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At least 289 records · Page 16Linked to original sources
PubMed2006

[Effects of lateral position and independent lung ventilation on unilateral acute lung injury in dogs].

OBJECTIVE: To investigate the effects of conventional ventilation, lateral position, asynchronous independent lung ventilation and synchronous independent lung ventilation on gas exchange, lung mechanics, hemodynamics, pulmonary perfusion and inflammatory mediators in dogs with a hydrochloric acid induced unilateral acute lung injury (ALI). METHODS: Twenty-eight dogs with hydrochloric acid induced unilateral ALI (the left lung) were ventilated with volume controlled ventilation. The animals were divided into four groups. The first group (group A, n = 7) received conventional ventilation in a supine position. The second group (group B, n = 7) received conventional ventilation in the healthy lung dependent position with the parameters as same as group A. The third group (group C, n = 7) received asynchronous independent lung ventilation. The fourth group (group D, n = 7) received synchronous independent lung ventilation with the parameters as same as group C. All the animals were observed for 4 h under the above described ventilation. Oxygenation, lung mechanics, hemodynamics and lung injury score were measured during the ventilation. The right and left pulmonary arterial blood flows were measured after 4 h ventilation. RESULTS: (1) After 30 min ventilation, PaO2/FiO2 in group A [(180 +/- 25) mm Hg, 1 mm Hg = 0.133 kPa] was significantly lower than those in group B, group C and group D [(277 +/- 23), (296 +/- 31), (299 +/- 22) mm Hg respectively, all P < 0.01]. PaO2/FiO2 in group C [(348 +/- 34) mm Hg] and group D [(343 +/- 29) mm Hg] was significantly increased when compared with that of group B [(314 +/- 33) mm Hg] after 60 min ventilation (P < 0.05), but there was no significant difference between group C and group D. (2) After 120 min ventilation, C(st) in group B [(23 +/- 4) ml/cm H2O] significantly increased when compared with that of group A [(19 +/- 2) ml/cm H2O, P < 0.05]. After 60 min ventilation, C(st)-L in group C and group D increased significantly as compared to the beginning of the ventilation. (3) The left lung pulmonary arterial flow in group B, group C and group D [(31.3 +/- 4.6)%, (27.5 +/- 1.3)% and (27.3 +/- 2.8)%, respectively] significantly decreased when compared with that of group A (38.3 +/- 2.2)% after 4 h ventilation (P < 0.05 and P < 0.01). CONCLUSIONS: Both lateral position and independent lung ventilation can improve gas exchange, while independent lung ventilation is better than lateral position ventilation. The improvement of oxygenation may be related to the effect on the distribution of pulmonary arterial flow.

Acute Lung Injury↗
PubMed1991

[The relationship between ventilatory lung motion and pulmonary perfusion shown by ventilatory lung motion imaging].

Using ventilatory lung motion imaging, which was obtained from two perfusion lung scintigrams with 99mTc-macroaggregated albumin taken in maximal inspiration and maximal expiration, the lung motion [E-I)/I) of the each unilateral lung was studied in various cardiopulmonary diseases. The sum of (E-I)/I(+) of the unilateral lung showed a decrease in the diseased lung of localized pleuropulmonary diseases, including primary lung cancer and pleural thickening, and in both lungs in cases of heart diseases, diffuse pulmonary diseases including diffuse interstitial pneumonia and diffuse panbronchiolitis. The sum of (E-I)/I(+) of the both lungs, which correlated with vital capacity and PaO2, showed a decrease in diffuse interstitial pneumonia, pulmonary emphysema, diffuse panbronchiolitis, primary lung cancer, pleural diseases and so on. (E-I)/I(+), correlated with pulmonary perfusion (n = 49, r = 0.51, p less than 0.001), but not a few cases showed mismatch, which was observed in primary lung cancer, pleural diseases, pulmonary emphysema, diffuse panbronchiolitis and so on. (E-I)/I(+) better correlated with pulmonary ventilation by ventilation scintigraphy with 81mKr or 133Xe (n = 49, r = 0.61, p less than 0.001) than pulmonary perfusion. The ventilatory lung motion imaging, which demonstrates the motion of the intra-pulmonary areas and lung edges, appears useful for estimating pulmonary ventilation of the perfused area as well as pulmonary perfusion.

