Comparison of the effects of water immersion and saline infusion on central haemodynamics in man.
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Biomedical subjects
Publications and source records attributed to M A Sackner.
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A new roentgenographic method is described for the estimation of mucous velocity in airways. Radiopaque discs of teflon mixed with bismuth trioxide were deposited in the trachea, and their motion was observed by a fluoroscopic image intensifier. Simultaneous measurements of disc movement were obtained by a previously reported cinebronchofiberscopic method and by the roentgenographic method in 6 anesthetized dogs. Mean +/- SD tracheal mucous velocity was 8.5 +/- 7.3 mm per min by the roentgenographic method, and 7.6 +/- 7.1 mm per min by the cinebronchofiberscopic method. Discrepancies between the 2 methods for individual disc velocities could be accounted for by the cumulative errors of both methods. The roentgenographic method was also used in 7 normal volunteers who did not have topical anesthesia of the tracheobronchial tree. The discs were blown through the inner channel of a bronchofiberscope, the tip of which was located just above the vocal cords. Placement of the discs on the tracheal mucosa generally did not produce coughing. Tracheal mucous velocity ranged from 7.4 to 19.4 mm per min as estimated from videotape recordings of the image intensifier images. There was no consistent difference in velocity between the erect or supine position, or after topical anesthesia with lidocaine.
Oral metaproterenol was administered daily for 3 months to asthmatic children. The study was designed to determine whether chronic tolerance developed to this drug. Initial and final crossovers on the first 2 and the last 2 days of the investigation to a test dose of metaproterenol and placebo failed to show tolerance as indicated by improvement in lung volumes and dynamic mechanics of breathing after metaproterenol. Forced expiratory volume in 1 sec was the test most consistent in demonstrating bronchodilation; the action of metaproterenol. Forced expiratory volume in 1 sec was the test most consistent in demonstrating bronchodilation; the action of metaproterenol appeared to last at least 5 hours as measured by this test. T of distribution of ventilation, e.g., single- and multiple-breath nitrogen washout tests, were not consistently altered by metaproterenol. These tests did not appear to be sufficiently sensitive to detect improvement even when airway resistance decreased and forced expiratory volume in 1 sec increased toward the normal range.
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The acute effects of a commercially available aerosol hair spray preparation and a Freon propellant on various pulmonary function tests and tracheal mucociliary transport were studied in 12 normal nonsmokers. Tracheal mucous velocity was estimated by a roentgenographic method. In 7 subjects exposed to hair spray by directing the aerosol to the hair for 20 sec, no significant changes occurred in any of the various pulmonary function parameters, whereas mean tracheal mucous velocity decreased by 57 per cent (P less than 0.001) 1 hour after exposure. This effect was transient and could no longer be demonstrated after 3 hours. No significant changes in tracheal mucous velocity or pulmonary function tests were observed in the 5 control subjects exposed to the Freon propellant alone. These observations suggest that acute exposure to aerosol hair spray produces a transient impairment of a pulmonary defense mechanism, and that measurements of mucociliary transport is a more sensitive indicator of this type of airway irritation than conventional pulmonary function tests.
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Utilizing the rebreathing of a gas mixture containing C2H2, C180, He O2, and N2, we obtained serial measurements of the pulmonary capillary blood flow (Qc), diffusing capacity per unit of alveolar volume (DL/VA), functional residual capacity (FRC), pulmonary tissue plus capillary blood volume (VTPC), and O2 comsumption (VO2) in five normal subjects under the following conditions: 1) 6 h of sitting, 2) 4 h of sitting while immersed in thermoneutral water to the neck, and 3) 4 h of lying in thermoneutral water to the neck. Water immersion (NI) was preceded and followed by 1-h prestudy and 1-h recovery periods. The measurements were made at 30-min intervals. Seated NI produced a fourfold increase in sodium excretion (UNaV), a 25-36% increase in Qc, a 45-59% increase in DL/VA, and a 30-36% decrease in FRC. This occurred as early as the 1st h of NI and persisted throughout the 4-h period of study. Throughout the seated control and NI periods, VO2, heart rate, and VTPC remained constant. During supine NI, Qc, HR, DL/VA, FRC, and VO2 did not differ significantly from supine prestudy. These date demonstrate that seated NI causes a significant increase of Qc and DL/VA which persists throughout the immersion period. Furthermore, the lack of change of VTPC suggests that the central vascular engorgement induced by seated NI is not accompanied by extravasation of fluid into the pulmonary interstitial space.
