Single-breath nitrogen test in excised human lungs

1981 ◽  
Vol 51 (6) ◽  
pp. 1568-1573 ◽  
Author(s):  
N. Berend ◽  
C. Skoog ◽  
W. M. Thurlbeck
Keyword(s):  
Transpulmonary Pressure ◽  
Phase Iii ◽  
Peripheral Airways ◽  
Single Breath ◽  
Human Lungs ◽  
Peripheral Airway ◽  
Normal Lungs ◽  
Airway Dimensions ◽  
Phase Iv

Pressure-volume curves and simulated single-breath nitrogen tests were performed on 32 excised left human lungs and the slope of phase III, and phase IV plus minimal volume, expressed as percent of the lung volume at a transpulmonary pressure of 30 cmH2O (closing capacity), was calculated. The lungs were graded as to the degree of emphysema and degree of peripheral airways disease. Peripheral airway dimensions were also measured. The closing capacity expressed as percent predicted in vivo was significantly correlated with the total pathological scores (P less than 0.01) and inflammation scores (P less than 0.01) as well as the transpulmonary pressures at the onset of phase IV (P less than 0.01). Correlations with the emphysema grade were not significant. The slopes of phase III were highly variable even among normal lungs and could not be shown to correlate with airways disease or emphysema.

Gravitational independence of single-breath washout tests in recumbent dogs

1988 ◽  
Vol 64 (2) ◽  
pp. 642-648 ◽  
Author(s):  
S. Tomioka ◽  
S. Kubo ◽  
H. J. Guy ◽  
G. K. Prisk
Keyword(s):  
Prone Position ◽  
Regional Distribution ◽  
Transpulmonary Pressure ◽  
Phase Iii ◽  
Closing Volume ◽  
Body Rotation ◽  
Single Breath ◽  
Volume Curve ◽  
Pressure Volume Curve ◽  
Phase Iv

To examine the mechanisms of lung filling and emptying, Ar-bolus and N2 single-breath washout tests were conducted in 10 anesthetized dogs (prone and supine) and in three of those dogs with body rotation. Transpulmonary pressure was measured simultaneously, allowing identification of the lung volume above residual volume at which there was an inflection point in the pressure-volume curve (VIP). Although phase IV for Ar was upward, phase IV for N2 was small and variable, especially in the prone position. No significant prone to supine differences in closing capacity for Ar were seen, indicating that airway closure was generated at the same lung volumes. The maximum deflections of phase IV for Ar and N2 from extrapolated phase III slopes were smaller in the prone position, suggesting more uniform tracer gas concentrations across the lungs. VIP was smaller than the closing volume for Ar, which is consistent with the effects of well-developed collateral ventilation in dogs. Body rotation tests in three dogs did not generally cause an inversion of phase III or IV. We conclude that in recumbent dogs regional distribution of ventilation is not primarily determined by the effect of gravity, but by lung, thorax, and mediastinum interactions and/or differences in regional mechanical properties of the lungs.

Influence of collateral ventilation on single-breath washout curves

1988 ◽  
Vol 64 (1) ◽  
pp. 429-434 ◽  
Author(s):  
S. Tomioka ◽  
S. Kubo ◽  
H. J. Guy ◽  
G. K. Prisk
Keyword(s):  
Transpulmonary Pressure ◽  
Phase Iii ◽  
Closing Volume ◽  
Single Breath ◽  
Age Related ◽  
Volume Curve ◽  
Pressure Volume Curve ◽  
Washout Curves ◽  
Collateral Ventilation ◽  
Phase Iv

To examine the relationship between airway closure and collateral ventilation, Ar bolus single-breath washout tests were performed in the supine position in 10 mature dogs (animals with a well-developed collateral ventilation). Transpulmonary pressure was measured simultaneously to obtain the volume above residual volume of the inflection point in the pressure-volume curve (VIP). In pigs, closing volume (CV/VC%, mean 27.4%, where VC is vital capacity) equaled the volume of inflection (VIP/VC%, mean 35.1%) when the dead space (0.07 liter) was accounted for, indicating simultaneous onset. In dogs, closing volume (CV/VC%, mean 48.1%) was greater than the volume of inflection (VIP/VC%, mean 27%). Furthermore, as closing volume increased, so did the volume exhaled between closing volume and the volume of inflection [(CV-VIP)/VC%]. These increases were strongly age related, with the oldest dogs showing the greatest differences between closing volume and volume of inflection. These results support the previous suggestion that this difference is a measure of the degree of collateral ventilation. We defined a concavity index (CI) of phase IV by measuring the ratio of the end-to-mid phase IV height above extrapolated phase III (no concavity implies CI = 2). Whereas pigs had a low CI (mean 3.3), dogs had a high CI (mean 10.6). In dogs, the CI correlated well with closing volume (CV/VC%) and the volume exhaled between closing volume and volume of inflection [(CV-VIP)/VC%]. Again, this relationship was strongly dependent on age, suggesting that the CI is also a valid indication of the degree of collateral ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhomogeneity of pulmonary ventilation during sustained microgravity as determined by single-breath washouts

