Biomedical subjects

S H Loring

Publications and source records attributed to S H Loring.

At least 55 records · Page 3Linked to original sources

PubMed1988

Pleural pressure increases during inspiration in the zone of apposition of diaphragm to rib cage.

The zone of apposition of diaphragm to rib cage provides a theoretical mechanism that may, in part, contribute to rib cage expansion during inspiration. Increases in intra-abdominal pressure (Pab) that are generated by diaphragmatic contraction are indirectly applied to the inner rib cage wall in the zone of apposition. We explored this mechanism, with the expectation that pleural pressure in this zone (Pap) would increase during inspiration and that local transdiaphragmatic pressure in this zone (Pdiap) must be different from conventionally determined transdiaphragmatic pressure (Pdi) during inspiration. Direct measurements of Pap, as well as measurements of pleural pressure (Ppl) cephalad to the zone of apposition, were made during tidal inspiration, during phrenic stimulation, and during inspiratory efforts in anesthetized dogs. Pab and esophageal pressure (Pes) were measured simultaneously. By measuring Ppl's with cannulas placed through ribs, we found that Pap consistently increased during both maneuvers, whereas Ppl and Pes decreased. Whereas changes in Pdi of up to -19 cmH2O were measured, Pdiap never departed from zero by greater than -4.5 cmH2O. We conclude that there can be marked regional differences in Ppl and Pdi between the zone of apposition and regions cephalad to the zone. Our results support the concept of the zone of apposition as an anatomic region where Pab is transmitted to the interior surface of the lower rib cage.

Airway Obstruction↗

PubMed1988

O2 cost of inspiratory and expiratory resistive breathing in humans.

In six normal male subjects we compared the O2 cost of resistive breathing (VO2 resp) between equivalent external inspiratory (IRL) and expiratory loads (ERL) studied separately. Each subject performed four pairs of runs matched for tidal volume, breathing frequency, flow rates, lung volume, pressure-time product, and work rate. Basal O2 uptake, measured before and after pairs of loaded runs, was subtracted from that measured during resistive breathing to obtain VO2 resp. For an equivalent load, the VO2 resp during ERL (184 +/- 17 ml O2/min) was nearly twice that obtained during IRL (97 +/- 9 ml O2/min). This twofold difference in efficiency between inspiratory and expiratory resistive breathing may reflect the relatively lower mechanical advantage of the expiratory muscles in overcoming respiratory loads. Variable recruitment of expiratory muscles may explain the large variation of results obtained in studies of respiratory muscle efficiency in normal subjects.

Adult↗

PubMed1987

Impedance and relative displacements of relaxed chest wall up to 4 Hz.

We measured the effective resistance (Reff) and elastance (Eeff) of the chest wall in four subjects, relaxed at functional residual capacity (FRC), during sinusoidal volume changes (5% vital capacity up to 4 Hz) delivered at the mouth. Subjects sat in a head-out body plethysmograph, and transthoracic pressure was measured with an esophageal balloon. Changes in Reff and in Eeff with frequency were nearly the same in all subjects. Reff (in cmH2O X l-1 X s) was 2.9 +/- 0.8 at 0.2 Hz and fell sharply to minimum values (0.5-0.9) at 1-4 Hz. Eeff (in cmH2O X l-1) increased from approximately 10 at the lowest frequency to a plateau of about 15 at 1-3 Hz and decreased above 3 Hz. In the same subjects, we measured the relative magnitude and phase between the displacements of different parts of the chest wall with magnetometers during identical sinusoidal forcing. Results indicate that the chest wall expands and deflates uniformly at frequencies up to 1 Hz. Thereafter the abdomen makes relatively larger excursions, and the relative magnitude and phase of displacement at different points on the chest wall show complex changes. We conclude that the frequency dependence of Reff and Eeff below 1 Hz is not due to nonuniformities in displacement of different parts of the chest wall. The frequency dependency of Reff is consistent with an increasing contribution of rate-independent plastic dissipation to the pressure difference in phase with flow as breathing frequency decreases.

Adult↗

PubMed1987

Forced expiratory wheezes are a manifestation of airway flow limitation.

