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Biomedical subjects

J R Rodarte

Publications and source records attributed to J R Rodarte.

At least 73 records · Page 4Linked to original sources
PubMed1989

The effects of positive expiratory pressure on isovolume flow and dynamic hyperinflation in patients receiving mechanical ventilation.

The use of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) has been advocated by some to assist in the weaning process of patients receiving mechanical ventilation for respiratory failure. The efficacy of this technique and its effect on respiratory system mechanics are not well understood. The theoretical advantage of CPAP or PEEP during the weaning process can be obliterated if excessive dynamic hyperinflation is induced. A key determinant of the individual response to this proposed weaning technique is the recognition of the presence or absence of expiratory flow limitation. We studied the effect of progressively increased levels of applied PEEP on isovolume expiratory flow and end-expiratory lung volume in seven patients during controlled mechanical ventilation. In the absence of expiratory flow limitation, passive expiratory flow decreased and end-expiratory lung volume increased when any level of PEEP was applied. In contrast, flow-limited patients did not demonstrate a change in isovolume expiratory flow or end-expiratory lung volume until the applied PEEP reduced the driving pressure for expiratory flow below a critical value. All patients demonstrated dynamic hyperinflation during controlled ventilation as evident by the existence of intrinsic PEEP. The nominal value of applied PEEP that caused a reduction in isovolume expiratory flow was unrelated to the initial level of intrinsic PEEP. The clinical implications of these findings with respect to CPAP therapy during weaning from mechanical ventilation are discussed.

Humans↗
PubMed1988

Coupling between rib cage and abdominal compartments of the relaxed chest wall.

The volume displacements of the rib cage and abdomen of relaxed seated subjects were measured as functions of pleural pressure with the chest wall expanded by airway pressure and with the chest wall distorted by an external force applied to the rib cage. From the measured displacements for the two independent loads, the three compliances that describe the mechanical properties of the relaxed chest wall modeled as a linear elastic system with two degrees of freedom were obtained. The cross compliance that describes the coupling between the rib cage and abdomen was found to be small and positive, 0.01-0.02 1/cmH2O. The displacement of the rib cage by the external force was consistent with the displacement predicted by use of standard methods for calculating the mechanical advantage of the force.

Abdomen↗
PubMed1988

Effects of unilateral pleural symphysis on respiratory system mechanics and gas exchange in anesthetized dogs.

Lateral thoracotomy with pleural abrasion and application of talc was performed on 8 adult beagle dogs. The dogs had no effusion detectable on roentgenogram at the time of study, and obliteration of the pleural space was later confirmed by autopsy. With the dogs under pentobarbital anesthesia, lung mechanics and gas exchange were studied before and 5 wk after surgery. Total lung capacity decreased to 78% of control value (p less than 0.05). After the operation, pressure-volume curves of the respiratory system were shifted down, along with significantly decreased compliance. Maximal flow at constant lung volume was not significantly increased. Arterial O2 and CO2 tensions were not significantly different. Rebreathing DLCO normalized for lung volume was unchanged. The slope of phase III of a single-breath nitrogen test was increased (p less than 0.05) after surgery. Unilateral surgical obliteration of the pleural space results in a pure restrictive pattern. It does not affect the gas exchange surface. The increase in the slope of phase III is suggestive of a nonhomogeneous distribution of ventilation.

Anesthesia↗
PubMed1988

Oxygen uptake during weaning from mechanical ventilation.

Total body oxygen uptake (VO2) increases during the transition from machine-assisted ventilation to spontaneous breathing. Since the volume of oxygen consumed by the respiratory muscles must contribute to the increase in VO2 (delta VO2), we explored whether delta VO2 and/or measurements of respiratory power output (Wresp) provide clinically useful information in the evaluation of disease state and weaning decisions in patients with respiratory failure. We determined the metabolic, ventilatory, and hemodynamic responses of ten patients during weaning from controlled mechanical ventilation, and compared delta VO2 and Wresp of patients without overt heart-lung disease (group 1) to that of patients with significant cardiopulmonary dysfunction and ventilator-dependent respiratory failure (group 2). We reasoned that for delta VO2 to be clinically useful, individual values must either clearly differ between groups, must be higher in patients with heart-lung disease, and/or correlate with weaning outcome and independent measurements of respiratory work. The VO2 increased in nine of ten patients. The differences between the groups in the values of delta VO2 (27 ml/min and 49 ml/min) and respiratory power (9.38 J/min and 11.99 J/min) were not significant. delta VO2 and Wresp were not correlated (r = 0.2), and neither predicted weaning outcome. We conclude that the sensitivity and specificity of delta VO2 and Wresp appear insufficient for evaluation of disease state and weaning decisions in individual patients.

Aged↗
PubMed1987

Respiratory impedance in normal humans: effects of bronchodilatation and bronchoconstriction.