1994 ◽  
Vol 76 (4) ◽  
pp. 1719-1729 ◽  
Author(s):  
H. J. Guy ◽  
G. K. Prisk ◽  
A. R. Elliott ◽  
R. A. Deutschman ◽  
J. B. West
Keyword(s):  
Vital Capacity ◽  
Normal Gravity ◽  
Parabolic Flight ◽  
Pulmonary Ventilation ◽  
Phase Iii ◽  
Single Breath ◽  
Relative Contribution ◽  
Cardiogenic Oscillations ◽  
Expiratory Flow Rates ◽  
Phase Iv

Gravity is known to cause inhomogeneity of ventilation. Nongravitational factors are also recognized, but their relative contribution is not understood. We therefore studied ventilatory inhomogeneity during sustained microgravity during the 9-day flight of Spacelab SLS-1. All seven crew members performed single-breath nitrogen washouts. They inspired a vital capacity breath of 100% oxygen with a bolus of argon at the start of inspiration, and the inspiratory and expiratory flow rates were controlled at 0.5 l/s. Control measurements in normal gravity (1 G) were made pre- and postflight in the standing and supine position. Compared with the standing 1-G measurements, there was a marked decrease in ventilatory inhomogeneity during microgravity, as evidenced by the significant reductions in cardiogenic oscillations, slope of phase III, and height of phase IV for nitrogen and argon. However, argon phase IV volume was not reduced, and considerable ventilatory inhomogeneity remained. For example, the heights of the cardiogenic oscillations during microgravity for nitrogen and argon were 44 and 24%, respectively, of their values at 1 G, whereas the slopes of phase III for nitrogen and argon were 78 and 29%, respectively, of those at 1 G. The presence of a phase IV in microgravity is strong evidence that airway closure still occurs in the absence of gravity. The results were qualitatively similar to those found previously during short periods of 0 G in parabolic flight.

Regional distribution of ventilation at residual volume in induced bronchospasm

1982 ◽  
Vol 53 (2) ◽  
pp. 361-366
Author(s):  
L. Delaunois ◽  
R. Boileau ◽  
J. Diodatti ◽  
J. Gauthier ◽  
R. R. Martin
Keyword(s):  
Lung Volume ◽  
Regional Distribution ◽  
Phase Iii ◽  
Residual Volume ◽  
Single Breath ◽  
Airway Opening ◽  
Collateral Pathways ◽  
Total Lung Resistance ◽  
Downward Slope ◽  
Phase Iv

The regional distribution of a bolus of gas inhaled at residual volume (RV) is attributed to regional airway closure and is responsible for the phase IV of the single-breath washout during the following deflation. As bronchospasm increases the range of airway opening pressures through the lung, the regional distribution of the bolus could change with effects on the shape of the single-breath washout. We investigated the regional distribution of boluses inhaled at RV and their single-breath washouts during methacholine-induced bronchospasm in prone dogs. With increasing total lung resistance (RL) we first observed in five out of eight animals a preferential “redistribution” of the bolus to the upper caudal regions of the lung, which could be partially attributed to the increased lung volume at RV. When maximal RL was attained, the bolus was evenly distributed through all regions of the lung in these animals with disappearance of phase IV and increased slope of phase III, and a final decrease of tracer concentration at low lung volumes was observed. We conclude from these data that increased bronchomotor tone in dogs results in a less homogeneous intraregional distribution of the bolus with increased slope of phase III and in a more even interregional distribution leading to disappearance of phase IV. In severe bronchospasm the downward slope at low lung volume suggests intraregional closed lung units emptying through collateral pathways into still open neighboring units.

Correlations of maximum expiratory flow with small airway dimensions and pathology

1982 ◽  
Vol 52 (2) ◽  
pp. 346-351 ◽  
Author(s):  
N. Berend ◽  
W. M. Thurlbeck
Keyword(s):  
Maximum Flow ◽  
Transpulmonary Pressure ◽  
Small Airway ◽  
Flow Volume ◽  
Human Lungs ◽  
Muscle Hyperplasia ◽  
Maximum Expiratory Flow ◽  
Expiratory Flow ◽  
Inflammation Score ◽  
Airway Dimensions

Pressure-volume and maximum expiratory flow-volume curves with air and a He-O2 mixture were performed in 25 excised human lungs. Small airway dimensions were measured, and the degree of various small airway lesions and emphysema was graded. Correlations were then made between the maximum flow (Vmax) at a transpulmonary pressure (PL) of 5 cmH2O and these measurements and scores. Small airway dimensions correlated poorly with Vmax. However, significant correlations were obtained between Vmax and the inflammation score (P less than 0.05), fibrosis score (P less than 0.05), and emphysema grade (P less than 0.01) but not smooth muscle hyperplasia or pigmentation. Neither the increase in flow with He-O2 nor the volume of flow correlated significantly with any small airway measurement or score.