Graded concentrations of oxygen were used to establish dose-duration relations for the effect of oxygen on tracheal mucous velocity and tracheobronchial histologic findings in the anesthetized dog. Observations of tracheal mucous velocity were made during 30-hour periods of breathing air (100-percent humidified and warmed to 38 degrees C) and oxygen mixtures (also 100-percent humidified and warmed to 38 degrees C). In animals breathing oxygen mixtures, the baseline tracheal mucous velocity was taken as the value while breathing room air at the experiment's start. No statistically significant differences in tracheal mucous velocity occurred during air breathing. Tracheal mucous velocity fell 45 percent from the baseline value after breathing 100-percent oxygen for two hours (P less than 0.01), fell 42 percent after 75-percent oxygen for nine hours (P less than 0.01) and fell 51 percent after 50-percent oxygen for 30 hours (P less than 0.001). Histologic examination of the trachea and major bronchi after six hours of 100-percent oxygen and 12 hours of 75-percent oxygen revealed signs of acute tracheobronchitis. Minor histologic alterations in the tracheobronchial tree occurred both in animals breathing air and 50-percent oxygen for 30 hours; therefore, histologic evidence of oxygen toxicity could not be established at 30 hours. These findings indicate that in the anesthetized dog, oxygen depresses mucous transport as a function of inspired oxygen concentration (FIO2) and that even FIO2 as low as 0.05 might be deleterious.
The present study was designed to assess the effects of two beta-adrenergic agonists, isoproterenol sulfate and carbuterol hydrochloride, and aerosolized Freon propellant (a mixture of Freon II, Freon 12, and Freon 114) on tracheal mucous velocity and cardiac output in anesthetized dogs. Five groups of ten animals each received the following dosages of aerosols: Freon, 20 puffs; isoproterenol, four puffs; carbuterol, four puffs; isoproterenol, 20 puffs; and carbuterol, 20 puffs. The puff was delivered by a standard metered aerosol; each puff of isoproterenol spray contained 75 mug of isoproterenol sulfate, and each puff of carbuterol spray contained 100 mug of carbuterol hydrochloride. Tracheal mucous velocity was not changed by receiving Freon, but administration of both isoproterenol and carbuterol caused a significant increase in this measurement, with peak increases ranging from 74 to 111 percent above control values. The duration of action for four and 20 puffs of isoproterenol and for four puffs of carbuterol was two hours. Twenty puffs of carbuterol increased tracheal mucous velocity for three hours. Administration of carbuterol effected a slightly larger increase in cardiac output than isoproterenol. The duration of action for the increased cardiac output was shorter than the duration of action for the increased tracheal mucous velocity. These studies indicate that beta-adrenergic agonists may have an important role in improving mucous transport in patients with chronic obstructive pulmonary disease in whom mucociliary clearance is depressed.