Total respiratory resistance and reactance from 3 to 30 Hz were determined by the method of forced random noise oscillation in 12 normal male subjects before and after bronchodilatation and bronchoconstriction induced by deep breaths of aerosols of isoproterenol and atropine and of methacholine and histamine. Isoproterenol and atropine induced small decreases in total respiratory resistance at most frequencies, and isoproterenol decreased resonant frequency slightly (P less than 0.01). After administration of both methacholine and histamine, resonance frequency increased (P less than 0.01) and total respiratory resistance became more frequency-dependent, increasing mainly in the lower frequency range. In six of the subjects, we attempted to produce central deposition of methacholine by rapid, shallow breathing and peripheral deposition of the drug by slow, deep breathing. Only two subjects had suggestive evidence of central bronchoconstriction. No difference was noted, however, in the impedance behavior with either type of breathing. In awake humans, impedance analysis does not seem to distinguish between central and peripheral airway constriction.

Adult↗
PubMed1987

Effect of variable parenchymal expansion on gas mixing.

Using implanted radiopaque markers, Hubmayr et al. (J. Appl. Physiol. 54: 1048-1056, 1983) and Olson et al. (J. Appl. Physiol. 57: 1710-1714, 1984) detected a variability in the volume changes of regions defined by the markers in intact and excised dog lungs, respectively. In dogs lying prone and in excised lobes, there is virtually no large-scale spatial organization of the variability. We interpret these data as evidence of an intrinsic heterogeneity of parenchymal expansion. The effect of variability of parenchymal expansion on gas mixing is calculated. From a statistical model, we infer that the variability of volume changes observed by Olson et al. is a result of an underlying variability with a larger magnitude at a smaller scale and that the variability at the smaller scale is large enough to explain the inefficiency of mixing observed in single-breath oxygen tests on excised dog lobes.

Animals↗
PubMed1987

Geometry and respiratory displacement of human ribs.

The three-dimensional coordinates of points in the ribs of two supine relaxed males, holding their breath at functional residual capacity (FRC) and with their glottis closed at total lung capacity (TLC), were obtained from volumetric X-ray computed tomographical images. The orientation of planes that best fit the data for each rib at each lung volume and the circular arcs that fit the points in the planes of the ribs were determined, and average values of these geometrical parameters for ribs 3-7 are reported. The planes of the ribs at TLC can be described as displaced from the planes at FRC by a rotation about an axis that passes near the spine. The pump handle and bucket handle components of rotation are 11 and 13 degrees, respectively, for rib 3 and both decrease with increasing rib number to 7 and 10 degrees at rib 7. The angles between the axes of rotation and the midplane are approximately 35 degrees for all 5 ribs. The radii of the circular arcs fit to the data at TLC are slightly larger than those at FRC, and this suggests that there is a small component of rotation normal to the plane of the rib.

Adult↗
PubMed1987

Regional ventilation during spontaneous breathing and mechanical ventilation in dogs.

We evaluated the effects of the different patterns of chest wall deformation that occur with different body positions and modes of breathing on regional lung deformation and ventilation. Using the parenchymal marker technique, we determined regional lung behavior during mechanical ventilation and spontaneous breathing in five anesthetized recumbent dogs. Regional lung behavior was related to the patterns of diaphragm motion estimated from X-ray projection images obtained at functional residual capacity (FRC) and end inspiration. Our results indicate that 1) in the prone and supine positions, FRC was larger during mechanical ventilation than during spontaneous breathing; 2) there were significant differences in the patterns of diaphragm motion and regional ventilation between mechanical ventilation and spontaneous breathing in both body positions; 3) in the supine position only, there was a vertical gradient in lung volume at FRC; 4) in both positions and for both modes of breathing, regional ventilation was nonlinearly related to changes in lobar and overall lung volumes; and 5) different patterns of diaphragm motion caused different sliding motions and differential rotations of upper and lower lobes. Our results are inconsistent with the classic model of regional ventilation, and we conclude that the distribution of ventilation is determined by a complex interaction of lung and chest wall shapes and by the motion of the lobes relative to each other, all of which help to minimize distortion of the lung parenchyma.

Animals↗
PubMed1987

Effect of effort on measurement of forced expiratory volume in one second.

