Functional evaluation of a new analeptic drug (vectarion) in patients with chronic hypoxemia and hypercapnia (preliminary study).
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Biomedical subjects
Publications and source records attributed to R Sergysels.
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The effect of i.v. perfused serotonin (75 microgram.kg-1.min-1) on bronchomotor tone was assessed in dogs by mechanical studies, with the result in an increase in total lung resistance. The increased residual volume (RV), closing capacity (CC) and slope of phase III (nitrogen single-breath washout) as well as the reduction of the helium response at low lung volumes suggest a peripheral action of the drug. Because of the large increase in total lung resistance and the decreased dead space (VD), bronchoconstriction of large airways must also be present. Vagal tone inhibition is incomplete whether by volume history or bilateral vagotomy and could be limited mainly to a segment which is situated between the equal pressure point and the most peripheral airways: maximal flows during partial expiratory flow-volume manoeuvres (PEFV) are lower than during maximal expiratory flow-volume manoeuvres (MEFV) and the volume of isoflow is higher in PEFV than in MEFV manoeuvers, suggesting that full inspiration reduces the bronchoconstriction induced by serotonin. On the other hand, the bilateral vagotomy did not reverse CC, RV, slope of phase III or VD back to control values. Isoproterenol i.v. injection improved all physiological measurements almost to the level of control values: beta-adrenergic stimulating drugs seem to inhibit completely serotonin induced bronchospasm, at all levels of the bronchial tree.
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Ventilation was analysed during a maximal and progressive exercise in 12 patients suffering from interstitial lung disease (ILD) and in 15 healthy subjects. "Rapid shallowing breathing" pattern was observed in patients with ILD. Both normals and patients showed a linear relationship between VE, VT/TI (mean inspiratory flow) and VCO2. The relationship between P0.1, the occlusion pressure at 0.1 S, and VCO2 exponential in both groups and significantly steeper in patients with ILD. P0.1/VE and P0.1/(VT/TI) ratios, indexes of thoracopulmonary impedance, and P0.1/VCO2 ratio, an index of respiratory drive per unit of CO2 output, were all inversely correlated in patients with VC% (vital capacity) and CLstat (static compliance). These results strongly suggest that in patients suffering from ILD the higher respiratory drive observed during exercise could be attributed to increased afferent reflexes originating from the lung and/or chest wall.
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Long-term follow-up of pulmonary function has been performed in four patients having recovered from "shock lung". In three patients there is a progressive normalization of lung volumes and lung compliance, whereas the pulmonary diffusing capacity improves but without attaining predicted levels. In the fourth patient, a delayed reduction of total lung capacity, lung compliance and diffusion capacity occurred. During the follow-up period (from one month to four years) there was no complaint and physical examination, electrocardiogram, chest roentgenogram, conventional pulmonary perfusion scintigraphy and arterial blood gases at rest were quite normal. These results are compatible with the persistence of some degree of interstitial lung disease after recovery from "shock lung".