Regional Lung Volume Research Articles

The lung volume at which shunting occurs with inhalation anesthesia.

The relationship between functional residual capacity (FRC) and shunt development with halothane anesthesia in 18 nonobese surgical patients (age, 21-34 yr) was studied. FRC was measured by helium dilution, and intrapulmonary shunt was distinguished from ventilation-perfusion inequality by multiple tracer inert gas elimination analysis. Awake supine FRC was 34.6 +/- 6.6% (mean +/- SD) of total lung capacity (TLC), and closing capacity (CC) was 29.8 +/- 5.3% of TLC. Anesthesia, muscle paralysis, tracheal intubation, and mechanical ventilation produced an average 14.6 +/- 13.3% FRC reduction to an average anesthesia FRC 29.8% of TLC (P = 0.002). Shunt increased from 1.2% +/- 1.5% awake to 8.6 +/- 8.3% during anesthesia (P = 0.005). A nonlinear relationship was found between shunt and FRC/TLC so that anesthetized subjects with an FRC less than awake CC had an average 11.4 +/- 8.3% shunt, whereas subjects with an FRC greater than CC had a 2.4 +/- 2.8% shunt (P = 0.025). Nonsmokers developed shunt only if FRC was less than CC. Smokers showed a significantly higher shunt for a given (FRC-CC)/TLC compared to nonsmokers (P less than 0.001). The slope of the regression of shunt on BMI (body mass index = weight/height2) showed a significant increase during anesthesia (P = 0.005), and smokers had a significantly higher slope compared to nonsmokers (P = 0.001). These findings suggest a gravity-dependent mechanism for intrapulmonary shunting during anesthesia. Therefore, shunting was due to dependent regional lung volume reduction associated with an FRC decrease to less than closing capacity. The enhanced intrapulmonary shunting in smokers may have been related to the increased dependent regional residual volume associated with smoking.

Noninvasive measurement of regional interstitial lung volume in sheep.

The noninvasive external radioflux detection method (ERD) measures net transvascular flux of tracer protein into and out of the lung extravascular compartment (EV) and time to zero flux between compartments. With this information we can now estimate regional interstitial volume in the field of the external probe (VIs). Dividing the mass of EV tracer by VIs, we obtain interstitial concentration ([Is]). Directly sampling plasma concentration of the tracer, we can construct plasma-interstitium equilibration curves that are analogous to plasma-lymph equilibration curves without invasive surgery. We completed 46 ERD studies in 21 sheep with chronic lung lymph fistulas. Sheep were studied under baseline conditions (n = 30) and after elevating left atrial pressure by mitral obstruction (n = 7), or intravascular volume infusion (n = 8), and increasing lung vascular permeability (n = 1). In each study we compared the slope of the regression through plasma-lymph concentration of tracer protein over time ([P]-[L], measured directly) with that through values of plasma-interstitial concentration ([P]-[Is], assessed noninvasively), an index of vascular permeability. For this correlation, r = 0.94, and the regression line approximates identity. Mean [Is] appears to approximate [L] in sheep.

Heterogeneous lung emptying during forced expiration.

Several lines of evidence suggest that the healthy mammalian lung empties homogeneously during a maximally forced deflation. Nonetheless, such behavior would appear to be implausible if for no other reason than that airway structure is known to be substantially heterogeneous among parallel pathways of gas conduction. To resolve this paradox we reexamined the degree to which lung emptying is homogeneous, and considered mechanisms that might control differential regional emptying. Twelve excised canine lungs were studied. Regional alveolar pressure relative to pleural pressure was used as an index of regional lung volume. By use of a capsule technique, alveolar pressure was measured simultaneously in each of six regions during flow-limited deflations; flow from the lung was measured plethysmographically. The standard deviation of interregional pressure differences, which was taken as an index of nonuniformity, was 0.0, 0.74, 0.64, and 0.90 cmH2O at mean recoil pressures of 30, 8.4, 4.5, and 2.1 cmH2O (0, 25, 50, and 75% expired vital capacity), indicating that interregional pressure differences increased more rapidly earlier in the deflation. When we examined the time rate of change of regional alveolar pressure as an index of regional flow, we observed an intricate pattern of differential regional behavior that was inapparent in the maximum expiratory flow-volume (MEFV) curve. The most plausible interpretation of these findings is that regions of the healthy excised canine lung empty heterogeneously to a small degree, but in an interdependent compensatory pattern that is inapparent in the configuration of the maximum expiratory flow-volume curve.

