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Biomedical subjects

J Milic-Emili

Publications and source records attributed to J Milic-Emili.

At least 163 records · Page 9Linked to original sources
PubMed1985

Decay of inspiratory muscle pressure during expiration in conscious humans.

In eight conscious spontaneously breathing adults we studied the decay of pressure developed by the inspiratory muscles during expiration (PmusI). PmusI was obtained according to the following equation: PmusI(t) = Ers X V(t) - Rrs X V(t), where V is volume and V is flow at any instant t during spontaneous expiration, and Ers and Rrs are, respectively, the passive elastance and resistance of the total respiratory system. Ers was determined with the relaxation method, and resistance with the interrupter method. All subjects showed marked braking of expiratory flow by PmusI. The mean time for PmusI to reduce to 50 and 0% amounted, respectively, to 23 and 79% of expiratory time. During expiration, 24-55% of the elastic energy stored during inspiration was used as resistive work and the remainder (45-76%) as negative work.

Adult↗
PubMed1985

Respiratory resistance in dogs by the single-breath and the forced oscillation methods.

Total respiratory resistance (Rrs) was measured in six anesthetized dogs with two different methods: the single-breath (SB) method, which provides the time constant of the system during a relaxed expiration and the forced oscillation (FO) method, which uses a pseudorandom noise signal applied at the airway opening. The comparison was made in three conditions: before muscle paralysis (A), after muscle paralysis (B), and after tracheal banding (C). In conditions A and B the two computed resistances correlated very well with each other (r = 0.98). No systematic difference between Rrs values obtained with the two methods was found. In condition C the respiratory resistance was clearly nonlinear from the flow-volume curves during SB and could be described with Rohrer's equation: Rrs = K1 X V + K2 X V2, where K1 and K2 are Kohrer's constant and V is flow. Rrs measured with FO was not frequency dependent during tracheal banding (C) and was virtually equivalent to K1. Since the FO method uses low flows as the input of the respiratory system and K1 could be ascribed to laminar flow, the numerical matching appears reasonable and tends to reinforce the validity of both methods of measurement. We conclude that, for the normal respiratory system, FO and SB methods are approximately equivalent. In the presence of a markedly alinear central airway resistance with normal lungs, the SB method appears to provide a more adequate description of the flow-resistive properties of the system.

Airway Resistance↗
PubMed1985

Interrupter technique for measurement of respiratory mechanics in anesthetized humans.

Flow (V), volume (V), and tracheal pressure (Ptr) were measured throughout a series of brief (100 ms) interruptions of expiratory V in six patients during anesthesia (halothane-N2O) and anesthesia-paralysis (succinylcholine). For the latter part of spontaneous expiration and throughout passive deflation during muscle paralysis, a plateau in postinterruption Ptr was observed, indicating respiratory muscle relaxation. Under these conditions, passive elastance of the total respiratory system (Ers) was determined as the plateau in postinterruption Ptr divided by the corresponding V. The pressure-flow relationship of the total system was determined by plotting the plateau in Ptr during interruption against the immediately preceding V. Ers averaged 23.5 +/- 1.9 (SD) cmH2O X l-1 during anesthesia and 25.5 +/- 5.4 cmH2O X l-1 during anesthesia-paralysis. Corresponding values of total respiratory system resistance were 2.0 +/- 0.8 and 1.9 +/- 0.6 cmH2O X l-1 X s, respectively. Respiratory mechanics determined during anesthesia paralysis using the single-breath method (W.A. Zin, L. D. Pengelly, and J. Milic-Emili, J. Appl. Physiol. 52: 1266-1271, 1982) were also similar. Early in spontaneous expiration, however, Ptr increased progressively during the period of interruption, reflecting the presence of gradually decreasing antagonistic (postinspiratory) pressure of the inspiratory muscles. In conclusion, the interrupter technique allows for simultaneous determination of the passive elastic as well as flow-resistive properties of the total respiratory system. The presence of a plateau in postinterruption Ptr may be employed as a useful and simple criterion to confirm the presence of respiratory muscle relaxation.

Adult↗
PubMed1985

Volume-time profile during relaxed expiration in the normal dog.

