Spontaneous Breathing Conditions Research Articles

Exploratory analysis of spontaneous versus paced breathing on heart rate variability in veterans with combat-related traumatic injury.

Respiration is a crucial determinant of autonomic balance and heart rate variability (HRV). The comparative effect of spontaneous versus paced breathing on HRV has been almost exclusively explored in healthy adults and never been investigated in an injured military cohort. To examine the effect of spontaneous versus paced breathing on HRV in veterans with combat-related traumatic injury (CRTI). Observational cohort study. ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study, Stanford Hall, UK. The sample consisted of 100 randomly selected participants who sustained CRTI (eg, amputation) during their deployment (Afghanistan 2003-2014) and were recruited into the ongoing ADVANCE prospective cohort study. Not applicable. HRV was recorded using a single-lead ECG. HRV data were acquired during a sequential protocol of 5-minute spontaneous breathing followed immediately by 5 minutesof paced breathing (six cycles/minute) among fully rested and supine participants. HRV was reported using time domain (root mean square of successive differences), frequency domain (low frequency and high frequency) and nonlinear (sample entropy) measures. The agreement between HRV during spontaneous versus paced breathing was examined using the Bland-Altman analysis. The mean age of participants was 36.5 ± 4.6 years. Resting respiratory rate was significantly higher with spontaneous versus paced breathing (13.4 ± 3.4 vs. 7.6 ± 2.0 breaths/minute; p < .001), respectively. Resting mean heart rate and root mean square of successive differences were significantly higher with paced breathing than spontaneous breathing (p < .001). Paced breathing significantly increased median low frequency power than spontaneous breathing (p < .001). No significant difference was found in the absolute power of high frequency between the two breathing protocols. The Bland-Altman analysis revealed poor agreement between HRV values during spontaneous and paced breathing conditions with wide limits of agreement. Slow-paced breathing leads to higher HRV than spontaneous breathing and could overestimate resting "natural-state" HRV.

Successful resection of bilateral parafalcine meningioma with unilateral interhemispheric and contralateral transfalcine approach under nonintubated spontaneous breathing conditions: illustrative case.

The best surgical approach for resecting bilateral parafalcine meningioma, as well as the optimal anesthesia and airway management for craniotomy in patients with interstitial pneumonia (IP) for preventing postsurgical exacerbation, remains unclear. A 66-year-old female with a history of multiple relapses of IP underwent craniotomy for resection of a 4.5-cm bilateral parafalcine meningioma located just beneath the inferior sagittal sinus. To avoid mechanical ventilation or high-concentration oxygenation, the entire procedure was performed under nonintubated spontaneous breathing conditions with a supraglottic airway/laryngeal mask airway (SGA/LMA) device. Half of the tumor was resected using the ipsilateral interhemispheric approach, while the remaining half was resected using the contralateral transfalcine approach (CTA). No brain retractors were required. Preoperative embolization contributed toward reducing blood loss and surgery duration. During most of the operation, additional oxygen administration was not required. The postoperative course was uneventful, without exacerbation of the IP. This case demonstrated the utility and feasibility of a unilateral interhemispheric approach combined with CTA for resection of a bilateral parafalcine meningioma. Additionally, this case provides an alternative method of airway and anesthesia management with an SGA/LMA device and nonintubated spontaneous breathing for the prevention of postoperative acute exacerbation of IP.

Establishment and validation of intravenous anesthesia with dexmedetomidine for pigs under assisted spontaneous breathing: A preclinical model of intensive care conditions.

Large animal models are frequently used to investigate new medical approaches. In most cases, animals are kept under general anesthesia and mandatory mechanical ventilation during the experiments. However, in some situations assisted spontaneous breathing is essential, e.g. when simulating conditions in a modern intensive care unit. Therefore, we established an anesthesia regime with dexmedetomidine and midazolam/ketamine in porcine models of assisted spontaneous breathing. The total intravenous anesthesia was used in lung healthy pigs, in pigs with oleic acid induced acute respiratory distress syndrome and in pigs with methacholine induced bronchopulmonary obstruction. We were able to maintain stable conditions of assisted spontaneous breathing without impairment of hemodynamic, respiratory or blood gas variables in lung healthy pigs and pigs with induced acute respiratory distress syndrome for a period of five hours and in pigs with induced bronchopulmonary obstruction for three hours. Total intravenous anesthesia containing dexmedetomidine enables stable conditions of assisted spontaneous breathing in healthy pigs, in pigs with induced acute respiratory distress syndrome and in pigs induced bronchopulmonary obstruction as models of intensive care unit conditions.