Heart Diseases↗
PubMed1989

[Exploration on the reconstruction of lung image and the estimation of lung tissue volume by single photon emission computed tomography (SPECT)].

We studied the use of single photon emission computed tomography (SPECT) for evaluating lung image and measuring lung tissue volume, in a lung phantom and healthy volunteers. Three conditions of image processing were tested using the phantom, and found out a backprojection method with using a Shepp-Logan filter and a pre-reconstruction smoothing of 3 X 3 pixels to be suited. A lung tissue volume was estimated from the summation of voxels in the region where the SPECT value was greater than an arbitrary threshold level. We changed phantom lung density from 0.34 g/cm3 to 0.58 g/cm3, but there was no significant effect in the estimated volume by the density change. Changes in the lung SPECT images and lung tissue volumes in healthy subjects were studied, after changing the lung volume by applying either continuous negative body-surface pressure (CNP) to the thorax or positive end-expiratory pressure (PEEP). Difference of the lung expansion in the two methods was visualized by the SPECT images. The lung tissue volumes obtained by SPECT were correlated with the functional residual capacity by Helium dilution method (r = 0.91, p less than 0.001). We concluded that lung SPECT could be used clinically to display the distribution of a tracer radio-isotope in the lungs and also used to estimate the lung tissue volume.

Adult↗
PubMed1994

Isolated single lung perfusion with doxorubicin is effective in eradicating soft tissue sarcoma lung metastases in a rat model.

The only effective therapy for patients with metastatic soft tissue sarcoma in the lung is surgical resection, with a 5-year survival of approximately 25%. Because systemic chemotherapy has not significantly affected survival in these patients, we began to investigate locoregional chemotherapy. We have previously shown that isolated single lung perfusion with doxorubicin in the rat results in higher lung tissue levels and lower systemic toxicity than does high-dose intravenous therapy. In the present study, we examined the safety of isolated lung perfusion with doxorubicin and its efficacy in the treatment of experimental pulmonary metastases from soft tissue sarcoma. In experiment 1, 15 F344 rats were randomized into three groups (n = 5): group I had isolated left lung perfusion with doxorubicin 320 micrograms/ml in saline solution; group II had left isolated lung perfusion with doxorubicin 480 micrograms/ml and group III with doxorubicin 640 micrograms/ml. All perfusions with doxorubicin were at 0.5 ml/min for 10 minutes followed by perfusion of saline solution for 5 minutes. On day 21, all animals underwent right (contralateral) pneumonectomy and were observed for over 10 days. In experiment 2, two groups of F344 rats were injected intravenously with 10(7) viable methylcholanthrene-induced sarcoma cells on day 0. On day 7, group I (n = 12) had left isolated lung perfusion with saline solution only and group II (n = 15) had isolated lung perfusion with doxorubicin 320 micrograms/ml. On day 21, all animals were killed, and their lungs were stained for metastases. Routine histologic sections from three animals from group II were examined. In experiment 1, 80% of the animals in group I survived contralateral pneumonectomy. There were no survivors in groups II and III. In experiment 2, three animals died after isolated lung perfusion (one from group I and two from group II), and one animal (group I) was excluded because of mediastinal tumor. All animals in both groups had massive tumor replacement of the right (untreated) lung. Group I animals had massive tumor replacement of the left (treated) lung, whereas animals in group II had eradication of metastases in nine of ten cases; no microscopic evidence of tumor was detected in all three animals evaluated for microscopic disease. Isolated lung perfusion with doxorubicin 320 micrograms/ml is safe and effective in eradicating experimental pulmonary sarcoma metastases in this model.

Animals↗
PubMed2004

Impact of lung volume on MR signal intensity changes of the lung parenchyma.