Adenosine 5′-monophosphate challenge elicits a more peripheral airway response than methacholine challenge

2011 ◽  
Vol 110 (5) ◽  
pp. 1241-1247 ◽  
Author(s):  
Alain Michils ◽  
Yvon Elkrim ◽  
Amaryllis Haccuria ◽  
Alain Van Muylem
Keyword(s):  
Airway Hyperreactivity ◽  
Phase Iii ◽  
Ventilation Distribution ◽  
Methacholine Challenge ◽  
Single Breath ◽  
Before And After ◽  
Asthma Patients ◽  
Peripheral Airway ◽  
Airway Response ◽  
Lung Periphery

Adenosine 5′-monophosphate (AMP) and methacholine are commonly used to assess airway hyperreactivity. However, it is not fully known whether the site of airway constriction primarily involved during challenges with either agent is similar. Using a ventilation distribution test, we investigated whether the constriction induced by each agent involves the lung periphery in a similar fashion. Ventilation distribution was evaluated by the phase III slope (S) of the single-breath washout, using gases with different diffusivities like helium (He) and hexafluorosulfur (SF6). A greater postchallenge increase in SHe reflects alterations at the level of terminal and respiratory bronchioles, while a greater increase in SSF6 reflects alterations in alveolar ducts, increases to an equal extent reflecting alterations in more proximal airways where gas transport is still convective for both gases. SSF6 and SHe were measured in 15 asthma patients before and after airway challenges (20% forced expired volume in 1-s fall) with AMP and methacholine. SHe increased to a greater extent than SSF6 after AMP challenge (5.7 vs. 3.7%/l; P = 0.002), with both slopes increasing to an equal extent after methacholine challenge (3.1%/l; P = 0.959). The larger increase in SHe following AMP challenge suggests distal ventilation impairment up to the level of terminal and respiratory bronchioles. With methacholine, the similar increases in SHe and SSF6 suggest a less distal impairment. AMP, therefore, seems to affect more extensively the very peripheral airways, whereas methacholine seems to have an effect on less distal airways.

Effect of posture on the single-breath oxygen test in normal subjects

1976 ◽  
Vol 41 (4) ◽  
pp. 474-479 ◽  
Author(s):  
D. A. Cortese ◽  
J. R. Rodarte ◽  
K. Rehder ◽  
R. E. Hyatt
Keyword(s):  
Prone Position ◽  
Normal Subjects ◽  
Standing Position ◽  
Phase Iii ◽  
Linear Gradient ◽  
Considerable Similarity ◽  
Single Breath ◽  
Normal People ◽  
Lateral Decubitus ◽  
Phase Iv

The effect of posture on phase III (alveolar nitrogen plateau) and phase IV (closing capacity) of the single-breath oxygen test was examined in 10 normal people. In part 1 of the study, subjects inspired and expired in the standing, supine, prone, and right lateral decubitus positions; there was no effect of posture on phase IV but slopes of phase III were higher when subjects were in the supine and lateral positions. In part 2, subjects inspired in the standing position and expired in one of the recumbent positions. Phase IV occurred infrequently except in the prone position (6 of 10 subj); slopes of phase III in part 2 were not consistently altered by changing posture. It is difficult to explain the failure of posture to alter phase IV solely on a model requiring a linear gradient of pleural pressure. The slope of phase III appears to depend more on the emptying patterns of small regions with widely varying volume-to-ventilation ratios than on gravity-dependent sequences of emptying. Finally, the data suggest a considerable similarity between the upright and prone positions in terms of lung filling and emptying.

