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Criteria for development of animal models of diseases of the respiratory system: the comparative approach in respiratory disease model development.

Advances in the understanding of human respiratory disease can come from careful clinical studies of the diseases as they occur in man, but such studies are naturally limited in terms of experimental manipulation. In the last 2 decades, an increasingly complex plethora of experimental respiratory disease models has been developed and utilized by investigators, but relatively less attention has been paid to the naturally occurring pulmonary diseases of animals as potential models. This paper is aimed at presenting selected examples of spontaneous pulmonary disease in animals that may serve as exploitable models for human chronic bronchitis, bronchiectasis, emphysema, interstitial lung disease, hypersensitivity pneumonitis, hyaline membrane disease, and bronchial asthma. Chronic bronchitis in dogs is characterized by chronic cough, excessive mucus production, and chronic inflammatory changes in bronchial walls. The disease affects mainly smaller-breed dogs of middle age or older. Equine chronic bronchitis tends to be a small airway disease with marked goblet cell proliferation and excessive mucus production, which may be accompanied by alveolar emphysema. Many animals develop bronchiectasis or bronchiolitis obliterans secondary to chronic suppurative bronchopneumonia, but chronic respiratory disease (CRD) of rats may be the most useful model of bronchiectasis. Models for emphysema must include actual alveolar destruction and ideally should be accompanied by appropriate pathophysiologic decrements. Many animals occasionally develop emphysema, but the disease has not been well documented, except possibly in horses. The interstitial lung diseases of man represent a complicated and poorly understood group of entities and near-entities. The same is true for animals, although interstitial lung disease in animals is much less common than bronchopneumonia. Cattle seem prone to develop interstitial lesions. Proliferative interstitial pneumonia of cattle includes many morphologic similarities to the spectrum of human interstitial pneumonitides. Fibrosing alveolitis of cattle is a morphologic end point that may have its origins in different forms of interstitial injury. Hypersensitivity pneumonitis has been best detailed in cattle and in horses and is clinically, etiologically, immunologically, and morphologically similar to the disease in man. Hyaline membrane disease has been poorly documented in animals, with the possible exception of the neonatal respiratory distress syndromes of foals and piglets. Bronchial asthma is similarly not well established as a spontaneous disease in animals, although experimental models exist. Eosinophilic bronchiolitis of cattle may represent a useful asthma model but has been poorly detailed. In order to make them useful as models, more attention should be paid to detailing the clinical, morphologic, and etiologic aspects of these naturally occurring animal pulmonary diseases.

Animals↗

An ACSL simulation of the respiratory system.

A simulation program for the respiratory system using ACSL (Advanced Continuous Simulation Language) is presented. The underlying model is based on the representation of ventilation as a phasic air movement in lungs during the respiratory cycle. The translation of the model with ACSL instructions is described in particular for continuous processes, such as respiratory gas exchanges, and discrete events, such as changes of respiratory phase. The advantages of using ACSL are discussed, and the utility of such a simulation program in both research and education is demonstrated.

Algorithms↗

Respiratory system mechanics in ventilated patients: techniques and indications.

For the past 50 years, basic research has provided valuable insights into the concepts of respiratory system mechanics, but clinical application in the critical-care arena remains in its infancy. On the basis of the limited information that is available on critically ill patients, we believe that physicians who are responsible for the care of mechanically ventilated patients must understand the mechanical interactions between humans and machines. With measurements of flow, volume, and pressure, a more precise quantitative evaluation of the respiratory system can be obtained than with clinical assessment alone. In this article, we discuss the principles, techniques, and clinical applications of measurements of respiratory system mechanics in ventilated patients and suggest directions for further research that may prove to be clinically relevant.

Humans↗

The effect of single-dose and continuous skeletal muscle paralysis on respiratory system compliance in paediatric intensive care patients.

