacity, as well as forced vital capacity, 1-sec forced expiratory volume, and peak flow. Resumption of smoking after cessation was attended by a deterioration in the slope of Phase III and closing capacity. The data suggest that the functional abnormalities in smokers are related to smoking and are at least partially reversible by cessation or significant modification of the smoking habit.

Adolescent↗

PubMed1988

Lung volume standards for healthy male lifetime nonsmokers.

Functional residual capacity (FRC), residual volume (RV), vital capacity (VC), and total lung capacity (TLC) were measured in 162 men aged 18.9 to 78.6 years using a multiple breath helium dilution technique. Multiple regression equations were generated to predict these lung parameters from the best weighted combination (p less than or equal to 0.05) of age, mass, standing height, body surface area, sitting height, biacromial breadth, end-tidal chest girth, expanded chest girth, and chest expansion (FRC: R = .748, SEE = 504 ml; RV: R = .725, SEE = 301 ml; VC: R = .808, SEE = 537 ml; TLC: R = .808, SEE = 551 ml; RV/TLC: R = .778, SEE = 4.15 percent). The range of normality was defined as the predicted value +/- the 95 percent confidence interval (two-tailed test). Cross-validation of other FRC, RV, VC, and TLC equations in the literature indicated that they were unsuitable for use with our data.

Adolescent↗

PubMed1990

[Effects of surgical correction on pulmonary function in pectus excavatum cases].

Preoperative and postoperative pulmonary function were compared by spirometry in one hundred and eleven cases, from 1980 to 1989, with pectus excavatum deformity. The patients consisted of 85 males and 26 females, aged 5-41 years. In the preoperative examination, mean values for % vital capacity (%VC), % 1 sec. timed vital capacity (FEV1.0%), % residual volume (%RV), % maximal voluntary ventilation (%MVV) were within normal limits. %VC had a tendency to decrease with increase in the degree of depression of the anterior chest wall. Postoperatively, %VC was significantly dropped, although no significant change was seen in FEV1.0%, %RV and %MVV. Seven of 10 cases with low %VC and four of 6 cases with low %VC and %RV preoperatively demonstrated improvement in %VC and %RV after sternal elevation surgery.

Adolescent↗

PubMed1998

[Evaluation of respiratory muscles].

Respiratory muscle weakness may be the sole cause of dyspnea or may aggravate dyspnea due to another respiratory disease, and is often difficult to recognise clinically. The assessment of respiratory muscles should follow a graded approach using tests of increasing complexity. Clinical examination should look for dyspnea, orthopnea, morning headache, daytime somnolence, fatigability, tachypnea, abdominal, or rib cage paradox, and amyotrophy. Imaging is useful in diagnosing diaphragmatic paralysis using chest radiograph, fluoroscopy or ultrasound. In cases of moderate to severe respiratory muscle weakness, lung volumes show reduced vital capacity and total lung capacity. Measuring the change in vital capacity from sitting to supine position is useful since it shows a 25-50% fall in cases of diaphragmatic paralysis. The specific and classical tests of respiratory muscle strength are maximum inspiratory and expiratory pressures (MIP and MEP) sustained during one second against near complete occlusion. Sniff nasal inspiratory pressure (SNIP) is a new and easier test of inspiratory muscle strength. Normal values obtained with these simple tests rule out clinically significant respiratory muscle weakness. In case of doubt, more complex and invasive tests can be used such as transdiaphragmatic pressure and magnetic stimulation of the phrenic nerves.

Diagnosis, Differential↗

PubMed2004

Pulmonary and biceps function after intercostal and phrenic nerve transfer for brachial plexus injuries.

This pseudo-randomized study was performed to compare the pulmonary function and biceps recovery after intercostal (19 cases) and phrenic (17 cases) nerve transfer to the musculocutaneous nerve for brachial plexus injury patients with nerve root avulsions. Pulmonary function was assessed pre-operatively and postoperatively by measuring the forced vital capacity, forced expiratory volume in 1 second, vital capacity, and tidal volume. Motor recovery of biceps was serially recorded. Our results revealed that pulmonary function in the phrenic nerve transfer group was still significantly reduced 1 year after surgery. In the intercostal nerve transfer group, pulmonary function was normal after 3 months. Motor recovery of biceps in the intercostal nerve group was significantly earlier than that in phrenic nerve group. We conclude that pulmonary and biceps functions are better after intercostal nerve transfer than after phrenic nerve transfer in the short term at least.

Adolescent↗

PubMed2001

Chest mechanics in morbidly obese non-hypoventilated patients.

Seventy-seven patients with morbid obesity, body mass index (BMI) 40-69.9 kg m(-2), who were candidates for gastroplasty, were studied in our laboratory as part of a pre-operative survey. They had no complaints other than obesity and were not cyanotic. A group of 28 lean subjects (BMI 20-29.8 kg m(-2)) who were candidates for abdominal surgery, without any respiratory complaint, were included as controls. For each patient a pulmonary function test was performed, measuring slow vital capacity with expiratory residual volume (ERV), forced vital capacity (flow/volume) and maximal voluntary ventilation (MVV). In obese patients the MVV is reduced as BMI increases. This results in the reduction of expiratory flows and volumes. Forced expiratory volume in 1 sec (FEV1) is reduced in proportion to the FVC reduction and is related to MVV. It is suggested that the main consequence of the burden of the chest wall by increased adipose mass is a reduction in its compliance, making inspiration increasingly difficult, and resulting in lower static volumes and flows.

