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Serial lung volume measurements during the perinatal period in infants with abdominal wall defects.

METHODS: Daily measurements of lung volume (functional residual capacity, FRC) were made during the perinatal period in eight infants (median gestational age, 37 weeks; range, 34 to 38 weeks) with abdominal wall defects. RESULTS: On the first day of life and before surgical intervention, four infants had FRCs below the reference range; the occurrence of low lung volumes was not significantly related to gestational age or diagnosis. Lung volume was further, but only temporarily, impaired by surgical closure of the abdominal wall defect, with a reduction in the median FRC from 25 mL/kg (range, 18 to 36) preoperatively to 12 mL/kg (range, 5 to 19) on the first postoperative day (P < .02). CONCLUSION: These data are consistent with abnormal antenatal lung growth in certain infants with abdominal wall defects.

Abdominal Muscles↗

Effects of inflation on the coupling between the ribs and the lung in dogs.

The coupling between the ribs and the lung in dogs increases with increasing rib number in the cranial part of the rib cage and then decreases markedly in the caudal part. The hypothesis was raised that this non-uniformity is primarily related to differences between the areas of the lung subtended by the different ribs, and in the current study we tested this idea by assessing the effects of passive lung inflation. Thus, by causing a descent of the diaphragm, inflation would expand the area of the lung subtended by the caudal ribs and improve the coupling between these ribs and the lung. The axial displacements of the ribs and the changes in airway opening pressure (DeltaP(ao)) were measured in anaesthetized, pancuronium-treated, supine dogs while loads were applied in the cranial direction to individual rib pairs at functional residual capacity (FRC) and after passive inflation to 10 and 20 cm H(2)O transrespiratory pressure. In agreement with the hypothesis, inflation caused an increase in DeltaP(ao) for ribs 9 and 10. The most prominent alteration, however, was a marked decrease in DeltaP(ao) for ribs 2-8; at 20 cm H(2)O, DeltaP(ao) for these ribs was only 30% of the value at FRC. Additional measurements indicated that this decrease in DeltaP(ao) results partly from the increase in diaphragmatic compliance but mostly from the reduction in outward rib displacement. This alteration in the pattern of rib motion should add to the decrease in muscle length to reduce the lung expanding action of the external intercostal muscles at high lung volumes.

Abdomen↗

Distribution of lung density after strenuous, prolonged exercise.

The postexercise alteration in pulmonary gas exchange in high-aerobically trained subjects depends on both the intensity and the duration of exercise (G. Manier, J. Moinard, and H. Stoïcheff. J. Appl. Physiol. 75: 2580-2585, 1993; G. Manier, J. Moinard, P. Techoueyres, N. Varène, and H. Guénard. Respir. Physiol. 83: 143-154, 1991). In a recent study that used lung computerized tomography (CT), evidence was found for accumulation of water within the lungs after exercise (C. Caillaud, O. Serre-Cousine, F. Anselme, X. Capdevilla, and C. Prefaut. J. Appl. Physiol. 79: 1226-1232, 1995). On representative slices of the lungs, mean lung density increased by 0.040 +/- 0.007 g/cm(3) (19%, P < 0.001) in athletes after a triathlon. To verify and quantify the mechanism, we determined the change in pulmonary density and mass after strenuous and prolonged exercise using another exercise protocol and methodology for CT scanning. Nine trained runners (age 30-46 yr) volunteered to participate in the study. Each subject ran for 2 h on a treadmill at a rate corresponding to 75% of maximum O(2) consumption. CT measurements were made before and immediately after the exercise test with the subject supine and holding his breath at a point close to functional residual capacity. The lungs were scanned from the apex to the diaphragm and reconstructed in 8-mm-thick slices. Attenuation values of X-rays in each part of the lung were expressed in Hounsfield units (HU), which are related to density (D): D = 1 + HU/1,000. No significant alteration in pulmonary density (0.37 +/- 0.04 vs. 0.35 +/- 0.03, not significant) was observed after the 2-h run test. Although lung volume slightly increased (change of 166 +/- 205 ml, P < 0.05), lung mass remained stable because of a change in density distribution. We failed to detect any changes in postexercise lung mass, suggesting that other mechanisms need to be considered to explain the observed alterations in pulmonary gas exchange after prolonged strenuous exercise.

Adult↗

Positive end expiratory pressure: effects on lung mechanics of premature lambs.

