scholarly journals Respiratory mechanics during initial lung aeration at birth in the preterm lamb

2020 ◽  
Vol 318 (3) ◽  
pp. L525-L532 ◽  
Author(s):  
Chiara Veneroni ◽  
David G. Tingay ◽  
Karen E. McCall ◽  
Prue M. Pereira-Fantini ◽  
Elizabeth J. Perkins ◽  
...  
Keyword(s):  
Lung Volume ◽  
Lung Mechanics ◽  
Forced Oscillation Technique ◽  
Volume Changes ◽  
Impedance Tomography ◽  
Lung Aeration ◽  
Sustained Inflation ◽  
Airway Opening ◽  
Respiratory System Resistance ◽  
Direct Reflection

Despite recent insights into the dynamic processes during lung aeration at birth, several aspects remain poorly understood. We aimed to characterize changes in lung mechanics during the first inflation at birth and their relationship to changes in lung volume. Intubated preterm lambs (gestational age, 124–127 days; n = 17) were studied at birth. Lung volume changes were measured by electrical impedance tomography (VL EIT). Respiratory system resistance (R5) and oscillatory compliance (Cx5) were monitored with the forced oscillation technique at 5 Hz. Lambs received 3–7 s of 8 cmH2O of continuous distending pressure (CDP) before delivery of a sustained inflation (SI) of 40 cmH2O. The SI was then applied until either Cx5 or the VL EIT or the airway opening volume was stable. CDP was resumed for 3–7 s before commencement of mechanical ventilation. The exponential increases with time of Cx5 and VL EIT from commencement of the SI were characterized by estimating their time constants (τCx5 and τVL EIT, respectively). During SI, a fast decrease in R5 and an exponential increase in Cx5 and VL EIT were observed. Cx5 and VL EIT provided comparable information on the dynamics of lung aeration in all lambs, with τCx5 and τVL EIT being highly linearly correlated ( r2 = 0.87, P < 0.001). Cx5 and VL EIT decreased immediately after SI. Despite the standardization of the animal model, changes in Cx5 and R5 both during and after SI were highly variable. Lung aeration at birth is characterized by a fast reduction in resistance and a slower increase in oscillatory compliance, the latter being a direct reflection of the amount of lung aeration.

Lung volume changes by electric impedance tomography (EIT) during endotracheal suctioning

2004 ◽  
Vol 21 (Supplement 32) ◽  
pp. 73
Author(s):  
S. Lindgren ◽  
H. Odenstedt ◽  
C. Olegard ◽  
S. Lundin ◽  
O. Stenqvist
Keyword(s):  
Lung Volume ◽  
Electric Impedance ◽  
Volume Changes ◽  
Endotracheal Suctioning ◽  
Electric Impedance Tomography ◽  
Impedance Tomography

scholarly journals Airway Closure during Surgical Pneumoperitoneum in Obese Patients

2019 ◽  
Vol 131 (1) ◽  
pp. 58-73 ◽  
Author(s):  
Domenico Luca Grieco ◽  
Gian Marco Anzellotti ◽  
Andrea Russo ◽  
Filippo Bongiovanni ◽  
Barbara Costantini ◽  
...  
Keyword(s):  
Lung Volume ◽  
Respiratory Mechanics ◽  
Lung Mechanics ◽  
Control Group ◽  
Obese Patients ◽  
Airway Closure ◽  
Alveolar Pressure ◽  
Opening Pressure ◽  
Airway Opening ◽  
Pressure Controlled

