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Kinematics and mechanics of midcostal diaphragm of dog.

Radiopaque markers were attached to the peritoneal surface of three neighboring muscle bundles in the midcostal diaphragm of four dogs, and the locations of the markers were tracked by biplanar video fluoroscopy during quiet spontaneous breathing and during inspiratory efforts against an occluded airway at three lung volumes from functional residual capacity to total lung capacity in both the prone and supine postures. Length and curvature of the muscle bundles were determined from the data on marker location. Muscle lengths for the inspiratory states, as a fraction of length at functional residual capacity, ranged from 0.89 +/- 0.04 at end inspiration during spontaneous breathing down to 0.68 +/- 0.07 during inspiratory efforts at total lung capacity. The muscle bundles were found to have the shape of circular arcs, with the three bundles forming a section of a right circular cylinder. With increasing lung volume and diaphragm displacement, the circular arcs rotate around the line of insertion on the chest wall, the arcs shorten, but the radius of curvature remains nearly constant. Maximal transdiaphragmatic pressure was calculated from muscle curvature and maximal tension-length data from the literature. The calculated maximal transdiaphragmatic pressure-length curve agrees well with the data of Road et al. (J. Appl. Physiol. 60: 63-67, 1986).

Animals↗

Regional lung function in pleural effusion.

In 6 seated subjects with small unilateral pleural effusion without other radiographic abnormality, we measured regional lung function using xenon-133, comparing the function of the lung on the side with the effusion to the function on the contralateral side. When both lungs were equilibrated with Xe, count rates were lower at the base with the effusion, indicating either collapse or displacement of lung in these regions. Regional lung expansion was measured as fractions of regional total lung capacity: regional functional residual capacity/regional total lung capacity and regional residual volume/regional total lung capacity. The distribution of boluses inhaled slowly from residual volume was also measured, In all subjects the results were the same on the side with the effusion as on the other side. These findings were compatible with effective static pleural pressure being the same on both sides and suggest that the reduction in count rate at the base with effusion was due to displacement rather than compression of lung. We also measured regional washout half-times during dynamic breathing and found them prolonged in regions underlying effusion, indicating that dynamic ventilation of these areas was reduced. We postulated that the dynamic pressure swings applied to these regions were decreased by the effusions.

Adult↗

[Diffusion ability of lungs at advanced age].

Changes in lungs ventilation is mainly studied in the research on the features of respiratory system in ageing process. The condition of alveolar--capillary oxygen diffusion expressing the presence of central acinar lung emphysema is much less investigated. The purpose of the research was to study particularities of lung diffusion ability, which is considered to be one of the important mechanisms determining blood oxygenation in elderly. Results of the research and discussion. The dynamic of body surface changes is much less variable with age, than the dynamic of the lung diffusion ability. This is considered to be the reason of preservation of age differences of lung diffusion ability referred to 1 M2 of a body surface. There are two differences in dynamic of DLCO (diffusion lungs capacity) referred to total lungs capacity and referred to 1 M2 of a body surface. The indicator of double correlation of vital capacity of lungs (VCL) of elderly patients and Dlco makes +0.764; between intrathoracic gas volume and DLCO +0.654; between the residual volume of lungs (RV) and DLCO +0.729; between the Tiffno index and DlCO +0.654. The same parameters of young patients with COPD were 0.112; -0.245; 0.105; 0.312 correspondingly. Age related reduction of ratio of lungs diffusion ability to total lungs capacity is less prominent comparing to the ratio of DlCO body surface. The sex dependant differences of DlCO/TC smooth out in with each decade in contrast to DlCO/m2. A close correlation was revealed between DLCO and vital lungs capacity, the residual volume of lungs, intrathoracic gas volume and Tiffno indicator in elderly patients with COPD.

Adult↗

Effects of chest wall on volume and strain patterns in canine lungs.

Lobar functional residual capacity-to-total lung capacity ratios (FRC/TLC) and strains in five supine anesthetized dogs were determined from volumes and side lengths of tetrahedra formed by multiple intraparenchymal markers whose positions were determined roentgenographically. Strain is related to fractional changes in length of elements in a Cartesian coordinate system and was used to describe parenchymal distortion. Volumes and strain patterns were compared in three states: intact dogs, after transection of forelimb structures to relieve traction on the chest wall, and in dogs' excised lungs. Removing traction (NT) decreased the plethysmographically determined FRC and the upper-to-lower lobe ratio (UL/LL) for FRC/TLC. The ratio in the NT state was more like the ratio in the excised lungs (UL/LL approximately equal to 1) than in the intact dog (UL/LL greater than 1). Strain patterns were similar between the intact and the NT states, indicating no lobar shape change at FRC between these two states. Strain in the excised lungs differed greatly from strains in the intact and NT states. We conclude that forelimb traction alters volume distribution between lobes and that lung-chest wall interactions are important in determining volume and strain patterns.