Lung and alveolar wall elastic and hysteretic behavior in rats: effects of in vivo elastase treatment

2003 ◽  
Vol 95 (5) ◽  
pp. 1926-1936 ◽  
Author(s):  
Kelly K. Brewer ◽  
Hiroaki Sakai ◽  
Adriano M. Alencar ◽  
Arnab Majumdar ◽  
Stephen P. Arold ◽  
...  
Keyword(s):  
Transpulmonary Pressure ◽  
Hysteretic Behavior ◽  
Segment Length ◽  
Alveolar Wall ◽  
Isolated Lungs ◽  
Relative Change ◽  
The Relationship ◽  
Average Angle ◽  
Normal Lungs

We investigated the relationship between the microscopic elastic and hysteretic behavior of the alveolar walls and the macroscopic mechanical properties of the whole lung in an in vivo elastase-treated rat model of emphysema. We measured the input impedance of isolated lungs at three levels of transpulmonary pressure (Ptp) and used a linear model to estimate the dynamic elastance and hysteresivity of the lungs. The elastance of the normal lungs increased steeply with Ptp, whereas this dependence diminished in the treated lungs. Hysteresivity decreased significantly with Ptp in the normal lungs, but this dependence disappeared in the treated lungs. To investigate the microscopic origins of these changes, the alveolar walls were immunofluorescently labeled in small tissue strips. By using a fluorescent microscope, the lengths and angular orientations of individual alveolar walls were followed during cyclic uniaxial stretching of the tissue strips. The microstrains (relative change in segment length) and changes in angle of the alveolar walls showed considerable heterogeneity, which was interpreted in terms of a network model. In the normal strips, the alveolar walls showed larger angular changes compared with the treated tissue, whereas the alveolar walls of the treated tissue tended to be more extensible. Hysteresis in the average angle change was also larger in the treated tissue than in the normal tissue. We conclude that the decreased Ptp dependence of elastance and the constant hysteresivity in the treated lungs are related to microstructural remodeling and network phenomena at the level of the alveolar walls.

Collateral ventilation in excised human lungs

1981 ◽  
Vol 50 (5) ◽  
pp. 927-930 ◽  
Author(s):  
N. Berend ◽  
C. Skoog ◽  
W. M. Thurlbeck
Keyword(s):  
Airway Closure ◽  
Single Breath ◽  
Human Lungs ◽  
Inflection Points ◽  
Total Lack ◽  
The Difference ◽  
Collateral Ventilation ◽  
Phase Iv

Pressure-volume (PV) curves and single-breath nitrogen (SBN) washout traces were obtained in 32 excised human lungs. Comparison of the volumes at the onset of phage IV of the SBN traces (V phase IV) and the volumes at the inflection points (VIP) of the PV curves revealed V phase IV to be significantly larger than VIP. We postulated that V phase IV was caused by bulk airway closure and that the difference between V phase IV and VIP was due to collateral ventilation. To test this we correlated V phas IV -- VIP with age and emphysema grades of the lungs. Significant correlations were obtained, demonstrating that with increasing age and emphysema grade V phase IV -- VIP also increased. This is consistent with the documented evidence for decreased resistance to collateral ventilation with increasing age and emphysema. In addition, in a total of 86 lungs we demonstrated that with increasing age and emphysema there is an increasing incidence of total lack of sigmoid deviation in the PV curve.

In vivo dimensional response of airways of different size to transpulmonary pressure

1975 ◽  
Vol 39 (1) ◽  
pp. 23-29 ◽  
Author(s):  
G. M. Tisi ◽  
V. D. Minh ◽  
P. J. Friedman
Keyword(s):  
Tidal Volume ◽  
Total Lung Capacity ◽  
Transpulmonary Pressure ◽  
Main Stem ◽  
Peripheral Airways ◽  
Lung Capacity ◽  
Linear Plot ◽  
The Difference ◽  
Lateral Roentgenograms

We studied four supine dogs that were anesthetized with pentobarbital, intubated, and ventilated with a piston pump. The dimensional response of central (CAW) (greater than 2 mm diam) and peripheral airways (PAW) (smaller than 2 mm diam) to changes in transpulmonary pressure (Ptp) was determined by progressive increments in tidal volume (VT). A specially designed electronics relay circuit permitted this relationship to be obtained for points of no flow during tidal volume breathing: i.e., preinspiration (FRC); end inspiration (FRC + VT). The airways were dusted with powdered tantalum. Six airway divisions were identified: four CAW: trachea, main stem, lobar, segmental; and two PAW: subsegmental, and lobular. AP and lateral roentgenograms were obtained by standard technics and primary magnification (mag factor 2). Airway diameters were plotted as a function of transpulmonary pressure between 3 and 26 cmH2O with the diameter at total lung capacity expressed as 100%. The data show that: 1) there is significant distensibility above 5 cmH2O for all airways from the trachea to the lobular airways; 2) that the pressure-diameter plot is a linear plot for each airway from 3 to 26 cmH2O with R values between 0.846 and 0.957; 3) the peripheral lobular airways are more distensible than the central airways (P smaller than 0.05). We attribute the difference in distensibility of the peripheral lobular airways to their lack of cartilaginous support, and their decreased muscular support when compared to the CAW.

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