To study the mechanism of generation of respiratory wheezes we examined the relationships between forced expiratory wheezes (FEW) and flow limitation in the lung. Tracheal lung sounds were measured in six healthy subjects during forced expiration through a flow-limiting valve in series with a high-impedance suction pump. Mouth pressure, esophageal pressure, transpulmonary pressure (Ptp), flow (V), and volume were also measured. For any flow rate, V was constant until the subject became flow limited. The onset of flow limitation was documented by a small change in V and a sudden change in Ptp, which was previously found by Olafsson and Hyatt to correspond to the beginning of the flow plateau of the isovolume pressure-flow curve (J. Clin. Invest. 48: 564-573, 1969). FEW started 107 +/- 45 ml (SD) after the onset of flow limitation. Additional 79 +/- 65 ml were exhaled between the onset of FEW to the final sharp drop in V. The frequency spectra of FEW were the same as those of respiratory wheezes found in obstructive airway diseases. Administration of inhaled bronchodilator (isoproterenol) did not eliminate the FEW, nor did it change their relationship to flow limitation. The sequence of events around the onset of FEW, and the tight correlation with the onset of flow limitation correspond well to recent experimental observations on the onset of flutter in collapsible, thick-walled latex tubes.

Adult↗

PubMed1986

Passive mechanics of upright human chest wall during immersion from hips to neck.

We have determined the mechanical effects of immersion to the neck on the passive chest wall of seated upright humans. Repeated measurements were made at relaxed end expiration on four subjects. Changes in relaxed chest wall configuration were measured using magnetometers. Gastric and esophageal pressures were measured with balloon-tipped catheters in three subjects; from these, transdiaphragmatic pressure was calculated. Transabdominal pressure was estimated using a fluid-filled, open-tipped catheter referenced to the abdomen's exterior vertical surface. We found that immersion progressively reduced mean transabdominal pressure to near zero and that the relaxed abdominal wall was moved inward 3-4 cm. The viscera were displaced upward into the thorax, gastric pressure increased by 20 cmH2O, and transdiaphragmatic pressure decreased by 10-15 cmH2O. This lengthened the diaphragm, elevating the diaphragmatic dome 3-4 cm. Esophageal pressure became progressively more positive throughout immersion, increasing by 8 cmH2O. The relaxed rib cage was elevated and expanded by raising water from hips to lower sternum; this passively shortened the inspiratory intercostals and the accessory muscles of inspiration. Deeper immersion distorted the thorax markedly: the upper rib cage was forced inward while lower rib cage shape was not systematically altered and the rib cage remained elevated. Such distortion may have passively lengthened or shortened the inspiratory muscles of the rib cage, depending on their location. We conclude that the nonuniform forcing produced by immersion provides unique insights into the mechanical characteristics of the abdomen and rib cage, that immersion-induced length changes differ among the inspiratory muscles according to their locations and the depth of immersion, and that such length changes may have implications for patients with inspiratory muscle deficits.

Abdomen↗

PubMed1986

Estimates of ventilation from body surface measurements in unrestrained subjects.

To make estimates of ventilation from measurements of body surface movements in unrestrained subjects, we measured changes in linear dimensions and cross-sectional areas of the rib cage (RC) and abdomen (AB) of six healthy unrestrained subjects during a variety of maneuvers. RC and AB anteroposterior diameters and abdominal length in the cephalocaudal axis (axial displacement) were measured with magnetometers, and RC and AB cross-sectional areas were measured with a respiratory inductance plethysmograph. Flow was measured at the mouth with a pneumotachograph and integrated electrically to give volume. Volume and body surface measurements were analyzed by multiple linear regression. Addition of the axial measurements to either the anteroposterior dimensions or cross-sectional areas of RC and AB improved estimates of tidal volume in all subjects (P less than 0.01). With measurements of axial displacement and cross-sectional area of the RC and AB, tidal volume could be reliably estimated to within 20% of actual ventilation. We conclude that measurement of axial displacements improves estimates of ventilation in unrestrained subjects.

Abdomen↗

PubMed1985

Radiographic visualization of airway wall movement during oscillatory flow in dogs.