1-hour t-piece spontaneous breathing trial vs 1-hour zero pressure support spontaneous breathing trial and reintubation at day 7: A non-inferiority approach

Physiological data suggest that T-piece and zero pressure support (PS0) ventilation both accurately reflect spontaneous breathing conditions after extubation. These two types of spontaneous breathing trials (SBTs) are used in our Intensive Care Unit to evaluate patients for extubation readiness and success but have rarely been compared in clinical studies. We performed a prospective observational study to confirm the hypothesis that 1-hour T-piece SBT and 1-h PS0 zero PEEP (ZEEP) SBT are associated with similar rates of reintubation at day 7 after extubation. A non-inferiority approach was used for sample size calculation. The cohort consisted of 529 subjects invasively ventilated for more than 24h and extubated after successful 1-hour T-piece SBT (n=303, 57%) or 1-h PS0 ZEEP SBT (n=226, 43%). The reintubation rate at day 7 was 14.6% with PS0 ZEEP and 17.5% with T-piece (difference-2.6% [95% confidence interval, -8.3% to 4.3%]; p=0.40). The reasons for reintubation did not differ significantly when compared between patients with 1-h PS0 ZEEP SBT and patients with 1-hour T-piece SBT. Our results suggest that successful 1-hour T-piece and 1-h PSO ZEEP SBTs are associated with similar reintubation rates at day 7.

A Gas-Powered, Patient-Responsive Automatic Resuscitator for Use in Acute Respiratory Failure: A Bench and Experimental Study.

During the COVID-19 pandemic, a need for innovative, inexpensive, and simple ventilator devices for mass use has emerged. The Oxylator (CPR Medical Devices, Markham, Ontario, Canada) is an FDA-approved, fist-size, portable ventilation device developed for out-of-hospital emergency ventilation. It has not been tested in conditions of severe lung injury or with added PEEP. We aimed to assess the performance and reliability of the device in simulated and experimental conditions of severe lung injury, and to derive monitoring methods to allow the delivery of safe, individualized ventilation during situations of surge. We bench-tested the functioning of the device with an added PEEP valve extensively, mimicking adult patients with various respiratory mechanics during controlled ventilation, spontaneous breathing, and prolonged unstable conditions where mechanics or breathing effort was changed at every breath. The device was further tested on a porcine model (4 animals) after inducing lung injury, and these results were compared with conventional ventilation modes. The device was stable and predictable, delivering a constant flow (30 L/min) and cycling automatically at the inspiratory pressure set (minimum of 20 cm H2O) above auto-PEEP. Changes in respiratory mechanics manifested as changes in respiratory timing, allowing prediction of tidal volumes from breathing frequency. Simulating lung injury resulted in relatively low tidal volumes (330 mL with compliance of 20 mL/cm H2O). In the porcine model, arterial oxygenation, CO2, and pH were comparable to conventional modes of ventilation. The Oxylator is a simple device that delivered stable ventilation with tidal volumes within a clinically acceptable range in bench and porcine lung models with low compliance. External monitoring of respiratory timing is advisable, allowing tidal volume estimation and recognition of changes in respiratory mechanics. The device can be an efficient, low-cost, and practical rescue solution for providing short-term ventilatory support as a temporary bridge, but it requires a caregiver at the bedside.

