Total Vital Capacity Research Articles

A neuromuscular respiratory outpatient clinic: Patient profile and experience (Beaumont Hospital)

Background Neuromuscular disorders (NMD) such as Duchenne Muscular Dystrophy (DMD) are characterised by slow progressive muscle atrophy and weakness [1]. Weak respiratory muscles, loss of ambulation and mechanical factors, cause a reduction in total lung capacity (TLC) and Vital Capacity (VC). Patients are at risk of developing acute conditions that decrease pulmonary function and in turn trigger acute respiratory failure [2]. Due to advancements in respiratory interventions NMD patients are progressing into an adulthood healthcare setting, there is a need for intervention in this phase of transition [1]. Currently in Ireland, children with NMD are diagnosed in a paediatric setting and transition to adult services without a designated medical consultant. In January 2012 a multidisciplinary Neuromuscular Respiratory Clinic was established in Beaumont Hospital. This is the first clinic of its kind in an adult setting in Ireland.

P.6.1 Clinical and upper limb evaluation at one year of non-ambulant patients with spinal muscular atrophy

Spinal muscular atrophy (SMA) is recessive hereditary disease of the anterior horn cells caused by deletions or mutations of the SMN1 gene. The loss of muscle strength and function in these patients is gradual. The assessment of the upper limbs in non-ambulant neuromuscular patients remains a challenge and data is even scarcer for SMA patients. Our study recruited a total of 23 non-ambulant SMA patients: 12 SMA type II (4 males/8 females) and 11 SMA type III (4 males/7 females) with an average age of 17.08 ± 6.5 (17.11 for SMA II and 17.05 for SMA III). The follow-up was at 6 months and at 1 year and consisted of strength and function evaluation. We used newly designed tools to precisely assess pinch (MyoPinch), grip (MyoGrip) and to assess the flexion/extension movements of wrist and fingers (MoviPlate). Existing measures, such as Motor Function Measure, Tapping, and the Brooke Upper Extremity Functional Rating Scale were also performed. Five patients prematurely terminated the study (one was lost to follow-up, two refused to continue and 2 for other reasons). The Brooke score of the patients was on average 3,7. The median total vital capacity was 45,5% and seven patients were non-invasively ventilated at night. Results demonstrated that assessments were feasible in nearly all upper limbs tested for MyoGrip, MyoPinch and MoviPlate. The results showed better scores of the upper limbs in function than strength. This study demonstrates the feasibility of a panel of upper limb muscle strength and function measures for Spinal Muscular atrophy which can be applied even to extremely weak patients.

Lung disease, T-cells and inflammation in common variable immunodeficiency disorders

Introduction. Besides hypogammaglobulinemia and recurrent infections, abnormalities of T-cells might contribute to lung damage in common variable immunodeficiency disorders (CVID). Materials and methods. In 16 adult patients, the majority of whom had pulmonary abnormalities, we studied T-cell subsets and markers of inflammation in bronchoalveolar lavage fluid (BALF) and blood and their relations with pulmonary function and high resolution computed tomography (HRCT). Results. We demonstrated that some of the lymphocyte abnormalities previously demonstrated in peripheral blood from CVID patients, such as low CD4/CD8 T-cell ratio, were also present in BALF. Moreover, low BALF CD4/CD8 ratio (≤ 1), found in seven patients, was significantly associated with higher blood CD8+ cell count and to lower values of the lung function variables; forced expiratory volume (FVC), total lung capacity (TLC), vital capacity (VC) and residual volume (RV) in % of predicted. The expression of the inflammatory markers HLA-DR and CCR5 on T-cells was significantly higher, and the expression of CCR7 significantly lower, in BALF compared to blood, possibly reflecting an inflammatory/cytotoxic T-cell phenotype within pulmonary tissue in CVID. Furthermore, patients with bronchiectasis had higher concentrations of the pro-inflammatory cytokine TNFα in plasma, compared to those without. Conclusion. Our findings suggest that inflammation and T-cell activation may be involved in the immunopathogenesis of pulmonary complications in CVID.