It has been suggested that radial movement of the central airway walls during oscillatory flow might contribute to the increased frequency dependence of compliance seen in chronic obstructive pulmonary disease (COPD) (J. Appl. Physiol. 26: 670-677, 1969). Radial airway wall motion has also been invoked to explain the frequency-dependent decreases in the efficiency of gas exchange during low-volume high-frequency ventilation (HFV) in histamine-bronchoconstricted dogs and in patients with respiratory insufficiency. To test the possibility that airway wall motion increases with bronchoconstriction, we measured central airway diameters using cinebronchoradiography in anesthetized tracheostomized dogs during oscillatory HFV [50 and 100 ml tidal volume (VT) at frequencies (f) of 2, 6, and 12 Hz], under control conditions, during electrical stimulation of the vagi, and after exposure to histamine aerosol. Cineradiobronchograms from two dogs were evaluated quantitatively for tracheal diameter and for lengths and diameters of a number of major airways. Under control conditions, the diameter of the airways fluctuated 7-9% of the mean with VT of 50 ml and 9-18% with VT of 100 ml in the range of frequencies studied. Bronchoconstriction produced by aerosolized histamine increased radial airway wall movement to 10-47% with VT of 50 ml, and during vagal stimulation diameters changed 7-20% at VT of 50 ml. After histamine, the central airways displayed large diameter changes during HFV, whereas more peripheral airways were markedly constricted and did not change in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

Effects of paralysis with pancuronium on chest wall statics in awake humans.

The influence of tonic inspiratory muscle activity on the relaxation characteristics of the chest wall, rib cage (RC), and abdominal wall (ABW) has been investigated in four highly trained subjects. Chest wall shape and volume were estimated with magnetometers. Pleural pressure (Pes) and abdominal pressure were measured with esophageal and gastric balloons, respectively. Subjects were seated reclining 30 degrees from upright, and respiratory muscle weakness was produced by pancuronium bromide until RC inspiratory capacity was decreased to 60% of control. Only minor changes were observed for Konno-Mead relaxation characteristics (RC vs. ABW) between control and paralysis. Similarly, although RC relaxation curves (RC vs. Pes) during paralysis were significantly different from control (P less than 0.05), the changes were small and not consistent. The differences between paralysis-induced changes in resting end-expiratory position of the chest wall and helium-dilution functional residual capacity (FRC) suggested changes in volume of blood within the chest wall. We conclude that 1) although tonic inspiratory activity of chest wall muscles exists, it does not significantly affect the chest wall relaxation characteristics in trained subjects; 2) submaximal paralysis produced by pancuronium bromide is likely to modify either spinal attitude or the distribution of blood between extremities and the thorax; these effects may account for the changes in FRC in other studies.

Blood Volume↗

PubMed1985

Chest wall distortion during resistive inspiratory loading.

We studied six (1 naive and 5 experienced) subjects breathing with added inspiratory resistive loads while we recorded chest wall motion (anteroposterior rib cage, anteroposterior abdomen, and lateral rib cage) and tidal volumes. In the five experienced subjects, transdiaphragmatic and pleural pressures, and electromyographs of the sternocleidomastoid and abdominal muscles were also measured. Subjects inspired against the resistor spontaneously and then with specific instructions to reach a target pleural or transdiaphragmatic pressure or to maximize selected electromyographic activities. Depending on the instructions, a wide variety of patterns of inspiratory motion resulted. Although the forces leading to a more elliptical or circular configuration of the chest wall can be identified, it is difficult to analyze or predict the configurational results based on insertional and pressure-related contributions of a few individual respiratory muscles. Although overall chest wall respiratory motion cannot be readily inferred from the electromyographic and pressure data we recorded, it is clear that responses to loading can vary substantially within and between individuals. Undoubtedly, the underlying mechanism for the distortional changes with loading are complex and perhaps many are behavioral rather than automatic and/or compensatory.

Abdominal Muscles↗

PubMed1985

Rib cage distortion during voluntary and involuntary breathing acts.

We examined chest wall and rib cage configuration in seven normal subjects during a variety of breathing maneuvers. Magnetometers were used to measure lower rib cage anteroposterior, lower rib cage transverse, upper rib cage anteroposterior, and abdomen anteroposterior diameters. Changes of these diameters were recorded during voluntary maneuvers, rebreathing, reading, and "natural" breathing. Relative motion of the rib cage and abdomen was displayed with the rib cage represented by the product of its lower anteroposterior and transverse diameters. During spontaneous breathing the rib cage and chest wall are near their relaxation configuration. During chemically driven ventilation the chest wall and rib cage progressively depart from this configuration. Much greater distortions of the chest wall and rib cage occurred during some voluntary maneuvers. Additionally, esophageal pressure and gastric pressure were measured during voluntary distortion of the rib cage. Substantial changes in lower rib cage shape occurred during voluntary maneuvers when compared with spontaneous breaths at the same transmural pressure. We conclude that the unitary behavior of the rib cage in normal subjects requires muscle coordination.