PURPOSE: To test the hypothesis that, in magnetic resonance (MR) imaging of healthy individuals, equal relative changes in lung volume cause equal relative changes in MR signal intensity of the lung parenchyma. MATERIALS AND METHODS: In two experimental runs, 10 volunteers underwent spirometrically monitored MR imaging of the lungs, with MR images acquired at 10 incremental lung volumes ranging from total lung capacity to 10% above residual volume. Average signal intensity, signal variability, and signal intensity integrals were calculated for each volunteer and for each lung volume. The effect of lung volume on signal intensity was quantified using linear regression analysis complemented by the runs test. Slopes and intercepts of regression lines were compared with an analysis of covariance. Slopes of the lines of best fit for lung volumes and signal intensities from the two runs were compared to the slope of the line of identity. Comparisons between the two runs were visualized using Bland and Altman plots. RESULTS: The slopes of the 10 individual regression lines yielded no significant differences (F = 1.703, P = 0.101; F = 1.321, P = 0.239). The common slopes were -0.556 +/- 0.027 (P = 0.0001) for the first and -0.597 +/- 0.0031 (P = 0.0001) for the second experimental run. Both slopes displayed no significant nonlinearity (P = 0.419 and P = 0.067). There was a strong association between changes in lung volumes (rs = 0.991, P = 0.0001) and changes in signal intensity (rs = 0.889, P = 0.0001) in the two experimental runs. Lines of best fit for lung volume and signal intensities were not significantly different from the slope of the line of identity (P = 0.321 and P = 0.212, respectively). CONCLUSION: Equal changes in lung volume cause equal changes in MR signal intensity of the lung parenchyma. This linear and reproducible phenomenon could be helpful in comparing pulmonary MR signal intensity between individuals.

Adult↗
PubMed1996

Flow cytometric analysis of lung lymphocytes in lung transplant recipients.

Lung transplantation is an accepted therapeutic modality in end-stage lung disease. Presently, histologic examination of tissue by transbronchial biopsy remains as the definitive diagnostic procedure for determining rejection. To begin addressing the usefulness of flow cytometric analysis of bronchoalveolar lavage fluid (BALF) in acute lung rejection, we prospectively studied the expression of markers on lymphocytes from BALF samples removed from 10 lung and heart-lung transplant recipients and compared their pattern with that of BALF lymphs obtained from normal volunteers (Norm) and nonrejecting heart transplant recipients (HT) who were receiving similar immunosuppressive regimens. Compared with both Norm and HT subjects, CD4+ lymphocytes in the BALF of lung transplant recipients was significantly reduced. A greater percentage of the CD4+ lymphocytes in nonrejecting lung transplant subjects also expressed the interleukin-2 receptor, but only during the early post-transplant period, suggesting possible reactivity to persistent donor cells. However, the CD8+ lymphocytes were increased only in lung transplant recipients undergoing acute lung rejection. We conclude that the immunologic milieu is indeed altered in the transplanted lung. Further studies in lung transplant recipients are required to evaluate the role of flow cytometry in the early detection of acute lung rejection.

Acute Disease↗
PubMed2005

Lung development and susceptibility to ventilator-induced lung injury.

RATIONALE: Ventilator-induced lung injury has been predominantly studied in adults. OBJECTIVES: To explore the effects of age and lung development on susceptibility to such injury. METHODS: Ex vivo isolated nonperfused rat lungs (infant, juvenile, and adult) were mechanically ventilated where VT was based on milliliters per kilogram of body weight or as a percentage of the measured total lung capacity (TLC). In vivo anesthetized rats (infant, adult) were mechanically ventilated with pressure-limited VTs. Allocation to ventilation strategy was randomized. MEASUREMENTS: Ex vivo injury was assessed by pressure-volume analysis, reduction in TLC, and histology, and in vivo injury by lung compliance, cytokine production, and wet- to dry-weight ratio. MAIN RESULTS: Ex vivo ventilation (VT 30 ml.kg(-1)) resulted in a significant reduction (36.0 +/- 10.1%, p < 0.05) in TLC in adult but not in infant lungs. Ex vivo ventilation (VT 50% TLC) resulted in a significant reduction in TLC in both adult (27.8 +/- 2.8%) and infant (10.6 +/- 7.0%) lungs, but more so in the adult lungs (p < 0.05); these changes were paralleled by histology and pressure-volume characteristics. After high stretch in vivo ventilation, adult but not infant rats developed lung injury (total lung compliance, wet/dry ratio, tumor necrosis factor alpha). Surface video microscopy demonstrated greater heterogeneity of alveolar distension in ex vivo adult versus infant lungs. CONCLUSION: These data provide ex vivo and in vivo evidence that comparable ventilator settings are significantly more injurious in the adult than infant rat lung, probably reflecting differences in intrinsic susceptibility or inflation pattern.