Inspiratory muscles contributions to postural control in healthy older women

It was hypothesized that induced inspiratory muscles effort, by an acute inspiratory resistance load (IRL) use, increases the postural sway and the neuromuscular activity of postural muscles in older adults. Fifteen older women breathed spontaneously, controlled (15 cycles/minute), and with acute IRL (15 cycles/minute and target load of 30 % of maximal inspiratory pressure) in random order. The breathing tasks were performed in an orthostatic position (eyes closed) during one minute on a baropodometer plate to acquire center-of-pressure (COP) oscillations and with electromyography (EMG) recording. The root mean square (RMS) of EMG was calculated. COP oscillations were higher with IRL use than spontaneous and controlled breathing tasks, but not between spontaneous and controlled conditions. EMG activity of Tibialis anterior and Soleus muscles were higher with IRL use in comparison to spontaneous and controlled breathing conditions. In conclusion, IRL use influenced the postural control through increased postural sway and neuromuscular compensation of the lower limbs in older women.

Impaired dynamic cerebral autoregulation in trained breath-hold divers.

Breath-hold divers (BHD) experience repeated bouts of severe hypoxia and hypercapnia with large increases in blood pressure. However, the impact of long-term breath-hold diving on cerebrovascular control remains poorly understood. The ability of cerebral blood vessels to respond rapidly to changes in blood pressure represents the property of dynamic autoregulation. The current investigation tested the hypothesis that breath-hold diving impairs dynamic autoregulation to a transient hypotensive stimulus. Seventeen BHD (3 women, 11 ± 9 yr of diving) and 15 healthy controls (2 women) completed two or three repeated sit-to-stand trials during spontaneous breathing and poikilocapnic conditions. Heart rate (HR), finger arterial blood pressure (BP), and cerebral blood flow velocity (BFV) from the right middle cerebral artery were measured continuously with three-lead electrocardiography, finger photoplethysmography, and transcranial Doppler ultrasonography, respectively. End-tidal carbon dioxide partial pressure was measured with a gas analyzer. Offline, an index of cerebrovascular resistance (CVRi) was calculated as the quotient of mean BP and BFV. The rate of the drop in CVRi relative to the change in BP provided the rate of regulation [RoR; (∆CVRi/∆T)/∆BP]. The BHD demonstrated slower RoR than controls (P ≤ 0.001, d = 1.4). Underlying the reduced RoR in BHD was a longer time to reach nadir CVRi compared with controls (P = 0.004, d = 1.1). In concert with the longer CVRi response, the time to reach peak BFV following standing was longer in BHD than controls (P = 0.01, d = 0.9). The data suggest impaired dynamic autoregulatory mechanisms to hypotension in BHD. NEW & NOTEWORTHY Impairments in dynamic cerebral autoregulation to hypotension are associated with breath-hold diving. Although weakened autoregulation was observed acutely in this group during apneic stress, we are the first to report on chronic adaptations in cerebral autoregulation. Impaired vasomotor responses underlie the reduced rate of regulation, wherein breath-hold divers demonstrate a prolonged dilatory response to transient hypotension. The slower cerebral vasodilation produces a longer perturbation in cerebral blood flow velocity, increasing the risk of cerebral ischemia.

Ultra-short heart rate variability recording reliability: The effect of controlled paced breathing.

Recent studies have reported that Heart Rate Variability (HRV) indices remain reliable even during recordings shorter than 5min, suggesting the ultra-short recording method as a valuable tool for autonomic assessment. However, the minimum time-epoch to obtain a reliable record for all HRV domains (time, frequency, and Poincare geometric measures), as well as the effect of respiratory rate on the reliability of these indices remains unknown. Twenty volunteers had their HRV recorded in a seated position during spontaneous and controlled respiratory rhythms. HRV intervals with 1, 2, and 3min were correlated with the gold standard period (6-min duration) and the mean values of all indices were compared in the two respiratory rhythm conditions. rMSSD and SD1 were more reliable for recordings with ultra-short duration at all time intervals (r values from 0.764 to 0.950, p<0.05) for spontaneous breathing condition, whereas the other indices require longer recording time to obtain reliable values. The controlled breathing rhythm evokes stronger r values for time domain indices (r values from 0.83 to 0.99, p<0.05 for rMSSD), but impairs the mean values replicability of domains across most time intervals. Although the use of standardized breathing increases the correlations coefficients, all HRV indices showed an increase in mean values (t values from 3.79 to 14.94, p<0.001) except the RR and HF that presented a decrease (t=4.14 and 5.96, p<0.0001). Our results indicate that proper ultra-short-term recording method can provide a quick and reliable source of cardiac autonomic nervous system assessment.

