[Effect of bronchospirometry on the function of external respiration and hemodynamics of the lesser circulation].
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Adolescent↗
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Bronchospirometry in bronchial carcinoma. I.
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Bronchial Neoplasms↗
[Separation of the airways: historical aspects].
Techniques to separate the airways to both lungs were employed in the laboratory by renowned physiologists like Pflüger and C. Bernard to study gas exchange. Pflüger's catheter, as used by Wolffberg in 1871 in the dog, essentially constituted an early example of endobronchial single lumen tube, and was to be the first airway separator introduced into man by Loewy and v. Schrötter in 1905 in experiments on circulation. As a variation of this device the carinal hook made ist appearance used by Hess in 1912 in rabbits. While the endobronchial catheters afforded airtight access to only one lung at a time for concomitantly studying ventilation in both lungs, a short tracheal cannula was combined with one introduced into the left main bronchus by Head in 1889, constituting as it were the prototype of double lumen (DL) tubes applicable to rabbits and turtles even. Werigo described 1892 a coaxial DL-tracheostomy cannula for dogs which construction principle was adopted in the first DL-bronchoscope used in man. In lung surgery during the 30s and 40s the ventilated lung was prevented from drowning by pus or secretions from the lung under surgery by sealing off ist main bronchus, either by endobronchial intubation or by a bronchial blocker inserted alongside the endotracheal tube. This principle gave rise to sophisticated devices, from the fixed combination of tube and blocker to the present-day tube housing a movable blocker. Remarkably, DL-intubation in its proper sense then was performed in bronchospirometry only. This technique was introduced by Jacobaeus upon suggestion of Liljestrand when dissatisfied with the restriction to sequential spirometry by customary bronchoscopic catheterization, relying on Frenckner's ingenious DL-bronchoscope. Rubber DL-tubes were developed by Gebauer 1939 and Zavod 1940 exclusively with bronchospirometry in mind, even E. Carlens primarily constructed his tube to improve this procedure. After its usage in over 100 bronchospirometries it was introduced for the first time in November 1949 for its familiar purpose: the resection of a tuberculous abscess in the right upper lobe. Once introduced into thoracic anaesthesia, the DL-principle so far fostered a wide variety of tube designs.
Animals↗
Chest physiotherapy and the distribution of ventilation.
The injured or postoperative thorax is commonly treated with physiotherapy employing "unilateral breathing" techniques. The ability of these methods to alter the distribution of ventilation and blood flow (oxygen uptake) was examined in four patients undergoing bronchospirometry. No change was observed in these measurements in the lung toward which efforts were being directed to either enhance or restrict the mechanics of breathing. To further examine the problem, two susceptible subjects were hypnotized following intubation for bronchospirometry, and emotional and physical states were suggested that limit motion in one hemithorax. This included the presence of pleuritic pain in one subject who had ample experience with this symptom. In no instance did we find a change in the distribution of ventilation or blood flow to the lung that was supposed to be limited; however, in 17 subjects, lying on one side produced a significant increase in ventilation and blood flow in the dependent lung. Lying on one side or the other consistently and predictably modified ventilation and blood flow, while attempts to produce similar changes by voluntary intention or commonly applied mechanical aids were ineffective.
Breathing Exercises↗
Capnography does not reliably detect double-lumen endotracheal tube malplacement.
Two patients are described in whom double-lumen endotracheal tube malplacement and its ventilatory consequences were not detected by infrared capnography. Problems were suspected on auscultation, and the malplacement was diagnosed by means of bronchospirometry. We conclude that bronchospirometry helps detect problems with endotracheal intubation.
Carbon Dioxide↗
[Relation of the fall in PO2 in ventilation of the lower lung in pulmonary surgery and the preoperative distribution of respiratory function].
Hypoxaemia during one-lung ventilation is influenced by the anatomic distribution of lung perfusion and hypoxic vasoconstriction. This study aimed to assess whether preoperative selective bronchospirometry could predict the degree of peroperative hypoxaemia. Twelve patients scheduled for pneumonectomy, lobectomy, wedge resection or decortication were included in the study. Preoperative data included the usual spirometric parameters, oxygen consumption, minute ventilation of each lung and arterial blood gases. A Carlens or Robertshaw tube was inserted in each case; the patients were ventilated with 100% oxygen and halothane was used for anaesthesia. Blood gases were measured during surgery before and after upper lung exclusion. When both lungs were ventilated, mean PaO2 was 390.5 +/- 92.4 mmHg; during one-lung ventilation, it fell to 210.8 +/- 109.2 mmHg. Routine spirometry could not predict the magnitude of fall in PaO2; however, it was correlated with the bronchospirometric oxygen consumption of each lung (r = 0.83; p less than 0.01). The anatomical distribution of lung perfusion seemed to be the predominant factor influencing the decrease in PaO2 during one-lung ventilation.