Effects of acute pleural effusion on respiratory system mechanics in dogs.

We determined regional (Vr) and overall lung volumes in six head-up anesthetized dogs before and after the stepwise introduction of saline into the right pleural space. Functional residual capacity (FRC), as determined by He dilution, and total lung capacity (TLC) decreased by one-third and chest wall volume increased by two-thirds the saline volume added. Pressure-volume curves showed an apparent increase in lung elastic recoil and a decrease in chest wall elastic recoil with added saline, but the validity of esophageal pressure measurements in these head-up dogs is questionable. Vr was determined from the positions of intraparenchymal markers. Lower lobe TLC and FRC decreased with added saline. The decrease in upper lobe volume was less than that of lower lobe volume at FRC and was minimal at TLC. Saline increased the normal Vr gradient at FRC and created a gradient at TLC. During deflation from TLC to FRC before saline was added, the decrease in lung volume was accompanied by a shape change of the lung, with greatest distortion in the transverse (ribs to mediastinum) direction. After saline additions, deflation was associated with deformation of the lung in the cephalocaudal and transverse directions. The deformation with saline may be a result of upward displacement of the lungs into a smaller cross-sectional area of the thoracic cavity.

Regional differences in expansion in excised dog lung lobes.

The position of small metallic markers embedded within the lung parenchyma and glued to the pleural surface of four excised right caudal dog lobes were determined during stepwise deflation from an airway opening pressure of 25 cmH2O in air-filled suspended lobes and 8 cmH2O in saline-filled lobes submerged in saline. Changes in the volumes of tetrahedrons formed by four noncoplanar markers were taken as regional lung volume changes at the centroids of the tetrahedron. In both air- and saline-filled lobes at all volumes below total lobe capacity (TLC) there was considerable variability in regional volume. The variability occurred at the first step below TLC and increased with deflation. Regions behaved consistently; regions that were proportionally larger or smaller than the overall lobe at any step tended to be larger or smaller, respectively, at all steps. There was a significant correlation between the regional behavior of the air- and saline-filled lobes. The variability of regional volume did not follow any clear topographical orientation. These results indicate there is considerable variability of lung compliance within small regions. This heterogeneity of regional parenchymal properties may be the anatomical basis of the nonuniformity of regional ventilation known to occur in intact animals and excised lobes within small regions at the same vertical height.

Predictability of skeletal muscle tension from architectural determinations in guinea pig hindlimbs.

The maximum tetanic tension (Po) generated by a skeletal muscle is determined by its functional cross-sectional area (CSA) and its specific tension (tension/CSA). Measurements of average fiber length (normalized to a sarcomere length of 2.2 micron), muscle mass, and approximate angle of pinnation of muscle fibers within a muscle were taken from 26 different guinea pig hindlimb muscles and were used to calculate CSA. The specific tension was assumed to be 22.5 N X cm-2 and was used to determine the estimated Po of each muscle studied. In a second group of guinea pigs the in situ Po of 11 selected hindlimb muscles and muscle groups were determined. Estimated and measured Po values were found to have a strong linear relationship (r = 0.99) for muscle and muscle groups tested. The specific tension of the soleus, a homogeneously slow-twitch muscle, was shown to be approximately 15.4 N X cm-2 (P less than 0.01). Therefore, in our hands a specific tension value of 22.5 N X cm-2 appears to be a reasonable value for all mixed muscles studied in the guinea pig hindlimb and can be used to estimate their Po.

Gas transport during high-frequency ventilation.

During high-frequency small-volume ventilation (HFV), the transport rate of gas from the mouth to a lung region is a function of two conductances (conductance is the transfer rate of a gas divided by its partial pressure difference): regional longitudinal gas conductance along the airways (Grlongi) and gas conductance between lung regions (Ginter). Grlongi per unit regional lung (gas) volume [Grlongi/(Vr beta g)] was determined during HFV in 11 anesthetized paralyzed dogs lying supine. The distribution of Grlongi/(Vr beta g) was nearly uniform during HFV when stroke volumes were less than approximately two-thirds of the Fowler dead-space volume. By contrast, the distribution of Grlongi/(Vr beta g) was nonuniform when the stroke volume exceeded approximately two-thirds of the Fowler dead-space volume and the oscillation frequency was 5 Hz. Gas conductance along the airways per unit lung gas volume [average Glongi/(V beta g)], for the entire lung, increased with stroke volume at all frequencies, but for a given product of oscillation frequency and stroke volume, the average Glongi/(V beta g) was greater when stroke volume was large and oscillation frequency was low. The average Glongi/(V beta g) increased with frequency up to a maximal value; the frequency at which the maximum occurred depended on the kinematic viscosity of the inspired gas mixture.