A novel particle filtering method for estimation of pulse pressure variation during spontaneous breathing.

BackgroundWe describe the first automatic algorithm designed to estimate the pulse pressure variation (text {PPV}) from arterial blood pressure (ABP) signals under spontaneous breathing conditions. While currently there are a few publicly available algorithms to automatically estimate text {PPV} accurately and reliably in mechanically ventilated subjects, at the moment there is no automatic algorithm for estimating text {PPV} on spontaneously breathing subjects. The algorithm utilizes our recently developed sequential Monte Carlo method (SMCM), which is called a maximum a-posteriori adaptive marginalized particle filter (MAM-PF). We report the performance assessment results of the proposed algorithm on real ABP signals from spontaneously breathing subjects.ResultsOur assessment results indicate good agreement between the automatically estimated text {PPV} and the gold standard text {PPV} obtained with manual annotations. All of the automatically estimated text {PPV} index measurements (text {PPV}_{text {auto}}) were in agreement with manual gold standard measurements (text {PPV}_{text {manu}}) within ±4 % accuracy.ConclusionThe proposed automatic algorithm is able to give reliable estimations of text {PPV} given ABP signals alone during spontaneous breathing.

Non-invasive methods to assess biomarkers of exposure and early stage of pulmonary disease in smoking subjects

Cigarette smoking is the major factor implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD), despite the fact that only susceptible smoking subjects develop this respiratory disease. In the last few years non-invasive techniques such as induced sputum (IS), exhaled nitric oxide (eNO) measurement and exhaled breath condensate (EBC) collection have been successfully established revealing an inflammatory status and oxidative stress indicators in the airways involved in the pathogenesis of several pulmonary diseases. Using these new non-invasive experimental tools recently, several efforts have been made to find new biomarkers in order to assess and monitor early lung damage induced by smoking. Tobacco smoke can acutely reduce eNO levels in healthy smokers and non-smoker subjects so it can play a role in anti-smoking programmes; its increase can be a positive parameter for subjects who are going to stop cigarette smoking and at the same time be used as an anti-smoking indicator. It can be useful to investigate the mechanism of cigarette-induced lung damage in an experimental setting and may potentially be useful for assessing of Environmental Tobacco Smoke (ETS) effects. Markers of oxidative stress have been detected in induced sputum of COPD subjects even though only few studies investigated the use of induced sputum to study smoke effects on the lungs of healthy subjects. Exhaled breath condensate (EBC) obtained by cooling exhaled air under conditions of spontaneous breathing is a promising biological fluid that could provide a real-time assessment of pulmonary pathobiology. The analysis of induced sputum and of exhaled air is feasible and non-invasive, can be useful to identify new biomarkers of exposure or susceptibility in COPD patients to enhance the understanding of airways changes due to current smoking and may be useful to find new biomarkers in order to assess and monitor early lung damage induced by smoke in order to prevent the progression of obstructive disease.

Involvement of the sympatho-vagal balance in the formation of respiration-dependent oscillations in the human cardiovascular system

The effect of deep breathing controlled in both rate and amplitude on the heart rate variability (HRV) and respiration-dependent blood flow oscillations was studied in the forearm and finger-pad skin of healthy 18- to 25-year-old volunteers. In order to reveal the effects of the divisions of the autonomic nervous system on the amplitudes of respiratory sinus arrhythmia (RSA) and skin blood flow oscillations, we studied the indices of the cardiovascular system in two groups of subjects with respectively lower and higher values of the sympatho-vagal balance. This index was calculated as a ratio of low frequency and high frequency HRV spectral power (LF/HF) under the conditions of spontaneous breathing. It was found that, in subjects with a predominant parasympathetic tone, the amplitudes of RSA and the rate of blood flow in the finger-pad skin were higher compared to subjects with a predominant sympathetic tone during respiration with the frequency lower than 4 cycle/min. In the forearm skin, where sympathetic innervation is weaker compared to the finger-pad skin, there were no significant differences in respiration-dependent oscillations of the rate of blood flow in two groups of subjects.

