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Measurements of vascular function using strain-gauge plethysmography: technical considerations, standardization, and physiological findings.

The main purpose of the present study was to examine the relationships between measures of fitness [estimated peak oxygen consumption (V(O2) peak) and handgrip strength] and forearm vascular function in 55 young (22.6 +/- 3.5 yr) adults. In addition, the present study considered methodological and technical aspects regarding the examination of the venous system using mercury in-Silastic strain-gauge plethysmography (MSGP). Forearm venous capacitance and outflow were examined using five different [7, 14, 21, 28, and 35 mmHg < diastolic blood pressure (DBP)] venous occlusion pressures and after a 5- and 10-min period of venous occlusion. A pressure of 7 mmHg < DBP and a period of 10 min venous occlusion produced the greatest (P < 0.05) venous capacitance and outflow, without altering arterial indexes. Reproducibility of forearm arterial and venous indexes were evaluated at rest and after 5 min of upper arm arterial occlusion at 240 mmHg on three different occasions within 10 days with the interclass correlation coefficient ranging from 0.70 and 0.94. Estimated V(O2) peak correlated with postocclusion arterial inflow (r = 0.54, P = 0.012) and resting venous outflow (r = 0.56, P = 0.016). Finally, handgrip strength was associated with venous capacitance (r = 0.57, P = 0.007) and outflow (r = 0.67, P = 0.001). These results indicate that the examination of forearm vascular function using MSGP is reproducible. Moreover, the data show the importance of careful consideration of the selection of venous occlusion pressure and period when implementing these measures in longitudinal trials. Finally, the associations between fitness and venous measures suggest a link between venous function and exercise performance.

Adult↗

Failure of body plethysmography in bronchial asthma.

To determine whether acute changes in lung volumes in asthma are accurately measured by body plethysmography, we induced acute changes in lung mechanics with acetylcholine in nine asthmatic patients and with salbutamol in six others. Total lung capacity (TLC) was measured with a body plethysmograph and derived from mouth pressure vs. box volume (Vbox) changes (TLCm) or esophageal pressure vs. Vbox changes (TLCes). In six patients (4 after acetylcholine) TLCm was significantly (P less than 0.05) different from prechallenge values (differences ranged from 0.29 to 1.55 liters), but TLCes did not change. In three additional patients both TLCm (mean difference 0.62 liter) and TLCes (mean difference 0.43 liter) changed (P less than 0.05), but no changes occurred in six others. An electrical analog of the lung demonstrates in the presence of intrathoracic airway obstruction overestimation of thoracic gas volume and TLC. This is due to the presence of a compliant extrathoracic airway that acts as a shunt impedance. The magnitude of the overestimation of TGV appears to depend on the distensibility of the extrathoracic airway and the degree of airway obstruction. We conclude that the plethysmographic method may introduce important errors in lung volume measurements in the obstructive syndrome, especially a severe one. Some of previously reported acute increases in TLC in asthmatics may be artifactual.

Acetylcholine↗

Influence of tissue compressibility on calibration for strain-gauge plethysmography.

Strain gauges employed in plethysmography for determination of limb blood flow tend to counter the expansion of the limb during venous occlusion. Traditionally a mechanical calibration is performed in situ to compensate for tissue compressibility. Greenfield, Whitney, and Mowbray stated that, otherwise, large errors would result (Br. Med. Bull. 19: 101-109, 1963). Nonetheless, not all of the recent reports on skin blood flow in humans have been based on a calibration procedure that corrects for tissue compressibility. To evaluate the significance of this problem, we developed a new strain-gauge holder that made possible frequent, reproducible, stretching of a single-strand Whitney gauge in situ. We compared the apparent sensitivity thus obtained to electrical or bench mechanical determinations. We independently determined tissue compressibility by recording limb circumference as tension in a circumferential tube was varied. Both techniques showed that tissue compressibility is a small source of error (5%) and that compressibility decreases during occlusion. Therefore the cumbersome holder and potential artifacts associated with the traditional technique need not be tolerated. We also investigated the consequences of nonuniform tension distribution and temperature changes; practical considerations for dealing with these are discussed.

Adult↗

Venous occlusion plethysmography reduces arterial diameter and flow velocity.