Topographical distribution of regional lung volume in anesthetized dogs.

The distribution of regional lung volume during static deflation from total lung capacity to functional residual capacity was determined from the positions of intraparenchymal metallic markers ascertained by a biplane video roentgenographic technique in supine and prone anesthetized dogs. Regional lung volumes were linearly related to overall lung volume so that regional volume could be characterized by a ventilation index (VI), which is the ventilation per alveolus relative to the ventilation of the overall lung. For the supine position, there were vertical and cephalocaudal gradients in VI in both the upper and lower lobes. Mean VI was greater in the lower lobe than in the upper lobe, but VI was less than would be predicted from extrapolation of the upper lobe relationship. For the prone position, there was no consistent gradient in VI in any direction. The magnitude of the gradients in VI and the effects of body position suggest that, in the recumbent dog, the thoracic cavity shape is a more important determinant of regional lung volume than is the effect of gravity on the lung itself.

Regional lung function in erect humans after lobectomy.

By using the 133Xe technique, we studied five erect adult subjects who had undergone lobectomy at least 2 mo previously and were otherwise normal, to allow comparison between operated and unoperated lungs; four subjects had undergone upper lobectomy, and one had undergone lower lobectomy. In addition we studied a sixth subject who had undergone lower lobectomy and had residual disease in the contralateral lung, and results from the diseased lung were discarded. At the same overall volume, lungs that had undergone lobectomy were more expanded than contralateral control lungs, and their washout half times were prolonged more than could be accounted for by their increased functional residual capacity-to-total lung capacity ratio. In subjects with upper lobectomy, apex-to-base gradients of regional lung volume were normal on the operated side when lung expansion was accounted for. In subjects with lower lobectomy, apex-to-base volume gradients were reduced on the side that had undergone resection, suggesting relative overexpansion of basal regions. These interpretations were supported by distributions of regional washout half times and of boluses inhaled at residual volume. We interpreted these results as indicating that both lung weight and lung-chest wall shape interaction determine the distribution of regional lung volumes.

Effect of fenoterol on small airways and regional lung function in asymptomatic asthma.

Lung function tests for small airways were performed before and after inhalation of fenoterol by 11 young asymptomatic asthmatics and in 8 control subjects. In the asthmatics, minimal impairment in the tests was found except for increased expansion of the lower part of the lung (133Xe regional lung volumes) and an "abnormal" distribution pattern of a bolus of Xe inhaled from the residual volume. This suggests enhanced airway closure, especially in the lower area of the lung. Usual therapeutic doses of fenoterol (0.4 to 0.6 mg in puffs) could not correct these abnormalities, but 1.2 mg given to 2 patients resulted in changes similar to those observed in normals. The results suggest that small airway impairment in asymptomatic asthmatics is not only related to enhanced bronchomotor tone, but also to anatomical changes located especially at the base of the lung.

Changes in distribution of ventilation with lung growth.

We systematically studied the effects of varying preinspiratory lung volumes and expiratory flow rates on the alveolar plateau of the single-breath oxygen test in children and adults. With inhalations of oxygen beginning at functional residual capacity (FRC) compared with residual volume (RV), the slope of phase III increased in 52 of 54 children and 6 of 6 adults (mean increase 29.2%, P less than 0.001) but then decreased at preinspiratory volumes greater than FRC. With maximal expiratory flows, the slopes were smaller than slopes from conventional maneuvers in 14 of 15 children by a mean 24.1%, P less than 0.001. These data suggest that apex-to-base differences in regional lung volume are a major determinant of the slope. Slopes (FRC maneuver) decreased as a function of the height of the children (r = -0.73, P less than 0.001), but differences in nitrogen concentration over the alveolar plateau increased with height (r = 0.70, P less than 0.001). This indicates that the apex-to-base differences in regional lung volume increase with lung size. An estimate of mixing efficiency between resident and inspired gas derived from the alveolar plateau increased with height for both RV (r = 0.40, P less than 0.005) and FRC maneuvers (r = 0.45, p less than 0.005) and was greater for FRC than RV (P less than 0.001). These increases in mixing efficiency are consistent with previously demonstrated decreases in closing volume with growth.

