scholarly journals Ventilation heterogeneity measured by multiple breath inert gas testing is not affected by inspired oxygen concentration in healthy humans

2017 ◽  
Vol 122 (6) ◽  
pp. 1379-1387 ◽  
Author(s):  
Susan R. Hopkins ◽  
Ann R. Elliott ◽  
G. Kim Prisk ◽  
Chantal Darquenne
Keyword(s):  
Oxygen Concentration ◽  
Healthy Subjects ◽  
Phase Iii ◽  
Ventilation Distribution ◽  
Healthy Humans ◽  
Ventilation Heterogeneity ◽  
Multiple Breath Washout ◽  
Residual Capacity ◽  
Gaussian Fit ◽  
Inspired Oxygen

Multiple breath washout (MBW) and oxygen-enhanced MRI techniques use acute exposure to 100% oxygen to measure ventilation heterogeneity. Implicit is the assumption that breathing 100% oxygen does not induce changes in ventilation heterogeneity; however, this is untested. We hypothesized that ventilation heterogeneity decreases with increasing inspired oxygen concentration in healthy subjects. We performed MBW in 8 healthy subjects (4 women, 4 men; age = 43 ± 15 yr) with normal pulmonary function (FEV1 = 98 ± 6% predicted) using 10% argon as a tracer gas and oxygen concentrations of 12.5%, 21%, or 90%. MBW was performed in accordance with ERS-ATS guidelines. Subjects initially inspired air followed by a wash-in of test gas. Tests were performed in balanced order in triplicate. Gas concentrations were measured at the mouth, and argon signals rescaled to mimic a N2 washout, and analyzed to determine the distribution of specific ventilation (SV). Heterogeneity was characterized by the width of a log-Gaussian fit of the SV distribution and from Sacin and Scond indexes derived from the phase III slope. There were no significant differences in the ventilation heterogeneity due to altered inspired oxygen: histogram width (hypoxia 0.57 ± 0.11, normoxia 0.60 ± 0.08, hyperoxia 0.59 ± 0.09, P = 0.51), Scond (hypoxia 0.014 ± 0.011, normoxia 0.012 ± 0.015, hyperoxia 0.010 ± 0.011, P = 0.34), or Sacin (hypoxia 0.11 ± 0.04, normoxia 0.10 ± 0.03, hyperoxia 0.12 ± 0.03, P = 0.23). Functional residual capacity was increased in hypoxia ( P = 0.04) and dead space increased in hyperoxia ( P = 0.0001) compared with the other conditions. The acute use of 100% oxygen in MBW or MRI is unlikely to affect ventilation heterogeneity. NEW & NOTEWORTHY Hyperoxia is used to measure the distribution of ventilation in imaging and MBW but may alter the underlying ventilation distribution. We used MBW to evaluate the effect of inspired oxygen concentration on the ventilation distribution using 10% argon as a tracer. Short-duration exposure to hypoxia (12.5% oxygen) and hyperoxia (90% oxygen) during MBW had no significant effect on ventilation heterogeneity, suggesting that hyperoxia can be used to assess the ventilation distribution.

Similar ventilation distribution in normal subjects prone and supine during tidal breathing

2002 ◽  
Vol 92 (2) ◽  
pp. 622-626 ◽  
Author(s):  
M. J. Rodríguez-Nieto ◽  
G. Peces-Barba ◽  
N. González Mangado ◽  
M. Paiva ◽  
S. Verbanck
Keyword(s):  
Normal Subjects ◽  
Phase Iii ◽  
Ventilation Distribution ◽  
Tidal Breathing ◽  
Ventilation Heterogeneity ◽  
Multiple Breath Washout ◽  
Residual Capacity ◽  
Slope Difference ◽  
The Difference ◽  
Phase Iii Slope

Multiple-breath washout (MBW) tests, with end-expiratory lung volume at functional residual capacity (FRC) and 90% O2, 5% He, and 5% SF6as an inspired gas mixture, were performed in healthy volunteers in supine and prone postures. The semilog plot of MBW N2concentrations was evaluated in terms of its curvilinearity. The MBW N2normalized slope analysis yielded indexes of acinar and conductive ventilation heterogeneity (Verbanck S, Schuermans D, Van Muylem A, Paiva M, Noppen M, and Vincken W. J App Physiol 83: 1907–1916, 1997). Also, the difference between SF6and He normalized phase III slopes was computed in the first MBW expiration. Only MBW tests with similar FRC in the prone and supine postures ( P > 0.1; n= 8) were considered. Prone and supine postures did not reveal any significant differences in curvilinearity, N2normalized slope-derived indexes of conductive or acinar ventilation heterogeneity, nor SF6-He normalized phase III slope difference in the first MBW expiration ( P > 0.1 for all). The absence of significant changes in any of the MBW indexes suggests that ventilation heterogeneity is similar in the supine and prone postures of normal subjects breathing near FRC.

