Bronchospirometry. IV. Ambient-air and oxygen-recording bronchospirometry.
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To assess the distribution of ventilation to each lung, we measured ventilation and maximum negative airway pressure during occluded inspiratory effort (Pmax) of the individual lungs in eight male patients immediately before and after right upper lobectomy using a double-lumen endotracheal tube at a constant depth of enflurane anesthesia (end-tidal concentration 1.7%). Compared with the breathing pattern observed immediately before surgery, minute ventilation, Pmax, and respiratory frequency significantly increased immediately after the surgery, whereas tidal volume was unchanged. Bronchospirometry revealed that tidal volumes on the nonoperated side significantly increased after the operation. In contrast, tidal volumes on the operated side significantly decreased after the operation and were associated with significantly smaller Pmax obtained from unilateral airway than those of the nonoperated side postoperatively. These results indicate that there are considerable differences in ventilatory function between the lungs on the operated side and nonoperated side. The lung on the nonoperated side can partially compensate for the impaired ventilatory function on the operated side.
It is possible to measure with a mass spectrometer the oxygen and carbon dioxide pressure in expired gas and alveolar gas in each lungs during a separate bronchospirometry. In 15 cases out of 26 (of which 21 had broncho-pulmonary cancers) it was possible to trace serious disorders of the alveolar-capillary exchanges in the diseased lung, probably related to an altered ventilation-perfusion relationship. This technique brings more data to the physio-pathologist than the plain measurement of the oxygen consumption of the diseased lung.
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