INFLUENCE OF REPETITIVE LUNG RECRUITMENT MANEUVERS (RM) AFTER CARDIOPULMONARY BYPASS (CPB)

PURPOSE: CPB for cardiac surgery has been implicated in causing atelectasis which is a major cause of intrapulmonary shunting and hypoxemia postoperatively. Total vital capacity maneuver (TVCM) performed before termination of the surgery reduces significantly intrapulmonary shunt but the benefit is rapidly lost in less than 4 hours. The study aimed to test if the repetition of RM for the lungs before and after extubation can reduce intrapulmonary shunt for a longer period after extubation (24 hours).

The smoker?s paradox and the real risk of smoking

No satisfactory explanations have been offered for the smoker's paradox, the greater short-term survival of smokers after a myocardial infarction nor for the large variations in the coronary risk rate for smoking ranging between 1 and 5.9. These discrepancies as well as the smoker's paradox may be caused by different baseline characteristics of smokers and nonsmokers, whereas the usually quoted coronary risk of 2 is derived from studies based on the assumption of equal baseline characteristics. As neither this assumption nor the possibility of unequal starting conditions have been tested, we examined the main cardiovascular risk factors in smoking and nonsmoking boys as near as possible to baseline, at the age of fourteen. This age appeared to be best suited, because boys starting to smoke early are most likely to become regular and heavy smokers. Of 336 boys, 39 had smoked 8.3+/-6.0 cigarettes/day for 15.5+/-11.2 months. Compared to nonsmokers, boys who started to smoke early had lower LDL cholesterol and alpha2-antiplasmin, greater handgrip strength, vital capacity and forced expiratory volume, better perfomance on bicycle ergometry and higher testosterone. The differences in total cholesterol, LDL cholesterol, vital capacity, handgrip strength, testosterone and alpha2-antiplasmin persisted after adjustment for age, body mass, and testosterone. In addition, the differences in perfomance on bicycle ergometry and forced expiratory volume persisted after adjustment for age. These favourable baseline characteristics of those starting to smoke early can explain the smoker's paradox. In addition, they suggest that the individual coronary risk in smokers is considerably higher than 2, because the assumption of equal baseline characteristics of smokers and nonsmokers cannot be upheld.

Intrapulmonary shunt after cardiopulmonary bypass: The use of vital capacity maneuvers versus off-pump coronary artery bypass grafting

Objectives: It has been proved in human subjects and animals that atelectasis is a major cause of intrapulmonary shunting and hypoxemia after cardiopulmonary bypass. Animal studies suggest that shunting can be prevented entirely by a total vital capacity maneuver performed before termination of bypass. This study aimed to test this theory in human subjects and to evaluate possible advantages of off-pump coronary artery bypass grafting. Methods: Twenty-four patients scheduled for coronary artery bypass grafting were randomly assigned to receive no total vital capacity maneuver (control group, n = 12) or standard total vital capacity maneuvers (TVCM group, n = 12). Additionally, 12 consecutive patients undergoing off-pump coronary artery bypass grafting (off-pump group) were studied. Systemic and central hemodynamics, the pattern of breathing, and ventilatory mechanics were evaluated after induction of anesthesia, after sternotomy, after cardiopulmonary bypass and skin closure, and 4 hours after extubation. Results: The use of total vital capacity maneuvers reduced (P <.05) intrapulmonary shunting after termination of cardiopulmonary bypass. However, shunting increased (P <.05) in all groups (control group, 8.2% ± 3.3% vs 25.6% ± 8.1%; TVCM group, 8.7% ± 3.4% vs 24.4% ± 8.5%; and off-pump group, 7.8% ± 2.8% vs 14.0% ± 5.3%) after extubation, but the increase was significantly (P <.05) less pronounced in the off-pump group. Furthermore, pulmonary compliance decreased (P <.05) in all groups except the off-pump group after extubation. Duration of hospital and intensive care unit stay was significantly shorter (P <.05) in the off-pump group than in the other groups. Conclusion: The development of intrapulmonary shunting and hypoxemia after coronary artery bypass grafting can be substantially reduced by performance of total vital capacity maneuvers while patients are mechanically ventilated. However, off-pump coronary artery bypass surgery is superior in preventing shunting and hypoxemia after bypass grafting in the immediate and early postoperative periods, probably leading to substantially shorter intensive care unit and hospital stays.J Thorac Cardiovasc Surg 2002;124:732-8

