Changes In Ventilation Research Articles

Characterization of diffuse lung function in children with Mycoplasma pneumoniae pneumonia

BackgroundMycoplasma pneumoniae infection accounts for a high proportion of community-acquired pneumonia and the incidence rate of severe M. pneumoniae pneumonia (MPP) has increased year by year. This study investigated the changes in lung diffusion function after M. pneumoniae infection, compared the lung diffusion and ventilation function of children with mild (MMPP) or severe M. pneumoniae pneumonia (SMPP) infections, and explored their clinical significance.ObjectiveTo study the changes in pulmonary ventilation and pulmonary diffusion function in children with MPP, and explore their clinical significance.MethodsData from 97 children with M. pneumoniae pneumonia hospitalized in Chengdu Women and Children's Central Hospital from June 2023 to December 2023 were collected and the participants were divided into an MMPP group (n = 44) and an SMPP group (n = 53). The changes in pulmonary ventilation function and diffusion function were compared between the two groups.ResultsThe Z-scores of forced vital capacity and forced expiratory volume in the first second in the SMPP and MMPP groups were −1.684 ± 0.902 and −1.986 ± 0.818, and 0.164 ± 1.795 and −0.6104 ± 1.276, respectively. In the SMPP group, the two aforementioned indicators were lower than the normal value and significantly lower than those in the MMPP group (P < 0.001). The carbon monoxide diffusion capacity in the SMPP group (−5.931 ± 0.827) was significantly lower than that in the MMPP group (−5.0775 ± 1.1134) (P < 0.001). The forced expiratory flow at 75% vital capacity and the maximum mid expiratory flow in the SMPP group were −2.006 ± 1.2582 and −1.878 ± 1.008, respectively, which were lower than the normal value.ConclusionSMPP results in more severe ventilation dysfunction and diffuse dysfunction than MMPP.

Air Hunger Far Exceeds Dyspnea Sense of Effort During Mechanical Ventilation and a Weaning Trial.

No systematic investigation into dyspnea in patients receiving prolonged ventilation (>21 days) after recovering from critical-illness has been published. To determine magnitude, nature and pathophysiological basis of dyspnea during an unassisted-breathing trial in prolonged-ventilation patients. Dyspnea intensity and descriptor selection were investigated in 27 prolonged-ventilation patients during a 60-min unassisted-breathing trial. Pressure-time product (PTP), respiratory mechanics, and transcutaneous PCO2 (PtcCO2) were also measured. Of 10 patients who reported dyspnea during assist-control ventilation, 9 (90.0%) selected "Not getting enough air" to characterize dyspnea. Tidal-volume setting was lower in dyspneic than non-dyspneic patients: 480.0 versus 559.4 ml (p<0.046). During the unassisted-breathing trial (n=26), patients developed increases in dyspnea (p<0.01) and PtcCO2 (p<0.01), but no change in minute ventilation. Dyspnea score was strongly linked to PtcCO2 (p<0.012) and airway resistance (p<0.013) but not respiratory work (although PTP was almost 3 times higher than normal). At 60 min into the trial, 83.3% of patients selected "Not getting enough air" on its own or in combination with "Too much effort" to describe discomfort whereas only 16.7% selected "Too much effort" on its own (p<0.001). Across the dyspnea spectrum, patients chose "Not getting enough air" overwhelmingly over other descriptor options (p<0.001). Patients developed increases in dyspnea and PtcCO2 but unchanged minute ventilation and work of breathing during an unassisted-breathing trial; patients selected air-hunger descriptors overwhelmingly over excessive effort; the observations support the belief that air hunger results from heightened respiratory-center stimulation combined with incapacity to increase minute ventilation.

Quasi-Steady Water Droplet Heat- and Mass-Transfer With Ventilation, Blowing, and Radiation

Abstract A quasi-explicit analytical model of quasi-steady (QS) water droplet heat- and mass-transfer, including radiation, in a prescribed gaseous environment with velocity slip, i.e., gas flow around the droplet, and high mass-transfer-rate blowing effects has been developed. The model is an extension of an atmospheric science model used for cloud and fog droplets in dilute and near-saturation conditions with negligible velocity slip (ventilation flow) and blowing. The new model includes the effects of ventilation flow, blowing, and change in relative humidity or supersaturation across the diffusion layer surrounding the droplet. Comparisons show significant improvement in accuracy over the conventional model, particularly for conditions of low relative humidity, low pressure, and high radiative flux.