Animals↗

Use of submaximal inhalation and spirometry to assess the effects of ozone exposure.

Spirometric measures of airway obstruction are strongly influenced by the neurally mediated reduction in total lung capacity that accompanies ozone exposure. This study was conducted to evaluate a method for quantifying the effects of performing spirometry from a reduced inspiratory position on measures of airway obstruction, and to apply the method to published ozone-response data. Nineteen healthy, nonsmoking adults, 18-30 yr of age, each performed 17 forced expiratory maneuvers from inspiratory volumes that ranged from functional residual capacity to total lung capacity. In general, measures of airway obstruction were related strongly to total expired volume, and approximately 80% of the ozone-induced decrease in forced expiratory volume in 1 s (FEV1.0) resulted from the reduction in forced vital capacity. Results indicated that, for young, healthy, nonsmoking adults, spirometric values from maneuvers conducted from reduced inspiratory positions can be predicted accurately and precisely in the unexposed state, allowing interpretation of measures of ozone-induced airway obstruction.

Adolescent↗

Density dependence of maximal expiratory flow in chronic obstructive pulmonary disease.

Pulmonary mechanics were studied in 22 patients with chronic obstructive pulmonary disease (COPD) who had no evidence of asthma. Eleven of the 22 patients had a density dependence of maximal expiratory flow within the reported normal range. Patients with normal density dependence (responders) were not different from those with decreased density dependence (nonresponders) in mean age, smoking history, symptoms of cough or dyspnea, maximal expiratory flow at 75, 50, and 25% of the vital capacity during air breathing, total lung capacity, or static elastic lung recoil at 50% of the vital capacity. The nonresponders had smaller vital capacity values, larger ratios of residual volume to total lung capacity, higher resistance, and lower static recoil at total lung capacity. There was a correlation between diffusing capacity for CO and density dependence. There was an inverse relationship between the change in density dependence after inhalation of isoproterenol and initial density dependence. Dysanaptic lung growth and increased compliance of the central airways are potential mechanisms for normal density dependence in these patients. The prevalence of normal density dependence in these patients with established COPD raises serious questions concerning the usefulness of density dependence in the early detection of COPD. The differences in density dependence may indicate differences in pathogenesis of the airflow obstruction and hence may be of prognostic significance.

Airway Resistance↗

Maximum respiratory pressures in morbidly obese subjects.

Maximum inspiratory and expiratory pressures were measured at residual volume, total lung capacity, and functional residual capacity in 45 morbidly obese patients who on average weighed 183% of their predicted weights. The pressures were compared to determinations made in 25 subjects of similar age whose mean weight was 99% of predicted. For both men and women, pressures generated by control subjects tended to be higher than those produced by obese patients but the differences were not statistically significant. The mean vital capacity and total lung capacity were also similar in the 2 subject groups. The results indicate that despite working constantly against a less compliant chest wall, obese patients do not increase their capacity to generate maximal respiratory pressures.

Adult↗

Tomographic comparison of ventilation techniques for CT-guided thoracoscopic staple excision of subcentimeter lung nodules.

This study was planned to compare the computed tomographic detectability of lung nodules in three ventilatory conditions: total lung capacity, high-frequency ventilation, and total lung deflation. In an ex vivo lung model, 44 nodules were simulated. Using computed tomography (CT) scans, nodules were detected and compared to the actual number and excised under CT guidance. Simulated nodules measured 6.2 +/- 2.1 mm and demonstrated an attenuation of 175 +/- 14 HU. Observer confidence was highest at total lung capacity (5.00 +/- 0.00), in comparison to high-frequency ventilation and total lung deflation (4.69 +/- 0.78, 4.94 +/- 0.27, p = .24). The kappa score for total lung capacity, high-frequency ventilation, and total lung deflation was 1.00, 0.96, and 0.98, respectively, indicating a very high interrater reliability. Although surgical devices generated a substantial artifact, 90% of nodules were excised. Thus, although total lung capacity produces the highest confidence level, all three of the ventilatory techniques examined have similar detection of subcentimeter pulmonary nodules using computed tomography scans.

Animals↗

Analysis of static pulmonary mechanics helps to identify functional defects in survivors of acute respiratory distress syndrome.

