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[Criteria of individual variations in the reactivity of the respiratory system].

Individual variations of the respiratory system reactivity have been studied in experiments on rats. It is shown expedient to estimate reactivity of the respiratory system to hypoxic hypoxia by the pattern of changes in the total oxygen uptake. Animals demonstrating no essential changes in the oxygen uptake in response to hypoxia (11% O2) are referred to individuals with high reactivity of the respiratory system; those responding by a drastic decrease in the oxygen uptake--to animals with low reactivity of the respiratory system. A strong correlation is determined between the respiratory system reactivity and individual resistance of organism to acute hypoxic hypoxia.

Acute Disease↗

Effects of carbon dioxide insufflation for laparoscopic cholecystectomy on the respiratory system.

The changes occurring in total respiratory system, lung and chest wall mechanics, lung volume and gas-exchange during abdominal insufflation with carbon dioxide for laparoscopic cholecystectomy were studied. Using the technique of rapid airway occlusion during constant flow inflation together with an oesophageal balloon, we computed compliance and maximum resistance of the respiratory system, subsequently apportioning it into its lung and chest wall components. Maximum resistance of the respiratory system was further divided into airway resistance and the viscoelastic properties of the lung and the chest wall. In 10 patients (group 1), we measured respiratory system, lung and chest wall mechanics (compliance and resistance), functional residual capacity, end-tidal carbon dioxide tension and oxygen saturation. In addition, arterial blood gas analysis and end-tidal carbon dioxide tension were measured in a second group of 10 patients (group 2). Measurements, in both groups, were obtained in the reverse Trendelenburg position, at 15 min after the induction of anaesthesia, 5 min and 45 min after abdominal insufflation and at 15 min after abdominal deflation. Tidal volume, respiratory rate, inspiratory flow and the fraction of inspired oxygen were similar in both groups and maintained constant during the procedure. We found that abdominal carbon dioxide insufflation caused: a reduction in compliance of the respiratory system (both lung and chest wall components) and of functional residual capacity; a marked increase in the maximum resistance of the respiratory system (mainly due to increases in the viscoelastic properties of the lung and chest wall); no change in oxygenation, but an increase in the end-tidal carbon dioxide tension (which was correlated closely with the arterial carbon dioxide tension). These changes were not affected by the duration of anaesthesia.

Abdomen↗

[Formation of respiratory system function in ontogeny. I. Intrauterine respiratory movements].

The fetus rhythmic respiratory movements originate long before the birth at a certain stage of its intrauterine development, i. e. the rhythmic respiratory activity is formed before the delivery. As the fetation takes place the character of respiratory system rhythmic activity shifts to stabilization of respiratory muscles rhythmic action towards the termination of gestation. The fetal respiratory movements are inhibited with the beginning of the generic act.

Animals↗

Partitioning of respiratory system resistance in children with respiratory insufficiency.

Using end-inspiratory airway occlusion, respiratory system resistance (Rrs) can be partitioned into a flow-resistive component (Rint), and an additional component (DeltaR), reflecting viscoelasticity and time constant inequalities. We studied flow and volume dependence of Rrs and its subdivisions (Rint and DeltaR) in 13 children, seven mechanically ventilated for pulmonary insufficiency (Group 1; six with parenchymal lung disease; one with lower airway obstruction) and six without primary lung disorder (Group 2). In comparison with healthy children, Rint was increased in the patient with lower airway obstruction and five of six patients without primary lung disorder but in only one of six with parenchymal lung disease. DeltaR was increased in all seven patients in Group 1 and in four of six patients in Group 2. The directions of changes in Rint and Rrs with increasing flow (isovolume conditions) and with increasing volume (isoflow conditions) were variable. DeltaR decreased exponentially (p < 0.05) with increasing flow in 11 of 13 subjects and increased with increasing tidal volume (VT) in 12 of 13. Thus, DeltaR was increased in most children on mechanical ventilation with or without primary lung disease; its volume and flow dependence were opposite to that of airway resistance.