Airway opening pressure, esophageal pressure, and flow were obtained during relaxed expirations in two normal anesthetized paralyzed dogs. The signal-to-noise ratio in the flow signals was greatly increased by averaging 10 different signals obtained with the same lung inflation volume. Numerical integration of an averaged flow signal then yielded the time course of the volume of the respiratory system above functional residual capacity (the elastic equilibrium volume). Comparison of volume signals obtained with different inflation volumes suggests that the resistance of the respiratory system increases with flow. The flow-volume and semilog volume curves show that expiration is induced by two apparently separate mechanisms: one causes emptying of most of the expired volume over a time interval of much less than 1 s, whereas the other contributes a relatively small amount to the expired volume over a significantly longer time (greater than or equal to 1 s). We postulate the first mechanism to be due to that of the respiratory system behaving like a single unit, with an elastance that is slightly volume dependent, emptying through a single airway which has a resistance that increases with flow. From the nature of airway opening pressure and esophageal pressure measured after occlusion in midexpiration, we conclude that the second mechanism is due to the viscoelastic properties (i.e., creep) of the respiratory system. The properties are manifest mainly in the chest wall.

Animals↗
PubMed1985

Noninvasive determination of respiratory system mechanics during mechanical ventilation for acute respiratory failure.

In 10 acutely ill patients mechanically ventilated for management of acute respiratory failure, respiratory system mechanics were determined with the interrupter technique as described recently (J Appl Physiol 1984; 56:681-690). Flow, volume, and tracheal pressure were measured throughout a series of brief expiratory interruptions. A plateau in tracheal pressure during interruption was observed in all patients, indicating respiratory muscle relaxation as well as equilibration between alveolar and tracheal pressure. Measurement of the plateau in postinterruption tracheal pressure, corresponding volume, and preceding flow enabled determination of the passive elastic and flow-resistive properties of the total respiratory system. In general, the volume-pressure relationship was linear over the expired volume examined and did not necessarily pass through the origin, indicating deviation of the end-expiratory lung volume during mechanical ventilation from the equilibrium position of the respiratory system. Elastance, or inverse slope of this relationship, averaged 16.88 +/- 1.90 (SE) cmH2O X 1(-1). The pressure-flow relationship of the respiratory system was curvilinear; resistance averaged 19.74 +/- 2.08 (SE) cmH2O X 1(-1) X s at a flow rate of 1.0 1 X s-1. In 6 patients the pressure-flow relationship was concave upward. An upward convexity, particularly towards end expiration, was present in the remaining patients. This was associated with characteristic "supramaximal" flow transients after expiratory interruptions, indicating the presence of dynamic airway compression and expiratory flow limitation. In conclusion, the interrupter technique enabled detailed examination of the passive elastic and flow-resistive properties of the total respiratory system in mechanically ventilated patients using simple, noninvasive equipment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. The effect of intrinsic positive end-expiratory pressure.

In mechanically ventilated patients with acute respiratory failure, the static compliance of the total respiratory system is conventionally obtained by dividing the tidal volume by the difference between the "plateau" pressure measured at the airway opening (PaO) during an occlusion at end-inspiration and positive end-expiratory pressure (PEEP) set by the ventilator. This analysis is valid only if the elastic recoil pressure of the respiratory system is zero at the end of expiration, indicating that the system has reached its elastic equilibrium point. To test if this is always the case, in 14 mechanically ventilated patients with acute respiratory failure, measurements were made of PaO and of flow and volume changes. In only 4 of the patients did expiratory flow become nil before end-expiration and inspiratory flow started synchronously with the onset of the positive-pressure swing delivered by the ventilator, indicating that in these 4 patients the end-expiratory elastic recoil pressure was indeed zero. By contrast, in the remaining 10 subjects, expiratory flow was still present when the ventilator had already begun to increase PaO, indicating that the end-expiratory elastic recoil pressure was not zero. Indeed, in all these 10 patients, a positive delta PaO (as much as 7.5 cm H2O) had to be applied by the ventilator before the actual onset of inspiratory flow. This delta PaO represents the pressure required to counterbalance the end-expiratory elastic recoil before inspiratory flow will begin, and can be termed intrinsic PEEP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Work of breathing in patients with chronic obstructive pulmonary disease in acute respiratory failure.