OBJECTIVE: To assess the utility of static lung pressure-volume measurements in identifying and categorizing pulmonary function test defects in survivors of acute respiratory distress syndrome (ARDS). DESIGN: Cross-sectional. SETTING: Pulmonary function laboratory at a tertiary referral hospital in northern India. PATIENTS: Six survivors of ARDS reporting for their first follow-up visit after discharge. MEASUREMENTS AND MAIN RESULTS: Spirometry and whole body plethysmography were performed to evaluate lung volumes and to collect static lung pressure-volume data; the latter were subjected to monoexponential analysis. Three patients had a restrictive ventilatory defect as evidenced by diminished vital capacity and total lung capacity, but only one had reduced static lung compliance. The other two patients had reduced recoil pressure at total lung capacity, suggestive of respiratory muscle weakness. Two other patients with normal lung volumes had reduced static lung compliance. Exponential analysis of pressure-volume data in the three patients with reduced static lung compliance was consistent with reduced distensibility and loss of lung units in one patient each. Additionally, two patients had high values for shape constant of the exponential curve, indicative of air space distention. CONCLUSIONS: Detailed analysis of static pressure-volume data can identify pulmonary function abnormality and categorize the dominant mechanism responsible for restrictive ventilatory defects in survivors of ARDS, even in patients with normal lung volumes. In addition to lung fibrosis, neuromuscular weakness also contributes to decline in pulmonary function.

Adolescent↗

Effect of positive expiratory pressure breathing in patients with cystic fibrosis.

The effect of positive expiratory pressure breathing, alone and in combination with coughing, was investigated in eight patients with cystic fibrosis. Functional residual capacity and total lung capacity was measured with a body plethysmograph before, during, and immediately after breathing with expiratory pressure of 5 and 15 cm H2O, and after a coughing period. The positive expiratory pressure breathing was carried out five times for two minutes with a two minute interval between each period. Mucus transport was measured in a peripheral lung region and over the whole lung by a radioactive aerosol tracer technique. Clearance measurements were carried out continuously during positive expiratory pressure breathing and during a control period. Two minutes' breathing with an expiratory pressure of 5 and 15 cm H2O caused an increase in mean (SEM) functional residual capacity from 2.6 (0.1) to 3.6 (0.3) and 4.4 (0.5) 1 and an increase in total lung capacity from 5.1 (0.2) to 5.9 (0.3) and 6.9 (0.4) 1. Lung volumes were higher during breathing with an expiratory pressure of 15 cm H2O than with 5 cm H2O; both returned to baseline values immediately after positive expiratory pressure breathing. Spontaneous mucus clearance and mucus clearance by coughing were not influenced by positive expiratory pressure breathing at either expiratory pressure. Thus in patients with cystic fibrosis positive expiratory pressure breathing increases lung volumes in relation to the expiratory pressure imposed; these changes in lung volume did not, however, lead to an improvement of mucus transport.

Adolescent↗

Maximal static pressures and lung volumes in young female swimmers: one year follow-up.

The relationship between the growth of lung volumes and the development of maximal static pressures was examined in a 1 year follow-up study of 17 female swimmers, initially less than 12 years of age. Lung volumes were measured by body plethysmography, and maximal static inspiratory and expiratory pressures were generated near residual volume, at functional residual capacity and near total lung capacity (TLC). The results were compared to the regressions obtained from cross-sectional data generated on 59 girls randomly selected from a local school. Height was similar in swimmers and controls. Vital capacity and total lung capacity increased during the year to exceed normal limits in 11 of 17 swimmers. The only significant increase of maximal static pressures during 1 year occurred in expiration near TLC in those swimmers initially less than 10 years of age, and all pressures fell within normal limits. We conclude that large lung volumes in swimmers cannot be accounted for by an increased ability to inflate and deflate the lung by the respiratory muscles.

Age Factors↗

Pulmonary damage after modest exposure to zinc chloride smoke.

Thirteen soldiers (11 men and two women) were exposed to zinc chloride smoke (ZCS) during a combat exercise. Even though their initial symptoms were modest, a prolonged follow up with lung function testing and blood samples was undertaken due to previous cases with fatal outcome after exposure to ZCS. Four weeks after exposure there were statistically significant declines from baseline values in lung diffusion capacity and total lung capacity of 16.2% and 4.3%, respectively. At the same time plasma levels of fibrinogen and zinc were significantly elevated, though mainly within the normal range. All variables showed a tendency towards normalization at follow up 8 weeks and 6 months after exposure. These findings indicate an unexpected quantifiable damage to lung parenchyma with a remarkable delay after modest exposure to zinc chloride smoke despite sparse initial symptoms. Exposure to high concentrations of ZCS may induce adult respiratory distress syndrome (ARDS) after a symptom free period of up to 12 days from exposure. Even though none of the soldiers in the present study developed ARDS the assessment of lung diffusion capacity and acute phase reactants is proposed as a supplement when monitoring patients after exposure to ZCS.