The measurement of peripheral blood flow by plethysmography assumes that the cuff pressure required for venous occlusion does not decrease arterial inflow. However, studies in five normal subjects suggested that calf blood flow measured with a plethysmograph was less than arterial inflow calculated from Doppler velocity measurements. We hypothesized that the pressure required for venous occlusion may have decreased arterial velocity. Further studies revealed that systolic diameter of the superficial femoral artery under a thigh cuff decreased from 7.7 +/- 0.4 to 5.6 +/- 0.7 mm (P less than 0.05) when the inflation pressure was increased from 0 to 40 mmHg. Cuff inflation to 40 mmHg also reduced mean velocity 38% in the common femoral artery and 47% in the popliteal artery. Inflation of a cuff on the arm reduced mean velocity in the radial artery 22% at 20 mmHg, 26% at 40 mmHg, and 33% at 60 mmHg. We conclude that inflation of a cuff on an extremity to low pressures for venous occlusion also caused a reduction in arterial diameter and flow velocity.

Adult↗

Calf blood flow and posture: Doppler ultrasound calibrated by plethysmography.

A procedure was developed that enables measurement of rapid variations in calf blood flow during voluntary rhythmic contraction of the calf muscles in supine, sitting, and standing positions. During the exercise, maximum blood velocity is measured by Doppler ultrasound equipment in the popliteal artery. The Doppler signals are calibrated by plethysmography to enable calculation of blood flow during exercise in ml.100 ml-1.min-1. Knowledge of the cross-sectional area of the vessel and the angle of insonation is not required in this procedure. Evaluation of the calibration method with 10 healthy volunteers showed that for each subject a new calibration was necessary after a change in posture; the relationship between the blood flow and the maximum Doppler frequency averaged over one heart cycle was linear for each calibration.

Blood Flow Velocity↗

Partitioning of airway and respiratory tissue mechanical impedances by body plethysmography.

We have tested the feasibility of separating the airway (Zaw) and tissue (Zti) components of total respiratory input impedance (Zrs,in) in healthy subjects by measuring alveolar gas compression by body plethysmography (Vpl) during pressure oscillations at the airway opening. The forced oscillation set up was placed inside a body plethysmograph, and the subjects rebreathed BTPS gas. Zrs,in and the relationship between Vpl and airway flow (Hpl) were measured from 4 to 29 Hz. Zaw and Zti were computed from Zrs,in and Hpl by using the monoalveolar T-network model and alveolar gas compliance derived from thoracic gas volume. The data were in good agreement with previous observations: airways and tissue resistance exhibited some positive and negative frequency dependences, respectively; airway reactance was consistent with an inertance of 0.015 +/- 0.003 hPa.s2.l-1 and tissue reactance with an elastance of 36 +/- 8 hPa/I. The changes seen with varying lung volume, during elastic loading of the chest and during bronchoconstriction, were mostly in agreement with the expected effects. The data, as well as computer simulation, suggest that the partitioning is unaffected by mechanical inhomogeneity and only moderately affected by airway wall shunting.

Adult↗

Description and validation of a novel liquid metal-free device for venous congestion plethysmography.

We present a newly developed electromechanical sensor with automated calibration for strain-gauge plethysmography (filtrass) and compare it to a conventional mercury-in-Silastic strain-gauge plethysmograph (MSG). Fluid filtration capacity (K(f)) and isovolumetric venous pressure (Piv) of the limb were assessed noninvasively with both devices in 29 healthy volunteers. We found significantly higher K(f) and Piv values with MSG [4.6 +/- 2.0 x 10(-3) ml. min(-1). mmHg(-1). 100 ml tissue(-1) (K(f) units; K(f)U) and 21.2 +/- 8.1 mmHg for Pvi], than with filtrass, giving values of 3.1 +/- 0.8 K(f)U and 15.1 +/- 7.1 mmHg. Because K(f) and Piv are profoundly influenced by the calibration, we investigated the quality of the calibration signal and its impact on the obtained values. We could show that the reproducibility of repeated calibrations was higher with filtrass (58% lower mean +/- SD). The data were grouped according to the quality of calibration, and we found no significant difference in K(f) and Piv between filtrass (3.0 +/- 0.7 K(f)U and 15.9 +/- 6.9 mmHg, respectively) and MSG with good calibration signal (3.3 +/- 0. 8 K(f)U and 18.6 +/- 7.1 mmHg, respectively; no significant difference). However, we obtained significantly higher MSG values (5. 6 +/- 2.0 K(f)U and 23.1 +/- 8.4 mmHg, respectively; P < 0.001) in the group with a bad calibration signal. We suggest that the filtrass sensor, which performs an automatic, standardized calibration procedure and shows a linear signal response to stretch, gives highly reproducible and reliable results and thus is more suitable for routine application.