scholarly journals Patterns of regional lung physiology in cystic fibrosis using ventilation magnetic resonance imaging and multiple-breath washout

2018 ◽  
Vol 52 (5) ◽  
pp. 1800821 ◽  
Author(s):  
Laurie J. Smith ◽  
Guilhem J. Collier ◽  
Helen Marshall ◽  
Paul J.C. Hughes ◽  
Alberto M. Biancardi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cystic Fibrosis ◽  
Total Lung Capacity ◽  
Resonance Imaging ◽  
Ventilation Distribution ◽  
Lung Clearance ◽  
Lung Capacity ◽  
Lung Clearance Index ◽  
Ventilation Heterogeneity ◽  
Multiple Breath Washout

Hyperpolarised helium-3 (3He) ventilation magnetic resonance imaging (MRI) and multiple-breath washout (MBW) are sensitive methods for detecting lung disease in cystic fibrosis (CF). We aimed to explore their relationship across a broad range of CF disease severity and patient age, as well as assess the effect of inhaled lung volume on ventilation distribution.32 children and adults with CF underwent MBW and 3He-MRI at a lung volume of end-inspiratory tidal volume (EIVT). In addition, 28 patients performed 3He-MRI at total lung capacity. 3He-MRI scans were quantitatively analysed for ventilation defect percentage (VDP), ventilation heterogeneity index (VHI) and the number and size of individual contiguous ventilation defects. From MBW, the lung clearance index, convection-dependent ventilation heterogeneity (Scond) and convection–diffusion-dependent ventilation heterogeneity (Sacin) were calculated.VDP and VHI at EIVT strongly correlated with lung clearance index (r=0.89 and r=0.88, respectively), Sacin (r=0.84 and r=0.82, respectively) and forced expiratory volume in 1 s (FEV1) (r=−0.79 and r=−0.78, respectively). Two distinct 3He-MRI patterns were highlighted: patients with abnormal FEV1 had significantly (p<0.001) larger, but fewer, contiguous defects than those with normal FEV1, who tended to have numerous small volume defects. These two MRI patterns were delineated by a VDP of ∼10%. At total lung capacity, when compared to EIVT, VDP and VHI reduced in all subjects (p<0.001), demonstrating improved ventilation distribution and regions of volume-reversible and nonreversible ventilation abnormalities.

Mechanical effects of obesity on airway responsiveness in otherwise healthy humans

2009 ◽  
Vol 107 (2) ◽  
pp. 408-416 ◽  
Author(s):  
Roberto Torchio ◽  
Alessandro Gobbi ◽  
Carlo Gulotta ◽  
Raffaele Dellacà ◽  
Marco Tinivella ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Lung Function ◽  
Body Mass ◽  
Airway Hyperresponsiveness ◽  
Healthy Subjects ◽  
Rest Period ◽  
Healthy Humans ◽  
Before And After ◽  
Maximum Expiratory Flow ◽  
Residual Capacity

We investigated whether obesity is associated with airway hyperresponsiveness in otherwise healthy humans and, if so, whether this correlates with a restrictive lung function pattern or a decreased number of sighs at rest and/or during walking. Lung function was studied before and after inhaling methacholine (MCh) in 41 healthy subjects with body mass index ranging from 20 to 56. Breathing pattern was assessed during a 60-min rest period and a 30-min walk. The dose of MCh that produced a 50% decrease in the maximum expiratory flow measured in a body plethysmograph (PD50MCh) was inversely correlated with body mass index ( r2 = 0.32, P < 0.001) and waist circumference ( r2 = 0.25, P < 0.001). Significant correlations with body mass index were also found with the maximum changes in respiratory resistance ( r2 = 0.19, P < 0.001) and reactance ( r2 = 0.40, P < 0.001) measured at 5 Hz. PD50MCh was also positively correlated with functional residual capacity ( r2 = 0.56, P < 0.001) and total lung capacity ( r2 = 0.59, P < 0.001) in men, but not in women. Neither PD50MCh nor body mass index correlated with number of sighs, average tidal volume, ventilation, or breathing frequency. In this study, airway hyperresponsiveness was significantly associated with obesity in otherwise healthy subjects. In obese men, but not in women, airway hyperresponsiveness was associated with the decreases in lung volumes.