Pulmonary mechanics were determined at 0, 3, 6, and 10 cm H2O positive and expiratory pressure (PEEP) in premature lambs at a mean gestational age of 134 days. Functional residual capacity increased (p less than 0.005) by 7% (1.6 ml/kg) per cm H2O PEEP. Dynamic lung compliance and specific compliance significantly decreased by 10% (0.11 ml/cm H2O/kg) and 9% (0.0051 l/cm H2O) per cm H2O PEEP, respectively, for PEEP above 3 cm H2O level. Inspiratory lung resistance increased significantly (p less than 0.05) only between 0 and 6 cm H2O PEEP while expiratory lung resistance increased (p less than 0.05) between 0 cm H2O PEEP and all higher levels. The data suggest that PEEP in excess of 3 cm H2O produces undesirable effects on lung mechanics in premature lambs. These results may be important in predicting contraindications and potential complications of positive pressure breathing in the newborn.

Animals↗

Inspired volume dependence of the slope of the alveolar plateau.

Two series of experiments were performed in nine healthy subjects. In series I, 96 single breath tests were performed in two subjects. The inspired gas contained 90% O2, 5% He and 5% SF6 and the slope of the alveolar plateau for N2, He and SF6 was computed. The following experimental conditions were considered variable: inspired volume with preinspiratory lung volume equal to residual volume or functional residual capacity (FRC), both with and without 10 sec breath-holding. In series II, each of the other 7 subjects performed 12 single breath N2 tests in which the subject inspired both 1 L and an inspiratory capacity (IC) of O2 from FRC with without 10 sec breath-holding. The main experimental observation is that without breath-holding the absolute value of the slope of the alveolar plateau is larger for 1 L inspiration than for an IC inspiration, whereas this volume dependence was smaller after 10 sec of breath-holding. Based on Milic-Emili model of the lung and on simulations of a multibranch point model of the acinus we concluded that, in so far as these models adequately describe gas distribution in the lung, intraregional parallel units presenting a sequential convective flow play an important role in the genesis of the alveolar plateau.

Adult↗

Use of an acoustic helium analyzer and microprocessor for rapid measurement of absolute lung volume during mechanical ventilation.

A technique developed to measure functional residual capacity during mechanical ventilation uses an acoustic helium analyzer and microprocessor to perform open-circuit helium washout. The acoustic helium analyzer has acceptable linearity up to a helium concentration of 50% and is stable. The microprocessor combines output from the acoustic analyzer and a ventilator with an expiratory flow signal, to compute lung volume rapidly during mechanical ventilation. In a sample of ten patients with various lung problems, open-circuit helium washout gave results similar to those of a closed-circuit helium-dilution technique during assist control or intermittent mandatory ventilation modes, with or without positive end-expiratory pressure. This open-circuit system has an advantage over other techniques because it is small and portable and can measure lung volume quickly without complicated maneuvers.

Acoustics↗

Effects of thoracic volume and shape on electromechanical coupling in abdominal muscles.

To assess the effects of lung volume and chest wall configuration on electromechanical coupling of the abdominal muscles, we examined the relationship between abdominal muscle pressure ( Pmus ) and electrical activity ( EMGab ) in eight normal subjects during expiratory efforts at lung volumes ranging from functional residual capacity (FRC) to FRC + 2.0 liters. At and above FRC, increases of lung volume did not significantly alter either the Pmus - EMGab relationship or abdominal surface linear dimensions, although expiratory efforts displaced the abdomen inward from its relaxed position. We attribute the constancy of delta Pmus /delta EMG above FRC to the negligible effects of increasing lung volume on abdominal configuration and muscle length. Expiratory efforts performed at lung volumes below FRC resulted in a wider range of abdominal indrawing . Under these conditions the EMGab required to augment Pmus by 30-40 cmH2O increased as the abdomen was displaced inward. This decrease of delta Pmus /delta EMGab appears to reflect muscle shortening, flattening of the abdominal wall, and possibly deformation of the rib cage.

Abdominal Muscles↗

Increased surface tension favors pulmonary edema formation in anesthetized dogs' lungs.