Endovascular stent-graft placement versus conventional open surgery in infrarenal aortic aneurysm: a prospective study on acute phase response and clinical outcome

Background: For the treatment of aortic aneurysm, stent-graft implantation is an alternative method to open surgery. There is no study comparing both methods with regard to endotoxaemia, the acute phase cascade, and clinical outcome. Methods: In this prospective study, we enrolled 40 patients (34 males, 6 females; mean age 72.1±7.5 [58–92] years) with infrarenal abdominal aortic aneurysm who underwent aortic surgery. Comparable groups of patients were treated with open ( n=20) or endovascular ( n=20) stent-graft implantation. To characterize the inflammatory response, plasma levels of endotoxin, endotoxin-neutralizing capacity (ENC), interleukin-6 (IL-6), C-reactive protein (CRP), and white blood cell count were determined. In all patients, measurements were performed on admission, skin suture, 4 h and from the first to fifth postoperative day. As parameters for the clinical outcome, we assessed daily temperature, lung function, pain, duration of postoperative hospital stay, and morbidity. Wilcoxon rank test was used for statistical analysis. Results: In both groups, a significant increase of endotoxin plasma levels and a decrease of ENC was found already after skin incision. IL-6 levels peaked 4 h postoperatively in both groups, whereas CRP rose at the first postoperative day, reaching a maximum at day 2. Conventionally operated patients had significantly higher plasma levels of endotoxin, IL-6, and CRP and lower ENC during and after surgery than patients with stent-graft implantation. Moreover, patients with endovascular stent grafting had significant less postoperative pain, less restriction of total vital capacity, a shorter hospital stay, and a lower morbidity. Conclusions: Endovascular stent grafting of infrarenal aortic aneurysm seems to be superior not only in terms of the inflammatory response but also in overall clinical outcome.

A Prospective Randomised Study on Endotoxaemia, Mediator Release and Morbidity in Conventional, Compared with Laparoscopic Cholecystectomy

Surgical procedures usually result in elevation of body temperature and changes of blood cell count or electrolyte levels, commonly known as the postoperative acute phase reaction. The present prospective randomised study compares the intensity of the postoperative acute phase reaction and postoperative morbidity in groups of patients who underwent either laparoscopic or conventional cholecystectomy. Conventionally-operated patients had significantly higher endotoxin plasma levels and a lower endotoxin-neutralisation capacity in the plasma 20 min after skin incision. This difference persisted until 6 h postoperatively. The plasma levels of interleukin-6 (IL-6) increased postoperatively, but did not differ between the two groups. C-reactive protein (CRP) increased postoperatively, with a maximum at 48 h after surgery. When comparing both groups, laparoscopically-operated patients had lower CRP-levels. The postoperatively elevated body temperature decreased significantly earlier in laparoscopically-operated patients, whereas there was no statistically relevant difference in the leukocyte count of the two groups. Contrary to studies from other authors, we did not find a significant increase of tumour necrosis factor (TNF-α). Patients with conventional cholecystectorny experienced significantly more postoperative pain, more restriction of total vital capacity and a longer postoperative hospital stay. In conclusion, patients who underwent laparoscopic rather than conventional cholecystectomy had a lower intensity postoperative acute phase reaction, as indicated by lower plasma endotoxin, CRP and body temperature, and a higher endotoxin-neutralisation capacity.

Total lung capacity in Andean highlanders.

Total lung capacity (TLC), residual volume (RV), and vital capacity (VC), as well as related measures of pulmonary function, were assessed in a sample of 39 male and 23 female native highlanders of Aymara ancestry (20.1-28.8 years) who were residing in La Paz, Bolivia (average altitude of about 3,600 m). After controlling for body and chest size, most measures of respiratory function were significantly larger in males than females (P < .05). Absolute TLC (1 BTPS) was significantly larger in the La Paz Aymara males than in highland Peruvian or Tibetan males (P < .05) but, after controlling for body size, TLC was only 1 and 4% larger in the La Paz Aymara than in highland Peruvians or Tibetans, respectively. Also, comparison of the body size-adjusted percentage increases in TLC, VC and RV above U.S. sea-level reference values in selected highland populations indicated that the enhanced TLCs of highlanders are primarily due to an enhancement of RV and secondarily due to an enhancement of VC. © 1994 Wiley-Liss, Inc.