The influence of yoga exercises with voluntary pulmonary ventilation changes on intracranial arterial blood flow

Introduction. Yoga breathing exercises that involve voluntary changes in pulmonary ventilation parameters can potentially influence cerebral circulation due to changes in CO2 content in arterial blood. Objective. To assess the effect of yoga breathing exercises with changes in pulmonary ventilation levels on blood flow parameters in the middle cerebral artery (MCA). Methods. The study included 21 participants, with an average age of 39.5±8.7 years, who were capable of performing yoga exercises at respiratory rates (RR) of 3–3.5/min and 1–1.5/min. For 5 minutes, participants underwent three stages: free breathing (stage 1), breathing with RR=3–3.5/min (stage 2), and breathing with RR=1–1.5/min (stage 3). During stages 2 and 3, the «full breathing» technique, which involves maximum deep inhalation and exhalation, was employed. Respiratory rate (RR), tidal volume (TI), minute ventilation (MV), end-tidal CO2 partial pressure (PetCO2), and oxygen fraction in exhaled air (FeO2) were recorded using spiro-gas analysis. Transcranial duplex scanning was used to measure peak systolic blood flow velocity (Vps), end-diastolic blood flow velocity (Vd), time-averaged maximum blood flow velocity (TAMAX), and resistance index (RI) in the right MCA. The velocity variation index (VVI) was calculated for each stage. Results. Compared to stage 1 (free breathing), stage 2 (RR = 3–3.5/min) showed an increase in MV and FeO2, a decrease in PetCO2, and reductions in Vps, Vd, and TAMAX, with an increase in RI. VVI decreased statistically insignificantly. In stage 3 (RR = 1–1.5/min), compared to stage 1, there was an increase in PetCO2, a decrease in MV and FeO2, and increases in Vps, Vd, and TAMAX, with a decrease in RI. VVI increased significantly. Conclusions. Yoga breathing exercises at respiratory rates of 3–3.5/min and 1–1.5/min result in multidirectional shifts in ventilation and gas exchange parameters, leading to changes in arterial cerebral blood flow (a decrease and increase in blood flow velocity with an increase and decrease in MV, respectively). VVI, reflecting fluctuations in blood flow velocity, increases significantly with reduced MV, likely due to the vasodilatory effect of CO2.

Impact of the estrous cycle on brain monoamines and behavioral and respiratory responses to CO2 in mice.

The prevalence of panic disorder is two to four times higher in women compared to that in men, and hormonal changes during the menstrual cycle play a role in the occurrence of panic attacks. Here, we investigated the effect of the estrous cycle on the ventilatory and behavioral responses to CO2 in mice. Female mice in proestrus, estrus, metestrus, or diestrus were exposed to 20% CO2, and their escape behaviors, brain monoamines, and plasma levels of 17β-estradiol (E2) and progesterone (P4) were measured. Pulmonary ventilation (V̇E), oxygen consumption (V̇O2), and body core temperature (TB) were also measured during normocapnia followed by CO2. Females exposed to 20% CO2 exhibited an escape behavior, but the estrous cycle did not affect this response. Females in all phases of the estrous cycle showed higher V̇E and lower TB during hypercapnia. In diestrus, there was an attenuation of CO2-induced hyperventilation with no change in V̇O2, whereas in estrus, this response was accompanied by a reduction in V̇O2. Hypercapnia also increased the concentration of plasma P4 and central DOPAC, the main dopamine metabolite, in all females. There was an estrous cycle effect on brainstem serotonin, with females in estrus showing a higher concentration than females in the metestrus and diestrus phases. Therefore, our data suggest that hypercapnia induces panic-related behaviors and ventilatory changes that lead to an increase in P4 secretion in female mice, likely originating from the adrenals. The estrous cycle does not affect the behavioral response but interferes in the ventilatory and metabolic responses to CO2 in mice.

Negative pressure breathing: the response of human respiration and circulation to different levels of rarefaction during inspiration.