Adult↗

Mathematical assessment of qualitative diagnostic calibration for respiratory inductive plethysmography.

We present a critical assessment of qualitative diagnostic calibration (QDC), which claims to provide a relative calibration of respiratory inductive plethysmography during natural breathing (Sackner MA, Watson H, Belsito AS, Feinerman D, Suarez M, Gonzalez G, Bizousky F, and Krieger B. J Appl Physiol 66: 410-420, 1989). QDC computes the calibration factor (K) by considering breaths of constant tidal volume (VT) and provides a criterion to select breaths when VT is unknown. We applied QDC on uncalibrated data constructed from simulated sets of thoracic and abdominal volumes, with a predefined K. As expected, QDC yields a correct K when applied to breaths at constant VT. In breathing at quasi-constant VT, the criterion for breath selection is shown to bias the results toward K = 1. For spontaneous breathing, the calculated K deviates from its predefined value and depends heavily on the selection criterion. We conclude that QDC will only provide a correct calibration factor when applied to an entire set of breaths with constant or quasi-constant VT. More generally, physiological conclusions based on QDC should be critically evaluated on a case-by-case basis.

Abdomen↗

Hyperoxia-induced changes in mouse lung mechanics: forced oscillations vs. barometric plethysmography.

Hyperoxia-induced lung damage was investigated via airway and respiratory tissue mechanics measurements with low-frequency forced oscillations (LFOT) and analysis of spontaneous breathing indexes by barometric whole body plethysmography (WBP). WBP was performed in the unrestrained awake mice kept in room air (n = 12) or in 100% oxygen for 24 (n = 9), 48 (n = 8), or 60 (n = 9) h, and the indexes, including enhanced pause (Penh) and peak inspiratory and expiratory flows, were determined. The mice were then anesthetized, paralyzed, and mechanically ventilated. Airway resistance, respiratory system resistance at breathing frequency, and tissue damping and elastance were identified from the LFOT impedance data by model fitting. The monotonous decrease in airway resistance during hyperoxia correlated best with the increasing peak expiratory flow. Respiratory system resistance and tissue damping and elastance were unchanged up to 48 h of exposure but were markedly elevated at 60 h, with associated decreases in peak inspiratory flow. Penh was increased at 24 h and sharply elevated at 60 h. These results indicate no adverse effect of hyperoxia on the airway mechanics in mice, whereas marked parenchymal damage develops by 60 h. The inconsistent relationships between LFOT parameters and WBP indexes suggest that the changes in the latter reflect alterations in the breathing pattern rather than in the mechanical properties. It is concluded that, in the presence of diffuse lung disease, Penh is inadequate for characterization of the mechanical status of the respiratory system.

Air Pressure↗

Venous cuff pressures from 30 mmHg to diastolic pressure are recommended to measure arterial inflow by plethysmography.

Venous occlusion strain gauge plethysmography (VOP) is based on the assumption that the veins are occluded and arterial inflow is undisturbed by the venous cuff pressure. Literature is not clear concerning the pressure that should be used. The purpose of this study was to determine the optimal venous occlusion pressure at which the highest arterial inflow is achieved in the forearm, calf, and leg by using VOP. We hypothesized that, for each limb segment, an optimal (range of) venous cuff pressure can be determined. Arterial inflow in each limb segment was measured in nine healthy individuals by VOP by using pressures ranging from 10 mmHg up to diastolic blood pressure. Arterial inflows were similar at cuff pressures between 30 and 60 mmHg for the forearm, leg, and calf. Arterial inflow in the forearm was significantly lower at 10 mmHg compared with the other cuff pressures. In addition, arterial inflows at 20 mmHg tended to be lower in each limb segment than flow at higher cuff pressures. In conclusion, no single optimum venous cuff pressure, at which a highest arterial inflow is achieved, exists, but rather a range of optimum cuff pressures leading to a similar arterial inflow. Venous cuff pressures ranging from 30 mmHg up to diastolic blood pressure are recommended to measure arterial inflow by VOP.