AbstractEditor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBackgroundAirway closure causes lack of communication between proximal airways and alveoli, making tidal inflation start only after a critical airway opening pressure is overcome. The authors conducted a matched cohort study to report the existence of this phenomenon among obese patients undergoing general anesthesia.MethodsWithin the procedures of a clinical trial during gynecological surgery, obese patients underwent respiratory/lung mechanics and lung volume assessment both before and after pneumoperitoneum, in the supine and Trendelenburg positions, respectively. Among patients included in this study, those exhibiting airway closure were compared to a control group of subjects enrolled in the same trial and matched in 1:1 ratio according to body mass index.ResultsEleven of 50 patients (22%) showed airway closure after intubation, with a median (interquartile range) airway opening pressure of 9 cm H2O (6 to 12). With pneumoperitoneum, airway opening pressure increased up to 21 cm H2O (19 to 28) and end-expiratory lung volume remained unchanged (1,294 ml [1,154 to 1,363] vs. 1,160 ml [1,118 to 1,256], P = 0.155), because end-expiratory alveolar pressure increased consistently with airway opening pressure and counterbalanced pneumoperitoneum-induced increases in end-expiratory esophageal pressure (16 cm H2O [15 to 19] vs. 27 cm H2O [23 to 30], P = 0.005). Conversely, matched control subjects experienced a statistically significant greater reduction in end-expiratory lung volume due to pneumoperitoneum (1,113 ml [1,040 to 1,577] vs. 1,000 ml [821 to 1,061], P = 0.006). With airway closure, static/dynamic mechanics failed to measure actual lung/respiratory mechanics. When patients with airway closure underwent pressure-controlled ventilation, no tidal volume was inflated until inspiratory pressure overcame airway opening pressure.ConclusionsIn obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.

The bimodal quasi-static and dynamic elastance of the murine lung

2008 ◽  
Vol 105 (2) ◽  
pp. 685-692 ◽  
Author(s):  
Graeme R. Zosky ◽  
Tibor Z. Janosi ◽  
Ágnes Adamicza ◽  
Elizabeth M. Bozanich ◽  
Vincenzo Cannizzaro ◽  
...  
Keyword(s):  
Lung Volume ◽  
Lung Mechanics ◽  
Mouse Lung ◽  
Forced Oscillation Technique ◽  
Mechanically Ventilated ◽  
Thoracic Gas Volume ◽  
Residual Capacity ◽  
Gas Volume ◽  
Tissue Elastance

The double sigmoidal nature of the mouse pressure-volume (PV) curve is well recognized but largely ignored. This study systematically examined the effect of inflating the mouse lung to 40 cm H2O transrespiratory pressure (Prs) in vivo. Adult BALB/c mice were anesthetized, tracheostomized, and mechanically ventilated. Thoracic gas volume was calculated using plethysmography and electrical stimulation of the intercostal muscles. Lung mechanics were tracked during inflation-deflation maneuvers using a modification of the forced oscillation technique. Inflation beyond 20 cm H2O caused a shift in subsequent PV curves with an increase in slope of the inflation limb and an increase in lung volume at 20 cm H2O. There was an overall decrease in tissue elastance and a fundamental change in its volume dependence. This apparent “softening” of the lung could be recovered by partial degassing of the lung or applying a negative transrespiratory pressure such that lung volume decreased below functional residual capacity. Allowing the lung to spontaneously recover revealed that the lung required ∼1 h of mechanical ventilation to return to the original state. We propose a number of possible mechanisms for these observations and suggest that they are most likely explained by the unfolding of alveolar septa and the subsequent redistribution of the fluid lining the alveoli at high transrespiratory pressure.

Assessing regional lung mechanics by combining electrical impedance tomography and forced oscillation technique

2018 ◽  
Vol 63 (6) ◽  
pp. 673-681 ◽  
Author(s):  
Chuong Ngo ◽  
Sarah Spagnesi ◽  
Carlos Munoz ◽  
Sylvia Lehmann ◽  
Thomas Vollmer ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Electrical Impedance Tomography ◽  
High Frequency ◽  
Electrical Impedance ◽  
Forced Oscillation ◽  
Pulmonary Function Tests ◽  
Lung Mechanics ◽  
Forced Oscillation Technique ◽  
Impedance Tomography ◽  
Regional Lung