Negative pressure breathing is breathing with decreased pressure in the respiratory tract without lowering pressure acting on the torso. We lowered pressure only during inspiration (NPBin). NPBin is used to increase venous return to the heart and is considered as a countermeasure against redistribution of body fluids toward the head during spaceflight. Aims of our study were: to obtain quantitative information on NPBin-induced changes in parameters of circulation and respiration in healthy human at various rarefactions; to identify main processes involved in cardiorespiratory response to NPBin. Cardiorespiratory response to 25min of NPBin were studied, rarefaction ranged from -10 to -25cmH2O. Parameters of systemic, cerebral, and peripheral hemodynamics, as well as respiratory and gas exchange parameters, were measured with non-invasive methods (Finometer, impedance cardiography, rheoencephalography, transcranial Doppler ultrasonography, laser Doppler flowmetry, capillaroscopy). Concentrations of endothelin-1, atrial and brain natriuretic peptides precursors in venous blood, O2 and CO2 tensions in arterialized capillary blood were measured. Tidal volume increased, respiratory rate decreased under NPBin with no significant changes in minute ventilation. Group averaged, respiratory rate and tidal volume changed approximately twice relative to their values observed under normal breathing. Despite the decrease in respiratory rate (up to 2-3 breaths/min), the results indicate CO2 wash-out. Changes in respiratory and gas exchange parameters were virtually independent of rarefaction level. Synchronous with breathing oscillations of circulatory parameters increased in amplitude under NPBin, while values of the parameters averaged over NPBin period changed little. Amplitude of oscillations in parameters associated with arteries virtually did not change with increasing rarefaction. Inspiration under NPBin reduced left ventricle stroke volume and arterial blood pressure, increased heart rate. Head blood filling decreased during inspiration under NPBin, the decrease increased almost linearly with increasing rarefaction. Parameters returned to their initial values after the end of inspiration. Peak-to-peak amplitude of oscillations under NPBin ranged: stroke volume 17-25mL, mean arterial pressure 7-9mmHg, heart rate 14-18bpm. Peripheral hemodynamics responded to NPBin little. Changes in stroke volume and central venous pressure during inspiration under NPBin appear to be the major phenomena mediating the effects of NPBin on the cardiorespiratory system.

The impact of different prong-nares ratio on ventilation in COPD patients using nasal high-flow (NHF) – a physiological study

IntroductionNasal high flow (NHF) is a popular technique to provide support in respiratory failure in different conditions. Recently published bench studies have hypothesized that airway pressure can be increased by using different cannula sizes and corresponding prongs resulting in a range of prong-nare ratios. We conducted this study to verify these experimental findings in clinical practice.MethodsWe characterized prong size and flow rate dependent changes in ventilation parameters and changes in hypercapnia in an interventional clinical setting. Outcome parameters included changes in mean airway pressure, tidal volume (TV), respiratory rate (RR), minute volume (MV) and decrease in pCO2. The ventilatory parameters were determined at 20, 30, 40 and 50 l/min with 3 different prong sizes. 20 and 40 l/min and the 3 different prong sizes were used to document the changes in pCO2.ResultsIn this study we demonstrate changes in ventilation with increasing flow rates of NHF. A significant increase in mean airway pressure was seen with every 10 l/min increase in flow rate. Respiratory rate and minute volume (using large prongs) changed significantly with larger increases in flow rate, while tidal volume was not significantly altered. When the flow rate was increased by 20 l/min (i.e. from 20 l/min to 40 l/min) capillary pCO2 decreased significantly. None of the measured values were significantly altered by the prong size used.ConclusionIn summary, we presented strong indications that different prong sizes have no influence on essential respiratory parameters or the elimination of pCO2 when using NHF in COPD patients.

Spatial Distribution and Decadal Variability of 129I and 236U in the Western Mediterranean Sea

This study investigates the spatial and temporal distribution of the artificial radionuclides 129I and 236U in the Western Mediterranean Sea, focusing on their connection to radionuclide sources and circulation dynamics. Taking advantage of unprecedented precision of accelerator mass spectrometry, both tracers were firstly investigated in 2013. Here, we examine tracer observations obtained along four stations (re-)visited during the TAlPro2022 expedition in May 2022. Distributions of both 129I and 236U were related to water masses and clearly linked to local circulation patterns: a tracer-poor surface Atlantic inflow, a thining of the tracer minimum at intermediate depths, and a higher tracer signal in Western Mediterranean Deep Waters due to dense water formation in the Algero-Provençal basin. The comparison to 2013 tracer data indicated recent deep ventilation of the Tyrrhenian Sea, the mixing of deep waters and enhanced stratification in intermediate waters in the Algero-Provençal basin due to a temperature and salinity increase between 2013 and 2022. We estimate an overall 129I increase of 20% at all depths between 0 and 500m with respect to 2013, which is not accompanied by 236U. This suggests either the lateral transport of 129I from the Eastern Mediterranean Sea, or an additional source of this tracer. The inventories of 129I calculated for each water mass at the four stations point to the deposition of airborne releases from the nuclear reprocessing plants (La Hague and Sellafield) on the surface Mediterranean waters as the more likely explanation for the 129I increase. This work demonstrates the great potential of including measurements of anthropogenic radionuclides as tracers of ocean circulation. However, a refinement of the anthropogenic inputs is necessary to improve their use in understanding ventilation changes in the Mediterranean Sea.

