Significant Decrease In Vital Capacity Research Articles

Vital Capacity in Different Body Postures among Medical Students

Background: Cross legged sitting posture (sukhasana, yogic) is normal sitting posture in India, Nepal and some neighboring countries. This posture is also claimed to deepen breath. However, not many studies have been documented to observe if there is any difference in vital capacity (VC) of lungs in standing, sitting erect posture in chair, and sitting erect in crossed legged posture. So, our aim is to compare the vital capacity in standing, sitting erect posture in chair, and crossed legged sitting posture. Methods: Forty medical and paramedical students (20 males and 20 females) of Nobel medical college were selected for the study. After selecting the students as per selection criteria, vital capacity was measured with spirometer in standing, sitting erect on chair (palms facing up and down) and sitting erect in crossed legged posture (palms facing up and down). One way ANOVA followed by post hoc analysis was done to compare the vital capacity among different postures. Data were expressed as Mean ± SD. p value <0.05 was considered significant. Results: Significant decrease in vital capacity was observed when posture changed from standing to erect sitting posture (sitting with palms facing up), {(2242.50ml ±155.830 vs 2095.0ml± 181.29) p=0.05} in females only. No significant changes were seen between erect sitting posture and crossed legged sitting posture in both palms facing up and down conditions. Conclusion: Vital capacity was highest in standing posture and lowest in erect sitting posture with palms facing up only in females. Though statistically not significant, among sitting postures, the vital capacity was high in crossed legged posture compared to sitting erect in chair in both males and females.

Effect of obesity on pulmonary functions in young adults with gender differentiation

Background: Respiratory diseases are among the comorbidities associated with obesity. According to changes in their lifestyles, young people are more likely to become obese. This correlation between obesity and respiratory diseases is particularly concerning for young people, as their lifestyle choices play a significant role in their overall health. Factors such as sedentary behavior, unhealthy eating habits, and a lack of physical activity contribute to the increased likelihood of obesity in this age group. Aims and Objectives: The objective of the study was to compare the respiratory fitness levels of obese males and females to evaluate the effect of obesity on respiratory fitness in young people. Materials and Methods: In this research study, 100 young adults of age group 18–25 years from medical college were examined. Two groups were made one group consisted of 50 adults with obesity and another group of 50 controls, encompassing both males and females. We have used body mass index and waistto-hip ratio to decide obesity. Vital capacity, peak expiratory flow rate (PEFR), and respiratory rate were measured in them. Results: Comparing the obese group to the control group, a significant decrease in vital capacity (2.50 ± 0.57 vs. 2.82 ± 0.61; P = 0.01*) and PEFR (487.44 ± 94.91 vs. 586.40 ± 77.78; P ≤ 0.001**). When comparing the vital capacity and PEFR of males and females who were obese, we observed that the females had a considerably reduced vital capacity (2.35 ± 0.51 vs. 2.67 ± 0.59; P < 0.05*) and reduced PEFR (400.00 ± 69.10 vs. 487.44 ± 94.91; P < 0.001**) than obese males. Conclusion: The findings indicate that young obese people, male and female alike, have a higher likelihood of developing respiratory comorbidities in the future. Compared to obese males, obese females are more vulnerable. Therefore, by promoting physical fitness among young people, we can help reduce the risk of developing respiratory comorbidities later in life. It is crucial to prioritize their health and provide them with the necessary support and resources to maintain a healthy lifestyle.

Results of quantitative chest-CT in chronic pulmonary graft-vs.-host disease (cGvHD) 3 years after allogeneic stem cell transplantation.