Animals↗
PubMedDate not supplied

Increased immunoreactive rat lung ICAM-1 in oleic acid-induced lung injury.

Levels of immunoreactive ICAM-1 in rat lung were followed during the kinetic development of acute oleic acid-induced lung injury in the rat by the ELISA assay. Significant increases in ICAM-1 immunoreactivity were found on rat lung membranes within 30 min of oleic acid injection. The increased immunoreactive ICAM-1 persisted for the duration of the study (4 h) and paralleled lung injury as measured by decreased lung compliance. Enhanced ICAM-1 immunofluorescence was also observed on cryostat sections of lungs from oleic acid-treated rats. No direct effect of oleic acid on ICAM-1 levels of cultured human umbilical vein endothelial cells or rat lung microvascular endothelial cells was observed. This suggests that either oleic acid raises rat lung ICAM-1 levels on endothelial cells by an indirect mechanism or that oleic acid increases ICAM-1 levels on other cell types, such as fibroblasts or lung epithelial cells, by direct or indirect mechanisms. Some of the increased ICAM-1 may also be due to the accumulation of ICAM-1 containing circulating leukocytes in the lung. The role of ICAM-1 in the pathophysiology of oleic acid-induced lung injury and the mechanism by which oleic acid increases ICAM-1 expression in the lung therefore remain to be defined by future experimentation.

Animals↗
PubMed1999

Differentiation-related expression of the Thomsen-Friedenreich glycotope in developing human lung and in lung carcinoma: lack of association with malignancy.

BACKGROUND: It has been proposed that the Thomsen-Friedenreich glycotope represents a general carcinoma-associated antigen and a candidate for the development of a tumor vaccine. However, the expression of the unmasked and masked (sialylated) forms in lung carcinomas, as well as in developing and adult human lung, has not been documented sufficiently. METHODS: Sections from 82 lung carcinomas, including squamous cell carcinomas, adenocarcinomas, and large cell and small cell carcinomas, as well as sections of developing and adult human lung were studied using the lectin amaranthin and a monoclonal antibody. RESULTS: All lung carcinomas but one bronchiolo-alveolar carcinoma were unreactive for the Thomsen-Friedenreich glycotope, whereas its sialylated form was detectable in well-differentiated squamous cell carcinomas and adenocarcinomas, including bronchiolo-alveolar carcinomas. Both unmasked and masked Thomsen-Friedenreich glycotopes were undetectable in large cell and small cell lung carcinomas. In all developmental stages of lung, the Thomsen-Friedenreich glycotope was expressed only in epithelia of the most peripheral parts of the bronchial tree, whereas its sialylated form was expressed in epithelia of all parts of the bronchial tree. In adult lung, the Thomsen-Friedenreich glycotope was expressed in pneumocytes, whereas its sialylated form was expressed ubiquitously in all epithelia. CONCLUSIONS: The Thomsen-Friedenreich glycotope in human lung represents a differentiation antigen, rather than a carcinoma-associated antigen. The sialylated form is expressed constitutively in both developing and adult lung and well-differentiated lung carcinomas. Thus, the Thomsen-Friedenreich glycotope is of limited value in the diagnosis of lung carcinoma, and there is no rationale for a Thomsen-Friedenreich glycotope-based immunotherapy for patients with this disease.

Adenocarcinoma↗
PubMed1993

Hepatocyte growth factor may act as a pulmotrophic factor on lung regeneration after acute lung injury.