The American Thoracic Society recommends that the largest FEV1 be reported from a set of forced expiratory vital capacity maneuvers performed with maximal expiratory effort. However, increased expiratory effort can decrease the FEV1. When we evaluated the peak expiratory flow rate (PEFR) in 5 normal subjects, measured from flow-volume curves, as a noninvasive index of expiratory effort, it was positively correlated with indices of effort obtained by using an esophageal balloon. We then measured the difference (dFEV1)between the largest FEV1 and FEV1 from the maneuver with the highest PEFR during 10 test sessions in 10 normal subjects. Thus, dFEV1 was always greater than or equal to 0. The mean dFEV1 was 110 ml for all sessions but decreased to 80 ml when maneuvers with poorly reproducible PEFR or forced expiratory vital capacity values were discarded. We also reviewed 9.471 spirometry sessions from outpatients and found dFEV1 to be greater than 50 ml in 26% of this population and greater than 151 ml in 7%. We concluded that during standard spirometry, FEV1 is inversely dependent on effort. Maximal effort decreases FEV1 because of the effect of thoracic gas compression on lung volume. We recommend that values from spirometry maneuvers that demonstrate submaximal effort, indicated by a decreased PEFR, be discarded. The flow-volume curve display of superimposed efforts facilitates the recognition of submaximal efforts.

Biophysical Phenomena↗
PubMed1987

Evaluation of bronchodilator responsiveness in mechanically ventilated patients.

Airway pressure, flow, and volume were measured before and after administration of aerosolized metaproterenol during controlled mechanical inflation and stepwise deflation of the relaxed respiratory system in 13 mechanically ventilated patients. An increase in passive expiratory flow at constant respiratory system recoil pressure was considered evidence of bronchodilatation. In 10 patients, at a respiratory system recoil pressure of 6 cm H2O (VP6), expiratory flow increased 21 to 500% above prebronchodilator level. In these 10 dynamically hyperinflated patients, an increase in VP6 was associated with a decrease in peak inspiratory pressure (Ppeak) (mean delta = -4.7 cm H2O) and a decrease in intrinsic positive end-expiratory pressure (Peepi) (mean delta = -2.4 cm H2O). The elastance of the respiratory system was not affected by metaproterenol, and the delta Peepi corresponded to a mean decrease in end-expiratory lung volume of 0.20 L. The results are consistent with predictions based on a single-compartment model. When mean expiratory flow is determined only by the tidal volume and expiratory time, a decrease in airway resistance results in a decrease in lung volume at which patients are ventilated. Therefore, the decrease in Ppeak is caused not only by a decrease in the resistive pressure cost but also by a decrease in the elastic pressure cost of inflating the respiratory system. It is emphasized that Ppeak and Peepi provide valuable information about bronchodilator-induced changes in lung function during controlled mechanical ventilation.

Adult↗
PubMed1986

Effect of heart weight on distribution of lung surface pressures in vertical dogs.

In head-up dogs the vertical gradient of transpulmonary pressure (VGTP) disappears after pneumothorax develops. Our laboratory recently confirmed that the heart moves downward and posteriorly with pneumothorax. To study the extent to which the heart is supported by the lungs, we used a linear elasticity model and finite-element analysis. The lung and heart were assumed to be symmetric along a vertical axis. Reported values of the elastic properties of lung and heart were assigned. The model was generated first without the heart, using the lung alone. The heart was then added to the model. Finally, heart weight was doubled. Adding the heart caused the VGTP to increase; doubling the heart weight further increased the VGTP. These increases were more pronounced at higher lung volumes. Lung inflation was accompanied by an upward displacement of the heart. Inclusion of the heart caused increased inhomogeneities in regional volume distribution. The effect of heart weight may in part explain why the VGTP in the head-up dog is greater than that predicted by lung density.

Animals↗
PubMed1985

Effect of resection of the sternum and manubrium in conjunction with muscle transposition on pulmonary function.

We recorded the changes in pulmonary function that occurred after removal of the sternum and manubrium and repair by pectoralis major muscle transposition in six patients. Of these patients, three had osteomyelitis of the manubrium and sternum, two had osteosarcoma of the sternum, and one had osteomyelitis and radionecrosis of the manubrium and sternum. Body plethysmography and the rebreathing, hypercapnic ventilatory response test with inductive plethysmographic recordings of chest-wall motion were performed preoperatively and postoperatively. Preoperatively, four of the six patients had evidence of mild to moderate chest-wall restriction. Pulmonary function was normal in the other two patients. Postoperatively, total lung capacity was unchanged but the vital capacity decreased 11.5% in the overall group. Static compliance, retractive force, and the steady-state diffusing capacity for carbon monoxide decreased modestly but significantly postoperatively. The expiratory flow rates and maximal voluntary ventilation remained unchanged. Preoperatively, the slope of the hypercapnic ventilatory response was less than that predicted. Postoperatively, the slope did not change. In three patients, however, increased dependence on the abdomen for breathing suggested a dynamic restriction of rib-cage motion. On the basis of our findings, we conclude that surgical removal of the sternum and manubrium in conjunction with muscle flap repair is a well-tolerated procedure. Any postoperative changes in pulmonary function are minor.

Adolescent↗
PubMed1985

Regional lung strain in dogs during deflation from total lung capacity.