Effect of posture on static lung volumes and pulmonary mechanics in pneumonectomized rabbits

Static lung volumes, lung (CL) and respiratory system compliance (Crs), and the slope of phase III of the single-breath O2 test (slope III) were measured in rabbits in the prone, supine, and right and left lateral positions. Control rabbits, rabbits that had the left lung removed (Px), and rabbits that had the left lung removed and replaced with wax (Px + W) were studied. Surgeries were performed > or = 7 wk before study. Lung volumes, Crs, and slope III were not different among groups. Total lung capacity, vital capacity, residual volume, Crs, and slope III were smallest in all rabbits in the prone position. Functional residual capacity and expiratory reserve volume were unaffected by posture in control rabbits but were larger in Px and Px + W rabbits in the left lateral position. CL was unaffected by posture but was smaller in Px and Px + W rabbits than in control rabbits. Pneumonectomy-induced changes in lung shape altered the effect of posture on functional residual capacity but not on regional lung function, as assessed by the single-breath O2 test.

Heterogeneity of maximal lobar emptying rates in dogs with compensatory lung growth.

Five dogs underwent left pneumonectomy at 10 wk of age, whereas four littermates underwent a sham operation. At 26 wk of age the postpneumonectomy dogs had total lung vital capacity (VC) and lung weight similar to controls, but maximum expiratory flow was reduced. Pressure capsules were glued to right lower (RLL) and right cardiac (RCL) lobes, and alveolar pressures (PA) were measured during forced expiration. In postpneumonectomy dogs RLL and RCL both emptied more slowly than in control dogs, and emptying was especially delayed in RCL, which underwent the most growth. When both lobes deflated together, PA in RCL and RLL were similar in control dogs, but in postpneumonectomy dogs PA in RCL exceeded that in RLL by approximately 3 cmH2O from 80 to 20% VC. Because the higher driving pressure in RCL compensated for the relatively high resistance of RCL, the pattern of lobar emptying was relatively uniform over these lung volumes. This result was compatible with interdependence of lobar maximum expiratory flows. In addition, at PA of 6-10 cmH2O in postpneumonectomy dogs, maximum emptying rates of RCL were less when RCL deflated alone than when RCL and RLL emptied together, again demonstrating interdependence of lobar maximum expiratory flow.

Control of ventilation in elite synchronized swimmers.

Synchronized swimmers perform strenuous underwater exercise during prolonged breath holds. To investigate the role of the control of ventilation and lung volumes in these athletes, we studied the 10 members of the National Synchronized Swim Team including an olympic gold medalist and 10 age-matched controls. We evaluated static pulmonary function, hypoxic and hypercapnic ventilatory drives, and normoxic and hyperoxic breath holding. Synchronized swimmers had an increased total lung capacity and vital capacity compared with controls (P less than 0.005). The hypoxic ventilatory response (expressed as the hyperbolic shape parameter A) was lower in the synchronized swimmers than controls with a mean value of 29.2 +/- 2.6 (SE) and 65.6 +/- 7.1, respectively (P less than 0.001). The hypercapnic ventilatory response [expressed as S, minute ventilation (1/min)/alveolar CO2 partial pressure (Torr)] was no different between synchronized swimmers and controls. Breath-hold duration during normoxia was greater in the synchronized swimmers, with a mean value of 108.6 +/- 4.8 (SE) vs. 68.03 +/- 8.1 s in the controls (P less than 0.001). No difference was seen in hyperoxic breath-hold times between groups. During breath holding synchronized swimmers demonstrated marked apneic bradycardia expressed as either absolute or heart rate change from basal heart rate as opposed to the controls, in whom heart rate increased during breath holds. Therefore the results show that elite synchronized swimmers have increased lung volumes, blunted hypoxic ventilatory responses, and a marked apneic bradycardia that may provide physiological characteristics that offer a competitive advantage for championship performance.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of lung volume expansion in tetraplegia