In 11 spontaneously breathing patients with chronic obstructive pulmonary disease (COPD) in acute ventilatory failure, we measured the total inspiratory (WItot) and total resistive (WI + Eres) work rate of breathing, together with lung mechanics (dynamic pulmonary elastance and inspiratory and expiratory pulmonary flow resistance). All variables were markedly increased compared with those in normal subjects. No significant correlation was found between WItot and WI + Eres with lung mechanics data. However, when WItot and WI + Eres were expressed per liter of ventilation, a significant positive correlation was found with all lung mechanics data. These results indicate that although in patients acutely ill with COPD, work rate and work per liter of ventilation are increased, only the latter is related to the severity of pulmonary mechanical impairment, and it could be used as one of the criteria for extubation. In addition, our results indicate that at end-expiration the alveolar pressure was positive (range, 6 to 13 cm H2O) in all patients (intrinsic PEEP), a fact that must necessarily affect hemodynamics; furthermore, it imposes an extra burden on the inspiratory muscles.

Acute Disease↗
PubMed1984

Effect of protein intake on ventilatory drive.

Previous studies have demonstrated that if isotonic amino acid infusions were administered at a rate that approximated normal daily protein requirements, a leftward shift of the minute ventilation X PaCO2 relationship occurred. This study examined the effect of the administration of parenteral nutrition, at a fixed caloric intake and two levels of nitrogen (N) intake, on the ventilatory response to CO2 in nutritionally depleted patients. The intent was to determine whether increasing protein intake from normal to twice normal requirements would result in a further enhancement of the ventilatory response to CO2. Eight patients with nutritional depletion (greater than 10% weight loss) were studied. The resting energy expenditure (REE) was measured during administration of 5% dextrose, using principles of indirect calorimetry. Each patient received parenteral nutrition for a 2-week period. Two diets were examined for a 1-week period each: 1) a high N intake-15 mg nitrogen per kcal REE (approximately 21 g/day), or b) a low N intake--7.5 mg nitrogen per kcal REE (approximately 11 g/day). The initial diet was assigned randomly. Total energy intake was set at 1.35 X REE as measured during administration of 5% dextrose solution. Nonprotein calories were administered as 50% glucose and 50% fat. Breathing patterns at rest and during inhalations of 2 and 4% CO2 were analyzed using a canopy-computer-spirometer system. With an increased nitrogen intake there was a significant reduction in resting arterial PaCO2 from 39.9 to 37.6 mmHg (P less than 0.05) with no significant change in pH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Ventilatory effects of biceps vibration during leg exercise in healthy humans.

The ventilatory effects of biceps tendon vibration were studied in healthy human subjects at rest and at two levels of light leg exercise. This was performed with intent to add the ventilatory effects of selective stimulation of muscle spindles to nervous and humoral respiratory inputs from contracting muscles. Tendon vibration performed in individuals at rest elicited a marked increase in respiratory frequency and in the ratio between inspiratory time and total breath duration with variable changes in tidal volume; this was in agreement with previous results (Jammes et al., 1981). When stimulation of biceps proprioceptors was performed during steady state exercise, the changes in ventilatory timing were attenuated, but variations in tidal volume often occurred. These results suggest that, when respiratory centers are being entrained by performance of work, further activation of muscle receptors exerts complex effects on the breathing pattern with a lack of facilitatory influences in ventilation and gas exchange.

Adult↗
PubMed1984

Interrupter technique for measurement of respiratory mechanics in anesthetized cats.

In six spontaneously breathing anesthetized cats (pentobarbital sodium, 35 mg/kg ip), airflow, changes in lung volume, and tracheal and esophageal pressures were measured. Airflow was interrupted by brief airway occlusions during relaxed expirations (elicited via the Breuer-Hering inflation reflex) and throughout spontaneous breaths. A plateau in tracheal pressure occurred throughout relaxed expirations and the latter part of spontaneous expirations indicating respiratory muscle relaxation. Measurement of tracheal pressure, immediately preceding airflow, and corresponding volume enabled determination of respiratory system elastance and flow resistance. These were partitioned into lung and chest wall components using esophageal pressure. Respiratory system elastance was constant over the tidal volume range, divided approximately equally between the lung and chest wall. While the passive pressure-flow relationship for the respiratory system was linear, those for the lung and chest wall were curvilinear. Volume dependence of chest wall flow resistance was demonstrated. During inspiratory interruptions, tracheal pressure increased progressively; initial tracheal pressure was estimated by backward extrapolation. Inspiratory flow resistance of the lung and total respiratory system were constant. Force-velocity properties of the contracting inspiratory muscles contributed little to overall active resistance.