Multiple-breath washout and washin experiments in steers

1996 ◽  
Vol 81 (2) ◽  
pp. 957-963 ◽  
Author(s):  
F. Rollin ◽  
D. Desmecht ◽  
S. Verbanck ◽  
A. Van Muylem ◽  
P. Lekeux ◽  
...  
Keyword(s):  
Phase Iii ◽  
Slope Ratio ◽  
Ventilation Distribution ◽  
Tidal Breathing ◽  
Ventilation Inhomogeneity ◽  
Multiple Breath Washout ◽  
The Mean ◽  
End Tidal ◽  
Sequential Emptying ◽  
Phase Iii Slope

Multiple-breath N2 washouts (WO) and washins (WI) were performed during regular tidal breathing in 11 unsedated healthy steers approaching pulmonary functional maturity (mean body weight = 271 kg). They inspired 20% O2 in 80% Ar during the WO and air during the WI. For each steer, we computed two indexes of ventilation inhomogeneity from the N2 WO curves: 1) the curvilinearity of the logarithm of end-tidal N2 concentrations as a function of cumulative expired volume reflected in the ratio of two slopes fitted between 100 and 50% and between 50 and 10%, respectively, of end-tidal N2 concentration of the first breath of the WO; and 2) the N2 phase III slope divided by the mean expired concentration (Sn) of each breath also plotted as a function of cumulative expired volume. Equivalent computation of both parameters was done on WI and WO curves, and similar results were obtained. The mean slope ratio was 0.812 +/- 0.119 (SD) for all the steers, which is consistent with topographic gravity-dependent specific ventilation distribution inhomogeneity. Sn was independent of the breath number both for WO and WI (mean Sn = 0.130 +/- 0.057 liters-1), suggesting that emptying between unequally ventilated units, is synchronous. This behavior resembles that observed in rats postmortem (S. Verbanck, E.R. Weibel, and M. Paiva. J. Appl Physiol. 71: 847–854, 1991) but contrasts with experiments in humans, in whom convection-dependent ventilation inhomogeneities generate a marked increase in Sn throughout the entire WO (A. B. H. Crawford, M. Makowska, M. Paiva, and L. A. Engel. J. Appl. Physiol. 59: 838–846, 1985). This is surprising because one would expect gravity-dependent sequential emptying in animals of this size.

Inter- and intraregional ventilation inhomogeneity in hypergravity and after pressurization of an anti-G suit

2003 ◽  
Vol 94 (4) ◽  
pp. 1353-1364 ◽  
Author(s):  
Mikael Grönkvist ◽  
Eddie Bergsten ◽  
Ola Eiken ◽  
Per M. Gustafsson
Keyword(s):  
Functional Residual Capacity ◽  
Inert Gas ◽  
Phase Iii ◽  
Ventilation Distribution ◽  
Ventilation Inhomogeneity ◽  
Gas Trapping ◽  
Residual Capacity ◽  
Trapped Gas ◽  
Phase Iii Slope

This study assessed the effects of increased gravity in the head-to-foot direction (+Gz) and anti-G suit (AGS) pressurization on functional residual capacity (FRC), the volume of trapped gas (VTG), and ventilation distribution by using inert- gas washout. Normalized phase III slope ( SnIII) analysis was used to determine the effects on inter- and intraregional ventilation inhomogeneity. Twelve men performed multiple-breath washouts of SF6 and He in a human centrifuge at +1 to +3 Gzwearing an AGS pressurized to 0, 6, or 12 kPa. Hypergravity produced moderately increased FRC, VTG, and overall and inter- and intraregional inhomogeneities. In normogravity, AGS pressurization resulted in reduced FRC and increased VTG, overall, and inter- and intraregional inhomogeneities. Inflation of the AGS to 12 kPa at +3 Gz reduced FRC markedly and caused marked gas trapping and intraregional inhomogeneity, whereas interregional inhomogeneity decreased. In conclusion, increased +Gzimpairs ventilation distribution not only between widely separated lung regions, but also within small lung units. Pressurizing an AGS in hypergravity causes extensive gas trapping accompanied by reduced interregional inhomogeneity and, apparently, results in greater intraregional inhomogeneity.