A randomized control trial evaluating the advice of a physiological-model/digital twin-based decision support system on mechanical ventilation in patients with acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is highly heterogeneous, both in its clinical presentation and in the patient's physiological responses to changes in mechanical ventilator settings, such as PEEP. This study investigates the clinical efficacy of a physiological model-based ventilatory decision support system (DSS) to personalize ventilator therapy in ARDS patients. This international, multicenter, randomized, open-label study enrolled patients with ARDS during the COVID-19 pandemic. Patients were randomized to either receive active advice from the DSS (intervention) or standard care without DSS advice (control). The primary outcome was to detect a reduction in average driving pressure between groups. Secondary outcomes included several clinically relevant measures of respiratory physiology, ventilator-free days, time from control mode to support mode, number of changes in ventilator settings per day, percentage of time in control and support mode ventilation, ventilation- and device-related adverse events, and the number of times the advice was followed. A total of 95 patients were randomized in this study. The DSS showed no significant effect on average driving pressure between groups. However, patients in the intervention arm had a statistically improved oxygenation index when in support mode ventilation (-1.41, 95% CI: -2.76, -0.08; p = 0.0370). Additionally, the ventilatory ratio significantly improved in the intervention arm for patients in control mode ventilation (-0.63, 95% CI: -1.08, -0.17, p = 0.0068). The application of the DSS led to a significantly increased number of ventilator changes for pressure settings and respiratory frequency. The use of a physiological model-based decision support system for providing advice on mechanical ventilation in patients with COVID-19 and non-COVID-19 ARDS showed no significant difference in driving pressure as a primary outcome measure. However, the application of approximately 60% of the DSS advice led to improvements in the patient's physiological state. clinicaltrials.gov, NCT04115709.

Regional Differences in Lung Ventilation During the Early Transition Period in Late Preterm and Term Neonates Assessed by Electrical Impedance Tomography.

Changes in lung ventilation are well documented in term neonates while in late preterm neonates these patterns are poorly understood despite their increased risk of respiratory morbidity. The study aimed to compare and clarify the differences in regional lung ventilation of late preterm and term neonates during the early adaptation period using electrical impedance tomography (EIT). The case-control study was conducted in the years 2020-2022. It included 51 late preterm neonates (LPN, Study group) and 45 term neonates (TN, Control) born by normal vaginal delivery (NVD). EIT examinations were performed with a Swisstom BB2 (Switzerland) equipment. The data recordings were performed no later than 30 (I Record), 60 (II), and 90 (III) minutes after the birth. Statistically significant differences between LPN and TN were observed in the non-dependent lung areas at I record, with more silent spaces observed in the LPN (p < 0.001). Differences in the dependent lung regions were observed across all recordings, with LPN demonstrating more silent spaces (p < 0.001). LPN demonstrated greater stretch-related changes in the 10% and 20% stretch categories across all recordings, while TN showed greater changes in the 50%, 70%, and 90% categories. Tidal volumes in the right lung of TN are distributed more towards the ventral and central ventral regions. In contrast, tidal volumes of LPN are distributed to the central dorsal and dorsal regions of the right lung. LPN during the first 90 min after the birth show reduced lung ventilation assessed by EIT, suggesting a possible impairment of early postnatal adaptation.

Dynamic 19F-MRI of pulmonary ventilation in lung transplant recipients with and without chronic lung allograft dysfunction

BackgroundBy the time chronic lung allograft dysfunction (CLAD), with its main phenotypes bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), is diagnosed by pulmonary function testing, irreversible damage to the lung allograft may already have occurred. Dynamic 19F-MRI of inhaled perfluoropropane may detect subtle changes in regional lung ventilation and provides a quantitative measure of regional lung function. We assessed feasibility of detecting regional ventilation dysfunction due to CLAD in lung transplant recipients. MethodsDynamic 19F-MRI was performed in ten lung transplant recipients, four without CLAD and six with CLAD (5 BOS, 1 RAS). Gas wash-in and washout dynamics were assessed and regional lung clearance index (RLCI) provided a quantitative metric of regional lung ventilation. ResultsBOS patients had substantially greater variation in regional ventilation compared with stable patients, with more regions of reduced ventilation, especially in the periphery. Tracer washout was homogeneous and rapid in stable patients but highly heterogeneous in CLAD. CLAD patients exhibited significant difference in RLCI between central and peripheral lung regions (p=0.0016) and a wider interquartile range of RLCI for wash-in compared with stable patients (no CLAD 4.1, BOS 10.5, p=0.036). FEV1 (% of baseline) negatively correlated with ventilation during wash-in, most strongly for the periphery (r=-0.844, p=0.0021). ConclusionsDynamic 19F-MRI identified quantifiable differences in regional ventilation in lung transplant recipients with and without CLAD and was well tolerated. Larger longitudinal studies using this approach will determine if early detection of changes in regional ventilation in lung transplant patients allows earlier CLAD detection.