Aged↗
Uncertainties in the expected value for forced expiratory volume in one second after surgery.
The purpose of this study is to understand better the reasons for the frequent unreliability of the expected value for the forced expiratory volume in one second (FEV1) in predicting surgical results after pneumonectomy. Measurement of FEV1 was performed in 159 patients before and after removal of one lung. Only 41 of the postoperative values for FEV1 differed from predicted values by less than 5 percent. The reason for the discrepancy can be technical, resulting either from the method used to assess the functional pulmonary distribution (bronchospirometry or isotopic procedure) or from the data used to calculate predicted FEV1. The discrepancy can also depend on the patient himself and particularly on the possibilities of the remaining lung to expand normally after surgery. Follow-up of patients confirmed the clinical and functional effects of erroneous predicted FEV1.
Adult↗
A comparative study of the effects of dry vs. humidified ventilation on canine lungs.
To compare the effects on canine ciliary and bronchial mucosal function of varying periods of ventilation with dry vs. humidified gas mixtures, 29 anesthetized dogs underwent 2, 4, and 6 hours of ventilation through a Carlen's double-lumen tube. Six dogs were evaluated by clearance studies, nine by differential bronchospirometry, six by surfactant studies, six by electron microscopy, and two by ventilation scanning. By means of two separate respiratory systems, dry gas (DG) was used to ventilate the right lung, and humidified gas (HG) ventilated the left lung in each dog. Serial chest roentgenograms showed more rapid clearance of inspired tantalum dust from the HG-ventilated lung in each of the six dogs, the disparity in clearance between the two lungs being more pronounced after longer periods of ventilation. The surface tension in DG-ventilated lungs increased fourfold, whereas in HG-ventilated lungs it increased only twofold as compared to preoperative values. Longer periods of ventilation did not change the surface tension appreciably in either DG- or HG-ventilated lungs. Scanning electron micrographs of bronchial mucosa from DG-ventilated lungs showed tangling and matting of cilia with a granular and stringy material attached to most cilia; these changes were much less pronounced in HG-ventilated lungs. Bronchospirometric studies showed an increase in ventilatory function in each of the lungs ventilated with the HG mixture (percent Vo2 on 100 percent oxygen increased 27.7 percent) to compensate for the decreased gas exchange provided by the contralateral DG-ventilated lung. Function in each of the lungs returned to normal within 24 hours. Ventilation scans with Xenon133 showed no apparent change in isotope uptake in the HG-ventilated lungs as compared to the DG lungs during the first 24 hours after ventilation. The observations from the present study suggest that ventilation of canine lungs with DG for 4 or more hours dries mucus and transiently retards mucociliary clearance and gas exchange. These changes may be minimized by ventilation with a humidified gas mixture. Application of these findings to patients undergoing prolonged general anesthesia and to lung preservation studies is suggested.
Animals↗
[Preoperative evaluation of the patient candidate for surgical intervention on the chest: methods of study and risk factors].
The authors review the main methods designed to evaluate operability and surgical risk in candidates for chest surgery. They also report on their own experience with 135 cases operated on for thoraco-pulmonary diseases requiring surgery; in these cases, postoperative complications were studied in relation to various respiratory parameters evaluated differentially and as a whole prior to surgery. This study enabled the investigators to establish that patients with CV, FEV1, FEF25-75 and Tiffffeneau Index values below 60% of the respective theoretical reference values run a very substantial risk of postoperative complications, with a post-surgical morbidity rate of more than 60% in such patients. Similar risks are run by patients with VR values below 60% or above 120% of predicted values or with Emphysema Index values above 120% of predicted values. The author's experience with fractional bronchospirometry revealed that, in the high-risk patient sample, a predicted postoperative FEV1 value of only 800 ml/sec is a poorly selective limit.
Adolescent↗
[Differential spirometry and computerized pulmonary ventilation- perfusion scintiphotography as preoperative functional studies in thoracic surgery].
With purposes of a better knowledge of the respiratory function, and for a more and more exact postoperative functional prognosis, the authors considered the results obtained by the differential bronchospirometry and the pulmonary ventilation-perfusion imaging. Through the study of 10 patients, susceptible of operations for lung extirpation, they could so evaluate the reliability and usefulness of said two functional investigations, which can integrate and complete each other.
Aged↗
Differential lung function in an infant with the Swyer-James syndrome.