Hepatocyte growth factor (HGF) has been shown to have hepatotrophic and renotropic functions for regeneration of the liver and kidney through its mitogenic, motogenic, and morphogenic properties. To examine the involvement of HGF in lung regeneration after acute injury, we analyzed changes of HGF mRNA, HGF activity, and HGF receptors in the rat lung after lung insult and measured HGF concentration in sera of patients with various lung diseases. Following the onset of acute lung injury induced by intratracheal hydrochloride injection, a compensatory DNA synthesis occurred in the bronchial epithelium with a peak at 24 h and in the alveolar epithelium with a peak at 48 h. Expression of HGF mRNA in the rat lung remarkably increased only 3 h after the treatment and HGF activity in the lung also increased to about 3-fold at 6 h later. HGF receptors in the lung but not in the other noninjured organs were down-regulated 12 h later. These marked increases in HGF mRNA and HGF activity and the concomitant down-regulation of HGF receptor occurred before the marked compensatory DNA synthesis in bronchial and alveolar epithelial cells. HGF concentration in sera of patients with various lung diseases, as measured by radioimmunoassay, was much higher than that in healthy donors. These results suggest that HGF is newly produced in the lung after acute lung injury and may have a role in regeneration of the lung.

Animals↗
PubMed2002

Prediction of postoperative lung function in patients with lung cancer: comparison of quantitative CT with perfusion scintigraphy.

OBJECTIVE: Prediction of postoperative lung function is important in preoperative evaluation of patients with lung cancer. Perfusion scintigraphy is the current method to assess the fractional contribution of lung function of the remaining lung. We developed a quantitative CT method and compared it with perfusion scintigraphy for predictions of postoperative forced expiratory volume in 1 sec (FEV1) in patients with lung cancer. SUBJECTS AND METHODS: Forty-four patients with lung cancer undergoing lung resection with preoperative CT and perfusion scintigraphy were enrolled. Quantitative CT used a dual threshold (-500 and -910 H) on standard preoperative CT to semiautomatically extract lung volume without emphysema or tumor and atelectasis, which we defined as "functional lung volume." Prediction was calculated from preoperative FEV1 multiplied by the fractional contribution of functional lung volume of the remaining lung by quantitative CT. Perfusion scintigraphy was the standard method. Predictions were correlated with postoperatively measured FEV1. RESULTS: Both quantitative CT and perfusion scintigraphy predicted postoperative FEV1 well in patients who underwent pneumonectomy (n = 28, r = 0.88 vs r = 0.86) and in lobectomy (n = 16, r = 0.90 vs r = 0.80) (both, p < 0.001). There was good agreement between the two methods by the Bland-Altman method. In the four patients with low measured postoperative FEV1 (<40% predicted normal), quantitative CT had true-positive prediction in four and perfusion scintigraphy, in only two. CONCLUSION: Given its simplicity, we proposed that quantitative CT be widely used in predicting postoperative FEV1.

Carcinoma, Non-Small-Cell Lung↗
PubMed2003

Effect of continuous hemofiltration on hemodynamics, lung inflammation and pulmonary edema in a canine model of acute lung injury.

OBJECTIVE: This study examined whether continuous hemofiltration favorably affects cardiopulmonary variables, lung inflammation, and lung fluid balance in a canine model of oleic acid induced acute lung injury. METHODS: Eleven pentobarbital-anesthetized dogs were randomly divided into a control (mechanical ventilation, MV) group (n=6) and a MV plus hemofiltration (HF) group (n=5). All animals received an intravenous injection of oleic acid (0.09 ml/kg) to induce acute lung injury. Continuous arterial-venous hemofiltration (blood flow 100 ml/min, ultrafiltration rate at 50-65 ml kg(-1) h(-1)) was started after establishment of oleic acid induced acute lung injury and continued for 4 h. Hemodynamics, lung mechanics, gas exchange, lung fluid balance, lung histology, and the level of plasma cytokines were assessed. RESULTS: After 240 min of HF treatment there was a significant increase in cardiac output, reduction in pulmonary arterial pressure, and improvement in both oxygenation and lung mechanics. Also, in the HF group the lung wet-to-dry weight ratio was significantly reduced. Histologically, HF reduced edema and inflammatory cell infiltration in the lung. There was also a significantly greater decrease in plasma IL-6 and IL-8 levels in the HF group than in group receiving MV alone. CONCLUSIONS: In a canine model of acute lung injury continuous HF improved cardiopulmonary function, reduced pulmonary edema, decreased lung permeability and inflammation, and decreased the plasma concentration of proinflammatory cytokines.