Imaging of ventilation and lung injury with low-frequency tomographic ultrasound.

Mechanical ventilation in the intensive care unit (ICU) is a life-saving technique for patients with acute respiratory failure, but is also associated with a high incidence of complications in the injured lung. Currently, there is no widely used monitoring technique to guide the ventilator setting to facilitate a precision medicine approach or to provide a real-time alert for developing adverse pulmonary conditions. Conventional ultrasound has been used as a thoracic bedside technology, but the lack of signal penetration into lung tissue results in images that often contain more information in their artifacts than in the images themselves. Perhaps the greatest obstacle to using traditional ultrasound in the ICU is the need for highly skilled technicians to perform the data collection. In contrast, low-frequency ultrasound (50-500 kHz) has been shown to penetrate the lung, and can detect air trapping in patients with chronic obstructive pulmonary disease (COPD). Here, we present a method of collecting low-frequency ultrasound computed tomographic (USCT) data in vivo on a mechanically ventilated porcine model and computing tomographic reconstructions of airflow during tidal breathing and induced lung injuries. We evaluate the ability of the novel low-frequency USCT system to image regional changes in sound speed in the thorax due to changes in airflow during tidal breathing and induced lung injuries. This represents the first study of low-frequency tomographic ultrasound imaging in vivo and the first to produce tomographic images of ventilatory changes invivo. USCT and computed tomography (CT) scan data were collected alternately on a mechanically ventilated Landrace pig weighing approximately 75 kg during tidal breathing, induced pneumothorax, atelectasis, and pleural effusion. The pneumothorax was induced by injecting air through a 5 mm thick intrathoracic tube inserted in the 8th posterior intercostal space. After removing the air, atelectasis was induced by ventilating the animal with a high concentration of oxygen and low tidal volumes. The pleural effusion was induced by injecting a saline solution through the tube. The USCT data were collected at 125 kHz using the USCT low-frequency ultrasound tomography (LUFT) system on a transducer belt placed around the animal's thorax. Tomographic reconstructions were computed from the USCT data using a regularized refraction-corrected Gauss-Newton-based time-of-flight reconstructionalgorithm. Cyclic changes in computed lung area during tidal breathing were demonstrated to agree with the respiratory rate on the mechanical ventilator. Reconstructed images computed at time steps during the procedure demonstrate regional changes consistent with what would be expected during the induced lung injury. No ground truth was available for images during the procedures since CT scans could only be taken before and after each established lunginjury. In this work, we have demonstrated in the first in vivo study using a mechanically ventilated porcine animal model that low-frequency ultrasound tomography has the ability to image regional changes in sound speed in the thorax corresponding to changes in airflow during tidal breathing and induced lung injury. The results show promise for using low-frequency USCT as a bedside imaging technique in the future for patients with acute respiratory distresssyndrome.

Study on the Natural Ventilation Model of a Single-Span Plastic Greenhouse in a High-Altitude Area

The natural ventilation model plays a crucial role in greenhouse environmental control. It has been extensively studied by previous researchers, but it is limited to low-altitude areas. This study established a numerical model of single-span plastic greenhouses in high-altitude areas. The model was validated using measured data, showing a good agreement between the measured and simulated values. By setting boundary conditions based on on-site monitoring data, ventilation rates were extracted under different conditions for numerical simulations. Through nonlinear fitting, an empirical formula for natural ventilation rates, with a determination coefficient (R2) of 0.9724, was derived. The formula was validated through an energy balance analysis of indoor air. Different ventilation opening sizes were simulated to derive an empirical formula for natural ventilation rates based on opening size. Building on this, the relationship between plant height and ventilation rate was analyzed. As the dominant factors of natural ventilation change with environmental fluctuations, this study also proposed the threshold wind speed for wind pressure ventilation, thermal pressure ventilation, and coupled ventilation, filling the knowledge gap in relevant ventilation rate calculations. This is the first time that a natural ventilation model of single-span plastic greenhouses in high-altitude areas has been proposed, providing the basis in terms of modeling for the further development of local facility agriculture.