Does increased baseline ventilation heterogeneity following chest wall strapping predispose to airway hyperresponsiveness?

2012 ◽  
Vol 113 (1) ◽  
pp. 25-30 ◽  
Author(s):  
David G. Chapman ◽  
Norbert Berend ◽  
Karla R. Horlyck ◽  
Gregory G. King ◽  
Cheryl M. Salome
Keyword(s):  
Chest Wall ◽  
Airway Hyperresponsiveness ◽  
Healthy Subjects ◽  
Forced Expiratory Volume ◽  
Airway Responsiveness ◽  
High Dose ◽  
Ventilation Heterogeneity ◽  
Similar Disease ◽  
Residual Capacity ◽  
Diffusion Convection

Baseline ventilation heterogeneity is associated with airway hyperresponsiveness (AHR) in asthma; however, it is unknown whether increased baseline ventilation heterogeneity leads to AHR or both are independent effects of similar disease pathophysiology. Reducing functional residual capacity (FRC) in healthy subjects increases baseline ventilation heterogeneity and airway responsiveness, but the relationship between the two is unclear. The aim was to determine whether an increase in baseline ventilation heterogeneity due to a reduction in FRC correlated with the increase in response to methacholine. In 13 healthy male subjects, ventilation heterogeneity was measured by multiple-breath N2 washout before a cumulative high-dose (0.79–200 μmol) methacholine challenge. On a separate day, the protocol was performed with chest wall strapping (CWS) to reduce FRC. Indexes of ventilation heterogeneity in the convection-dependent (Scond) and diffusion-convection-dependent (Sacin) airways were calculated from the multiple-breath N2 washout. CWS decreased FRC by 15.6 ± 2.7% ( P < 0.0001). CWS increased the percent fall in forced expiratory volume in 1 s during bronchial challenge ( P = 0.006), and the magnitude of this effect was independently determined by the effect of CWS on Sacin and FRC ( radj2 = 0.55, P = 0.02). This suggests that changes in baseline ventilation heterogeneity in healthy subjects are sufficient to increase airway responsiveness, independent of the presence of disease pathology.

Effect of airway closure on ventilation distribution

1989 ◽  
Vol 66 (6) ◽  
pp. 2511-2515 ◽  
Author(s):  
A. B. Crawford ◽  
D. J. Cotton ◽  
M. Paiva ◽  
L. A. Engel
Keyword(s):  
Normal Subjects ◽  
Phase Iii ◽  
Mixing Efficiency ◽  
Breath Holding ◽  
Airway Closure ◽  
Ventilation Distribution ◽  
Residual Capacity ◽  
Lung Periphery ◽  
Phase Iii Slope ◽  
Volume Range

We examined the effect of airway closure on ventilation distribution during tidal breathing in six normal subjects. Each subject performed multiple-breath N2 washouts (MBNW) at tidal volumes of 1 liter over a range of preinspiratory lung volumes (PILV) from functional residual capacity (FRC) to just above residual volume. All subjects performed washouts at PILV below their measured closing capacity. In addition five of the subjects performed MBNW at PILV below closing capacity with end-inspiratory breath holds of 2 or 5 s. We measured the following two independent indexes of ventilation maldistribution: 1) the normalized phase III slope of the final breaths of the washout (Snf) and 2) the alveolar mixing efficiency of those breaths of the washout where 80–90% of the initial N2 had been cleared. Between a mean PILV of 0.28 liter above closing capacity and that 0.31 liter below closing capacity, mean Snf increased by 132% (P less than 0.005). Over the same volume range, mean alveolar mixing efficiency decreased by 3.3% (P less than 0.05). Breath holding at PILV below closing capacity resulted in marked and consistent decreases in Snf and increases in alveolar mixing efficiency. Whereas inhomogeneity of ventilation decreases with lung volume when all airways are patent (J. Appl. Physiol. 66: 2502–2510, 1989), airway closure increases ventilation inequality, and this is substantially reduced by short end-inspiratory breath holds. These findings suggest that the predominant determinant of ventilation distribution below closing capacity is the inhomogeneous closure of airways subtending regions in the lung periphery that are close together.

