scholarly journals Nasal high flow clears anatomical dead space in upper airway models

2015 ◽  
Vol 118 (12) ◽  
pp. 1525-1532 ◽  
Author(s):  
Winfried Möller ◽  
Gülnaz Celik ◽  
Sheng Feng ◽  
Peter Bartenstein ◽  
Gabriele Meyer ◽  
...  
Keyword(s):  
Dead Space ◽  
Cylindrical Tube ◽  
Upper Airway ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Tube Model ◽  
Tracer Gas ◽  
Nasal Cavities ◽  
Gas Removal ◽  
Airway Model

Recent studies showed that nasal high flow (NHF) with or without supplemental oxygen can assist ventilation of patients with chronic respiratory and sleep disorders. The hypothesis of this study was to test whether NHF can clear dead space in two different models of the upper nasal airways. The first was a simple tube model consisting of a nozzle to simulate the nasal valve area, connected to a cylindrical tube to simulate the nasal cavity. The second was a more complex anatomically representative upper airway model, constructed from segmented CT-scan images of a healthy volunteer. After filling the models with tracer gases, NHF was delivered at rates of 15, 30, and 45 l/min. The tracer gas clearance was determined using dynamic infrared CO2 spectroscopy and 81mKr-gas radioactive gamma camera imaging. There was a similar tracer-gas clearance characteristic in the tube model and the upper airway model: clearance half-times were below 1.0 s and decreased with increasing NHF rates. For both models, the anterior compartments demonstrated faster clearance levels (half-times < 0.5 s) and the posterior sections showed slower clearance (half-times < 1.0 s). Both imaging methods showed similar flow-dependent tracer-gas clearance in the models. For the anatomically based model, there was complete tracer-gas removal from the nasal cavities within 1.0 s. The level of clearance in the nasal cavities increased by 1.8 ml/s for every 1.0 l/min increase in the rate of NHF. The study has demonstrated the fast-occurring clearance of nasal cavities by NHF therapy, which is capable of reducing of dead space rebreathing.

scholarly journals Nasal high flow reduces dead space

2017 ◽  
Vol 122 (1) ◽  
pp. 191-197 ◽  
Author(s):  
Winfried Möller ◽  
Sheng Feng ◽  
Ulrike Domanski ◽  
Karl-Josef Franke ◽  
Gülnaz Celik ◽  
...  
Keyword(s):  
Soft Palate ◽  
Dead Space ◽  
High Flow ◽  
Respiratory Support ◽  
Breath Holding ◽  
Dependent Manner ◽  
Upper Airways ◽  
Nasal Cavities ◽  
Dose Dependent ◽  
Expired Air

Recent studies show that nasal high flow (NHF) therapy can support ventilation in patients with acute or chronic respiratory disorders. Clearance of dead space has been suggested as being the key mechanism of respiratory support with NHF therapy. The hypothesis of this study was that NHF in a dose-dependent manner can clear dead space of the upper airways from expired air and decrease rebreathing. The randomized crossover study involved 10 volunteers using scintigraphy with 81mKrypton (81mKr) gas during a breath-holding maneuver with closed mouth and in 3 nasally breathing tracheotomized patients by volumetric capnography and oximetry through sampling CO2 and O2 in the trachea and measuring the inspired volume with inductance plethysmography following NHF rates of 15, 30, and 45 l/min. The scintigraphy revealed a decrease in 81mKr gas clearance half-time with an increase of NHF in the nasal cavities [Pearson’s correlation coefficient cc = −0.55, P < 0.01], the pharynx (cc = −0.41, P < 0.01), and the trachea (cc = −0.51, P < 0.01). Clearance rates in nasal cavities derived from time constants and MRI-measured volumes were 40.6 ± 12.3 (SD), 52.5 ± 17.7, and 72.9 ± 21.3 ml/s during NHF (15, 30, and 45 l/min, respectively). Measurement of inspired gases in the trachea showed an NHF-dependent decrease of inspired CO2 that correlated with an increase of inspired O2 (cc = −0.77, P < 0.05). NHF clears the upper airways of expired air, which reduces dead space by a decrease of rebreathing making ventilation more efficient. The dead space clearance is flow and time dependent, and it may extend below the soft palate. NEW & NOTEWORTHY Clearance of expired air in upper airways by nasal high flow (NHF) can be extended below the soft palate and de facto causes a reduction of dead space. Using scintigraphy, the authors found a relationship between NHF, time, and clearance. Direct measurement of CO2 and O2 in the trachea confirmed a reduction of rebreathing, providing the actual data on inspired gases, and this can be used for the assessment of other forms of respiratory support.