Hypoxic burden - definitions, pathophysiological concepts, methods of evaluation, and clinical relevance.

Obstructive sleep apnea (OSA) is a common chronic condition that affects over a billion people worldwide and is associated with adverse cardio- and cerebrovascular consequences. Currently, the go-to clinical measure that determines the presence and severity of OSA is the apnea-hypopnea index (AHI). The AHI captures the frequency of respiratory events due to changes in ventilation that are associated with either oxygen desaturations or arousal from sleep. The AHI is poorly correlated to adverse outcomes in OSA with poor prognostic ability. To overcome the limitations of AHI and perhaps driven by the ease of acquisition, several studies have suggested characterizing nocturnal hypoxia in OSA, termed as "hypoxic burden". The purpose of this review is to focus on the hypoxic burden in OSA, its various definitions, and its utility in moving OSA diagnosis beyond the AHI. Several measures and definitions of hypoxic burden have been proposed and studied that show promise in overcoming limitations of AHI and also have a greater prognostic ability than AHI. More recently, area-based measures that attempt to characterize the depth and duration of oxygen desaturations, i.e., nocturnal hypoxia in OSA, have been shown to better relate to incident cardiovascular disease than AHI. In this review, we delve into the evidence for these novel area-based metrics and also delve into the pathophysiological concepts underlying nocturnal hypoxia while cautioning the reader on interpretation of the recent findings relating hypoxic burden to adverse outcomes in OSA. In this review on hypoxic burden, we focus on the need that has driven the sudden influx of studies assessing hypoxic burden for various outcomes of OSA, its underlying pathophysiology, the various definitions, and clinical relevance. We hope that the reader can appreciate the nuances underlying hypoxic burden in OSA and suggest the need for a cohesive framework for moving beyond the AHI with hypoxic burden.

Lung function in patients with asthma in the post-COVID period

Aim. To assess the lung function in patients with bronchial asthma (BA) after new-onset coronavirus infection.Materials and methods. Fifty-five patients who underwent COVID-19 participated in the study under conditions of voluntary informed consent. The main group consisted of 30 patients with mild BA, the comparison group – 25 patients without chronic respiratory diseases (CRD). According to chest computed tomography (CT) findings, the degree of lung parenchyma involvement was classified as follows: mild COVID-19 (CT 0 stage) in 14 patients; moderate COVID-19 (CT 1-2 stages) in 27 patients; and severe COVID-19 (CT 3-4 stages) in 14 patients. Lung function tests were conducted once, adhering to both Russian and international standards.Results. In patients with BA, obstructive pulmonary function impairment was predominant at CT 1-2 stages (79%), CT 0 stage (67%), and CT 3-4 stages (43%). Lung diffusion capacity (LDC) was impaired predominantly in CT 3-4 stages in both BA patients and those without CRD, occurring in 57% of cases. Analysis of lung function showed that LDC reduction was detected in 17% of BA cases and 24% of non-CRD cases. There were no statistically significant changes in pulmonary ventilation among BA patients with impaired LDC compared to patients without CRD.Conclusion. All patients with respiratory symptoms after COVID-19 should undergo comprehensive lung function assessment to identify bronchial obstruction, impaired lung diffusion capacity, and ensure timely intervention.

Increased Ventilatory Efficiency in Supramaximal Compared to Graded Exercise in Athletes