Adult↗

PubMed1976

Closing volumes in man immersed to the neck in water.

Closing volumes (CV), along with residual volume (RV), vital capacity (VC), along with residual volume (RV), vital capacity (VC), and expiratory reserve volume (ERV) were determined in 10 subjects in the dry and while immersed to the neck in water. Closing volumes during immersion increased 41.3% (P less than 0.001) over dry values while RV decreased 9.35% (P less than 0.001) and VC decreased 9.94% (P less than 0.001). The large decrease of 71.3% (P less than 0.001) in ERV resulted in the impingement of closing capacity (CV + RV) on the tidal volume in 9 out of 10 subjects. We interpret this to mean that airway closure occurs during tidal ventilation in immersed subjects and may result in impaired gas exchange. When tourniquets were applied to all four limbs during immersion closing volumes increased only 32.1%, but increased to 64.3% when they were removed. If engorgement of peribronchial vessels predisposes airways to collapse, a reduction of plasma volume during an extended period of immersion might lessen this possibility. In a series of long term (2.5-h) immersion experiments where moderate reductions (-10 to -7%y in plasma volume were observed, we found, however, no correlative changes in closing volume.

Adult↗

PubMed2003

Effects of rapid saline infusion on lung mechanics and airway responsiveness in humans.

Lung mechanics and airway responsiveness to methacholine (MCh) were studied in seven volunteers before and after a 20-min intravenous infusion of saline. Data were compared with those of a time point-matched control study. The following parameters were measured: 1-s forced expiratory volume, forced vital capacity, flows at 40% of control forced vital capacity on maximal (Vm(40)) and partial (Vp(40)) forced expiratory maneuvers, lung volumes, lung elastic recoil, lung resistance (Rl), dynamic elastance (Edyn), and within-breath resistance of respiratory system (Rrs). Rl and Edyn were measured during tidal breathing before and for 2 min after a deep inhalation and also at different lung volumes above and below functional residual capacity. Rrs was measured at functional residual capacity and at total lung capacity. Before MCh, saline infusion caused significant decrements of forced expiratory volume in 1 s, Vm(40), and Vp(40), but insignificantly affected lung volumes, elastic recoil, Rl, Edyn, and Rrs at any lung volume. Furthermore, saline infusion was associated with an increased response to MCh, which was not associated with significant changes in the ratio of Vm(40) to Vp(40). In conclusion, mild airflow obstruction and enhanced airway responsiveness were observed after saline, but this was not apparently due to altered elastic properties of the lung or inability of the airways to dilate with deep inhalation. It is speculated that it was likely the result of airway wall edema encroaching on the bronchial lumen.

Administration, Inhalation↗

PubMed1987

Pre-oxygenation and the parturient patient.

The effects of pre-oxygenation were studied by continuous expired oxygen analysis in twenty pregnant patients and ten nonpregnant controls. The Magill system and a demand valve breathing system were both studied with tidal and vital capacity breathing. Rapid pre-oxygenation was possible with the demand valve system but the technique was associated with air leaks around the mask. Vital capacity breathing with the Magill system was inefficient in practice because of rebreathing and air leaks, and the recently proposed four vital capacity breath technique provided suboptimal alveolar oxygenation in pregnant subjects. Oxygenation in pregnant subjects was significantly faster than in nonpregnant controls and was achieved after just 2 minutes of tidal breathing from a standard Magill system with a prefilled reservoir. Care was necessary to ensure a gas-tight seal around the facemask.

Adult↗

PubMed2003

Aerosolized pentamidine prophylaxis against AIDS-related Pneumocystis carinii pneumonia and its short- and long-term effects on pulmonary function in the Japanese.

We evaluated the incidence of prophylaxis failure with aerosolized pentamidine (AP) for Pneumocystis carinii pneumonia (PCP) in Japanese patients with human immunodeficiency virus (HIV) infection, and we examined the short- and long-term effects of AP on pulmonary function. The patients inhaled 300 mg of pentamidine by ultrasonic nebulizer, after the inhalation of procaterol (80 micrograms), every 4 weeks. PCP developed in 2 of 16 patients receiving primary prophylaxis with AP, and in 4 of 13 patients with secondary prophylaxis. The CD4(+) T-lymphocyte count was very low in the patients with prophylaxis failure. The chest radiographic presentations were atypical in 4 of the 6 patients with prophylaxis failure. There were no significant changes in the vital capacity (VC), VC/predictive VC (%VC), forced expiratory volume in 1 s (FEV(1.0)), FEV(1.0)/forced vital capacity (FEV(1.0)%), and maximum expiratory flow rate at 25% of vital capacity (MEF(25))/height comparing values before and after initial AP treatment. However, a reduction of oxygen saturation (SpO(2)) of over 3% was noted in 4 patients during the initial AP administration. In 9 patients receiving AP prophylaxis for more than 36 months, we compared the pulmonary function parameters between the baseline and final observations (mean, 52.7 months). There were no changes in VC, %VC, FEV(1.0,) FEV(1.0)%, and SpO(2), but there was a statistically significant decline in MEF(25)/height after long-term AP treatment. We concluded that the incidence of prophylaxis failure with AP for PCP in Japanese patients was similar to that in Western patients, and that long-term AP treatment affected MEF(25)/height in spite of the safe pulmonary effects in short-term AP inhalation.

AIDS-Related Opportunistic Infections↗