Effects of preinsipiratory volume on the nitrogen closing volume test

The effect of varying the preinspiratory volume (V iair; range: 0–75% vital capacity, VC) on the nitrogen closing volume (CV) test was studied in twelve seated subjects, aged 24–62 years. When V iair was increased from 0 to about 12% VC, the height of phase IV, the amplitude of the cardiogenic oscillations, CV and the slope of phase III increased. The height of phase IV and the amplitude of the cardiogenic oscillations showed a maximum at V iair = 12% VC , although the average CV was about 18% VC. While the height of phase IV and the amplitude of the cardiogenic oscillations decreased when V iair was increased above 12% VC, CV did not change and the slope of phase III increased consistently. These results cannot be explained solely by the regional lung volume model of Sutherland et al. (1968). However, if that model is extended to include the assumption that within a region alveoli behind closed airways may be differently expanded, we predict CV to be underestimated at low V iair, independently of the upper to lower concentration difference, in agreement with present findings. This assumption would also explain why the maximal height of phase IV can be obtained at a V iair lower than CV.

Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed prone man.

The intrapulmonary distribution of inspired gas (ventilation/unit lung volume, VI), functional residual capacity (FRC), closing capacity (CC), and the slope of phase III were determined in five awake and five anesthetized-paralyzed volunteers who were in the prone position with the abdomen unsupported. After induction of anesthesia-paralysis, FRC was less in four of five subjects and CC was consistently less. At FRC there was no difference in the vertical gradient of regional lung volumes between the awake and anesthetized-paralyzed prone subjects. Also, there was no difference in VI between the two states. The normalized slope of phase III decreased consistently with induction of anesthesia-paralysis, but the vertical distribution of a 133Xe bolus inhaled from residual volume was not different between the two states. The data of the study are compatible with 1) a pattern of expansion of the respiratory system during anesthesia-paralysis and mechanical ventilation different than that during spontaneous breathing and 2) a more uniform intraregional distribution of inspired gas and/or a different sequence of emptying during anesthesia-paralysis.

Configuration of the chest wall during increased gravitational stress in erect humans

Using magnetometers we measured changes in the dimensions of the rib cage and abdomen in three seated subjects at + 1 G Z, + 2 G Z and two subjects at + 3 G Z. Measurements were made during normal tidal breathing and at a variety of lung volumes during relaxation. We found that changes in thoraco-abdominal shape could be summarized by measuring antero-posterior and lateral diameters at the angle of Louis, the xyphisternal junction and a level 1 cm cephalad to the umbilicus. During increased acceleration, at all lung volumes, antero-posterior diameters decreased and lateral diameters increased at both the angle of Louis and the xyphisternum, the greater change occuring at the lower level. At the umbilicus, a-p diameter decreased while lateral diameter changed little. Changes were small, always being less than 10% of the dimensions measured at + 1 G Z. Cross-sectional area of the rib cage increased slightly. Changes in diameter and cross-section of the rib cage were similar t those observed during a Muller maneuver, which decreased gravitational differences in regional lung volume, while increased acceleration is known to increase these regional volume differences. We conclude that in erect humans the vertical distribution of regional volumes, and by implication regional pleural surface pressure, is independent of chest wall shape.

Regional lung function in spontaneous pneumothorax.

Using xenon-133, we measured regional lung volumes in three seated young men with 25 to 40 per cent pneumothorax. There was no gravitational gradient of regional lung expansion in the lung affected by the pneumothorax. There was no gravitational gradient of regional lung expansion in the lung affected by the pneumothorax, whereas an apex-to-base gradient of regional volume was apparent on the contralateral, normal side. When over-all lung volume increased from residual volume to 20 per cent of vital capacity, there was little volume change in the lungs with pneumothoraces. These lungs received relatively small fractions of boluses inhaled at residual volume and bolus distributuion was even from apex to base on the sides with the pneumothoraces. Regional washout half-times were not prolonged in lungs with pneumothoraces and did not differ from apex to base, whereas in unaffected lungs, half-times at the apex exceeded those at the base. The results indicated that regional volume and half-time gradients were absent when gravitational gradients of pleural surface pressure were abolished by pneumothorax. Lungs with pneumothorax demonstrated uniform airway closure at low lung volumes, and it is suggested that this is the chief cause of ventilation maldistribution in spontaneous pneumothorax.