Coupled and reduced dimensional modeling of respiratory mechanics during spontaneous breathing

In this paper, we develop a total lung model based on a tree of 0D airway and acinar models for studying respiratory mechanics during spontaneous breathing. This model utilizes both computer tomography-based geometries and artificially generated lobe-filling airway trees to model the entire conducting region of the lung. Beyond the conducting airways, we develop an acinar model, which takes into account the alveolar tissue resistance, compliance, and the intrapleural pressure. With this methodology, we compare four different 0D models of airway mechanics and determine the best model based on a comparison with a 3D-0D coupled model of the conducting airways; this methodology is possible because the majority of airway resistance is confined to the lower generations, that is, the trachea and the first few bronchial generations. As an example application of the model, we simulate the flow and pressure dynamics under spontaneous breathing conditions, that is, at flow conditions driven purely by pleural space pressure. The results show good agreement, both qualitatively and quantitatively, with reported physiological values. One of the key advantages of this model is the ability to provide insight into lung ventilation in the peripheral regions. This is often crucial because this is where information, specifically for studying diseases and gas exchange, is needed. Thus, the model can be used as a tool for better understanding local peripheral lung mechanics without excluding the upper portions of the lung. This tool will be also useful for in vitro investigations of lung mechanics in both health and disease.

Exhaled breath condensate as a biomonitor for metal exposure: a new analytical challenge

The study of exhaled breath condensate (EBC) obtained by cooling exhaled air under conditions of spontaneous breathing is considered one of the areas with higher interest in respiratory health research. The use of EBC for elemental determination in occupational exposure requires a standard methodological procedure to implement its practice in occupational studies. EBC is an inhomogeneous sample with organic and particulate matter in suspension, which may hamper analytical results reliability. Total reflection X-ray fluorescence and inductive coupled-plasma mass spectrometry (ICP-MS) techniques were chosen as both are multielemental, require small sample volumes and have appropriate detection limits. Estimation of the overall uncertainty in both techniques was carried out using a pool of EBC collected from a group of workers of a lead processing industry to perform precision and trueness studies for K, Mn, Cu, Cd, Sb and Pb. Precision was estimated in terms of repeatability using the native EBC sample pool and trueness in terms of recovery obtained from spiking aliquots of the EBC pool with K, Mn, Cu, Cd, Sb and Pb at different concentrations. Recovery was the most significant contribution to total uncertainty. The overall uncertainties obtained for ICP-MS enabled to discriminate between groups of individuals exposed to different levels of contaminants. Therefore EBC proved to be useful in human biomonitoring.

Spontaneous fluctuations in the peripheral photoplethysmographic waveform: roles of arterial pressure and muscle sympathetic nerve activity

Assessment of spontaneous slow waves in the peripheral blood volume using the photoplethysmogram (PPG) has shown potential clinical value, but the physiological correlates of these fluctuations have not been fully elucidated. This study addressed the contribution of arterial pressure and muscle sympathetic nerve activity (MSNA) in beat-to-beat PPG variability in resting humans under spontaneous breathing conditions. Peripheral PPG waveforms were measured from the fingertip, earlobe, and toe in young and healthy individuals (n = 13), together with the arterial pressure waveform, electrocardiogram, respiration, and direct measurement of MSNA by microneurography. Cross-spectral coherence analysis revealed that among the PPG waveforms, low-frequency fluctuations (0.04-0.15 Hz) in the ear PPG had the highest coherence with arterial pressure (0.71 ± 0.15) and MSNA (0.44 ± 0.18, with a peak of 0.71 ± 0.16 at 0.10 ± 0.03 Hz). The normalized midfrequency powers (0.08-0.15 Hz), with an emphasis on the 0.1-Hz region, were positively correlated between MSNA and the ear PPG (r = 0.77, P = 0.002). Finger and toe PPGs had lower coherence with arterial pressure (0.35 ± 0.10 and 0.30 ± 0.11, respectively) and MSNA (0.33 ± 0.10 and 0.26 ± 0.10, respectively) in the LF band but displayed higher coherence between themselves (0.54 ± 0.09) compared with the ear (P < 0.001), which may suggest the dominance of regional vasomotor activities and a common sympathetic influence in the glabrous skin. These findings highlight the differential mechanisms governing PPG waveform fluctuations across different body sites. Spontaneous PPG variability in the ear includes a major contribution from arterial pressure and MSNA, which may provide a rationale for its clinical utility.