The possibility that surface tension may affect the hydrostatic transmural pressure of pulmonary vessels and the development of pulmonary edema was studied in anesthetized, open-chested dogs. Isogravimetric pressure (the static intravascular pressure at which transmural osmotic and hydrostatic pressures are balanced such that net fluid flux is zero and lung weight is constant) was measured in nine animals under three conditions: (a) control, normal surface tension, at an alveolar pressure of 30 cm H2O with the apenic lung at room temperature; (b) after increasing surface tension by cooling and ventilating at a low functional residual capacity, at an alveolar pressure sufficient to produce the same lung volume present during control measurements; and (c) after restoring surface tension by rewarming while holding the lung at a high inflation volume, again at the control lung volume. Lung volumes were established from external dimensions and confirmed +/- 10% by deflation spirometry. The isogravimetric pressure (relative to alveolar pressure) was significantly less with increased surface tension than during either the initial control condition (P less than 0.01), or when the surface tension has been restored (P less than 0.01). Similar changes occurred in each of three additional studies performed with control alveolar pressures of 10 cm H2O. Thus, increased surface tension favors fluid leakage presumably because it increases the microvascular transmural pressure.

Anesthesia↗

Controlled delivery of krypton-81m boli in normal subjects: results and implications.

Interregional sequential filling potentially affects lung ventilation imaging, depending on the distribution of the tracer within the inspired volume. We investigated its importance quantitatively under near tidal breathing conditions in the upright lung using a short-lived radioactive tracer. Ten normal volunteers performed two runs of 900-ml breaths (from functional residual capacity) in which 100 ml of 81mKr boli were delivered "early" or "late" in inspiration, i.e., 50 ml or 450 ml volumetric depth. Apex-to-base gradients in the vertical profile were -106 +/- 22 (s.e.) counts/cm (early) and -187 +/- 24 (s.e.) counts/cm (late). Ratios of upper-to-lower regional ventilation (U/L) were 0.88 +/- 0.01 (s.e.) (early) and 0.81 +/- 0.01 (s.e.) (late). Simulations with a compartment model show that a simple pattern of sequential filling can by itself account for the experimental results observed. Control over 81mKr delivery can be important to physiologically accurate assessment of ventilation-perfusion matching. Controlled delivery techniques could also modify effectiveness and targeting of other inhaled agents including therapeutic aerosols.

Administration, Inhalation↗

The role of carbon dioxide in the development of pulmonary insufficiency.

The effects of carbon dioxide (PCO2 = 40 versus PCO2 = 20) on pulmonary function changes during 2 hours of hemorrhagic hypotension followed by resuscitation are evaluated in 21 dogs. Pulmonary hemodynamics, mechanics, gas exchange, functional residual capacity, and morphology are studied. In the preshock period, hypocapnia is associated with a decreased cardiac output, increased dead space, and increased alveolar-arterial (A-a) gradiant (room air). During the period of hypotension, all parameters in both groups changed similarly. After resuscitation, the A-a gradients in the two groups further widened. Following the return to control levels of normocapnia in all animals, the group which had been hypocapnic during the hypotensive episode continued to show increased shunting (20 versus 13 percent, p less than 0.05). These results correlated well with cinemicroscopic findings, which showed the normocapnic group to have less interstitial edema and better capillary flow.

Animals↗

Ventilatory pattern and chest wall mechanics during ketamine anesthesia in humans.

The effects of anesthetic doses of ketamine (iv bolus of 3 mg X kg-1 followed by a continuous infusion of 20 micrograms X kg-1 X min-1) on functional residual capacity (FRC) measured by the helium dilution method and on the breathing pattern recorded by a noninvasive method (NIM) based on chest wall circumference changes were studied in 14 ASA P.S. I patients. Ketamine anesthesia was associated with: 1) the maintenance of FRC, minute ventilation, and tidal volume; 2) an increase in rib cage contribution to tidal breathing; and 3) an alteration of volume-motion relationships of the chest wall compartments. It is concluded that: 1) in contrast to volatile anesthetic agents, ketamine anesthesia has a sparing effect on intercostal muscle activity, which may explain the maintenance of FRC; and 2) changes in chest wall geometry and compliance induced by anesthetic agents must be taken into account for NIM to be valid.

Adult↗

Response of normal infants to inhaled histamine.