ABSTRACT Background: Supramaximal constant work rate tests (CWR) elicit intense hyperventilation, thus potentially up-shifting ventilation (⩒E)-to-carbon dioxide (CO2) responses when compared to graded exercise tests (GXT) in athletes. We predicted higher ventilatory efficiency on supramaximal CWR using a new method, challenging the classic orthodox interpretation of an increased ⩒ E -⩒CO2 as ventilatory inefficiency. This misinterpretation could make difficult to differentiate between physiological hyperventilation from heart disease conditions in athletes. Methods: On different days, a GXT and a CWR at 110% of the maximal velocity achieved in the GXT were performed. Twenty-seven athletes completed the two tests and were compared for usual (linear regression) and log-transformed new variables for ventilatory efficiency through paired t-Student statistics. Results: The ⩒ E -⩒CO2 slope (31.4 ± 4.9 vs. 26.2 ± 3.4, p < .001), ⩒ E -⩒CO2 intercept (7.2 ± 7.5 vs. 2.8 ± 4.2, p < .007), ⩒ E /⩒CO2 nadir (33.0 ± 3.6 vs. 25.4 ± 2.2, p < .001), ⩒CO2-log⩒ E slope (10.8 ± 2.9 vs. 6.9 ± 2.2 L*logL−1, p < .001), and η⩒ E (36.0 ± 12 vs. 22.8 ± 8.1%, p < .001) values were all significantly higher in the CWR compared to the GXT. We registered a bi-modal nadir response for ⩒E/⩒CO2 on CWR for 22 out of 27 subjects for the first time. A weak association was observed between ⩒ E /⩒CO2 nadir (coefficient of determination ~ 27%) and time to exhaustion. Conclusions: The new method allows us to improve the quantification and interpretation of ventilatory efficiency in athletes, avoiding misinterpretation due to the up-shifting elicited by the usual ⩒ E -⩒CO2 slope and ⩒ E /⩒CO2 nadir indices, which may be confounded with ventilatory inefficiency. This study suggests that ventilatory changes underpin better ventilatory efficiency during CWR.

Difference in expiratory flow limitations development in normoxia and hypoxia in healthy individuals

The present study investigated the maintenance/repeatability of expiratory flow limitation (EFL) between normoxia and hypoxia.Fifty-one healthy active individuals (27 men and 24 women) performed a lung function test and a maximal incremental cycling test in both normoxia and hypoxia (inspired oxygen fraction = 0.14) on two separate visits.During exercise in normoxia, 28 participants exhibited EFL (55 %). In hypoxia, another cohort of 28 participants exhibited EFL. The two groups only partly overlapped.Individuals with EFL only in normoxia reported lower maximal ventilation values in hypoxia than in normoxia (n=5; −13.5 ± 7.8 %) compared to their counterparts with EFL only in hypoxia (n=5; +6.7 ± 6.3 %) or without EFL (n=18; +5.1 ± 10.3 %) (p=0.004 and p<0.001, respectively).EFL development may be induced by different mechanisms in hypoxia vs. normoxia since the individuals who exhibited flow limitation were not the same between the two environmental conditions. This change seems influenced by the magnitude of the maximal ventilation change.

The independent effects of hydrostatic pressure and hypercapnic breathing during water immersion on ventilatory sensitivity and cerebrovascular reactivity.

Head-out water immersion (HOWI) induces ventilatory and hemodynamic changes, which may be a result of hydrostatic pressure, augmented arterial CO2 tension, or a combination of both. We hypothesized that the hydrostatic pressure and elevated CO2 tension that occur during HOWI will contribute to an augmented ventilatory sensitivity to CO2 and an attenuated cerebrovascular reactivity to CO2 during water immersion. Twelve subjects [age: 24 ± 3 yr, body mass index (BMI): 25 ± 3 kg/m2] completed HOWI, waist water immersion with CO2 (WWI + CO2), and WWI, where a rebreathing test was conducted at baseline, 10, 30, and 60 min, and postimmersion. End-tidal pressure of carbon dioxide ([Formula: see text]), minute ventilation, expired gases, blood pressure, heart rate, and middle cerebral artery blood velocity were recorded continuously. [Formula: see text] increased throughout all visits (P ≤ 0.011), was similar during HOWI and WWI + CO2 (P ≥ 0.264), and was greater during WWI + CO2 versus WWI at 10, 30, and 60 min (P < 0.001). When HOWI vs. WWI + CO2 were compared, the change in ventilatory sensitivity to CO2 was different at 10 (0.59 ± 0.34 vs. 0.06 ± 0.23 L/min/mmHg; P < 0.001), 30 (0.58 ± 0.46 vs. 0.15 ± 0.25 L/min/mmHg; P < 0.001), and 60 min (0.63 ± 0.45 vs. 0.16 ± 0.34 L/min/mmHg; P < 0.001), whereas there were no differences between conditions for cerebrovascular reactivity to CO2 (P ≥ 0.163). When WWI + CO2 versus WWI were compared, ventilatory sensitivity to CO2 was not different between conditions (P ≥ 0.642), whereas the change in cerebrovascular reactivity to CO2 was different at 30 min (-0.56 ± 0.38 vs. -0.30 ± 0.25 cm/s/mmHg; P = 0.010). These data indicate that during HOWI, ventilatory sensitivity to CO2 increases due to the hydrostatic pressure, whereas cerebrovascular reactivity to CO2 decreases due to the combined effects of immersion.NEW & NOTEWORTHY Although not fully elucidated, the ventilatory and hemodynamic alterations during water immersion appear to be a result of the combined effects of immersion (i.e., elevated [Formula: see text], central hypervolemia, increased cerebral perfusion, increased work of breathing, etc.). Our findings demonstrate that an augmented ventilatory sensitivity to CO2 during immersion may be due to the hydrostatic pressure across the chest wall, whereas an attenuated cerebrovascular reactivity to CO2 may be due to the combined effects of immersion.