OBJECTIVE: To investigate the effect of single dose and continuous skeletal muscle paralysis on respiratory system compliance in 53 paediatric intensive care patients. DESIGN: Prospective clinical study. SETTING: Multidisciplinary paediatric intensive care unit. PATIENTS: Twenty-three children ventilated for acute pulmonary pathology, and 30 ventilated for isolated intracranial pathology, who initially had normal lungs. INTERVENTIONS: The 23 patients with acute pulmonary pathology received a single dose of muscle relaxant to facilitate diagnostic procedures. Fifteen patients with isolated intracranial pathology received continuous skeletal muscle paralysis for longer than 24 h, and the other 15 received no paralysis. MEASUREMENTS AND RESULTS: Respiratory system compliance deteriorated by 14% from 0.519 +/- 0.2 to 0.445 +/- 0.18 ml cmH2O-1 kg-1 (p < 0.001) following a single dose of muscle relaxant in the 23 patients with acute pulmonary pathology. In the 15 with isolated intracranial pathology who received continuous skeletal muscle paralysis there was a progressive deterioration in compliance, which reached 50% of the initial compliance by day 4 of paralysis (p < 0.001) and improved back to normal following discontinuation of paralysis. There were no changes in compliance in the 15 patients with isolated intracranial pathology who were ventilated but not paralysed. The paralysed patients required mechanical ventilation longer than the non-paralysed patients (p < 0.001), and 26% of these patients developed nosocomial pneumonia (p = 0.03), a complication that was not seen in the non-paralysed patients. CONCLUSIONS: Skeletal muscle paralysis results in immediate and progressive deterioration of respiratory system compliance and increased incidence of nosocomial pneumonia. The benefits of paralysis should be balanced against the risks of deteriorating pulmonary function.

Acute Disease↗

Physiology and pathophysiology of proteinase-activated receptors (PARs): PARs in the respiratory system: cellular signaling and physiological/pathological roles.

Proteinase-activated receptors (PARs), a family of G protein-coupled receptors, are widely distributed in the mammalian body, playing a variety of physiological/pathophysiological roles. In the respiratory systems, PARs, particularly PAR-2 and PAR-1, are expressed in the epithelial and smooth muscle cells. In addition to the G(q/11)-mediated activation of the phospholipase C beta pathway, epithelial PAR activation causes prompt and/or delayed prostanoid formation, leading to airway smooth muscle relaxation and/or modulation of an inflammatory process. PAR-2 present in the epithelium and smooth muscle is considered primarily pro-inflammatory in the respiratory system, although PAR-2 may also be anti-inflammatory under certain conditions. In the lung epithelial cells, PAR-2 can also be activated by exogenous proteinases including house dust mite allergens, in addition to various possible endogenous agonist proteinases. Clinical evidence also suggests possible involvement of PARs, particularly PAR-2, in respiratory diseases. PARs thus appear to play critical roles in the respiratory systems, and the agonists/antagonists for PARs may serve as the novel therapeutic strategy for treatment of certain respiratory diseases including asthma.

Animals↗

Measurements of respiratory system resistance by the interrupter technique in healthy and asthmatic children.

We studied respiratory system resistance by the interrupter technique (Rint) in healthy and asthmatic children, paying special attention to the effect of cheek compliance and the effects of supporting the cheeks, the influence of lung volume at which interruption was performed, the effect of direction of flow before occlusion (inspiration vs. expiration), and short-term reproducibility of this method. One hundred and thirty-two children (36 controls and 96 asthmatics) were included in the study (mean, 9.0 +/- SD 3.6 years). Rint was calculated from the ratio of the alveolar pressure (estimated from moth pressure during occlusion) to the flow prior to interruption. We observed that 1) underestimation of airway resistance due to upper airway compliance can be minimized by supporting the cheeks; Rint was significantly lower when measured without supporting the cheeks than with support of the cheeks in controls (3.9 +/- 0.9 vs. 4.7 +/- 1.2 cmH2O.L-1.s, respectively) and asthmatics (5.2 +/- 1.6 vs 6.9 +/- 2.0 cmH2O.L-1.s); the quantitative differences of Rint with and without cheek support was larger in small children and in the most obstructed children; 2) performing occlusion at mid-tidal volume accurately reflected the respiratory system resistance of the whole respiratory cycle since we observed no difference in Rint when performing occlusion at different volumes during quiet respiration or at the middle of tidal volume; 3) Rint measured during expiration was higher than Rint obtained during inspiration in controls and in asthmatics; moreover, the effect of direction of flow before occlusion was greater in the small children; 4) Rint was closely correlated to height in controls (r = -0.82; P < 0.001); and 5) short-term reproducibility (at 15 min intervals) was satisfactory in controls and asthmatics (coefficients of variation were 9% and 7%, respectively).

Adolescent↗

The physiology of mucus and sputum production in the respiratory system.

The main function of the respiratory system is to draw air into the lungs to allow the exchange of gases with blood circulating to the lungs. This blood supplies the cells of the body with oxygen and removes the waste products of metabolism. Tissues of the respiratory tract are thin and delicate, and become thinnest at the surfaces of the aveoli, where gaseous exchange occurs. The body has a number of mechanisms which protect these tissues and ensure that debris and bacteria do not reach them.

Cystic Fibrosis↗

Respiratory system, lung, and chest wall mechanics after longitudinal laparotomy in rats.