The age at which nonspecific bronchial hyperresponsiveness (BHR) is first seen in humans is unknown, though both genetic and environmental factors have been implicated in its development. The current study aimed to establish whether BHR to histamine can be demonstrated in normal infants. Twelve infants, mean age of 7.8 months (range, 3 to 18 months), were studied. None had any history of a previous significant respiratory illness. Respiratory function was monitored using the maximal flow at function residual capacity (VmaxFRC) obtained with the forced expiratory flow-volume technique. Histamine was inhaled in doubling concentrations from 0.125 to 8 g.L-1. A greater than 30% fall in VmaxFRC was considered a response. All infants responded to histamine, the geometric mean concentration for their response being 1.4 g.L-1. Associated transient changes for the group were an increase in respiratory rate (p less than 0.02) and a fall in SaO2 (p less than 0.001). Forced expiratory flow-volume curves were concave in all infants after the last dose of histamine. We speculate that humans are born with "bronchial hyperresponsiveness" and that genetic or environmental factors determine which infants lose it thereafter.

Bronchi↗

Does phase 2 of the expiratory PCO2 versus volume curve have diagnostic value in emphysema patients?

It has been postulated that serial inhomogeneity of ventilation in the peripheral airways in emphysema is represented by the shape of expiratory carbon dioxide tension versus volume curve. We examined the diagnostic value of this test in patients with various degrees of emphysema. The volumes between 25-50% (V25-50) and 25-75% (V25-75) of the expiratory carbon dioxide tension versus volume curve were determined in 29 emphysematous patients (20 severely obstructed and 9 moderately obstructed), 12 asthma patients in exacerbation of symptoms, and 28 healthy controls. Discriminant analysis was used to examine whether these diagnostic groups could be separated. With regard to phase 2 of the expiratory CO2 versus volume curve (mixture of anatomic deadspace and alveolar air), a plot of intercept versus slope of the relationships of (V25-50) and (V25-75) versus inspiratory volume (VI) from functional residual capacity (FRC), obtained during natural breathing frequency, proved to be most discriminating in the separation between healthy controls and severely obstructed emphysema patients. Separating healthy controls and severely obstructed emphysema patients on the basis of the discriminant line for V25-50, 9 of the 12 asthma patients in exacerbation were classified as normal, and only 5 of the 9 moderately obstructed emphysema patients as emphysematous. For V25-75 involvement of phase 3 of the curve (alveolar plateau) in asthma patients in exacerbation caused a marked overlap with the severely obstructed emphysema patients. In the healthy controls, a fixed breathing frequency of 20 breaths.min-1 led to an increase of both volumes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Progressive decline in plethysmographic lung volumes in infants: physiology or technology?

During the last 30 years, there has been an unexplained trend toward declining values for plethysmographic assessments of lung volume at functional residual capacity (FRC) in infants. The aim of this study was to compare data collected from healthy infants using contemporary equipment with published reference data and to explore reasons for discrepancies. Lung volumes were measured in 32 healthy infants (age, 4-93 weeks; weight, 3.9-12.4 kg) using a new, commercially available infant plethysmograph. Mean (SD) FRC was 19.6 (3.4) ml/kg (within subject coefficient of variation 3.4 [2.3%]), which was on average 7.0 [3.5] ml/kg and 2.3 [1.2] SD (Z) scores lower than the recently collated reference data from an American Thoracic Society task force. A total of 66% of these healthy infants had a FRC that was below the predicted normal range. Comparison of equipment, software, and protocols with those from previous reports revealed the importance of minimization of dead space and of adequate subtraction of all compressible occluded volume when calculating FRC in infants. These findings emphasize the need to establish reference data for lung function tests in infants that are appropriate for the equipment and protocols in current use.

Age Factors↗

Measurement of lung volumes during active and quiet sleep in infants.

The question of whether functional residual capacity (FRC) falls in infants during active sleep has been clouded by studies using different subject groups and techniques for measurements of lung volume and determination of sleep state. Twenty healthy full-term infants within the first week of life participated in the present study. Neurophysiological and behavioral criteria were used to define sleep state, and measurements of FRC were made using a specially constructed closed-circuit helium dilution system. Regularity of respiration was recorded using magnetometers on the chest and a modified respirator monitor. Results showed that no significant changes in FRC occurred, related either to sleep state or to regularity of respiration. In addition, we failed to detect any differences in FRC between the sexes.

Body Weight↗

Evaluation of bronchodilator responses in patients with "irreversible" emphysema.