To quantify lung parenchymal changes in symptomatic patients with chronic pulmonary graft-versus-host disease 3 years after allogeneic stem cell transplantation (allo-SCT) by means of CT-densitometry (CTD) and to compare results with those of established pulmonary function tests (PFT). The study group consisted of 26 patients with pulmonary cGvHD (19 males, 7 females; mean age, 49.29±15.89; range, 19-72 years). The diagnosis was based on clinical symptoms, PFT and chest-CT findings. CTD and PFT were performed both in the pre- and post-transplantation setting and results compared with each other. CT scans were obtained during suspended deep inspiration including the whole lungs. The mean lung attenuation (MLD), low attenuation values (LAV) and distribution of focal parenchymal abnormalities compatible with emphysema (HU <-950) were quantitatively calculated with histograms and graphics. On PFT, total lung capacity (TLC), residual volume (RV), vital capacity (VC), forced expiratory volume in 1 s (FEV1s) and diffusion capacity for carbon monoxide (DLCOSB) were registered. Changes in end-inspiratory lung volume and density (MLD and LAV) in symptomatic cGvHD patients in mean three years after allo-SCT proved all not significant, but there was a clear trend towards an increase in lung volume and a decrease in lung attenuation. These results were similar throughout all classes of bronchiolitis obliterans (BO) by cGvHD. PFT showed a significant decrease in VC, FEV1s but only a minimal decrease in DLCOSB. Changes in FVC after stem cell transplantation correlated with changes in LAV (r=0.649, P=0.031). Predicted VC correlated with changes in LAV (r=0.771, P=0.005). There was a correlation between the absolute difference of FEV1 and DLCOSB (r=0.64, P=0.14) before and after stem cell transplantation. End-inspiratory phase CT lung parenchyma quantification in symptomatic patients with pulmonary cGvHD 3 years after allo-SCT shows discrete changes over the pre-transplantation setting representing airway obstruction, mirroring airflow limitation on PFT. Its use enables exclusion of relevant parenchymal destruction (emphysema-equivalent lung density) at this time.

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection

BackgroundInterscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function.MethodsThis was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block.Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test.ResultsThe spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p <0.001, Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported.ConclusionA different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients.Trial registrationGerman Clinical Trials Register (DRKS number 00009908, registered 26 January 2016).

Pulmonary Functions after Injection Sclerotherapy of Esophageal Varices and after Band Ligation

Aim of the study: To study changes in pulmonary function tests after esophageal variceal injection sclerotherapy in comparison to changes after esophageal variceal band ligation. Patients & methods: This study was designed as non randomized controlled study. Thirty patients with hepatic cirrhosis & portal hypertension who were admitted to Hepatology, Gastroenterology and Infectious Diseases department , Benha university hospital for elective esophageal variceal therapy (secondary prophylaxis) were classified into group I:15 patients treated with sclerotherapy by using 5-15 ml ethanolamine oleate and group II:15 patients treated with band ligation. Patients were subjected for full clinical evaluation including history, general, chest, and abdominal examination. Laboratory and radiological investigation including complete blood count, liver function tests, kidney function tests and blood sugar and plain chest x-ray (P.A. and lateral views) were done. Pulmonary function tests and arterial blood gasses were done before, one day after and one week after the procedure. Results: The results revealed , significant decrease in vital capacity in group I one day after injection ( p ˂ 0.05),but no significant decrease in vital capacity in group II. There was a significant decrease in PaO2 in group I one day after injection sclerotherapy ( p ˂ 0.05) but no significant changes in group II and no significant changes in PaCO2 in both groups one day after the procedures. The study has also revealed no significant changes in FVC,FEV1/FVC and PaCO2 in group I and group II after procedures. The study revealed significant linear correlation between the decreases in PaO2 and the percentage decrease in vital capacity( p ˂ 0.05). One week after procedure, pulmonary functions that has been affected in group I returned back to baseline values. Conclusions: esophageal injection sclerotherapy produces restrictive defect (decrease in PaO2 and vital capacity) in pulmonary functions one day after injection and improved within one

Is routine postoperative enteral feeding after oesophagectomy worthwhile?

A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether, in patients undergoing an oesophagectomy for cancer, immediate postoperative enteral feeding (via percutaneous jejunostomy or nasojejunostomy) provides better patient outcomes as compared to waiting until oral feeding can be instituted. Four randomized controlled trials represented the best evidence to answer the clinical question. The first study randomized 25 patients into enteral feeding via jejunostomy (n = 13) versus a routine diet without jejunostomy (n = 12). The authors found no statistical difference in outcomes including length of stay, anastomotic complications and mortality. They did not report any catheter-related complications. A second study included patients undergoing an oesophagectomy or a pancreatodudenectomy, randomized to immediate postoperative jejunostomy feeding (n = 13) or remaining unfed for 6 days (n = 15). They reported one incident of detachment of the catheter from the abdominal wall. They also noted a statistically significant decrease in vital capacity and FEV1 in enterally fed patients. There was no difference in length of stay or anastomotic complications. They concluded that there was no indication for routine use of immediate postoperative enteral feeding in those patients without significant preoperative malnutrition. A third report randomized their post-oesophagectomy patients into enteral feeding via jejunostomy (n = 20) versus crystalloid only (n = 20). The also found no difference in length of stay, anastomotic leak rate or mortality. One catheter was removed due to concerns over respiratory function. They also concluded that there was no measurable benefit in early enteral feeding. The last of these 4 studies randomized patients into naso-duodenal feeding (n = 71) and jejunostomy feeding groups (n = 79). As in previous trials, they found no statistically significant difference between length of stay or anastomotic leak rates. Mortality was higher in the jejunostomy group, although the team did not attribute the deaths to the catheter. They found both methods equally effective in providing postoperative nutrition. In summary, all the trials concluded that routine postoperative enteral nutrition was feasible, but there was no evidence suggesting that it conferred any clinical benefits.