A previously healthy two year old boy had an adenoviral infection at the age of 13 months and developed hyperlucency of the left lung, chronic respiratory distress, and failure to thrive. Bronchodilators and steroid treatment had no effect. Radionuclide lung scans using an intravenous bolus of xenon-133 both before and after treatment showed substantially reduced function on the hyperlucent side and modestly reduced function on the other side. Fibreoptic bronchoscopy showed no structural abnormalities. Partial forced expiratory flow volume (PEFV) curves, generated from end inspiration by rapid compression of the chest wall with an inflatable jacket, were obtained from the total respiratory system and from each lung separately by inflating a Fogarty catheter in the contralateral mainstem bronchus. Expiratory flow rates and volumes during both tidal breathing and PEFV manoeuvres were considerably decreased in the hyperlucent lung. PEFV curves from the "healthy" right lung and from the total respiratory system were similar in shape and showed a moderately obstructive pattern. The right lung ventilated about four times as much as the left when measured by bronchospirometry and about three times as much when measured by the radionuclide technique. The lung scans appeared to reflect adequately the functional abnormality in this infant with the Swyer-James syndrome.
Child, Preschool↗
Static lung volumes in healthy subjects assessed by helium dilution during occlusion of one mainstem bronchus.
BACKGROUND: Single lung function is usually assessed by radioisotopes or, more rarely, by bronchospirometry in which a double lumen catheter is used to separate ventilation of the two lungs. The latter is more precise but less comfortable. An alternative bronchoscopic method is described for determining the volume of a single lung. METHODS: One mainstem bronchus was temporarily occluded with an inflatable balloon during fibreoptic bronchoscopy in 12 healthy volunteers aged 18-29 years. The functional residual capacities (FRC) of the right, left, and both lungs were measured in duplicate by closed circuit helium dilution. Supplementary vital capacity (VC) manoeuvres permitted calculation of single lung capacities (TLC) and residual volumes (RV). RESULTS: The standard deviation of a single determination of capacities of the right, left, and both lungs were: TLC, 80, 96, and 308 ml; VC, 56, 139, 171 ml; FRC, 131, 74, and 287 ml; RV, 112, 185, and 303 ml, respectively. The sum of the right and left unilateral TLC was not different from bilateral TLC (6.12 v 5.95 l) and the sum of the unilateral FRC was not different from the bilateral FRC (2.60 v 2.78 l). The sum of the unilateral VC was lower than bilateral VC (4.52 v 4.80 l), that of the unilateral RV was higher than bilateral RV (1.60 v 1.16 l). For all subdivisions of lung volume, the right lung was larger than the left. The most common complaint was substernal discomfort during complete exhalation. Oxygen saturation rarely fell below 90%. CONCLUSIONS: Temporary occlusion of a mainstem bronchus in normal subjects is safe, relatively simple, and allows fairly precise and accurate measurements of unilateral static lung volumes. Occlusion at TLC, however, probably prevents proper emptying of the non-occluded lung.
Adolescent↗
Terminal nitrogen rise.
Eighteen-breath nitrogen washouts were performed on eight subjects. Each washout could be simulated by a four-compartment model, each compartment with a different ventilation-to-volume ratio and a variable contribution to expiratory flow. In large breaths initiated near residual volume, a terminal nitrogen rise (TNR) was seen. To account for the TNR with this model, there were relatively small changes in flow from compartments with markedly different nitrogen concentration. Reasons are given for believing these compartments could not be the upper and lower lung. Three of these subjects were studied in the supine, seated, and head-down positions. The TNR was seen at the same lung volume in all positions. At routine bronchospirometry in a second group of subjects, sampling with small catheters during a nitrogen washout showed a TNR in the expirate of lungs, lobes, segments, and subsegments in the upright and supine positions. Apparently a large vertical hydrostatic gradient is unnecessary to produce a TNR. Finally, the TNR was shown to occur at that lung volume where transpulmonary pressure is very small and changing rapidly with volume. This TNR was often followed by a terminal nitrogen fall while the lung was continuing to empty. The TNR occurs when flow from a large poorly ventilated compartment increases relative to the flow from other compartments. A model of lung in which the poorly ventilated compartment develops high specific compliance at low lung volume explains these data.
Adult↗
The effect of granulomatous pulmonary disease in dogs on the response of the pulmonary circulation to hypoxia.