scholarly journals Double tracer gas single-breath washout: reproducibility in healthy subjects and COPD

2014 ◽  
Vol 44 (5) ◽  
pp. 1210-1222 ◽  
Author(s):  
Kim Husemann ◽  
Nina Berg ◽  
Jennifer Engel ◽  
Johannes Port ◽  
Christoph Joppek ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Vital Capacity ◽  
Intraclass Correlation ◽  
Phase Iii ◽  
Chronic Obstructive ◽  
Clinical Settings ◽  
Tracer Gas ◽  
Obstructive Pulmonary Disease ◽  
Single Breath ◽  
Multiple Breath Washout

The applicability and interpretation of inert tracer gas washout tests is hampered by the lack of feasible protocols and reproducibility data. We assessed feasibility, variability and reproducibility of a new easy to perform double tracer gas (DTG) single-breath washout (SBW) test and compared this with conventional nitrogen washouts.In 40 healthy nonsmokers and 20 patients with stable chronic obstructive pulmonary disease (COPD), we performed three N2 vital capacity SBWs, three N2 multiple-breath washouts and three tidal DTG-SBW tests. Follow-up was after 1 week, 1 month and 6 months. Main outcomes were the lung clearance index (LCI) (N2 multiple-breath washout), slope of phase III (dN2) (N2 vital capacity SBW) and slope of phase III (SIIIDTG) (DTG-SBW).In healthy subjects, mean±sd LCI at baseline was 6.94±0.61, dN2 0.99±0.42% N2 per litre and SIIIDTG −0.206±0.108 g·mol−1·L−1. In COPD, LCI and dN2 were significantly higher (LCI 12.23±2.67, dN2 7.43±5.38% N2 per litre; p<0.001) and SIIIDTG significantly steeper (−0.653±0.428 g·mol−1·L−1, p<0.001). Reproducibility was high for main outcome parameters: the intraclass correlation coefficient over 6 months was 0.77 (0.86 in COPD) for LCI, 0.82 (0.89) for dN2 and 0.83 (0.93) for SIIIDTG.The tidal DTG-SBW is a reproducible test in healthy and COPD subjects that seems attractive for use in routine clinical settings.

Effect of lung volume on ventilation distribution

1989 ◽  
Vol 66 (6) ◽  
pp. 2502-2510 ◽  
Author(s):  
A. B. Crawford ◽  
D. J. Cotton ◽  
M. Paiva ◽  
L. A. Engel
Keyword(s):  
Lung Volume ◽  
Normal Subjects ◽  
Phase Iii ◽  
Mixing Efficiency ◽  
Ventilation Distribution ◽  
Single Breath ◽  
Wide Range ◽  
Residual Capacity ◽  
Phase Iii Slope ◽  
Volume Range

To examine the effect of preinspiratory lung volume (PILV) on ventilation distribution, we performed multiple-breath N2 washouts (MBNW) in seven normal subjects breathing 1-liter tidal volumes over a wide range of PILV above closing capacity. We measured the following two independent indexes of ventilation distribution from the MBNW: 1) the normalized phase III slope of the final breaths of the washout (Snf) and 2) the alveolar mixing efficiency during that portion of the washout where 80–90% of the lung N2 had been cleared. Three of the subjects also performed single-breath N2 washouts (SBNW) by inspiring 1-liter breaths and expiring to residual volume at PILV = functional residual capacity (FRC), FRC + 1.0, and FRC - 0.5, respectively. From the SBNW we measured the phase III slope over the expired volume ranges of 0.75–1.0, 1.0–1.6, and 1.6–2.2 liters (S0.75, S1.0, and S1.6, respectively). Between a PILV of 0.92 +/- 0.09 (SE) liter above FRC and a PILV of 1.17 +/- 0.43 liter below FRC, Snf decreased by 61% (P less than 0.001) and alveolar mixing efficiency increased from 80 to 85% (P = 0.05). In addition, Snf and alveolar mixing efficiency were negatively correlated (r = 0.74). In contrast, over a similar volume range, S1.0 and S1.6 were greater at lower PILV. We conclude that, during tidal breathing in normal subjects, ventilation distribution becomes progressively more inhomogeneous at higher lung volumes over a range of volumes above closing capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

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