Effect of Mycophenolate Mofetil on Pulmonary Function in Scleroderma-Associated Interstitial Lung Disease

We sought to determine the effectiveness of mycophenolate mofetil (MMF) in scleroderma- associated interstitial lung disease (SSc-ILD). We retrospectively identified patients who met criteria for systemic sclerosis, had evidence of SSc-ILD on chest CT, received > 1 g/d of MMF for >or= 6 months, and had pulmonary function data available. Vital capacity (VC) and diffusion capacity of the lung for carbon monoxide (Dlco) at treatment onset were compared with VC and Dlco values 12 months before and 12 months after treatment onset. Twelve-month values were imputed from regression lines generated using all VC and Dlco measurements made in the 24-month period either prior to or following treatment onset. Among 13 patients who met inclusion criteria, MMF was associated with a significant improvement in VC (mean, + 159 mL; confidence interval [CI], + 30 to + 289 mL; and + 4% of the predicted normal value; CI, + 2 to + 7%) after 12 months of treatment. In contrast, patients had a significant decrease in VC (mean, - 239 mL; CI, - 477 to - 0.5 mL; and - 5% of the predicted normal value; CI, - 11 to - 0.3%) in the 12 months prior to MMF treatment. Dlco did not change significantly during MMF treatment (mean, + 1% of the predicted normal value; CI, - 2 to + 5%) but decreased significantly in the 12 months prior to treatment (mean, - 5% of the predicted normal value; CI, - 10 to - 1%). These retrospective data suggest MMF improves VC in patients with SSc-ILD.

Disminución de la capacidad vital en el período postoperatorio de la craneotomía electiva

To assess the vital capacity (VC), tidal volume, minute volume and respiratory rate during the first four postoperative days of elective craniotomy and how they are correlated with smoking, associated diseases and respiratory symptoms. Ninety-four patients were initially evaluated for elective craniotomy and they were included in this study only if they presented normal consciousness level and spontaneous breathing at the first postoperative. The preoperative and postoperative evaluations comprised physical examination and ventilometry up to the fourth postoperative. The repeated measures analysis of variance was used to the ventilation measurements. The significance level adopted for all the statistical tests was p = 0.05. Sixty-two patients were included in this study. There was a 20% fall in the VC from the first to the third postoperative (p = 0.001). Patients with systemic arterial hypertension presented in the preoperative period a lower mean VC (2.59 L) than the patients without (3.28 L) (p = 0.045). Smokers presented a lower mean VC (2.65 and 1.95 L) than the nonsmokers (3.13 and 2.43 L), both in the preoperative and in the postoperative, but with no statistic significance (p = 0.090). After elective craniotomy, there is a significant decrease in VC immediately after surgery, improving gradually thereafter; there was no difference in VC between the smoking and nonsmoking patients in the pre- and postoperative as well.

Pulmonary function pre- and post-total laryngectomy.

Pulmonary function pre- and post-total laryngectomy was assessed in 16 patients without overt inspiratory stridor preoperatively. It could be shown that total laryngectomy is associated with a significant decrease in vital capacity and in an increase in inspiratory flow-volume values 9 days postoperatively. The inspiratory values tended to increase slightly over the next half year. The measured expiratory flow-volume values were preoperatively already significantly lower than the predicted values, and no significant changes could be observed immediately after the operation nor after 6 months. These alterations have to be taken into account when judging the pulmonary function after total laryngectomy.

Quality of life following esophagectomy with three-field lymphadenectomy for carcinoma, focusing on its relationship to vocal cord palsy.