Regional lung distortion during deflation from total lung capacity to functional residual capacity (FRC) in intact supine and prone anesthetized dogs was determined from the displacement of multiple metallic markers embedded in the lung parenchyma. Distortion was expressed as strain (epsilon), which is related to fractional length changes. In the supine position, transverse strain (epsilon yy) was larger than vertical strain (epsilon xx) and cephalocaudal strain (epsilon zz) in the upper lobe. The FRC of the lower lobe was smaller than FRC of the upper lobe and all strains were larger, but epsilon zz increased most and became equal to epsilon yy. In the prone position, epsilon yy was largest in all upper lobes and in three of four lower lobes. Strains and volumes of the upper and lower lobes were similar. The upper and lower lobes rotated slightly around different axes, indicating that interpleural fissures allow additional degrees of freedom for the lungs to conform to the thoracic cavity. In the prone position, there were no consistent gradients of strain or volume. These results indicate that, in determining the regional distribution of FRC in the recumbent dog, in addition to the effect of gravity on the lung, there are important interactions between lung and thoracic cavity shapes.

Animals↗
PubMed1985

Effects of chest wall on volume and strain patterns in canine lungs.

Lobar functional residual capacity-to-total lung capacity ratios (FRC/TLC) and strains in five supine anesthetized dogs were determined from volumes and side lengths of tetrahedra formed by multiple intraparenchymal markers whose positions were determined roentgenographically. Strain is related to fractional changes in length of elements in a Cartesian coordinate system and was used to describe parenchymal distortion. Volumes and strain patterns were compared in three states: intact dogs, after transection of forelimb structures to relieve traction on the chest wall, and in dogs' excised lungs. Removing traction (NT) decreased the plethysmographically determined FRC and the upper-to-lower lobe ratio (UL/LL) for FRC/TLC. The ratio in the NT state was more like the ratio in the excised lungs (UL/LL approximately equal to 1) than in the intact dog (UL/LL greater than 1). Strain patterns were similar between the intact and the NT states, indicating no lobar shape change at FRC between these two states. Strain in the excised lungs differed greatly from strains in the intact and NT states. We conclude that forelimb traction alters volume distribution between lobes and that lung-chest wall interactions are important in determining volume and strain patterns.

Animals↗
PubMed1985

Distortion of submerged dog lung lobes.

The conically shaped caudal lobes of dog lungs were submerged, tip downward in saline, and the lateral surfaces of the lobes were thereby exposed to a hydrostatic gradient in transpulmonary pressure. The force that was required to balance the buoyancy was applied through a clip attached to the tip of the lobe. The locations of metal markers implanted in the parenchyma and attached to the surface were tracked, and regional volume and the horizontal and vertical components of strain were obtained as functions of vertical position. An engineering analysis of the deformation is qualitatively consistent with the data, but the predicted strains are larger than the observed strains. From the experimental and analytical results, we conclude that, for this deformation, the regional volume-local transpulmonary pressure curve closely follows the pressure-volume curve because negative horizontal strains nearly balance the positive vertical strain caused by the buoyancy force.

Animals↗
PubMed1985

Effects of acute pleural effusion on respiratory system mechanics in dogs.

We determined regional (Vr) and overall lung volumes in six head-up anesthetized dogs before and after the stepwise introduction of saline into the right pleural space. Functional residual capacity (FRC), as determined by He dilution, and total lung capacity (TLC) decreased by one-third and chest wall volume increased by two-thirds the saline volume added. Pressure-volume curves showed an apparent increase in lung elastic recoil and a decrease in chest wall elastic recoil with added saline, but the validity of esophageal pressure measurements in these head-up dogs is questionable. Vr was determined from the positions of intraparenchymal markers. Lower lobe TLC and FRC decreased with added saline. The decrease in upper lobe volume was less than that of lower lobe volume at FRC and was minimal at TLC. Saline increased the normal Vr gradient at FRC and created a gradient at TLC. During deflation from TLC to FRC before saline was added, the decrease in lung volume was accompanied by a shape change of the lung, with greatest distortion in the transverse (ribs to mediastinum) direction. After saline additions, deflation was associated with deformation of the lung in the cephalocaudal and transverse directions. The deformation with saline may be a result of upward displacement of the lungs into a smaller cross-sectional area of the thoracic cavity.

Animals↗
PubMed1985

Interdependence of regional expiratory flow.

Flows from different lung regions interact at the junctions of the bronchial tree, and flow from each region depends on the driving pressures for other regions. At each junction, flow from the region with the higher driving pressure is favored. As a result there is a limit on the difference in alveolar pressures that can develop during expiratory flow from a lung with regional differences in lung compliance and airway resistance. The limiting pressure difference is smaller for lower flow. A nonuniform lung therefore empties more uniformly if it empties slowly, and maximum flow at low lung volume may be greater than it would be at the same lung volume during a maximal expiratory vital capacity maneuver.

Airway Resistance↗