Adolescent↗

[Respiratory system elastance and resistance measured by proportional assist ventilation in patients with respiratory muscle weakness].

OBJECTIVE: Non-invasive ventilatory therapy has prolonged survival of myopathy patients with hypoventilation. Efficacy of non-invasive ventilation depends on both elastance and resistance of the respiratory system. Although these parameters are important in the prescription of respiratory management, conventional respiratory function test does not show the appropriate answer in patients with severe respiratory muscle weakness. In muscular dystrophy, muscle tends to be shortened due to its fibrosis, when muscle becomes atrophic and weak; fibrosis of respiratory muscle tissues presumably causes high thoracic elastance. We evaluated the total respiratory system elastance and resistance during proportional assist ventilation (PAV) in myopathy patients. METHODS: In PAV with 100% assist, using BiPAP Vision ventilator, airway pressure exceeds 20 cmH2O or tidal volume exceeds 1.5 liter (run-away phenomenon) when the volume assist or the flow assist is higher than the individual elastance or the resistance, respectively. Twenty myopathy patients with ventilatory failure and 7 healthy controls were evaluated, including 7 patients with Duchenne muscular dystrophy (DMD), 2 patients with congenital myopathy (CM), 1 patient with limb-girdle muscular dystrophy (LG), 6 patients with myotonic dystrophy (MyD) and 4 patients with acid maltase deficiency (AMD). Seventeen patients used a nasal mask and 3 patients had a tracheostomy tube. Fifteen patients used a pressure-preset ventilator, and 3 patients used a volume-preset ventilator. RESULTS: In all patients with DMD, CM and LG, respiratory system elastance was higher than 20 (cmH2O/L) and than in all patients with AMD and MyD except 1 MyD patient. Follow-up measurement after half a or one year showed increase of respiratory system elastance in 2 DMD patients and 1 CM patient, but almost no change in 3 AMD patients. The elastance measured during PAV was consistent with the clinical impression of muscle shortening. One exceptional MyD patient showed extremely high elastance (more than 58 cmH2O/L), which reflected the fixed thoracic spine and increase of abdominal visceral fat. Resistance was normal in all patients except a LG patient with pulmonary aspergillosis and a history of pulmonary tuberculosis who showed 14 (cmH2O/L/s). In a CM patient who developed emphysema, resistance increased from 5 to 12 (cmH2O/L/s) in a year, although forced expiratory volume 1.0% (FEV1.0/FVC) remained normal. Respiratory system resistance measurement was useful to detect a lung disease, because obstructive disorder is underestimated with FEV1.0/FVC when vital capacity is low. CONCLUSION: The respiratory system elastance and resistance measured during PAV are useful parameters in evaluation of mechanical features of the lung, thorax and airway. It is recommended to keep both parameters normal in patients who may require ventilatory assist due to progression of respiratory muscle weakness.

Adult↗

Survival of Danish cancer patients 1943-1987. Respiratory system.

Cancers of the respiratory system are among the most common types of malignant neoplasms in the industrialized world. Thus, this group constitute about 20% of all male and about 8% of all female cancers diagnosed in Denmark during the recent years. Altogether respiratory cancers contribute with around 3,700 (14%) new cases of the about 26,000 cancers diagnosed a year, including skin cancers. Since lung cancer, which in general have a very bad prognosis with a relative 5-year survival of 6%, is the far major cancer subtype in the respiratory system (about 90% of all respiratory cancers), the survival of all respiratory cancers combined is poor. However, the survival of the relative rarely sinonasal and laryngeal cancers are fairly good with 5-year relative survival rates in men of 47% and 61% and in women of 51% and 62%, respectively, during the 1980s. In general, only very small improvements in survival during the period of registration have been observed, the largest being in sinonasal neoplasms, where the 5-year relative survival for the men have increased from 18% around 1945 to 47% around 1985, and for the women from 30% around 1945 to 51% around 1985. Since the aetiology of the major part of respiratory cancers is fairly known, i.e. especially tobacco smoking and to some extent several factors in the working environment, it seem most likely that the major progress will come from primary prevention.