The consequences of lung volume expansion on pulmonary function and respiratory muscle strength were examined in eight stable tetraplegic subjects and compared to a control group. Measurements of total lung capacity, vital capacity, static inspiratory and expiratory mouth pressure were made before and after 1 month of treatment with either IPPB or a fixed volume ventilator. Pre-treatment tests were comparable with other reports of lung function in tetraplegia but there was no improvement following either treatment. It is concluded that lung volume expansion alone has no major effect on lung function in stable tetraplegia. It is suggested however that it may be more useful in patients with recent injury or in combination with other methods of respiratory muscle training.

Lung statics and connective tissues after penicillamine in bleomycin-treated hamsters.

Penicillamine was administered intraperitoneally to male golden hamsters for 30 days following a single intratracheal dose of bleomycin. Penicillamine treatment increased soluble collagen and decreased glycosaminoglycans in both normal and fibrotic lungs; total collagen and elastin were not significantly changed in normals but were lower in fibrotic animals. The proportions of the different glycosaminoglycans were not affected by penicillamine treatment. When related to body weight, the total lung capacity, vital capacity, and compliance both at low and high lung volumes were increased in animals that received only penicillamine when compared with animals that did not, but interpretation of these results is difficult because penicillamine-treated animals had low body weights. Lung statics were the same in animals that received penicillamine after bleomycin as in those that received bleomycin only, though penicillamine partially reversed the connective tissue expression of the bleomycin lung injury. We conclude that factors other than connective tissue levels are important in determining the mechanical behavior of fibrotic lungs.

Effects of compensatory lung growth in irradiation-induced regional pulmonary fibrosis in the baboon.

Regional pulmonary fibrosis was induced in juvenile baboons by bilateral exposure of the upper lung zones to 3,000 to 4,000 rads of irradiation with cobalt-60. The resulting lesion was studied by physiologic, histologic, and biochemical analyses. Total lung capacity and vital capacity were decreased in irradiated animals compared to nonirradiated control animals. Decreased lung compliance and diffusing capacity among irradiated animals were due to loss of volume alone. Histologically, lobes obtained surgically 6 months after irradiation and at necropsy 12 months after irradiation showed similar changes. Affected areas showed dense collagenous connective tissue around blood vessels and in thickened alveolar septa. Irradiated lobes had significantly decreased dry weight and lobar content of protein and deoxyribonucleic acid. Although lobar collagen content also was decreased at necropsy, the concentration of collagen was increased in fibrotic areas due to greater loss of other tissue components. Lobar elast...

Lung function and risk of myocardial infarction and sudden cardiac death.

In a serach for risk factors for myocardial infarction and sudden cardiac death, the mean total vital capacity as measured at multiphasic health checkups was lower in persons who later had a first myocardial infarction than in risk-factor-matched controls (3.17 vs. 3.29 liters, 395 pairs, P less than 0.05) and non-risk-factor-matched controls (3.16 vs. 3.41 liters, 401 pairs, P less than 0.001). Findings were little affected by age and height adjustment and were similar for sudden cardiac death. The first-second vital capacity was also inversely related to later development of these conditions, but the ratio of that measurement to total vital capacity was not. Heavy smoking, productive cough, exertional dyspnea and cardiac enlargement were associated with diminished total capacity. However, exclusion of subjects with these findings did not reduce the predictive value of total vital capacity. Diminished vital capacity deserves continued attention as a possible coronary risk factor. Its relation to subsequent coronary events is not well explained.

Vital capacity and congestive heart failure. The Framingham study.