To clarify the quality of life of patients who underwent esophagectomy for carcinoma by right thoracotomy, laparotomy and cervical anastomosis, 116 patients who were cancer free at the time of mailing a questionnaire were analyzed. A significant decrease in vital capacity for 3 years postoperatively, as well as in the percentage of ideal body weight, between 3 and 5 years were observed in 57 patients with three-field lymphadenectomy. Patients' quality of life undergoing three-field dissection was worse than those with less radical lymphadenectomy (59 cases) in terms of the performance status and difficulty in talking at 60 months or more postoperatively. Around 20% of all patients reported severe hoarseness due to permanent recurrent nerve paralysis, resulting in poor quantity of food intake at 24 months or less postoperatively and restricted daily activity and difficulty in talking at 60 months or more after the operation. When a patient suffers from vocal cord insufficiency caused by permanent paralysis of the recurrent nerve, early treatment before discharge from the hospital should be performed to improve the quality of life of such a patient.

The Ventilatory Response to Arm Elevation of Patients With Chronic Obstructive Pulmonary Disease

Although arm activity is poorly tolerated by patients with COPD, the ventilatory response to arm elevation alone is not well understood. We therefore studied the ventilatory response to arm elevation using a customized arm support sling to eliminate the effect of an increase in metabolic activity that might be attributable to independent arm elevation and used leg exercise to increase metabolic activity. During arm elevation at rest, there was a significant decrease in vital capacity (180 ml) and a small decrease in functional residual capacity (120 ml) as measured by body plethysmography. Minute ventilation was unchanged. When supported arm elevation (SAE) was compared with the control arm position (CAP), minute ventilation was unchanged although the pattern of breathing became more rapid and shallow (mean +/- SD, SAE vs CAP: fb = 17.9 +/- 5.3 vs 16.2 +/- 4.8 breaths.min-1; VT = 533 +/- 126 vs 579 +/- 142 ml; p < 0.05). During steady-state leg exercise, the increase in VO2, VCO2 and VE did not differ between SAE and CAP; however, both fb and VT changed toward a more rapid, shallow pattern of breathing (SAE vs CAP: fb = 24.3 +/- 3.0 vs 22.8 +/- 3.5 breaths.min-1; VT = 990 +/- 293 vs 1,081 +/- 309 ml; p < 0.05). During unsupported arm elevation VO2, VCO2, and VE, and fb were significantly greater than during the CAP. Approaches that train arm muscles and strategies that either support arm muscles or allow for frequent rests during upper arm activity may improve the endurance and the quality of life for COPD patients.

Effects of water temperature on pulmonary volumes in immersed human subjects

Pulmonary volumes and capacities have been measured at three water temperatures (Tw = 25, 34, 40 °C) in standing subjects immersed up to the shoulders. The comparison of data obtained in air with those obtained in thermoneutral immersion (Tw = 34 °C) confirms the results previously published in several studies. The comparison of data obtained in immersion at different Tw shows: 1. 1. A significant decrease in vital capacity (VC) with bath temperature (VC 40 °C > VC 34 °C > VC 25 °C). The same decrease is observed in the inspiratory reserve volume (IRV) while the expiratory reserve volume (ERV), the residual volume (RV) and the functional residual capacity (FRC) do not vary. 2. 2. A significant decrease in maximum breathing capacity (MBC) with bath temperature (MBC 40 °C > MBC 25 °C). 3. 3. A significant increase in tidal volume (VT) in cold or hot water compared to thermoneutral water (V t40 °C >V t34 °C; V t34 °C < V t °C) during quiet breathing. Breathing frequency does not change, thus ventilation (V̇) follows the same evolution as V t. The relative abdominal (ABD) contribution to V t, estimated by a double belt inductance plethysmograph, is reduced at T w = 25 °C but unchanged at T w = 40 °C compared to thermoneutral bath. Beside variations in the metabolic state, the variations of the pulmonary volumes as a function of T w are estimated to be mainly due to alterations in respiratory muscles functioning.

Effect of rib cage and abdominal restriction on total respiratory resistance and reactance.