It has been demonstrated that respiratory resistance and elastance increase whilst the abdomen remains open during longitudinal laparotomy. We wished to determine whether changes also occur after abdominal closure in the same animal preparation. In 10 sedated, anaesthetized paralysed, and mechanically-ventilated rats (309 +/- 33 (SD) g), resistances and elastances of the respiratory system, lung, and chest wall were measured both before longitudinal laparotomy and directly after abdominal closure. Furthermore, the resistances were also split into their initial and difference components, the former reflecting the Newtonian resistances and the latter representing the viscoelastic/inhomogeneous pressure dissipations in the system. For this purpose, the end inflation occlusion during constant inspiratory flow method was used. After laparotomy, no statistically significant changes were found in elastances and resistances of the respiratory system, lungs and chest wall (paired Student's t-test, significance level = 5%). It can be concluded that after midline xiphipubic laparotomy accompanied by bilateral ventro-dorsal infracostal incision, respiratory resistances and elastances were not different from those found in the control condition.

Animals↗

Physiological basis for resonant frequencies in respiratory system impedances in dogs.

The lumped six-element model of the respiratory system proposed by DuBois et al. (J. Appl. Physiol. 8: 587-594, 1956) has often been used to analyze respiratory system impedance (Zrs) data. This model predicts a resonance (relative minimum in Zrs) at fr between 6 and 10 Hz and an antiresonance (relative maximum in Zrs) at far at higher frequencies (greater than 64 Hz). The far is due to the lumped tissue inertance (Iti) and the alveolar gas compression compliance (Cg). An fr and far have been recently reported in humans, but the far was shown to be not related to Iti and Cg, but instead it is the first acoustic antiresonance of the airways due to their axial dimensions). Zrs data to frequencies high enough to include the far have not been reported in dogs. In this study, we measured Zrs in dogs for frequencies between 5 and 320 Hz and found an fr at 7.5 +/- 1.6 Hz and two far at 97 +/- 13 and 231 +/- 27 Hz (far,1 and far,2, respectively). When breathing 80% He-20% O2, the fr shifted to 14 +/- 2 Hz, far,1 did not change (98 +/- 9 Hz), and far,2 increased to greater than 320 Hz. The behavior of fr and far,1 is consistent with the structure-function implied by the six-element model. However, the presence of an far,2 is not consistent with this model, because it is the airway acoustic antiresonance not represented in the model. These results indicate that, for frequencies that include the fr and far,1, the six-element model can be used to analyze Zrs data and reliable estimates of the model's parameters can be extracted by fitting the model to the data. However, more complex models must be used to analyze Zrs data that include far,2.

Airway Resistance↗

Effect of changes in lung volume on respiratory system compliance in newborn infants.

Total respiratory system compliance (Crs) at volumes above the tidal volume (VT) was studied by use of the expiratory volume clamping (EVC) technique in 10 healthy sleeping unsedated newborn infants. Flow was measured with a pneumotachograph attached to a face mask and integrated to yield volume. Volume changes were confirmed by respiratory inductance plethysmography. Crs measured by EVC was compared with Crs during tidal breathing determined by the passive flow-volume (PFV) technique. Volume increases of approximately 75% VT were achieved with three to eight inspiratory efforts during expiratory occlusions. Crs above VT was consistently greater than during tidal breathing (P less than 0.0005). This increase in Crs likely reflects recruitment of lung units that are closed or atelectatic in the VT range. Within the VT range, Crs measured by PFV was compared with that obtained by the multiple-occlusion method (MO). PFV yielded greater values of Crs than MO (P less than 0.01). This may be due to braking of expiratory airflow after the release of an occlusion or nonlinearity of Crs. Thus both volume recruitment and airflow retardation may affect the measurement of Crs in unsedated newborn infants.

Humans↗

Respiratory system mechanics in sedated, paralyzed, morbidly obese patients.