Adult↗

Contractile properties of the human diaphragm during chronic hyperinflation.

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD) and hyperinflation of the lungs, dysfunction of the diaphragm may contribute to respiratory decompensation. We evaluated the contractile function of the diaphragm in well-nourished patients with stable COPD, using supramaximal, bilateral phrenic-nerve stimulation, which provides information about the strength and inspiratory action of the diaphragm. METHODS: In eight patients with COPD and five control subjects of similar age, the transdiaphragmatic pressure generated by the twitch response to phrenic-nerve stimulation was recorded at various base-line lung volumes, from functional residual capacity to total lung capacity, and during relaxation and graded voluntary efforts at functional residual capacity (twitch occlusion). RESULTS: At functional residual capacity, the twitch transdiaphragmatic pressure ranged from 10.9 to 26.6 cm of water (1.07 to 2.60 kPa) in the patients and from 19.8 to 37.1 cm of water (1.94 to 3.64 kPa) in the controls, indicating considerable overlap between the two groups. The ratio of esophageal pressure to twitch transdiaphragmatic pressure, an index of the inspiratory action of the diaphragm, was -0.50 +/- 0.05 in the patients, as compared with -0.43 +/- 0.02 in the controls (indicating more efficient inspiratory action in the patients than in the controls). At comparable volumes, the twitch transdiaphragmatic pressure and esophageal-to-transdiaphragmatic pressure ratio were higher in the patients than in normal subjects, indicating that the strength and inspiratory action of the diaphragm in the patients were actually better than in the controls. Twitch occlusion (a measure of the maximal activation of the diaphragm) indicated near-maximal activation in the patients with COPD, and the maximal transdiaphragmatic pressure was 106.9 +/- 13.8 cm of water (10.48 +/- 1.35 kPa). CONCLUSIONS: The functioning of the diaphragms of the patients with stable COPD is as good as in normal subjects at the same lung volume. Compensatory phenomena appear to counterbalance the deleterious effects of hyperinflation on the contractility and inspiratory action of the diaphragm in patients with COPD. Our findings cast doubt on the existence of chronic fatigue of the diaphragm in such patients and therefore on the need for therapeutic interventions aimed at improving diaphragm function.

Aged↗

Activation of bronchoalveolar lavage T lymphocytes and clinical, functional and radiological features in sarcoidosis.

Previous studies on the relationship between activated BAL T lymphocytes and clinical features in sarcoidosis revealed controversial results. We determined lavage lymphocytes, T lymphocytes, activated T lymphocytes, helper, suppressor and natural killer cells in 50 patients with pulmonary sarcoidosis and compared the results with clinical findings, serum angiotensin converting enzyme (ACE), the radiological pattern and lung function data (vital capacity [VC], total lung capacity [TLC], FEV1, transfer coefficient KCO and arterial-alveolar oxygen difference [AaDO2] during exercise). Patients with erythema nodosum (n = 7) showed a lower proportion of activated T lymphocytes (p < 0.05) and lymphocytes (p < 0.01) than the other patients. There was a significant correlation between activated T lymphocytes and AaDO2 during exercise (r = 0.49, p < 0.001), and an inverse correlation was seen between activated T lymphocytes and VC or TLC (r = -0.35 and r = -0.36, p < 0.01). We conclude that the percentage of activated BAL T cells may be related to the degree of parenchymal involvement as expressed by functional disturbance.

Adult↗

Tracking of airway and tissue mechanics during TLC maneuvers in mice.

A tracking impedance estimation technique was developed to follow the changes in total respiratory impedance (Zrs) during slow total lung capacity maneuvers in six anesthetized and mechanically ventilated BALB/c mice. Zrs was measured with the wave-tube technique and pseudorandom forced oscillations at nine frequencies between 4 and 38 Hz during inflation from a transrespiratory pressure of 0-20 cmH2O and subsequent deflation, each lasting for approximately 20 s. Zrs was averaged for 0.125 s and fitted by a model featuring airway resistance (Raw) and inertance, and tissue damping and elastance (H). Lower airway conductance (Glaw) was linearly related to volume above functional residual capacity (V) between 0 and 75-95% maximum V, with a mean slope of dGlaw/dV = 13.6 +/- 4.6 cmH2O-1. s-1. The interdependence of Raw and H was characterized by two distinct and closely linear relationships for the low- and high-volume regions, separated at approximately 40% maximum V. Comparison of Raw with the highest-frequency resistance of the total respiratory system revealed a marked volume-dependent contribution of tissue resistance to total respiratory system resistance, resulting in the overestimation of Raw by 19 +/- 8 and 163 +/- 40% at functional residual capacity and total lung capacity, respectively, whereas the lowest frequency reactance was proportional to H; these findings indicate that single-frequency resistance values may become inappropriate as surrogates of Raw when tissue impedance is changing.