Abdominal Muscles↗

PubMed1985

Respiratory mechanical effects of abdominal distension.

We develop a theory to predict the partitioning of a change in volume of the abdominal contents into the end-expiratory volume changes of the lung, rib cage, and anterior abdominal wall. First, we calculate the distribution of such a volume change using the relative compliances of the three compartments. We then consider the inspiratory influence of abdominal pressure on the rib cage and its effect on the distribution of this volume. We test our theory by inducing gastric distension in three experienced laboratory personnel. We instilled and subsequently withdrew 1 liter of water from a gastric balloon and examined the effects of this change in gastric volume on the relaxation characteristics of the respiratory system. The distribution of the volume change that would be expected from the observed relative compliances of the three compartments would be approximately 66% into change in lung volume, 25% into change in rib cage volume, and 9% into change in abdominal volume. Instead, in line with our predictions for acute gastric distension, approximately 33% went into decrease in lung volume, 40% into increase in rib cage volume, and 26% into increase in abdominal volume. These results suggest that the interactions among the rib cage, abdomen, and diaphragm are such as to defend against large changes in end-expiratory lung volume in the face of abdominal distension.

Abdomen↗

PubMed1985

Pressure-flow relationships of endotracheal tubes during high-frequency ventilation.

We studied the pressure-flow relationships of various endotracheal tubes (ETT) at frequencies (f) and tidal volumes (VT) in the range used for high-frequency ventilation (HFV) (f: 2-32 Hz, VT: 15-100 ml). Sinusoidal flows were applied to ETT inserted into a rigid bottle or into the tracheae of three anesthetized paralyzed dogs, while pressure fluctuations were measured both proximal and distal to the ETT. The pressure drops in the ETT were nonlinearly related to the peak flow rate and were VT dependent, suggesting that turbulent frictional head loss and convective acceleration were important. The pressure drops measured in vitro were found to be in good agreement with the predictions of a nonlinear oscillatory pressure-flow equation (derived herein), which incorporate the effects of turbulent frictional losses, convective acceleration, inertance, and compliance. The pressure drops measured in situ were 30-50% higher than with the corresponding f-VT combinations in vitro. Possible explanations of these differences are junctional losses at the tip of the ETT or the nonrigid character of the trachea.

Animals↗

PubMed1985

Dependence of diaphragmatic length on lung volume and thoracoabdominal configuration.

Changes in lung volume can be partitioned into volume displacements of the rib cage and abdomen. Abdominal displacements are often used as estimates of diaphragmatic displacements and changes in lengthening of diaphragmatic muscle. We used X-rays, ultrasound, and linear measurements of thoracic and abdominal diameters to estimate relationships among lung volume, thoracoabdominal configuration and diaphragmatic length, and we found that diaphragmatic length was strongly dependent on rib cage as well as abdominal displacement. In three subjects, the diaphragm shortened 57-85% as much during a breath made without abdominal displacement as during a normal breath in which the abdominal wall moved outward with the rib cage. We conclude that changes in diaphragmatic length can be estimated from surface measurements without radiation and that the length of the diaphragm cannot be estimated from displacements of the abdominal wall alone.

Abdomen↗

PubMed1984

Effect of posture on upper and lower rib cage motion and tidal volume during diaphragm pacing.

We monitored changes in upper and lower rib cage dimensions and tidal volume during bilateral phrenic nerve pacing in a quadraplegic subject with a flaccid chest wall paralysis. Both upper and lower rib cage showed inward (paradoxical) motion during paced breaths in supine (horizontal) and upright positions on a tilt table. In both postures, abdominal compression changed only the lower rib cage to orthodox motion. Abdominal compression in the supine posture decreased tidal volume 10 to 20%, while end-inspiratory diaphragm length, assessed from end-expiratory volume, did not change. Abdominal compression in the upright posture caused end-expiratory volume to fall and increased tidal volume 200%. These observations suggest that isolated diaphragm contraction can move the lower ribs independently from the upper ribs and that tidal volume is determined both by the resting length of the diaphragm and by diaphragmatic load.

Adult↗

PubMed1983

Chest wall configurational changes before and during acute obstructive episodes in asthma.