The effects of inspiratory flow and inflation volume on the mechanical properties of the respiratory system in eight sedated and paralyzed postoperative morbidly obese patients (aged 37.6 +/- 11.8 yr who had never smoked and had normal preoperative seated spirometry) were investigated by using the technique of rapid airway occlusion during constant-flow inflation. With the patients in the supine position, we measured the interrupter resistance (Rint,rs), which in humans probably reflects airway resistance, the "additional" resistance (delta Rrs) due to viscoelastic pressure dissipation and time-constant inequalities, and static respiratory elastance (Est,rs). Intra-abdominal pressure (IAP) was measured by using a bladder catheter, and functional residual capacity was measured by the heliumdilution technique. The results were compared with a previous study on 16 normal anesthetized paralyzed humans. Compared with normal persons, we found that in obese subjects: 1) functional residual capacity was markedly lower (0.645 +/- 0.208 liter) and IAP was higher (24 +/- 2.2 cmH2O); 2) alveolar-arterial oxygenation gradient was increased (178 +/- 59 mmHg); 3) the volume-pressure curve of the respiratory system was curvilinear with an "inflection" point; 4) Est,rs, Rint,rs, and delta Rrs were higher than normal (29.3 +/- 5.04 cmH2O/l, 5.9 +/- 2.4 cmH2O.l-1.s, and 6.4 +/- 1.6 cmH2O.l-1.s, respectively); 5) Rint,rs increased with increasing inspiratory flow, Est,rs did not change, and delta Rrs decreased progressively; and 6) with increasing inflation volume, Rint,rs and Est,rs decreased, whereas delta Rrs rose progressively. Overall, our data suggest that obese subjects during sedation and paralysis are characterized by hypoxemia and marked alterations of the mechanical properties of the respiratory system, largely explained by a reduction in lung volume due to the excessive unopposed IAP.

Adult↗

Dose effects of inhaled ipratropium bromide on the impedance of the respiratory system in normal subjects.

The influence of cholinergic receptor blockade on the impedance of the respiratory system was studied in 10 healthy volunteers in a frequency spectrum between 4 and 52 Hz by means of the forced pseudo random-noise oscillation technique. Ipratropium bromide was used in the inhaled form in two doses (0.040 and 0.200 mg). Both does caused a significant decrease in oscillatory airway resistance, Rrs. No dose effect on Rrs was found. Both doses caused an increase in the reactance of the respiratory system, Xrs. This increase in Xrs was significantly greater after the inhalation of the higher dose. The effect of both doses on the real part of impedance can be explained by a dilation of the central airways. Furthermore, inhaled ipratropium bromide, especially in the higher dose, led to an increase in the imaginary part of impedance suggesting a decrease in the capacitance of pulmonary structures in normal subjects.

Administration, Inhalation↗

A mathematical model of the human respiratory system.

A model of the human respiratory system is proposed which has a satisfactory performance under different physiological conditions. The model comprises a continuous plant and a discrete controller which generates and updates the drive signal to the plant at the end of every breath to represent the Hering-Breuer reflex. Arterial and central medullary sensors are included. The lung volume, dead space volume, cardiac output and cerebral blood flow are time varying. The respiratory work is minimized. The model is examined and simulation results of its performance in hypercapnia, hypoxia, periodic breathing and moderate exercise are presented. The responses presented include the relatively fast transients of Cheyne-Stokes breathing and the slower transients associated with carbon dioxide inhalation.

Blood Circulation↗

A method of calculating total respiratory system compliance from resonant frequency: validity in a rabbit model.

Ten anesthetized, tracheotomized, adult rabbits were used to test the validity of a method for calculation of total respiratory system compliance from resonant frequency (Cr). Reference values were obtained during constant flow inflation of the relaxed respiratory system by dividing the volume gain by the related difference in pressure at the airway opening (inflation method compliance, Ci). The animals were connected to a new type of servo-controlled infant ventilator. Besides volume-controlled mechanical ventilation at constant inspiratory flow rate and intermittent mandatory ventilation, there is a negative ventilator resistance mode integrated in this device for resistive unloading (Schulze A, Schaller P, Gehrhardt B, Mädler H-J, Gmyrek D: Pediatr Res 28:79-82, 1990). To measure resonant frequency (fr), the respiratory system was totally unloaded for a short period by a negative ventilator resistance exceeding the combined resistances of the endotracheal tube and airways. This evoked a continuous oscillation at fr. By analogy with electrical circuit theory, Cr was calculated according to C = 1/(4 pi 2.I.fr2) where C is compliance and I is inertance. The inertance of the endotracheal tube is given and that of the bronchial tree was ignored assuming a much greater total cross-sectional area and therefore much lower inertance when compared with the endotracheal tube. Three pairs of Ci - Cr values were obtained from each animal: 1) during intact respiratory muscle activity; 2) after pancuronium relaxation, and 3) after surfactant depletion by saline washout.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Patterns of laryngeal electromyography and the activity of the respiratory system during spontaneous laughter.