Age Factors↗

Respiratory system impedance from 4 to 40 Hz in paralyzed intubated infants with respiratory disease.

To describe the mechanical characteristics of the respiratory system in intubated neonates with respiratory disease, we measured impedance and resistance in six paralyzed intubated infants with respiratory distress syndrome, three of whom also had pulmonary interstitial emphysema. We subtracted the effects of the endotracheal tube after showing that such subtraction was valid. Oscillatory flow was generated from 4 to 40 Hz by a loudspeaker, airway pressure was measured, and flow was calculated from pressure changes in an airtight enclosure mounted behind the flow source (speaker plethysmograph). After subtraction of the endotracheal tube contribution, resistance ranged from 22 to 34 cmH2O liter-1 s; compliance from 0.22 to 0.68 ml/cmH2O; and inertance from 0.0056 to 0.047 cmH2O liter-1 s2. Our results indicate that, for these intubated infants, the mechanics of the respiratory system are well described as resistance, compliance, and inertance in series. Most of the inertance, some of the resistance, and little of the compliance are due to the endotracheal tube. When the contribution of the endotracheal tube is subtracted, the results are descriptive of the subglottal respiratory system. These data characterize the neonatal respiratory system of infants with respiratory distress syndrome (with or without pulmonary interstitial emphysema) in the range of frequencies used during high frequency ventilation.

Airway Resistance↗

Passive compliance of total respiratory system in preterm newborn infants with respiratory distress syndrome.

The passive compliance of the total respiratory system (CRS) was measured by the occlusion technique in 34 preterm newborn infants with respiratory distress syndrome. Gestational age ranged from 27 to 33 weeks. Preterm newborn infants were divided into four groups on the basis of clinical criteria. Group 1 consisted of 10 infants tested during the first postnatal days (1 to 3 days) while acutely ill and requiring ventilation and oxygen therapy. After the acute phase of respiratory distress syndrome, two groups were tested: group 2 consisted of nine infants (5 to 22 days of age) who no longer required ventilation, and group 3 consisted of six infants (7 to 28 days of age) who subsequently had bronchopulmonary dysplasia. Group 4 consisted of nine infants older than 1 month of age with confirmed bronchopulmonary dysplasia. Group 1 had significantly lower CRS and CRS normalized for body weight (CRS/BW) than group 2 had (P less than 0.001). In groups 3 and 4 CRS was significantly lower than in group 2 (P less than 0.001), as was CRS/BW (P less than 0.001). There was no significant difference in CRS and CRS/BW values between groups 3 and 4. This cross-sectional study in preterm infants with respiratory distress syndrome suggests that CRS may have predictive value in regard to development of bronchopulmonary dysplasia after the acute phase of respiratory distress syndrome.

Bronchopulmonary Dysplasia↗

Some virological and pathomorphological aspects of the respiratory system in the experimental infection with respiratory syncytial virus associated with influenza virus, parainfluenza virus type 3 and adenovirus in the mouse.

Infections with respiratory syncytial virus Long strain, associated with influenza virus, A/Beijing 353/89 (H3N2) strain, parainfluenza virus type 3, 739-2D strain, and adenovirus type 3, were experimentally induced in white mice, causing histological, histochemical and histoenzymatic lesions at the respiratory system level, the severity of which exceeded the one observed in the controls infected with a single virus. The pathomorphological changes made up an inflammatory, predominantly infiltrative, lymphohistiocytic, then exudative and alterative picture. The severest and most frequent lesion was the diffuse interstitial, often peribronchiolovascular, bronchopneumonia, which might involve large parenchyma areas. Another highly frequent pulmonary lesion was the thickening of interalveolar septa, due to stasis hyperemia, oedema and the predominantly lymphocytic cytoinfiltrate. At the level of the extrapulmonary airways, the lesion present in all experimental models was the denudation of epithelium cilia. In the viral association in which influenza virus was included, an alteration, the hyalinosis of tunica media of the vessels, as well as of the Reisseisen's muscle, was also observed, in addition to the cytoinfiltrate; when the association was achieved with parainfluenza virus type 3, many macrophages and erythrocytes and a few fibroblasts appeared in the cytoinfiltrate, the alteration being the same as in the former model; when the association contained adenovirus, there appeared necrosis, abundant lymphocytes and lysis of the Reisseisen's muscle in the bronchopulmonary block. The associated infections were demonstrated by the presence of homologous serum antibodies and by positive IF reactions in the pulmonary tissue.