We induced bronchial obstruction in 7 otherwise healthy asthmatic subjects and then measured the degree of airway obstruction and the dimensions of the chest wall including the anteroposterior (AP) diameters of the upper and lower rib cage and the abdomen and the transverse diameter of the lower rib cage. Airway obstruction was accompanied by a pronounced increase in the end-expiratory AP diameter of the upper rib cage in all 7 subjects and of the low lateral rib cage in 3 of the 4 subjects in whom this was measured. Other end-expiratory dimensions showed variable changes. In 6 of 7 subjects, obstruction caused the lower rib cage to become more elliptical in cross section during inspiration; transient inward motion of the lower anterior rib cage during early inspiration was noted. This latter motion coupled with the continuous outward motion of the upper anterior rib cage produced a pronounced rocking motion of the sternum during inspiration. These distortions of the chest cage were maximal when obstruction was most severe and gradually diminished as obstruction resolved. These inspiratory changes in chest cage cross-sectional configuration are similar to those seen in normal subjects who attempt to overcome external resistive loading by the increased use of inspiratory muscles; the end-expiratory configuration in asthma indicates an increase in functional residual capacity, which is actively maintained. Multiple degrees of freedom of motion of the chest cage exist during obstructive episodes. Estimates of volume change from measurements of rib cage cross-sectional area and abdominal diameter should be made with caution.

Abdomen↗

PubMed1982

Abdominal muscle use during quiet breathing and hyperpnea in uninformed subjects.

Although there is electromyographic evidence for abdominal muscle activity during quiet breathing in standing subjects, several studies have shown, or assumed, that subjects normally breathe on their relaxation characteristics. This latter observation would by itself suggest that abdominal muscles do not contract during quiet breathing. To test this assumption we observed abdominal and rib cage displacements with magnetometers in 17 uninformed subjects. During quiet breathing most subjects showed evidence of tonic or phasic abdominal muscle contraction while standing and sitting but not supine. Subjects studied during hyperpnea immediately following exercise-showed evidence of greater abdominal muscle contraction than at rest. We conclude that most subjects standing at rest normally contract their abdominal muscles.

Abdominal Muscles↗

PubMed1982

Analysis of volume displacement and length changes of the diaphragm during breathing.

Diaphragmatic volume displacements cause equal displacements of abdominal contents. Since the rib cage forms a variable part of the abdominal container (the variable part being its area of apposition with the diaphragm) the rib cage and ventral abdominal wall share in abdominal displacements. The fraction of total rib cage volume displacement (delta Vrc) contributing to abdominal displacement is predicted from anatomic considerations and measurements. During quiet inspirations it is estimated that more than half of delta Vrc goes into abdominal expansion. This displacement plus the outward displacement of the anterolateral abdominal wall constitute the diaphragmatic displacement. In a typical inspiration in which delta Vrc accounts for 3/4 of the lung volume change, the diaphragm displaces nearly the same volume. Associated changes in diaphragm length are estimated with a model. Diaphragm shortening during an inspiration in which only the rib cage expands is estimated to be only 11% less than during a normal inspiration. We conclude that the direct rib cage contribution to lung volume change is much less, and that diaphragmatic contribution is much more than was previously thought.

Abdominal Muscles↗

PubMed1982

Action of the diaphragm on the rib cage inferred from a force-balance analysis.

Displacements of the rib cage are determined by the intrinsic passive properties of the rib cage, rib cage musculature, pleural and abdominal pressures, and the diaphragm. The diaphragm's mechanical actions on the rib cage are inferred from a force-balance analysis in which the diaphragm is seen to cause expansion of the rib cage by pulling cephalad at its insertions on the lower ribs (insertional component) and by raising intra-abdominal pressure, which pushes outward on the diaphragm's zone of apposition to the rib cage (appositional component). Goldman and Mead suggested that the diaphragm, acting alone, could drive both the rib cage and abdomen on their passive characteristics. The force-balance analysis shows that the diaphragm's inspiratory action on the rib cage is less than predicted by Goldman and Mead, but that in the special circumstances of their experiment (low lung volumes), the appositional component is large and the rib cage can be driven close to its passive characteristics. The force-balance analysis is consistent with recent observations by other investigations and is incompatible with the model proposed by Macklem and colleagues and with the Goldman-Mead hypothesis. Experiments on three subjects produced data consistent with the force-balance analysis, showing that the inspiratory action of the diaphragm on the rib cage is greatest at low lung volumes.

Abdominal Muscles↗