Abstract There is a lack of noninvasive pulmonary function tests which can assess regional information of the lungs. Electrical impedance tomography (EIT) is a radiation-free, non-invasive real-time imaging that provides regional information of ventilation volume regarding the measurement of electrical impedance distribution. Forced oscillation technique (FOT) is a pulmonary function test which is based on the measurement of respiratory mechanical impedance over a frequency range. In this article, we introduce a new measurement approach by combining FOT and EIT, named the oscillatory electrical impedance tomography (oEIT). Our oEIT measurement system consists of a valve-based FOT device, an EIT device, pressure and flow sensors, and a computer fusing the data streams. Measurements were performed on five healthy volunteers at the frequencies 3, 4, 5, 6, 7, 8, 10, 15, and 20 Hz. The measurements suggest that the combination of FOT and EIT is a promising approach. High frequency responses are visible in the derivative of the global impedance index $\Delta {Z_{{\text{eit}}}}(t,{f_{{\text{os}}}}).$ The oEIT signals consist of three main components: forced oscillation, spontaneous breathing, and heart activity. The amplitude of the oscillation component decreases with increasing frequency. The band-pass filtered oEIT signal might be a new tool in regional lung function diagnostics, since local responses to high frequency perturbation could be distinguished between different lung regions.

Linking lung function and inflammatory responses in ventilator-induced lung injury

2011 ◽  
Vol 300 (1) ◽  
pp. L112-L120 ◽  
Author(s):  
Vincenzo Cannizzaro ◽  
Zoltan Hantos ◽  
Peter D. Sly ◽  
Graeme R. Zosky
Keyword(s):  
Lung Function ◽  
Lung Injury ◽  
Tidal Volume ◽  
Lung Volume ◽  
Inflammatory Responses ◽  
Lung Mechanics ◽  
Forced Oscillation Technique ◽  
Ventilation Strategy ◽  
Ventilator Induced Lung Injury ◽  
Tnf Α

Despite decades of research, the mechanisms of ventilator-induced lung injury are poorly understood. We used strain-dependent responses to mechanical ventilation in mice to identify associations between mechanical and inflammatory responses in the lung. BALB/c, C57BL/6, and 129/Sv mice were ventilated using a protective [low tidal volume and moderate positive end-expiratory pressure (PEEP) and recruitment maneuvers] or injurious (high tidal volume and zero PEEP) ventilation strategy. Lung mechanics and lung volume were monitored using the forced oscillation technique and plethysmography, respectively. Inflammation was assessed by measuring numbers of inflammatory cells, cytokine (IL-6, IL-1β, and TNF-α) levels, and protein content of the BAL. Principal components factor analysis was used to identify independent associations between lung function and inflammation. Mechanical and inflammatory responses in the lung were dependent on ventilation strategy and mouse strain. Three factors were identified linking 1) pulmonary edema, protein leak, and macrophages, 2) atelectasis, IL-6, and TNF-α, and 3) IL-1β and neutrophils, which were independent of responses in lung mechanics. This approach has allowed us to identify specific inflammatory responses that are independently associated with overstretch of the lung parenchyma and loss of lung volume. These data provide critical insight into the mechanical responses in the lung that drive local inflammation in ventilator-induced lung injury and the basis for future mechanistic studies in this field.

scholarly journals Pressure-limited sustained inflation vs. gradual tidal inflations for resuscitation in preterm lambs

2015 ◽  
Vol 118 (7) ◽  
pp. 890-897 ◽  
Author(s):  
David G. Tingay ◽  
Graeme R. Polglase ◽  
Risha Bhatia ◽  
Clare A. Berry ◽  
Robert J. Kopotic ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Lung Injury ◽  
Gradual Increase ◽  
Lung Mechanics ◽  
Arterial Oxygen ◽  
Volume Distribution ◽  
Dependent Lung ◽  
Impedance Tomography ◽  
Sustained Inflation ◽  
Mrna Markers