Small animal Review

2021 ◽  
Vol 26 (2) ◽  
pp. 1-1
Author(s):  
Bryn Tennant
Keyword(s):  
Gall Bladder ◽  
Small Animal ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Non Invasive

Summary: In the Small Animal Review, we summarise three papers published recently in other veterinary journals. This month includes a paper on creating antibiograms, pathogenesis of gall bladder mucocoeles and using non-invasive high-flow nasal catheters to provide supplemental oxygen in hypoxemic animals.

scholarly journals Experimental Evaluation of Dry Powder Inhalers During In- and Exhalation Using a Model of the Human Respiratory System (xPULM™)

2021 ◽  
Author(s):  
Richard Pasteka ◽  
Joao Pedro Santos da Costa ◽  
Mathias Forjan
Keyword(s):  
Respiratory Tract ◽  
Respiratory System ◽  
Particle Number ◽  
Particle Diameter ◽  
Upper Airway ◽  
System Model ◽  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Pharmaceutical Aerosols ◽  
Airway Model

Dry powder inhalers are used by a large number of patients worldwide to treat respiratory diseases. The objective of this work is to experimentally investigate changes in aerosol particle diameter and particle number concentration of pharmaceutical aerosols generated by five dry powder inhalers under realistic inhalation and exhalation conditions. The active respiratory system model (xPULM&trade;) was used as a model of the human respiratory system and to simulate a patient undergoing inhalation therapy. A mechanical upper airway model was developed, manufactured and introduced as a part of the xPULM&trade; to represent the human upper respiratory tract with high fidelity. Integration of optical aerosol spectrometry technique into the setup allowed for evaluation of pharmaceutical aerosols. The results show that the upper airway model increases the resistance of the overall system and act as a filter for bigger particles (&gt;3 &micro;m). Furthermore, there is a significant difference (p &lt; 0.05) in mean particle diameter between inhaled and exhaled particles with the majority of the particles depositing in the lung. The minimum deposition is reached for particle size of 0.5 &micro;m. The mean particle number concentrations exhaled are 2.94% (BreezHaler&reg;), 2.66% (Diskus&reg;), 10.24% (Ellipta&reg;) 2.13% (HandiHaler&reg;) and 6.22% (Turbohaler&reg;). In conclusion, the xPULM&trade; active respiratory system model is a viable option for studying interactions of pharmaceutical aerosols and the respiratory tract in terms of applicable deposition mechanisms. The model can support the reduction of animal experimentation in aerosol research and provide an alternative to experiments with human subjects.

Effect of Inhaling Patterns on Aerosol Drug Delivery: CFD Simulation

2008 ◽  
Author(s):  
Jinho Kim ◽  
Jim S. Chen
Keyword(s):  
Secondary Flow ◽  
Particle Deposition ◽  
Cfd Simulation ◽  
Dry Powder Inhaler ◽  
Upper Airway ◽  
Aerosol Deposition ◽  
Dose Inhaler ◽  
Breath Holding ◽  
Pharmaceutical Aerosols ◽  
Airway Model

Inhaled Pharmaceutical Aerosols (IPAs) delivery has great potential in treatment of a variety of respiratory diseases, including asthma, pulmonary diseases, and allergies. Aerosol delivery has many advantages. It delivers medication directly to where it is needed and it is effective in much lower doses than required for oral administration. Currently, there are several types of IPA delivery systems, including pressurized metered dose inhaler (pMDI), the dry powder inhaler (DPI), and the medical nebulizer. IPAs should be delivered deep into the respiratory system where the drug substance can be absorbed into blood through the capillaries via the alveoli. Researchers have proved that most aerosol particles with aerodynamic diameter of about 1–5 μm, if slowly and deeply inhaled, could be deposited in the peripheral regions that are rich in alveoli [1–3]. The purpose of this study is to investigate the effects of various inhaling rates with breath-holding pause on the aerosol deposition (Dp = 0.5–5 μm) in a human upper airway model extending from mouth to 3rd generation of trachea. The oral airway model is three dimensional and non-planar configurations. The dimensions of the model are adapted from a human cast. The air flow is assumed to be unsteady, laminar, and incompressible. The investigation is carried out by Computational Fluid Dynamics (CFD) using the software Fluent 6.2. The user-defined function (UDF) is employed to simulate the cyclic inspiratory flows for different IPA inhalation patterns. When an aerosol particle enters the mouth respiratory tract, its particles experience abrupt changes in direction. The secondary flow changes its direction as the airflow passes curvature. Intensity of the secondary flow is strong after first bend at pharynx and becomes weaker after larynx. In flow separation, a particle can be trapped and follow the eddy and deposit on the surface. Particle deposition fraction generally increases as particle size and inhaling airflow velocity increase.