Albumins↗
PubMed2001

Therapeutic time-window of a group IIA phospholipase A2 inhibitor in rabbit acute lung injury: correlation with lung surfactant protection.

OBJECTIVE: We attempted to determine whether group IIA secretory phospholipase A2 (sPLA2-IIA) blockade after the onset of lung injury exerted therapeutic efficacy in the treatment of oleic acid (OA)-induced acute lung injury by using S-5920/LY315920Na, a novel specific inhibitor of sPLA2-IIA, with special interest in the changes of lung surfactant. DESIGN: Prospective animal study. SETTING: University laboratory. SUBJECTS: Forty Japanese white rabbits. INTERVENTIONS: The rabbits, under anesthesia, were endotracheally intubated and mechanically ventilated and then were divided into the following groups: OA + vehicle groups, intravenous infusion of OA for the first 2 hrs (0.1 mL x kg(-1) x hr(-1)) with the addition of vehicle (1 or 2 hrs after OA administration, each n = 9, total 18 rabbits); OA + S-5920/LY315920Na groups, treated identically to the OA control with the addition of S-5920/LY315920Na (1 mg/kg bolus followed by infusion at 0.5 mg x kg(-1) x hr(-1)) after OA (1 or 2 hrs after OA administration, each n = 9, total 18 rabbits); saline control groups, treated with saline instead of OA with the addition of vehicle (1 hr after OA administration, 4 rabbits). Arterial blood gas, lung mechanics, lung inflammation, lung surfactant phospholipids, and production of inflammatory mediators in the lung were measured. MEASUREMENTS AND MAIN RESULTS: Treatment with S-5920/LY315920Na 1 hr after OA infusion, but not 2 hrs after infusion, significantly attenuated the lung injury, as estimated by hypoxemia, decreased lung compliance, pulmonary edema, and vascular permeability. The therapeutic efficacy was similar to that found in our previous pretreatment study. The treatment after 1 hr dramatically inhibited OA-induced surfactant degradation in the bronchoalveolar lavage fluid (BALF), without affecting the concentrations of thromboxane A2, leukotriene B4, and interleukin-8 in BALF. The degree of surfactant degradation in BALF paralleled well with the severity of the lung injury. Furthermore, recombinant human sPLA2-IIA reproduced the similar hydrolysis pattern of isolated surfactant in vitro, which was inhibited by S-5920/LY315920Na. CONCLUSIONS: Our results indicate that therapeutic blockade of sPLA2-IIA ameliorated lung dysfunction via protection of surfactant degradation in an animal model of acute lung injury, and they suggest a new strategy in treating clinical acute lung injury.

Acetates↗
PubMed2005

CXCR2 is critical for dsRNA-induced lung injury: relevance to viral lung infection.