Support of the mechanically complex preterm lung needs to facilitate aeration while avoiding ventilation heterogeneities: whether to achieve this gradually or quickly remains unclear. We compared the effect of gradual vs. constant tidal inflations and a pressure-limited sustained inflation (SI) at birth on gas exchange, lung mechanics, gravity-dependent lung volume distribution, and lung injury in 131-day gestation preterm lambs. Lambs were resuscitated with either 1) a 20-s, 40-cmH2O pressure-limited SI (PressSI), 2) a gradual increase in tidal volume (Vt) over 5-min from 3 ml/kg to 7 ml/kg (IncrVt), or 3) 7 ml/kg Vt from birth. All lambs were subsequently ventilated for 15 min with 7 ml/kg Vt with the same end-expiratory pressure. Lung mechanics, gas exchange and spatial distribution of end-expiratory volume (EEV), and tidal ventilation (electrical impedance tomography) were recorded regularly. At 15 min, early mRNA tissue markers of lung injury were assessed. The IncrVt group resulted in greater tissue hysteresivity at 5 min ( P = 0.017; two-way ANOVA), higher alveolar-arterial oxygen difference from 10 min ( P < 0.01), and least uniform gravity-dependent distribution of EEV. There were no other differences in lung mechanics between groups, and the PressSI and 7 ml/kg Vt groups behaved similarly throughout. EEV was more uniformly distributed, but Vt least so, in the PressSI group. There were no differences in mRNA markers of lung injury. A gradual increase in Vt from birth resulted in less recruitment of the gravity-dependent lung with worse oxygenation. There was no benefit of a SI at birth over mechanical ventilation with 7 ml/kg Vt.

scholarly journals Early onset of airway derecruitment assessed using the forced oscillation technique in subjects with asthma

2019 ◽  
Vol 126 (5) ◽  
pp. 1399-1408 ◽  
Author(s):  
Kris Nilsen ◽  
Francis Thien ◽  
Cindy Thamrin ◽  
Matt J. Ellis ◽  
G. Kim Prisk ◽  
...  
Keyword(s):  
Lung Volume ◽  
Forced Oscillation ◽  
Lung Mechanics ◽  
Control Group ◽  
Forced Oscillation Technique ◽  
Rapid Reduction ◽  
Control Subjects ◽  
Volume Curve ◽  
Volume Relationship ◽  
Highly Correlated

Derecruitment of air spaces in the lung occurs when airways close during exhalation and is related to ventilation heterogeneity and symptoms in asthma. The forced oscillation technique has been used to identify surrogate measures of airway closure via the reactance (Xrs) versus lung volume relationship. This study used a new algorithm to identify derecruitment from the Xrs versus lung volume relationship from a slow vital capacity maneuver. We aimed to compare two derecruitment markers on the Xrs versus volume curve, the onset reduction of Xrs (DR1vol) and the onset of more rapid reduction of Xrs (DR2vol), between control and asthmatic subjects. We hypothesized that the onset of DR1vol and DR2vol occurred at higher lung volume in asthmatic subjects. DR1vol and DR2vol were measured in 18 subjects with asthma and 18 healthy controls, and their relationships with age and height were examined using linear regression. In the control group, DR1vol and DR2vol increased with age ( r2 = 0.68, P < 0.001 and r2 = 0.71, P < 0.001, respectively). DR1vol and DR2vol in subjects with asthma [76.58% of total lung capacity (TLC) and 56.79%TLC, respectively] were at higher lung volume compared with control subjects (46.1 and 37.69%TLC, respectively) ( P < 0.001). DR2vol correlated with predicted values of closing capacity ( r = 0.94, P < 0.001). This study demonstrates that derecruitment occurs at two points along the Xrs-volume relationship. Both derecruitment points occurred at significantly higher lung volumes in subjects with asthma compared with healthy control subjects. This technique offers a novel way to measure the effects of changes in airways/lung mechanics. NEW & NOTEWORTHY This study demonstrates that the forced oscillation technique can be used to identify two lung volume points where lung derecruitment occurs: 1) where derecruitment is initiated and 2) where onset of rapid derecruitment commences. Measurements of derecruitment increase with age. The onset of rapid derecruitment was highly correlated with predicted closing capacity. Also, the initiation and rate of derecruitment are significantly altered in subjects with asthma.

Sign in / Sign up

Export Citation Format

Share Document