Airway Resistance↗
PubMed1984

Model analysis of tidal volume response to inspiratory elastic loads.

Based on experimental inspiratory driving pressure waveforms and active respiratory impedance data of anesthetized cats, we made model predictions of the factors that determine the immediate (first loaded breath) intrinsic (i.e., nonneural) tidal volume compensation to added inspiratory elastic loads. The time course of driving pressure (P) was given by P = atb, where a is the pressure at 1 s from onset of inspiration and represents the intensity of neuromuscular drive, t is time, and b is an index of the shape of the driving pressure wave. For a given active respiratory impedance, tidal volume compensation to added elastic loads decreases with increasing inspiratory duration and decreasing value of b but is independent of a. We have also assessed the validity of the "effective elastance" (Lynne-Davies et al., J. Appl. Physiol. 30: 512-516, 1971) as a predictor of tidal volume responses to elastic loads. In absence of vagal feedback, the effective elastance appears to be a reliable predictor, except for short inspiratory duration and a very high intrinsic resistance.

Airway Resistance↗
PubMed1984

Effect of respiratory apparatus on respiration.

A mouthpiece plus noseclip (MP + NC) is frequently used in performing measurements of breathing patterns. Although the effects the apparatus exerts on breathing patterns have been studied, the mechanism of the changes it causes remains unclear. The current study examines the effects on respiratory patterns of a standard (17-mm-diam) MP + NC during room air (RA) breathing and the administration of 2 and 4% CO2 in normal volunteers and in patients 2-4 days after abdominal operation. When compared with values obtained with a noninvasive canopy system, the MP + NC induced increases in minute ventilation (VE), tidal volume (VT), and mean inspiratory flow (VT/TI), but not frequency (f) or inspiratory duty cycle, during both RA and CO2 administration. The percentage increase in VE, VT, and VT/TI caused by the MP + NC decreased as the concentration of CO2 increased. During RA breathing, the application of noseclip alone resulted in a decrease in f and an increase in VT, but VE and VT/TI were unchanged. The changes were attenuated during the administration of 2 and 4% CO2. Reducing the diameter of the mouthpiece to 9 mm abolished the alterations in breathing pattern observed with the larger (17-mm) diameter MP.

Adult↗
PubMed1984

Effect of resistive loading on inspiratory work output in anesthetized cats.

In five spontaneously breathing anesthetized cats, we determined the inspiratory elastic (Wel), resistive (Wres), and total (WI) mechanical work rates (power) during control and first loaded inspirations through graded linear resistances (delta R) by "Campbell diagrams" based on measurement of esophageal pressure. WI did not change with delta R's up to 0.31 cmH2O X ml-1 X s, the concomitant decrease in Wel being balanced by an increase in Wres. The stability of WI in the face of delta R's was due to the vagally mediated prolongation of inspiration and the intrinsic properties of the respiratory system and of the contracting inspiratory muscles. To assess the separate contributions of volume-related and flow-related intrinsic mechanisms to the stability of WI, we made model predictions of the immediate effects of delta R's on inspiratory mechanical work output based on measurements of inspiratory driving pressure waves and passive and active respiratory resistance and elastance on the same five cats. The results suggest that the intrinsic stability of WI in the face of delta R's is provided primarily by the active elastance.

Airway Resistance↗
PubMed1984

Muscle pressure and flow during expiration in infants.