In 14 healthy male subjects we studied the effects of rib cage and abdominal strapping on lung volumes, airway resistance (Raw), and total respiratory resistance (Rrs) and reactance (Xrs). Rib cage, as well as abdominal, strapping caused a significant decrease in vital capacity (respectively, -36 and -34%), total lung capacity (TLC) (-31 and -27%), functional residual capacity (FRC) (-28 and -28%), and expiratory reserve volume (-40 and -48%) and an increase in specific airway conductance (+24 and +30%) and in maximal expiratory flow at 50% of control TLC (+47 and +42%). The decrease of residual volume (RV) was significant (-12%) with rib cage strapping only. Abdominal strapping resulted in a minor overall increase in Rrs, whereas rib cage strapping produced a more marked increase at low frequencies; thus a frequency dependence of Rrs was induced. A similar pattern, but with lower absolute values, of Rrs was obtained by thoracic strapping when the subject was breathing at control FRC. Xrs was decreased, especially at low frequencies, with abdominal strapping and even more with thoracic strapping; thus the resonant frequency of the respiratory system was shifted toward higher frequencies. Partitioning Rrs and Xrs into resistance and reactance of lungs and chest wall demonstrated that the different effects of chest wall and abdominal strapping on Rrs and Xrs reflect changes mainly of chest wall mechanics.

Resting Lung Function in Children after Repair of Tetralogy of Fallot

Children with tetralogy of Fallot had pulmonary function tests (PFT) after intracardiac repair (ICR). According to the age at time of ICR and to the existence or not of palliative surgery preceding ICR, they were divided into three groups. Group 1 had ICR at a mean of one year one month of age (range four months to one year seven months), that is, during the active period of postnatal lung growth. Groups 2 and 3 had ICR later in childhood, that is, respectively, at four years seven months (range two years nine months to 11 years 9 months) and at five years four months (range two years seven months to 11 years five months). In group 3, ICR was preceded by palliative surgery. The PFT at rest included measurement of lung volumes (functional residual capacity), vital capacity (VC), dynamic or static compliance (CL), total pulmonary resistance, lung transfer factor for CO (TLCO) and blood gases. Group 1 had normal lung function suggesting that early repair of TOF saves lung development. In groups 2 and 3, significant decrease in VC(p less than 0.01) and CL (p less than 0.01) were found suggesting impaired alveolar growth. Additional defect in TLCO (p less than 0.01) in group 3 suggested that palliative surgery induces abnormal vascular growth. Thus, the present functional results suggest repair of TOF during the two first years of life, ie, the active period of postnatal lung growth.

Respiratory Tolerance of Bisoprolol and Metoprolol in Asthmatic Patients

The respiratory tolerance of the beta 1-adrenoceptor-selective blockers bisoprolol and metoprolol was investigated in eight male asthmatic patients. The interaction with the bronchodilatory effect of the beta 2-adrenoceptor-selective agonist terbutaline was studied to compare the beta 1-adrenoceptor selectivity of 10 and 20 mg bisoprolol and 100 mg metoprolol. The three beta-blocker doses caused a significant decrease in heart rate at rest. Systolic and diastolic blood pressure decreased significantly after administration of 20 mg bisoprolol and 100 mg metoprolol, but not after administration of 10 mg bisoprolol. Both beta-blockers caused an increase in bronchoconstriction, as measured by a significant fall in peak expiratory flow rate (PEFR). Only 10 mg bisoprolol caused a significant decrease in vital capacity (VC) and forced expiratory volume in 1 s (FEV1). Bronchoconstriction was rapidly reversed by inhalation of terbutaline in all patients. There were no differences between the responses of FEV1, VC, and PEFR to terbutaline with any of the beta-blockers, indicating a good degree of beta 1-adrenoceptor selectivity of 10 and 20 mg bisoprolol and 100 mg metoprolol in humans.

Vital capacity, exercise performance, and blood gases at altitude as related to age.

Vital capacity (VC) rarely may decrease 35-60% in healthy mountain climbers associated with high-altitude pulmonary edema (HAPE). In the age range 58-71 yr, five of six men during a week or more on White Mt. in 1962 had decreases in VC from 20 to 32% without frank symptoms of HAPE, Dill, one of the five, had decreases in VC again on White Mt. in 1977 and 1978. Yet none of 11 young climbers on White Mt. studied by Hultgren (personal communication) had a significant decrease in VC. Dill's arterial O2 saturation at age 87 at 485 Torr was about 79% in rest and 74% when VO2 was 0.74 ml/min.kg. His aerobic capacity at age 87 yr was 18 ml/min.kg at 695 Torr and 15 at 485 Torr.