Laryngeal muscle electromyography (EMG) and measures of the behavior of the respiratory system have been made during spontaneous laughter in two groups of subjects. The smaller group also had a direct measure of tracheal pressure during this behavior. Laryngeal adductors such as the thyroarytenoid (TA) and lateral cricoarytenoid (LCA) exhibited brief high-amplitude bursts of activity, at a rate of approximately 5 Hz, which were usually associated on a 1 : 1 basis with the sound bursts (ha ha ha) of laughter. The laryngeal abductor, posterior cricoarytenoid (PCA), also showed bursts of activity that were out of phase with TA and LCA. The cricothyroid (CT) was only weakly, if at all, modulated during the bursting activity of the other laryngeal muscles. Tracheal pressure usually exhibited positive pressure pulses during laughter that were often, but not always, temporally correlated to the bursts of laryngeal adductor EMG activity. Such pressure modulations appeared to precisely determine when-and if-phonation was produced during the laugh. During laughter, laryngeal EMG is highly stereotyped both within and between subjects. In most instances, this activity appears to be supported by coordinated pulses of tracheal pressure. The periaqueductal gray (PAG) has been shown in animal studies to produce emotionally indicative vocalizations, in which the laryngeal and respiratory system are coordinated. Therefore, it is suggested that the PAG is involved with the production of laughter.

Action Potentials↗

Respiratory system mechanics in guinea pigs after acute hemorrhage: role of adrenergic stimulation.

We evaluated the effects of acute blood loss on the respiratory mechanics of guinea pigs. We measured respiratory system elastance (Ers) and resistance (Rrsmax) using the end-inflation occlusion method. Rrsmax was partitioned into its homogeneous component (Rrsmin) and that due to the unevenness within the respiratory system (Rrsu). Respiratory mechanics were studied both before and immediately after bleeding in eight animals. Another eight guinea pigs had received propranolol previously and were also submitted to hemorrhage. Propranolol-treated animals showed higher control values of Rrsmax (p less than .02) and Rrsmin (p less than .0001). Animals not treated with propranolol exhibited a decrease (p less than 0.001) in Rrsmax after hemorrhagic hypovolemia (from 0.375 +/- 0.051 to 0.323 +/- 0.042 cm H2O/ml.sec), due to a decrease (p less than 0.005) in Rrsmin (from 0.140 +/- 0.031 to 0.094 +/- 0.032 cm H2O/ml.sec), whereas Ers and Rrsu did not change. Propranolol-treated animals showed an increase (p less than .001) in Rrsmax (from 0.512 +/- 0.133 to 0.664 +/- 0.144 cm H2O/ml.sec), Rrsu (p less than 0.01) from 0.252 +/- 0.09 to 0.345 +/- 0.139 cm H2O/ml.sec, and Ers (p less than 0.001) (from 4.565 +/- 0.933 to 5.402 +/- 1.24 cm H2O/ml) after bleeding. The results indicate that the immediate effects of acute bleeding on respiratory mechanics are significantly influenced by catecholamines.

Airway Resistance↗

Cellular defense of the avian respiratory system: dose-response relationship and duration of response in intratracheal stimulation of avian respiratory phagocytes by a Pasteurella multocida bacterin.

In experiments analyzing dose-response, intratracheal inoculation of chickens with 10(8) and 10(9) avirulent Pasteurella multocida organisms induced the migration within 24 hr of large numbers of respiratory lavage cells (RLC) with increased phagocytic proportions and phagocytic capacity. Doses from 10(4) to 10(7) organisms per bird resulted in elevated numbers of RLCs that were not significantly higher (P > 0.05) than values of uninoculated or mock-inoculated control chickens. When analyzing the duration of response, we found that inoculation with 10(9) organisms resulted in significantly higher (P < 0.05) numbers of RLCs for 63 to 89 hr without significant elevation in phagocytic proportion and capacity. The numbers of RLCs were elevated, although not significantly (P > 0.05), up to 11 days after inoculation. These results indicate that RLCs migrate to the respiratory tract only in response to a relatively high number of stimulating bacterial organisms and that the duration of response is relatively short. Although there were elevated numbers of RLCs beyond 89 hours after stimulation, the question remains as to whether these cells would enhance nonspecific defense of the respiratory system of chickens.

Animals↗

Comparison of methods of measurement of compliance of the respiratory system in children.

Compliance of the respiratory system (Crs) was compared using 2 previously described methods, namely, the passive expiratory flow and multiple occlusion techniques. These 2 methods have the advantage of being totally noninvasive, but both have limitations precluding their use in some circumstances. The results of this study of 10 intubated patients, who varied widely in age (premature newborn to adolescence) and diseases, showed no significant difference between the Crs obtained by the 2 methods. The Crs measurements can therefore be used interchangeably, the choice of technique being dependent on the subjects' clinical state.

Child↗