Airway Resistance↗

Comparison of helium dilution and plethysmographic lung volumes in pregnant women.

The multibreath helium equilibration method is the technique recommended for routine measurement of static lung volumes in normal subjects. However, pregnancy could be an exception to this general rule, due to airway closure during the second half of gestation. The aim of this study was to compare the measurements of lung volumes by plethysmography and helium dilution during pregnancy. Twenty three healthy women were studied at 12, 24 and 36 weeks of pregnancy, and 4 months postpartum. Total lung capacity (TLC), functional residual capacity (FRC) and residual volume (RV) were measured by multibreath helium equilibration (TLCHe, FRCHe and RVHe) and by plethysmography (TLCbox, FRCbox and RVbox). Only at 36 weeks were there differences between the two methods. RVbox was significantly larger than RVHe (1.01+/-0.18 vs 0.77+/-0.21 L; p<0.001). FRCbox was larger than FRCHe (1.95+/-0.32 vs 1.60+/-0.32 L; p<0.001) and TLCbox was larger than TLCHe (4.83+/-0.52 vs 4.45+/-0.51 L; p<0.05). The 95% limits of agreement for differences between lung volumes measured by the two techniques (helium dilution - plethysmography) at 36 weeks were: -0.42 to -0.06 L for RV; -0.54 to -0.17 L for FRC; and -0.66 to -0.11 L for TLC. We conclude that using the multibreath helium equilibration method to measure lung volumes in at-term pregnant women results in underestimation of functional residual capacity and total lung capacity.

Adult↗

The effect of irradiation on lung function and perfusion in patients with lung cancer.

PURPOSE: To prospectively study the changes in lung function in patients with lung carcinoma treated with relatively high doses of irradiation. METHODS AND MATERIALS: Lung function was assessed prior to and at 6 and 12 months following radiation therapy by a clinical dyspnea score, formal pulmonary function tests (lung volume spirometry and diffusion capacity) as well as an ipsilateral hemithorax lung perfusion scan. Changes in dyspnea score were evaluated by the chi-square and the Fishers exact test. Changes in formal lung function tests were compared with the t-test for dependent data and correlations with the t-test for independent data. Fifty-one patients were entered into the study. There were 42 evaluable patients at 6 months after irradiation and 22 evaluable patients at 12 months after irradiation. RESULTS: A worsening of dyspnea score from 1 to 2, which is clinically acceptable, occurred in 50% or more of patients. However, a dyspnea score of 3, which is a serious complication, developed in only 5% of patients. The diffusion capacity (DLCO) decreased by 14% at 6 months and 12% at 12 months) (p < 0.0001). The forced vital capacity and total lung capacity decreased between 6% and 8% at 6 months and 12 months, which was statistically significant. The forced expiratory volume in 1 s decreased between 2 and 3% at 6 month and 12 months, which was not statistically significant. The ipsilateral hemithorax perfusion decreased by 17 and 20% at 6 and 12 months (p < 0.0001). There was no correlation between the initial hemithorax perfusion, or its decrease at follow up and the decrease in DLCO. CONCLUSION: Lung irradiation results in some loss of lung function in patients with lung cancer with a projected survival of 6 months or more. The pretreatment DLCO assessment should be useful in predicting clinical tolerance to irradiation.

Adult↗

Vertical gradients of lung density in healthy supine men.

Computed tomography was used to determine the vertical gradient of physical density in peripheral lung tissue of 12 healthy supine subjects, at total lung capacity and residual volume. At total lung capacity the mean (SD) density of peripheral lung tissue at the level of the mid right atrium was 0.0715 (0.017) g/cm3 and the vertical gradient of density was slight. At residual volume the density of peripheral tissue at the same level was 0.272 (0.067) g/cm3 and the vertical density gradient was curvilinear and more pronounced. Predictions of the gradient at residual volume were made on the basis of the known compliance of the lung and measured effects were attributed to the action of gravity on blood vessel distensibility at total lung capacity. These predictions agreed closely with the actual density gradient measured at residual volume and provide a basis for forecasting the vertical density gradient that would exist in healthy lungs at any degree of inflation. Departure from these gradients would imply local abnormalities of lung compliance, distribution of mechanical stress, or distensibility of vessels.

Humans↗