This report is concerned with an assessment of the utility of the vital capacity in anticipating the occurrence of congestive heart failure in susceptible persons before overt symptoms and signs. To this end, an examination of the relation of routinely measured biennial vital capacities to subsequent incidence of clinically overt myocardial decompensation over the next two years was undertaken. In 5209 persons so evaluated over an 18 year period it was found that risk of congestive heart failure varied over a 10-fold range in inverse proportion to their vital capacity (standardized for height) in persons still free of clinical evidence of myocardial decompensation. Also, among persons at high risk of failure (due to coronary disease, hypertension or rheumatic heart disease) chances of developing congestive failure were doubled in men with low vital capacities and tripled in women. Examination of the net contribution of vital capacity to risk of congestive failure revealed that a low vital capacity was associated with development of congestive failure even after taking into account other contributing factors including blood pressure, relative weight, pulse rate, cigarette smoking, heart enlargement on X-ray, ECG-LVH, blood glucose and age. Both a persistently low and a recent fall in vital capacity were associated with increased risk of congestive failure. Obstructive lung disease was not a factor in either case since FEV 1 /total vital capacity (TVC) was unrelated to congestive heart failure incidence. The simple total vital capacity thus appears to have considerable utility as a practical, noninvasive office procedure for evaluating failing left ventricular performance.

Physiologic diagnosis of subclinical emphysema.

The present study was designed to determine whether screening pulmonary function tests could establish a diagnosis of emphysema that was clinically unsuspected in patients undergoing thoracotomy for a localized surgical problem. Seven patients had significantly reduced single-breath diffusing capacity for carbon monoxide (36 to 69 per cent of predicted) and abnormalities in maximal expiratory flow-volume curves, especially at small lung volumes. Maximal expiratory flow was only slightly reduced at 20 per cent of total vital capacity exhaled (57 to 90 per cent of predicted), but was markedly reduced (17 to 46 per cent of predicted) at 80 per cent of total vital capacity exhaled. Despite these physiologic abnormalities, all patients had normal or questionably abnormal values for vital capacity, total lung capacity, forced expiratory volume in one second, and airway resistance. Anatomic studies of lobes or lungs removed within a week after physiologic studies revealed diffuse emphysema in these 7 patients. T...

Study of lung function changes among different grades of byssinosis.

<b>El-Sadik, Y. M., Moselhi, M., El-Hinady, A. R., and Mostafa, M. N. (1972).</b><i>Brit. J. industr. Med.,</i><b>29,</b> 184-187. <b>Study of lung function changes among different grades of byssinosis.</b> This study comprised 80 workers of whom 50 are byssinotics, 15 are chronic asthmatic bronchitics, and 15 are free of chest symptoms. A comparison of the changes in forced expiratory volume in one second due to exposure in the first working day in the week among them (80 workers) showed a greater reduction in byssinotics than among the others. Reduced maximum expiratory flow rates were found only in byssinotics. Independent of exposure, only third-grade byssinotic cases (22 out of 50) showed changes in predicted vital capacity, residual volume, total lung capacity, three seconds per cent vital capacity, total vital capacity timed in seconds, and air velocity index. The pattern of changes in these lung functions is mostly obstructive; only two cases showed the pattern of restrictive disease. This study denotes that two types of changes in pulmonary functions occur due to byssinosis. The first type is a temporary change in pulmonary functions which occurs only on exposure to the aetiological factor (cotton or flax dust). This type occurs among all grades of the disease. The nature of this type is obstructive. The second type of change is permanent. This type occurs only among the third grade of the disease and is not dependent on immediate exposure. This type of change is mostly obstructive but may show some restriction.

Retinal Field Shrinkage, Age, Pulmonary Function, and Biochemistry

Retinal field shrinkage was studied with Goldmann perimetry in 144 healthy Ss of the Normative Aging Study. It has been shown that manipulation of the O2 content of inspired air to the level of hypoxia resulted in shrinkage of the visual field, attributable to reduction in O2 tension below the high metabolic requirements of the retina. In the present investigation the question was raised whether this effect occurs when breathing ordinary air, on the basis of normal variability in pulmonary function tests. Significant relationships were given by total vital capacity and FEV with age held constant. In addition the effect of a number of biochemistry variables was explored. Higher serum pepsinogin had a significant effect with pulmonary and age effects controlled. This may be related to physique since tall, lean men have been shown to have higher serum pepsinogen. The failure of serum cholesterol to figure significantly suggests that retinal field shrinkage is not due to atherosclerosis.