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The isolated effects of alterations of lung inflation and transmural pulmonary arterial pressure (pressure difference between intravascular and pleural pressure) on pulmonary arterial blood volume (Vpa) were investigated in anesthetized intact dogs. Using transvenous phrenic nerve stimulation, changes in transmural pulmonary arterial pressure (Ptm) at a fixed transpulmonary pressure (Ptp) were produced by the Mueller maneuver, and increases in Ptp at relatively constant Ptm by a quasi-Valsalva maneuver. Also, both Ptm and Ptp were allowed to change during open airway lung inflation. Vpa was determined during these three maneuvers by multiplying pulmonary blood flow by pulmonary arterial mean transit time obtained by an ether plethysmographic method. During open airway lung inflation, mean (plus or minus SD) Ptp increased by 7.2 (plus or minus 3.7) cmH2O and Ptm by 4.3 (plus or minus 3.4) cmH2O for a mean increase in Vpa by 26.2 (plus or minus 10.7) ml. A pulmonary arterial compliance term (Delta Vpa/Delta Ptm) calculated from the Mueller maneuver was 3.9 ml/cmH2O and an interdependence term (Delta Vpa/Delta Ptp) calculated from the quasi-Valsalva maneuver was 2.5 ml/cmH2O for a 19% increase in lung volume, and 1.2 ml/cmH2O for an increase in lung volume from 19% to 35%. These findings indicate that in normal anesthetized dogs near FRC for a given change in Ptp and Ptm the latter results in a greater increase of Vpa.
The impairment of mucociliary transport by dry air breathing and the restoration of function with subsequent humidification of inspired air were investigated in anesthetized dogs. Tracheal mucous velocity was measured by a cinebronchofiberscopic technique. The breathing of dry air through an uncuffed endotracheal tube produced almost complete cessation of the flow of tracheal mucus after 3 h. Subsequent breathing of air at 38 degrees C with 100% relative humidity restored tracheal mucous velocity to control values by the end of and additional 3 h. Histologic examination of the trachea at the end of the 3-h dry air breathing period revealed focal areas of sloughing of the ciliated epithelium and submucosal inflammation. Although morphometry was not employed, the inflammatory changes appeared to have progressed during 3 h of breathing fully humidified air subsequent to the dry air breathing period. These findings were consistent with previous reports that the inflammatory response to injury of the tracheobronchial mucosa might be delayed and that the mucociliary transport system has a great deal of functional reserve. We found that an artificial heat and moisture exchanger placed on the proximal end of an endotracheal tube partially protects against the suppression of tracheal mucous velocity caused by dry air breathing.
Probably no other diagnostic interpretive technique has revolutionized pulmonary medical practice in so short a time as flexible bronchofiberscopy. This state of the art review deals with flexible bronchofiberscopy, as well as comparisons to rigid bronchoscopic techniques. Historic development, specifications, indications, contraindications, sterilization of the instrument, and complications of these methods are discussed. Accessory procedures to bronchofiberscopy including biopsy, brushing, lavage, foreign body extraction, selective bacterial cultures, and research applications are considered. Finally, recommendations are made as to the training of a physician who performs bronchofiberscopy.
A rebreathing method for estimating diffusing capacity, membrane diffusing capacity, pulmonary capillary blood volume, pulmonary capillary blood flow, and pulmonary tissue volume consists of rebreathing into a bag for 15 sec while acetylene, (18O)-carbon monoxide, oxygen, and helium are continuously sampled by a mass spectrometer. Because the masses of carbon monoxide and nitrogen are nearly identical at 28, it was necessary to use a stable isotope, C18O, to distinguish this gas with the mass spectrometer. Comparison of the pulmonary capillary blood flow by the rebreathing technique with the simultaneously obtained indicator dilution measurement in anesthetized dogs revealed good agreement. Estimations of pulmonary tissue volume appeared to be quite reproducible and consistent; the values tended to be somewhat smaller and less variable among normal subjects than reported by other investigators. After subtraction of capillary blood volume, tissue volume was 311 plus or minus 73 ml at rest and increased significantly to 352 plus or minus 61 ml at 75 watts of exercise. Pulmonary tissue volume in dogs using the rebreathing method averaged 9.2 ml per kg of body weight, a mean comparable to previously reported estimates using the ether plethysmographic method. The slope of pulmonary capillary blood flow (cardiac output in normal subjects) as a function of oxygen consumption during exercise in normal subjects of 0.0060 times oxygen consumption in milliliter per min was identical to published values. The rebreathing technique provides a rapid, reliable, noninvasive method for estimating pulmonary hemodynamic parameters.