BACKGROUND: Respiratory viral infections are characterized by the infiltration of leukocytes, including activated neutrophils into the lung that can lead to sustained lung injury and potentially contribute to chronic lung disease. Specific mechanisms recruiting neutrophils to the lung during virus-induced lung inflammation and injury have not been fully elucidated. Since CXCL1 and CXCL2/3, acting through CXCR2, are potent neutrophil chemoattractants, we investigated their role in dsRNA-induced lung injury, where dsRNA (Poly IC) is a well-described synthetic agent mimicking acute viral infection. METHODS: We used 6-8 week old female BALB/c mice to intratracheally inject either single-stranded (ssRNA) or double-stranded RNA (dsRNA) into the airways. The lungs were then harvested at designated timepoints to characterize the elicited chemokine response and resultant lung injury following dsRNA exposure as demonstrated qualititatively by histopathologic analysis, and quantitatively by FACS, protein, and mRNA analysis of BAL fluid and tissue samples. We then repeated the experiments by first pretreating mice with an anti-PMN or corresponding control antibody, and then subsequently pretreating a separate cohort of mice with an anti-CXCR2 or corresponding control antibody prior to dsRNA exposure. RESULTS: Intratracheal dsRNA led to significant increases in neutrophil infiltration and lung injury in BALB/c mice at 72 h following dsRNA, but not in response to ssRNA (Poly C; control) treatment. Expression of CXCR2 ligands and CXCR2 paralleled neutrophil recruitment to the lung. Neutrophil depletion studies significantly reduced neutrophil infiltration and lung injury in response to dsRNA when mice were pretreated with an anti-PMN monoclonal Ab. Furthermore, inhibition of CXCR2 ligands/CXCR2 interaction by pretreating dsRNA-exposed mice with an anti-CXCR2 neutralizing Ab also significantly attenuated neutrophil sequestration and lung injury. CONCLUSION: These findings demonstrate that CXC chemokine ligand/CXCR2 biological axis is critical during the pathogenesis of dsRNA-induced lung injury relevant to acute viral infections.

Journal Article↗
PubMed2006

Redistribution of blood flow and lung volume between lungs in lateral decubitus postures during unilateral atelectasis and PEEP.

The effect of left lung atelectasis on the regional distribution of blood flow (Q), ventilation (V(A)) and gas exchange on the right lung ventilated with 100% O2 was studied in anesthetized dogs in the lateral decubitus posture. Q and V(A) were measured in 1.7 ml lung volume pieces using injected and aerosolized fluorescent microspheres, respectively. Hypoxic pulmonary vasoconstriction (HPV) in the atelectatic lung shifted flow to the ventilated lung. The increased flow in the ventilated lung ensured adequate gas exchange, compensating for the hypoxemia due to shunt contributed by the atelectatic lung. Left lung atelectasis caused a compensatory increase in the ventilated lung FRC that was smaller in the right (RLD) than left (LLD) lateral posture, the effect of lung compression by the atelectatic lung and mediastinal contents in the RLD posture. The O2 deficit measured by (A-a)DO2 increased with left lung atelectasis and was exacerbated in the LLD posture by 10 cm H2O PEEP, a result of increased shunt caused by a shift in Q from the ventilated to the atelectatic lung. The PEEP-induced O2 deficit was eliminated with inversion to the RLD posture.

Adaptation, Physiological↗
PubMed2003

Low lung function and incident lung cancer in the United States: data From the First National Health and Nutrition Examination Survey follow-up.

BACKGROUND: Obstructive lung disease and lung cancer are tobacco-related diseases that can remain clinically silent until late in the disease process. We sought to define the risk for incident lung cancer among a national cohort of US adults with and without obstructive lung disease. METHODS: We studied participants in the First National Health and Nutrition Examination Survey, who had up to 22 years of follow-up. We classified subjects as having moderate or severe obstructive lung disease at baseline if the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) was less than 70% and the FEV1 was less than 80% of the predicted value. We also determined incident cases of lung cancer during the follow-up period. RESULTS: A total of 113 lung cancers occurred in the 5402 adults in the cohort. In the proportional hazards model adjusted for covariates of age, sex, race, education, smoking status, and duration and intensity of smoking, the presence of moderate or severe obstructive lung disease was associated with a higher risk for incident lung cancer (hazard ratio, 2.8; 95% confidence interval, 1.8-4.4). CONCLUSIONS: The presence of moderate or severe obstructive lung disease is a significant predictor of incident lung cancer in long-term follow-up. This finding may be useful clinically and in studies evaluating the utility of new tools for the early detection of lung cancer.

Adult↗
PubMed2003

Evaluation of changes in central airway dimensions, lung area and mean lung density at paired inspiratory/expiratory high-resolution computed tomography.