Adult↗

Chest wall kinematic determinants of diaphragm length by optoelectronic plethysmography and ultrasonography.

To estimate diaphragm fiber length from thoracoabdominal configuration, we measured axial motion of the right-sided area of apposition by ultrasonography and volumes displaced by chest wall compartments [pulmonary, abdominal rib cage, and abdomen (Vab)] by optoelectronic plethysmography in four normal men during quiet breathing and incremental exercise without and with expiratory flow limitation. Points at the cephalic area of apposition border were digitized from echo images and mapped into three-dimensional space, and the axial distance from the xyphoidal transverse plane (D(ap)) was measured simultaneously with the volumes. Linear regression analysis between changes (Delta) in D(ap) and the measured volume changes under all conditions showed that 1) DeltaD(ap) was linearly related more to DeltaVab than to changes in pulmonary and abdominal rib cage volumes; and 2) this was highly repeatable between measures. Multiple stepwise regression analysis showed that DeltaVab accounted for 89-96% of the variability of DeltaD(ap), whereas the rib cage compartments added <1%. We conclude that, under conditions of quiet breathing and exercise, with and without expiratory flow limitation, instantaneous DeltaD(ap) can be estimated from DeltaVab.

Adult↗

Automatic classification of activity and apneas using whole body plethysmography in newborn mice.

An increasing number of studies in newborn mice are being performed to determine the mechanisms of sleep apnea, which is the hallmark of early breathing disorders. Whole body plethysmography is the method of choice, as it does not require immobilization, which affects behavioral states and breathing. However, activity inside the plethysmograph may disturb the respiratory signal. Visual classification of the respiratory signal into ventilatory activity, activity-related disturbances, or apneas is so time-consuming as to considerably hamper the phenotyping of large pup samples. We propose an automatic classification of activity based on respiratory disturbances and of apneas based on spectral analysis. This method was validated in newborn mice on the day of birth and on postnatal days 2, 5, and 10, under normoxic and hypoxic (5% O(2)) conditions. For both activity and apneas, visual and automatic scores showed high Pearson's correlation coefficients (0.92 and 0.98, respectively) and high intraclass correlation coefficients (0.96-0.99), supporting strong agreement between the two methods. The present results suggest that breathing disturbances may provide a valid indirect index of activity in freely moving newborn mice and that automatic apnea classification based on spectral analysis may be efficient in terms of precision and of time saved.

Algorithms↗

Unrestrained plethysmography is an unreliable measure of airway responsiveness in BALB/c and C57BL/6 mice.

There has been significant utilization of the technique described by Hamelmann et al. (Am J Respir Crit Care Med 156: 766-775, 1997) in which a parameter, enhanced pause (Penh), related to airways responsiveness is noninvasively measured by unrestrained plethysmography (UP). Investigating this technique, we sought to answer these questions: 1). How do changes in Penh compare with changes in traditional plethysmographic and lung mechanical parameters? 2). How do UP parameters perform in two different mouse strains? Awake immunized and control BALB/c (n = 16) and C57BL/6 (n = 14) mice were placed in the UP chamber and exposed to doses of aerosolized methacholine while the following parameters were measured at each concentration: inspiratory time (Ti), expiratory time (Te), total time (Ttot), Ti/Ttot, peak inspiratory pressure, peak expiratory pressure, Pause, Penh, tidal volume (Vt), Vt/Ti, Vt/Te, and Vt/Ttot. The next day, lung resistance (Rl) and compliance (Cl) were invasively measured in the same animals. For the BALB/c, the parameters with the highest magnitude of correlation coefficient vs. Rl are (in order) 1). Cl, 2). Pause and Penh, 3). parameters of breathing frequency (Te, Ttot, Ti), and 4). parameters related to Vt (inspiratory pressure, expiratory pressure). Flow parameters (Vt/Ttot, Vt/Te, Vt/Ti) and duty cycle parameters (Ti/Ttot) had insignificant correlations. This ordering is significantly different in C57BL/6 mice, in which the parameters with the largest correlations are 1). Cl, 2). parameters of breathing frequency, and 3). flow parameters. Pause, Penh, Vt, and duty cycle parameters had insignificant correlations. These data show that Penh is problematic in the sense that it is strain specific; it behaves very differently in BALB/c and C57BL/6 mice. We suggest that UP parameters largely originate as part of reflex control of breathing processes, rather than in the lung mechanics and conclude that it is inappropriate to use UP parameters in general, and Penh specifically, as substitute variables for invasive mechanical indexes such as Rl.