We studied the effect of diffuse granulomatous pulmonary disease on the reponse of the pulmonary circulation to hypoxia in two series of experiments in intact dogs. First, in animals with unilateral disease, vasoconstriction in the diseased lung was compared to that in the contralateral control lung. Second, in animals with bilateral disease, the vasoconstriction of pulmonary shunt pathways was compared to that of the rest of the pulmonary vasculature. We assessed vasoconstriction in each study by measuring the distribution of pulmonary blood flow between the test and control set of vessels during 21 and 12% oxygen breathing. In the first set of experiments, we measured apportionment of the blood flow between the two lungs by bronchospirometry and the krypton bolus method. In normal dogs, hypoxia did not shift blood flow systematically from one lung to the other. In 10 dogs with unilateral disease, general hypoxia increased the proportion of blood flow to the diseased lung. The mean percent of blood flow to the left lung in eight dogs with disease in that lung rose from 29% during air breathing to 32% (P < 0.001). In the second set of experiments, we measured apportionment of the blood flow between shunt pathways and gas-exchanging pathways by a constant infusion of radio-active krypton and the standard shunt formula. In eight dogs with bilateral disease, hypoxia consistently increased the flow through shunt pathways, from a mean value of 10% of pulmonary blood flow to 14% (P < 0.005).Thus, diffuse granulomatous disease causes a decreased vasoconstrictive response to hypoxia both in diseased, gas-exchanging regions and in shunt pathways. In proliferative interstitial pulmonary disease, generalized hypoxia causes shifts in pulmonary blood flow which do not ameliorate but rather worsen the hypoxemia of systemic arterial blood.
Animals↗
Prediction of postoperative pulmonary function with the lateral position test. A prospective study.
Ten patients undergoing pneumonectomy were evaluated with the lateral position test (LPT) in addition to routine pulmonary function tests (PFTs). On the basis of the percentage of ventilation estimated to be contributed by each lung on LPT, predictions were made for expected values for each patient's post-pneumonectomy PFTs. One to three months after surgery patients were again evaluated with complete pulmonary function studies. Results were found to agree closely with preoperative predictions in most patients. We conclude that the easily performed LPT, previously found to yield values which correlate with those found on bronchospirometry and macroaggregate lung scanning, does indeed yield acceptable results clinically and is deserving of more widespread application, especially in the large number of institutions without nuclear medicine capabilities.
Adult↗
Evaluation before thoracotomy.
When a thoracotomy is being considered, the physician must first determine whether the lesion is potentially resectable. However, an equally important decision is whether the patient can tolerate pulmonary resection if there are other serious underlying medical problems. In any patient with signs or symptoms of pulmonary disease, a spirogram, arterial blood gas study and electrocardiogram should be done as part of the routine preoperative evaluation. The detection of abnormal pulmonary function should prompt preoperative institution of respiratory care to optimize maximally a patient's cardiorespiratory status before operation. If any of several indicators of a high risk of postoperative cardiopulmonary problems are found, split pulmonary function studies should be done to determine whether the lung remaining after resection will have adequate ventilation and perfusion. Xenon radiospirometry is preferable to bronchospirometry and right heart catheterization because of its noninvasiveness. Resection should not be undertaken in the presence of a predicted postoperative forced expiratory volume in one second (FEV(1)) less than 0.8 liter, an arterial carbon dioxide partial pressure (PaCO(2)) greater than 45 mm of mercury or Xenon scans which show poor ventilation/perfusion ( V/ Q) matchup in what would be the remaining lung after resection. A case is reported which shows the value of this approach to preoperative evaluation in determining the risk of postoperative problems.
Adenocarcinoma↗
[Bronchospirometric and rheographic characteristics of external respiration and hemodynamics of the lesser circulation in purulent lung diseases].
Using bronchospirometry and rheography the external respiration and hemodynamics of the minor circulatory circuit were studied in 164 patients with suppurative processes in the lung. Ventilatory-respiratory indices were found to be reduced in the affected and "healthy" lung. A correlative dependence between the gravity of respiratory disorders and the state of the minor circulation hemodynamics was proved statistically.
Adolescent↗
[The thoracic radiographic picture in routine monitoring following unilateral allogenic lung transplantation in the dog].
Undesired effects of nonspecific immunosuppression may be delimited by individual dosage. Early recognition of allograft rejection is the presupposition for that steering. As long as immunologic test methods require a great expense of equipment, personnel, and time, and as other methods (bronchospirometry, lung puncture) after lung transplantation additionally endanger the recipient, clinical routine examinations are particularly important, primarly thorax x-ray examinations. The authors report on serial chest radiographs during the courses after 71 unilateral orthotopic allogenic pulmonary transplantations in dogs with regard to the findings at obduction. Possibilities of differential diagnosis shall be found by that, and the limits of interpreting x-ray films after lung transplantation shall be disclosed. Certain distinctive marks in the x-ray findings indicate the various possible complications; they can not be relied upon, however, when they only extend to the graft (hemorrhage, infection, rejection).
Animals↗