Adenoviridae Infections↗

Oscillatory mechanics of the respiratory system in normal rats.

Respiratory system impedances were measured by a modified forced oscillatory technique in 30 normal male CRD-free Sprague-Dawley rats at frequencies between 20 and 90 Hz. A resonance frequency was found (mean = 39 Hz) below which reactances were negative and above which reactances were positive. Resistances were generally found to be frequency dependent, increasing with increasing frequencies. Frequency dependent behavior in resistance has been ascribed to inhomogeneities in parallel airway pathways and to the effects of airway wall compliance. optimization techniques were used to estimate the values of parameters in a variety of lumped-parameter mechanical networks incorporating parallel pathways and/or airway wall compliance. The model whose response compared the best with the data and that resulted in the most consistent parameter values was found to be one where the airways are separated into central and peripheral components by a shunt pathway containing an airway wall compliance. The mean values for each of the parameters within the model were central airway resistance (54 cm H2O/L/sec), peripheral airway resistance (53 cm H2O/L/sec), central airway inertance (0.058 cm H2O/L/sec2), peripheral airway inertance (0.116 cm H2O/L/sec2)(, airway wall compliance (0.182 X 10(-4) L/cm H2O), and respiratory system compliance (1.267 X 10(-4) L/cm H2O).

Airway Resistance↗

Effect of curare on maximum static PV relationships of the respiratory system.

The effect of respiratory muscle weakness on the maximum static pressure-volume (PV) characteristics of the respiratory system was studied in four healthy males infused slowly with d-tubocurarine (dtc). Inspiratory capacity (IC), expiratory reserve volume (ERV), maximum static inspiratory and expiratory mouth pressures at four lung volumes, and handgrip were measured during induction of, and recovery from muscle weakness. The maximum effect of dtc varied among the muscle groups tested; peripheral muscles were most severely affected, expiratory muscles moderately, and inspiratory muscles least affected. At each level of weakness studied, decreases of IC and ERV were proportional to decreases of maximum static mouth pressures. Vital capacity, measured at each level of weakness was much less than values predicted from the static mechanical properties of the respiratory system. Our findings suggest that the marked change in the extremes of lung volume during submaximal neuromuscular blockade (SMNB) is due, in part, to unequal distribution of muscle weakness, reflected by decreased ability to change ribcage dimensions even at modest levels of SMNB.

Abdomen↗

Age related changes in the rate of stress relaxation within the rat respiratory system.

Stress relaxation within the respiratory system was examined in young rats at different ages, 0-1 day old (GPI), 4-5 days old (GPII) and 30-40 days old (GPIII). Each rat was anesthetized, tracheostomized and placed inside a saline filled plethysmograph with the tracheal cannula projecting through the wall of the plethysmograph. Volume history was standardized by three inflations to a mean transrespiratory system pressure (P) of 20-25 cm H2O, then P was set to zero and lung volume was abruptly increased by rapidly withdrawing fluid from the plethysmograph. Following the volume step, lung volume was maintained constant and changes in P due to stress relaxation were recorded for 30 sec. The rate of stress relaxation was obtained by calculating the slope (R) of the normalized change in P per unit of time on a semi-log plot. GPIII rats exhibited the slowest rate (R = 0.068 +/- 0.004 SD) whereas GPII rats demonstrated the fastest rate (R = 0.092 +/- 0.011 SD). Stress relaxation in GPI was intermediate (R = 0.076 +/- 0.005 SD). Values of dynamic (Cdyn) and static (Cstat) compliance were determined for rats similar in age to the three age groups used to determine R. The difference between Cstat and Cdyn increased with R and was greatest in rats between 0 and 6 days old. We conclude that: (1) stress relaxation within the rat respiratory system at 30-40 days is less than that found in rats during the first week after birth, and (2) changes in the viscoelastic properties of the respiratory system may contribute to age related variation in the difference between Cstat and Cdyn.