The postinspiratory activity of the inspiratory muscles (Pmusl) was estimated in 12 infants (2 to 4 days old) by analysis of the rise in mask pressure after airway occlusion at end inspiration. We reasoned that if at the end of inspiration Pmusl instantaneously ceased, the mask pressure would immediately increase to the relaxation pressure value corresponding to that volume. Any delay would suggest some degree of Pmusl. In 9 infants, Pmusl reached zero before the end of an average expiration (TE), although lasting for a long portion of TE (83% +/- 25 SD). We then compared the expiratory tidal flow-volume curves during resting breathing with the curves of "relaxed" expirations. In general, the tidal curve shows a linear portion that can be extrapolated to zero flow. From this extrapolation it is apparent that the end-expiratory level (FRC) is above the resting volume of the respiratory system (Vr), the FRC-Vr difference averaging 3.11 ml/kg. In 6 infants, the tidal expiratory flow-volume curve was displaced to the left of the "relaxed" curve, whereas in the remaining infants the two curves superimposed. These analyses suggest that in infants during tidal breathing (1) Pmusl can substantially contribute to the rise in FRC, and (2) the final portion of expiration is in most cases "relaxed." In some infants, however, a braking mechanism, probably of laryngeal origin, further decreases the expiratory flow and may contribute in maintaining the mean lung volume elevated.

Functional Residual Capacity↗
PubMed1983

Measurement of pleural pressure with esophageal balloon in anesthetized humans.

Simultaneous measurement of tracheal and esophageal pressures during occluded inspiratory efforts (occlusion test) was used to assess the validity of the esophageal balloon technique in anesthetized supine subjects. Ten ASA 1 patients undergoing general anesthesia (halothane 1 MAC, nitrous oxide 70%, and oxygen) for minor surgery were studied. Esophageal pressure (Pes) was measured using a 5-cm-long balloon and was plotted against tracheal pressure (Pt). Occlusion tests were performed at end expiration with the balloon top positioned 5, 10, 15, and 20 cm above the cardia. The results show that with the balloon positioned at the classical level of 10 cm above the cardia, the difference between delta Pes and delta Pt did not exceed 8% in seven of 10 subjects. In the remaining three, however, the difference between delta Pes and delta Pt ranged between +20% and -40%. By repositioning the balloon to 5 or 15 cm above the cardia, a locus was found in all subjects where the difference is less than 10%. We conclude that the esophageal balloon technique can be used in anesthetized supine subjects to give reliable measurements of changes in pleural pressure, provided that it is validated with the occlusion test.

Adult↗
PubMed1983

Decay of inspiratory muscle pressure during expiration in anesthetized cats.

In six spontaneously breathing anesthetized cats (pentobarbital sodium, 35 mg/kg) we studied the antagonistic pressure developed by the inspiratory muscles during expiration (PmusI). This was accomplished in two ways: 1) with our previously reported method (J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 52: 1266-1271, 1982) based on the measurement of changes in lung volume and airflow during spontaneous expiration, together with determination of the total passive respiratory system elastance and resistance; and 2) measurement of the time course of changes in tracheal/pressure after airway occlusion at end inspiration, up to the moment when the inspiratory muscles become completely relaxed. The agreement between the two methods is generally good, both in the amplitude of PmusI and in its time course. We also applied the first method to spontaneous expirations through added linear resistive loads. These did not alter the relative decay of PmusI. Thus in anesthetized cats the braking action of the inspiratory muscles does not decrease when expiratory resistive loads are added, i.e., when such braking is clearly not required.

Anesthesia, General↗
PubMed1983

A new method for measurement of respiratory resistance.

A new method for measuring the resistance of the total respiratory system is presented. The method uses a device comprising a solenoid valve, a multiperforated plate, and a pneumotachograph. The multiperforated plate serves as a constant resistor (Rk) that is used to partially occlude the airway opening, thus rapidly and briefly reducing airflow during natural expiration. If it is assumed that the driving pressure remains constant during the very short period the airway is partially occluded, the respiratory flow immediately preceding the addition of Rk (V) and the flow reduction during partial occlusion (delta V) allow calculation of the resistance of the total respiratory system. The resistance of 14 normal subjects and 18 patients with chronic obstructive pulmonary disease (COPD) was measured with this new method as well as with the body plethysmographic method: 90% of the interrupter values fell within +/- 0.6 cmH2O . l-1.s of the plethysmographic values, and all fell within +/- 0.8 cmH2O . l-1.s.

Airway Resistance↗