scholarly journals Reductions in dead space ventilation with nasal high flow depend on physiological dead space volume: metabolic hood measurements during sleep in patients with COPD and controls

2018 ◽  
Vol 51 (5) ◽  
pp. 1702251 ◽  
Author(s):  
Paolo Biselli ◽  
Kathrin Fricke ◽  
Ludger Grote ◽  
Andrew T. Braun ◽  
Jason Kirkness ◽  
...  
Keyword(s):  
Respiratory Rate ◽  
Dead Space ◽  
Minute Ventilation ◽  
High Flow ◽  
Physiological Dead Space ◽  
Copd Patients ◽  
Dead Space Volume ◽  
Anatomical Dead Space ◽  
Dead Space Ventilation ◽  
Space Volume

Nasal high flow (NHF) reduces minute ventilation and ventilatory loads during sleep but the mechanisms are not clear. We hypothesised NHF reduces ventilation in proportion to physiological but not anatomical dead space.11 subjects (five controls and six chronic obstructive pulmonary disease (COPD) patients) underwent polysomnography with transcutaneous carbon dioxide (CO2) monitoring under a metabolic hood. During stable non-rapid eye movement stage 2 sleep, subjects received NHF (20 L·min−1) intermittently for periods of 5–10 min. We measured CO2 production and calculated dead space ventilation.Controls and COPD patients responded similarly to NHF. NHF reduced minute ventilation (from 5.6±0.4 to 4.8±0.4 L·min−1; p<0.05) and tidal volume (from 0.34±0.03 to 0.3±0.03 L; p<0.05) without a change in energy expenditure, transcutaneous CO2 or alveolar ventilation. There was a significant decrease in dead space ventilation (from 2.5±0.4 to 1.6±0.4 L·min−1; p<0.05), but not in respiratory rate. The reduction in dead space ventilation correlated with baseline physiological dead space fraction (r2=0.36; p<0.05), but not with respiratory rate or anatomical dead space volume.During sleep, NHF decreases minute ventilation due to an overall reduction in dead space ventilation in proportion to the extent of baseline physiological dead space fraction.

Expiratory and arterial partial pressure relations under different ventilation-perfusion conditions

1983 ◽  
Vol 54 (6) ◽  
pp. 1745-1753 ◽  
Author(s):  
A. Zwart ◽  
S. C. Luijendijk ◽  
W. R. de Vries
Keyword(s):  
Partial Pressure ◽  
Dead Space ◽  
Gas Analysis ◽  
Lung Model ◽  
Breathing Patterns ◽  
Tracer Gas ◽  
Physiological Dead Space ◽  
Arterial Partial Pressure ◽  
The Difference ◽  
End Tidal

Inert tracer gas exchange across the human respiratory system is simulated in an asymmetric lung model for different oscillatory breathing patterns. The momentary volume-averaged alveolar partial pressure (PA), the expiratory partial pressure (PE), the mixed expiratory partial pressure (PE), the end-tidal partial pressure (PET), and the mean arterial partial pressure (Pa), are calculated as functions of the blood-gas partition coefficient (lambda) and the diffusion coefficient (D) of the tracer gas. The lambda values vary from 0.01 to 330.0 inclusive, and four values of D are used (0.5, 0.22, 0.1, and 0.01). Three ventilation-perfusion conditions corresponding to rest and mild and moderate exercise are simulated. Under simulated exercise conditions, we compute a reversed difference between PET and Pa compared with the rest condition. This reversal is directly reflected in the relation between the physiological dead space fraction (1--PE/Pa) and the Bohr dead space fraction (1--PE/PET). It is argued that the difference (PET--Pa) depends on the lambda of the tracer gas, the buffering capacity of lung tissue, and the stratification caused by diffusion-limited gas transport in the gas phase. Finally some determinants for the reversed difference (PET--Pa) and the significance for conventional gas analysis are discussed.

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