Airway Resistance↗

Use of whole-body plethysmography to compare bronchodilator inhaler efficacy.

Whole-body plethysmography is not included in guidelines from regulatory authorities for the development of treatments or delivery devices for lung disease, despite its potential advantages compared to spirometry. Two separate studies were undertaken to assess the use of specific airway conductance (sGaw) as a pharmacodynamic endpoint for the comparison of two bronchodilator delivery systems (a novel dry powder inhaler and a standard metered dose inhaler). The first pilot study involved delivery of a single dose of salbutamol (200 micrograms) to 12 healthy volunteers and determination of sGaw up to 120 min after treatment. The second study involved delivery of cumulative doses of salbutamol (100, 200 and 400 micrograms) to 19 healthy volunteers with demonstrated reversibility of sGaw to the bronchodilator and measurement of sGaw up to 240 min after treatment. In both studies, increases in sGaw after treatment were significant compared to placebo and larger than the recorded increases in FEV1. Increases in sGaw were similar for both delivery devices and support the therapeutic equivalence of the two products. Power calculations indicated that the second study had appropriate statistical power to discriminate between treatments. It is concluded that the assessment of sGaw in healthy volunteers may be a useful and sensitive pharmacodynamic endpoint for use in the development of bronchodilators and their delivery devices.

Adult↗

Volume status and body composition of chronic dialysis patients: utility of bioelectric impedance plethysmography.

We assessed the utility of bioelectric impedance plethysmography (BIA) for measuring acute volume changes and body composition in patients with renal disease. Chronic hemodialysis and peritoneal dialysis patients were evaluated before and after dialysis. Total body water, as measured by BIA, predicts body weight. Acute changes in body water, induced by dialysis, are not predicted well by data derived from BIA. Body fat (%) and fat-free mass (%), determined by anthropometry, are predicted well by body composition data derived by BIA. BIA is useful for assessing body composition in this population, but must be cautiously applied to the measurement of acute volume changes.

Body Composition↗

[Comparative study by body plethysmography and spirometry with the helium dilution method in patients with tuberculosis].

The persisting defects after treatment of tuberculosis in 51 patients were evaluated by a simultaneous measurement of the functional residual capacity (FRC) using the body plethysmograph and the helium dilution method. In most patients large volumes of trapped air were detected by the difference of two methods of measurement. The amount of trapped air showed to be dependent of the other pulmonary parameters obtained: Tiffeneau index, FRC measured by body plethysmography, difference between predicted and measured FRC.

Airway Resistance↗

Enduring effects of modified ECT on the cerebral circulation in man. A computerized study by cerebral impedance plethysmography.

The response of the cerebral circulation to modified ECT was monitored by computer programmes in 18 psychotic patients using cerebral impedance plethysmography. Each patient was recorded daily prior to, during and following the course of ECT. Results indicated that ECT was accompanied after 2 h by a marked increase in cerebral blood flow (CBF) in depressed patients; the schizophrenics showed a decrease in CBF. Patients whose blood flow had improved tended to return to previous levels progressively during the first week.

Adolescent↗

Impedance plethysmography: the relationship between venous filling and sensitivity and specificity for proximal vein thrombosis.

We investigated the hypothesis that the diagnostic accuracy of impedance plethysmography (IPG) for thrombosis of the popliteal or more proximal veins increases with enhanced venous filling. Venous filling was increased by prolonging cuff occlusion and by sequential testing. IPG and vengography were performed on 169 legs with and 317 legs without proximal vein thrombosis. The sensitivity and specificity of IPG rose significantly with increased venous filling. Changes in venous filling were associated with corresponding changes in emptying in normal legs, but not those with proximal vein thrombosis, so that the regression lines relating venous filling and emptying in normal and abnormal legs diverged significantly (P less than 0.001). If the IPG sequence had been terminated after only a single 45 second occlusion time test, sensitivity would have deteriorated by 10% and specificity by 20%. These observations indicate that the accuracy of IPG can be significantly enhanced if optimal venous filling is obtained.

Evaluation Studies as Topic↗