The interaction of the lung and chest wall in dogs

The deformation of the lung by the chest wall was observed on radiographs of the ribs and interspaces and on morphologic preparations of samples cut from the frozen thorax. The effect of these deformities on the distribution of ventilation and regional lung volume of the underlying lung was determined using Xenon 133. We found that ribs and interspaces deform the lung surface with different radii of curvature, suggesting local differences in pleural pressure and that traction on the thoracic limb caused deformities in the underlying interspaces which were similar to those produced by 20 cm H 2O mouth pressure. Xenon 133 showed that these changes in pressure had no effect on the regional volume or on ventilation distribution in the underlying lung. We conclude that changes in pleural pressure produced by localized deformities exert their effect close to the deformity and that the underlying lung responds to the average pressure exerted over a much larger area of the pleural surface.

Functional scintigraphic radiospirometry. First clinical results in patients with lung diseases

First clinical results of patients with diseases of the lungs. The previous experiences on patients with diseases of the lungs reveal that the regional function diagnostics of the lungs may be extended and improved by functional scintigraphic radiospirometry. Because of the determination of regional lung volumes restrictive lung diseases can be differentiated and analysed more exactly than it has been possible before by the examinations of perfusion and ventilation alone. A further advance of the determination of lung volume is that the question of functional operability can be cleared up exactly. In our opinion the routine use of the functional scintigraphic radiospirometry is justified. A contraindication for this kind of examination should only be pregnancy.

Effect of negative abdominal pressure on regional lung vòlume in supine dogs

Using 133Xe we measured regional lung volumes from apex to base in supine dogs during the application of negative abdominal pressure (−50 cm H 2O). Changes in rib cage shape were monitored with magnetometers. Negative abdominal pressure caused a decrease of 5 % in the cross-sectional area of the upper rib cage and a decrease of 19 % in the cross-sectional area of the lower rib cage. These changes were similar to those observed when the dog was tilted to the erect position. Over the 10 cm of lung examined, control measurements showed a mean apex-to-base gradient of 1.4% TLC/cm, apical regions being more expanded than basal. Negative abdominal pressure increased this gradient to a mean of 2.1 % TLC/cm. This change was in qualitative agreement with measurements of costal pleural surface pressure made in similar experiments by others. However, the changes we observed tended to be smaller than those predicted on the basis of costal pleural surface pressure. Since regional volumes represented the average of the pressures operating on lung regions, it was suggested that during negative abdominal pressure this average differed from pressure measured at the costal surface.

Voluntary changes of thoracoabdominal shape and regional lung volumes in humans.

We measured regional lung volumes from apex to base in humans during changes in thoracoabdominal shape which we monitored with magnetometers. In erect subjects, voluntary changes of shape at FRC did not change regional volume distribution. In supine subjects, the effect of negative pressure applied to the abdomen and a similar thoracoabdominal configuration achieved by voluntary means were studied. The distribution of regional volumes in both situations was the same as that measured during relaxation at the same overall lung volumes. We concluded that neither voluntary changes in shape nor negative abdominal pressure influenced the human pleural pressure gradient. This result, which differed from findings in animals, was probably because the human chest was relatively stiff and behaved with one degree of freedom; all parts of the human rib cage changed dimensions proportionally while negative abdominal pressure distorted the rib cage of animals.

Chest wall distortion and regional lung volume distribution in erect humans.

Using 133Xe measured the regional distribution of FRC and of boluses administered at FRC in seated subjects during relaxation, lateral compression of the lower rib cage, and contraction of the inspiratory muscles so that mouth pressure was 50 cmH2O subatmospheric. Lateral compression increased apex-to-base differences of volume and bolus distribution, suggesting an increase of the apex-to-base gradient of pleural surface pressure. Changes in rib cage shape were measured with magnetometers and were qualitatively similar to those associated with increases in apex-to-base difference of pleural surface pressure in animals. Inspiratory effort decreased apex-to-base difference in volume and induced a similar trend in bolus distribution. Though changes in the rib cage shape were directionally similar, they were much smaller than those associated with decreased pleural surface pressure gradients in animals, and the changes in regional volume we observed were more likely due to forces generated by diaphragmatic contraction. These results were compatible with the apex-to-base gradient of pleural pressure being strongly influenced by shape adaptation between lung and chest wall.