Aging↗

Aging and the respiratory system.

All the components of the respiratory system are affected by aging, though at different rates: i) the lung elastic recoil decreases; ii) PaO2 decreases and the D(A-a)O2 increases; iii) the chest wall becomes stiffer; iv) the inspiratory muscles loose strength; and v) the respiratory centres are less sensitive. Residual volume, closing volume and function residual capacity increase, whereas vital capacity and FEV1 progressively decrease. The flow volume curve becomes more convex to the volume axis at low lung volume. Whether these changes are due to aging or associated with aging is a matter of debate. However, the aging lung is more fragile in the face of respiratory and systemic diseases than the respiratory system of young adults. Nutrition, smoking habits and sleep-related disorders also affect the respiratory system. Although bronchial asthma may also appear in the elderly, chronic obstructive pulmonary disease is one of the most common respiratory diseases in advanced life and is a major cause of respiratory failure and ICU admission. Age in itself is not a risk factor of respiratory failure, but elderly patients have an increased risk of mortality for both acute respiratory failure (the failing lung), and exacerbated chronic ventilatory failure (the failing pump). Although advanced age can influence the final outcome of elderly patients from the intensive care unit (ICU), admission to the ICU as well as the institution of mechanical ventilation should not be denied on the basis of age alone, since the severity of illness, prior health status and admitting diagnosis have more weight than age in the final outcome.

Adult↗

[The respiratory system im chronic pyelonephritis].

The respiratory system was studied in 221 patients with chronic pyelonephritis (CP), satisfactory renal function and varying arterial pressure (AP) using tests of systemic hemodynamics, echocardiography, zonal rheography of the lungs and rheospirography. Ventilation-perfusion correlations were also taken into account. It is shown that the respiratory system, along with circulatory organs, is involved in the pathological process at early stages of pyelonephritic inflammation. Patients with the so-called "normal high AP" develop vascular dysfunction in the lungs manifesting in enlarged pulmonary artery base without an increase in pressure gradient in it, gradual growth of resistance of not only systemic vascular bed of the greater but lesser circulation as well, ventilation dysfunction of the lungs by the restrictive type, imbalance between the ventilatory reserve and reserve of pulmonary and systemic blood flow with progression of arterial hypertension.

Adult↗

[Evaluation of mechanic characteristics of the respiratory system in artificial ventilation].

Measuring respiratory mechanics is reputed to be difficult and therefore is seldom done in intensive care units although simple techniques are available. Air flow interruption after constant rate inflation enables the total respiratory system resistance (Rrs) to be divided into airway resistance (Raw) and additional resistance (delta R), the latter being associated with the viscosity and elasticity of the respiratory system and with the inhomogeneity of the lung. Thus, in patients with chronic obstructive lung disease this end-inspiratory air flow interruption provides physiopathological data (increase of Rrs to the detriment of Raw and delta R, due to major disparities of time constants in the lung) and therapeutic data (optimum ventilation mode reducing the patient's breathing work during assisted ventilation). Air flow interruption at the end of expiration measures the intrinsic positive end-expiratory pressure which indicates hyperinflation with damaging effects on cardiac performance and respiratory muscle function and constitutes a major factor of weaning failure. Combining the end-inspiratory and end-expiratory techniques enables a realistic and complete pressure-volume curve to be drawn easily. It is therefore possible during mechanical ventilation to evaluate the characteristics of respiratory mechanics very precisely and very simply. This should improve both our understanding of some diseases and our management of ventilated patients.

Humans↗