Spatially resolved assessment of serotonin‐induced bronchoconstrictive responses in the rat lung using 3He ventilation MRI under spontaneous breathing conditions

The effect on lung ventilation of bronchoconstriction induced by serotonin (intravenous injection of 50 microg/kg of serotonin) was imaged using a hyperpolarized (3)He MR ventilation protocol in spontaneously breathing rats. Lung function maps assessing airflow obstruction, a key feature in clinical pneumology, were derived from dynamic image series acquired after inhalation of (3)He gas. Dynamic ventilation (3)He MR images spanning a respiratory cycle were obtained using a retrospective cine image reconstruction procedure. Two parameters, defined as signal amplitude and maximum signal decay rate, were derived from the time course of the MR signal for each pixel. These parameters were averaged over regions of interest placed in the lower part of the right and left lungs and submitted to statistical analysis. A homogeneous and significant decrease of signal amplitude and maximum signal decay rate after serotonin injection was observed for each rat on the parametric color maps. The data indicate that dynamic ventilation HP (3)He MRI can be used to assess, in a spatially resolved manner, the ventilation function of spontaneously breathing rats and the effects of agents eliciting short-lasting bronchoconstriction.

Heart rate variability and muscle sympathetic nerve activity response to acute stress: the effect of breathing

Previous research has suggested a relationship between low-frequency power of heart rate variability (HRV; LF in normalized units, LFnu) and muscle sympathetic nerve activity (MSNA). However, investigations have not systematically controlled for breathing, which can modulate both HRV and MSNA. Accordingly, the aims of this experiment were to investigate the possibility of parallel responses in MSNA and HRV (LFnu) to selected acute stressors and the effect of controlled breathing. After data were obtained at rest, 12 healthy males (28 +/- 5 yr) performed isometric handgrip exercise (30% maximal voluntary contraction) and the cold pressor test in random order, and were then exposed to hypoxia (inspired fraction of O(2) = 0.105) for 7 min, during randomly assigned spontaneous and controlled breathing conditions (20 breaths/min, constant tidal volume, isocapnic). MSNA was recorded from the peroneal nerve, whereas HRV was calculated from ECG. At rest, controlled breathing did not alter MSNA but decreased LFnu (P < 0.05 for all) relative to spontaneous breathing. MSNA increased in response to all stressors regardless of breathing. LFnu increased with exercise during both breathing conditions. During cold pressor, LFnu decreased when breathing was spontaneous, whereas in the controlled breathing condition, LFnu was unchanged from baseline. Hypoxia elicited increases in LFnu when breathing was controlled, but not during spontaneous breathing. The parallel changes observed during exercise and controlled breathing during hypoxia suggest that LFnu may be an indication of sympathetic outflow in select conditions. However, since MSNA and LFnu did not change in parallel with all stressors, a cautious approach to the use of LFnu as a marker of sympathetic activity is warranted.

Modeling fetal--maternal heart-rate interaction

The influence of maternal respiration on the occurrence of short-term fetal--maternal heart-rate coordination was examined using a model, which considers both heart-rate characteristics and effects of maternal respiratory sinus arrhythmia. Epochs of fetal--maternal heart-rate coordination were identified in model data produced at varying respiratory rates and compared with epochs found in real data acquired in mother-fetus pairs. The model results suggest that the low incidence of epochs found in the real data at low-breathing rates may be explained by heart-rate characteristics, but that the higher incidence at fast rates must be due to other factors.