The aim of this study was to improve the understanding of interdependencies of dynamic changes in central airway dimensions, lung area and lung density on HRCT. The HRCT scans of 156 patients obtained at full inspiratory and expiratory position were evaluated retrospectively. Patients were divided into four groups according to lung function tests: normal subjects ( n=47); obstructive ( n=74); restrictive ( n=19); or mixed ventilatory impairment ( n=16). Mean lung density (MLD) was correlated with cross-sectional area of the lung (CSA(L)), cross-sectional area of the trachea (CSA(T)) and diameter of main-stem bronchi (D(B)). The CSA(L) was correlated with CSA(T) and D(B). MLD correlated with CSA(L) in normal subjects ( r=-0.66, p<0.0001) and patients with obstructive ( r=-0.62, p<0.0001), restrictive ( r=-0.83, p<0.0001) and mixed ventilatory impairment ( r=-0.86, p<0.0001). The MLD correlated with CSA(T) in the control group ( r=-0.50, p<0.0001) and in patients with obstructive lung impairment ( r-0.27, p<0.05). In patients with normal lung function a correlation between MLD and D(B) was found ( r=-0.52, p<0.0001). CSA(L) and CSA(T) correlated in the control group ( r=0.67, p<0.0001) and in patients with obstructive lung disease ( r=0.51, p<0.0001). The CSA(L) and D(B) correlated in the control group ( r=0.42, p<0.0001) and in patients with obstructive lung disease ( r=0.24, p<0.05). Correlations for patients with restrictive and mixed lung disease were constantly lower. Dependencies between central and peripheral airway dimensions and lung parenchyma are demonstrated by HRCT. Best correlations are observed in normal subjects and patients with obstructive lung disease. Based on these findings we postulate that the dependencies are the result of air-flow and pressure patterns.

Adolescent↗
PubMed2005

Lung transplantation with lungs from donors fifty years of age and older.

BACKGROUND: A shortage of donors has led to the progressive expansion of criteria for donor selection in lung transplantation. The outcome of recipients of lungs from donors aged 50 years or older is analyzed systematically. METHODS: From March 1998 to June 2003, 49 recipients received lungs from donors aged 50 years or older (range 50-64 years, mean 54 +/- 3 years). This group of recipients was compared with 244 patients receiving lungs from donors aged less than 50 years (range 7-49 years, mean 32 +/- 11 years). This study was undertaken on all 293 patients at our institution who received Perfadex-preserved lungs (Vitrolife, Goteborg, Sweden). RESULTS: Recipient age, sex, and indications for transplant did not differ significantly between groups. Also, the percentage of the different types of transplants (bilateral or single lung transplantation) performed was equal in both cohorts. Donor Pa(O2) /F(IO2) ratios before lung retrieval (415 +/- 91 vs 439 +/- 113, respectively) and length of ischemic time (347 +/- 67 minutes vs 351 +/- 84 minutes, respectively) did not differ significantly between the older and younger donor groups. The following posttransplant parameters were also not statistically different: first Pa(O2)/F(IO2) at intensive care unit arrival (274 +/- 125 in the older donor group vs 253 +/- 119 in the younger donor group, respectively), mechanical ventilation time (328 +/- 427 hours vs 269 +/- 425 hours, respectively), and length of stay in the intensive care unit (16 +/- 18 days vs 14 +/- 18 days, respectively). Recipient survival in the older and younger donor groups at 30 days, 3, 6, 12, 24, and 60 months was 77% +/- 6%, 75% +/- 6%, 73% +/- 7%, 73% +/- 7%, 68% +/- 5%, and 68% +/- 4% versus 86% +/- 2%, 83% +/- 3%, 80% +/- 3%, 78% +/- 3%, 71% +/- 4%, and 66% +/- 4%, respectively. CONCLUSIONS: Lung grafts from elderly donors have been considered as marginal organs for transplantation. However, this study indicates that transplantation of lungs from carefully selected donors aged 50 years or more may lead to similar short- and long-term outcomes compared with lungs from younger donors. The use of lungs from elderly donors may help to increase the number of donor organs in lung transplantation.

Adolescent↗