Given the emerging physiological and clinical rationale for pharmacological lung-volume reduction, assessment of volume responses to bronchodilators is likely to be highly relevant in chronic obstructive pulmonary disease (COPD). The authors examined the magnitude of lung-volume reduction after acute bronchodilator treatment in patients with advanced emphysema. Eighty-four stable patients with emphysema (mean+/-SEM forced expiratory volume in one second (FEV1): 32+/-1% predicted) performed spirometry and body plethysmography before and 15-30 min after 200 microg salbutamol. Only irreversible patients with a postbronchodilator change in FEV1 <10% pred were considered in this study. Postsalbutamol, the majority of subjects (83%) had significant improvements in one or more lung volumes: on average, residual volume (RV), functional residual capacity (FRC), inspiratory capacity (IC), forced vital capacity and slow vital capacity changed by -18+/-2, -10+/-1, 8+/-1, 9+/-1 and 7+/-1% pred (p<0.0005 each). Total lung capacity (TLC) decreased 0.12+/-0.04 L (p<0.01). Change in IC reflected change in FRC (r=-0.60, p<0.0005), but more strongly in the 57% of patients with no significant change in TLC (r=-0.93, p<0.0005). The magnitude and frequency of volume responses were greatest in patients with the most severe COPD; for example, RV decreased by 0.51+/-0.09 L (23+/-4% pred) and 0.27+/-0.04 L (14+/-2% pred) in severe and moderate subgroups, respectively. Significant reductions in lung hyperinflation occurred in the absence of a change in forced expiratory volume in one second after low-dose salbutamol in a majority of patients with advanced emphysema; the greatest changes occurred in those with the most severe disease.

Aged↗

Tracheal size and shape: effects of change in intraluminal pressure.

We used CT to examine the tracheas of two healthy adults at functional residual capacity, first at an intratracheal pressure of +20-cm H2O and then at -20-cm H2O. In the intrathoracic portions of the tracheas there was little change in cross-sectional area between the two pressures. However, in the neck the cross-sectional areas decreased by about one third from the higher pressure to the lower. The membranous posterior wall of the woman's extrathoracic trachea bulged backwards strikingly at the higher pressure but was drawn well into the tracheal lumen at the lower pressure. The two tracheas were 6% and 12% shorter at the lower pressure, and the intratracheal volume was 17% to 23% less. The data show that the size and shape of the extrathoracic portion of the normal adult trachea are very responsive to moderate changes in intraluminal pressure.

Female↗

A comparison of pressure- and volume-controlled ventilation at different inspiratory to expiratory ratios.

BACKGROUND: Inverse ratio ventilation (IRV) is frequently used in severe acute respiratory failure. IRV may lead to intrinsic positive end-expiratory pressure (PEEP) and is thought to improve oxygenation and to have advantageous effects on lung mechanics. Published data to support the use of IRV are scarce. This animal study compares external PEEP with intrinsic PEEP in pressure- and volume-controlled ventilation. METHODS: Fifteen pigs were randomly treated with 1. volume-controlled PEEP ventilation (I:E ratio 1:2) (VCV PEEP), 2. volume-controlled ventilation (I:E ratio 4:1) (VCIRV) and 3. pressure-controlled ventilation (I:E ratio 4:1) (PCIRV). Baseline measurements were performed using volume-controlled ventilation (I:E ratio 1:2) (VCV ZEEP). Lung mechanics, haemodynamics and gas exchange were measured by standard methods and functional residual capacity (FRC) by the sulphur hexafluoride technique. RESULTS: In comparison to VCV PEEP, PCIRV resulted in reduced peak airway pressure (32 +/- 3 vs. 27 +/- 6 cm H2O, P < 0.001) and increased mean airway pressure (14 +/- 2 vs. 22 +/- 5 cm H2O, P < 0.001). FRC was 942 +/- 264 ml in VCV PEEP and 1024 +/- 390 ml in PCIRV (n.s.). Oxygen delivery was lower in PCIRV (458 +/- 193 vs. 346 +/- 150 ml/min, P < 0.05). Physiologic dead space was 14 +/- 4% in PCIRV and 20 +/- 6% in VCV PEEP and VCIRV (P < 0.005). CONCLUSIONS: Inverse ratio ventilation did not result in improved FRC in comparison to conventional volume-controlled PEEP ventilation. PCIRV allows for a reduction in minute ventilation but the increase in mean airway pressure compromises circulation.

Airway Resistance↗