In Vivo Imaging of Carbon Nanotube Biodistribution Using Magnetic Resonance Imaging

As novel engineered nanoparticles such as carbon nanotubes (CNTs) are extensively used in nanotechnology due to their superior properties, it becomes critical to fully understand their biodistribution and effect when accidently inhaled. A noninvasive follow-up study would be beneficial to evaluate the biodistribution and effect of nanotube deposition after exposure directly in vivo. Combined helium-3 and proton magnetic resonance resonance (MRI) were used in a rat model to evaluate the biodistribution and biological impact of raw single-wall CNTs (raw-SWCNTs) and superpurified SWCNTs (SP-SWCNTs). The susceptibility effects induced by metal impurity in the intrapulmonary instilled raw-SWCNT samples were large enough to induce a significant drop in magnetic field homogeneity detected in 3He MR image acquired under spontaneous breathing conditions using a multiecho radial sequence. No MRI susceptibility variation was observed with SP-SWCNT exposition even though histological analysis confirmed their presence in instilled lungs. Proton MRI allowed detection of intravenously injected raw-SWCNTs in spleen and kidneys using gradient echo sequence sensitive to changes of relaxation time values. No signal modifications were observed in the SP-SWCNT injected group. In instilled groups, the contrast-to-noise ratio in liver, spleen, and kidneys stayed unchanged and were comparable to values obtained in the control group. Histological analysis confirms the absence of SWCNTs in systemic organs when SWCNTs were intrapulmonary instilled. In conclusion, the presence of SWCNTs with associated metal impurities can be detected in vivo by noninvasive MR techniques. Hyperpolarized 3He can be used for the investigation of CNT pulmonary biodistribution while standard proton MR can be performed for systemic investigation following injection of CNT solution.

Measurement of respiratory pulse transit time variation as an intravascular volume index in simulated hemorrhage.

We examined the usefulness of respiratory pulse transit time (PTT) variation as an intravascular volume index in young, healthy, spontaneous, paced breathing volunteers exposed to simulated central hypovolemia by lower body negative pressure (LBNP). With paced breathing at 0.25 Hz, beat-to-beat finger blood pressure (BP), heart rate (HR), cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR), and PTT were measured non-invasively in 18 healthy volunteers. Graded central hypovolemia was generated using LBNP from 0 to -20, -30, -40, and -50 mmHg. Respiratory PTT variation (PTTV) was calculated as the difference of maximal and minimal values divided by their respective means. Respiratory-frequency PTT variability (PTTRF) using power spectral analysis was also estimated. During LBNP, SV, CO and PTTRF decreased, but PTT, PTTV and TPR increased significantly. PTTV did not correlate with SV changes (r = -0.08, P = 0.52), but PTTRF (r = 0.58, P < 0.01) and PTT (r = 0.43, P < 0.01) did during progressive hypovolemia. PTTRF is more applicable to the changes in intravascular volume than PTT and PTTV, suggesting spectral analysis of PTT might be used as a dynamic preload index in patients with spontaneous and paced breathing condition, which needs further studies.

During exercise non-invasive ventilation in chronic restrictive respiratory failure

Exercise intolerance limits chronic restrictive respiratory failure (CRF) patients from participating in daily activities. The specific modalities that could improve exercise tolerance in these patients remain to be established. To investigate exercise endurance and associated physiological responses with non-invasive ventilation (NIV) during exercise in restrictive CRF patients. Eighteen patients (63+/-11 years, total lung capacity (TLC)=59+/-16% of predicted value) performed maximal exercise in spontaneous breathing conditions (MWLE) and during two constant workload exercise (CWLE) tests at 75% Pmax, with or without NIV in random order. "NIV Responders" were defined by an increase in CWLE duration of more than 50% when using NIV. For the whole group, CWLE duration when using NIV increased from 5.6+/-4.6 to 9.6+/-8.1 min. Increase in CWLE duration correlated with reduction in heart rate and oxygen desaturation, and dyspnea relief during exercise. NIV responders (n=9) showed more severe lung restriction (TLC: 2.6+/-0.7 versus 3.5+/-1.1L; forced vital capacity: 1.0+/-0.16 versus 1.46+/-0.38 L). At the end of MWLE, responders had a lower Vt (0.60+/-0.09 versus 0.89+/-0.34 L), a higher dead-space ratio (0.51+/-0.06 versus 0.38+/-0.12) and lower oxygen pulse (4.5+/-1.2 versus 7.4+/-3.9 ml/beat). In severely restrictive patients, NIV during exercise significantly improved exercise duration and tolerance and increased alveolar ventilation. The enrollment of the patients started before July 1, 2005.