Diagnosing Radial Ventilation in Dropsonde Observations of Hurricane Sam (2021)

Abstract This study presents a method to diagnose radial ventilation, the horizontal flux of relatively low-θe air into tropical cyclones, from dropsonde observations. We used this method to investigate ventilation changes over three consecutive sampling periods in Hurricane Sam (2021), which underwent substantial intensity changes over 3 days. During the first and last periods, coinciding with intensification, the ventilation was relatively small due to a lack of spatial correlation between radial flow and θe azimuthal asymmetries. During the second period, coinciding with weakening, the ventilation was relatively large. The increased ventilation was caused by greater shear associated with an upper-level trough, tilting the vortex, along with dry, low-θe air wrapping in upshear. The spatial correlation of the radial inflow and anomalously low-θe air resulted in large ventilation at mid- to upper levels. Additionally, at low to midlevels, there was evidence of mesoscale inflow of low-θe air in the stationary band complex. The location of these radial ventilation pathways and their effects on Sam’s intensity are consistent with previous idealized and real-case modeling studies. More generally, this method offers a way to monitor ventilation changes in tropical cyclones, particularly when there is full-troposphere sampling around and within a tropical cyclone’s core. Significance Statement Ventilation, the injection of relatively dry and/or cool air into a tropical cyclone, may weaken a storm. In contrast, the lack of ventilation is favorable for intensification. The purpose of this study is to present a method to diagnose ventilation using aircraft dropsonde observations. Using dropsonde observations collected in Hurricane Sam (2021), there was a period of increased lateral ventilation in two regions around the storm that coincided with when the storm rapidly weakened. The results suggest that monitoring ventilation from dropsonde observations, when available, may be useful for anticipating ventilation-induced intensity changes in tropical cyclones and further studying ventilation pathways.

Controls on Early Cretaceous South Atlantic Ocean circulation and carbon burial – a climate model–proxy synthesis

Abstract. Black shale sediments from the Barremian to Aptian South Atlantic document the intense and widespread burial of marine organic carbon during the initial stages of seafloor spreading between Africa and South America. The enhanced sequestration of atmospheric CO2 makes these young ocean basins potential drivers of the Early Cretaceous carbon cycle and climate perturbations. The opening of marine gateways between initially restricted basins and related circulation and ventilation changes are a commonly invoked explanation for the transient formation and disappearance of these regional carbon sinks. However, large uncertainties in palaeogeographic reconstructions limit the interpretation of available palaeoceanographic data and prevent any robust model-based quantifications of the proposed circulation and carbon burial changes. Here, we present a new approach to assess the principal controls on the Early Cretaceous South Atlantic and Southern Ocean circulation changes under full consideration of the uncertainties in available boundary conditions. Specifically, we use a large ensemble of 36 climate model experiments to simulate the Barremian to Albian progressive opening of the Falkland Plateau and Georgia Basin gateways with different configurations of the proto-Drake Passage, the Walvis Ridge, and atmospheric CO2 concentrations. The experiments are designed to complement available geochemical data across the regions and to test circulation scenarios derived from them. All simulations show increased evaporation and intermediate water formation at subtropical latitudes that drive a meridional overturning circulation whose vertical extent is determined by the sill depth of the Falkland Plateau. The densest water masses formed in the southern Angola Basin and potentially reached the deep Cape Basin as Walvis Ridge Overflow Water. Palaeogeographic uncertainties are as important as the lack of precise knowledge of atmospheric CO2 levels for the simulated temperature and salinity spread in large parts of the South Atlantic. Overall temperature uncertainties reach up to 15 °C and increase significantly with water depth. The ensemble approach reveals temporal changes in the relative importance of geographic and radiative forcings for the simulated oceanographic conditions and, importantly, nonlinear interactions between them. The progressive northward opening of the highly restricted Angola Basin increased the sensitivity of local overturning and upper-ocean stratification to atmospheric CO2 concentrations due to large-scale changes in the hydrological cycle, while the chosen proto-Drake Passage depth is critical for the ocean dynamics and CO2 response in the southern South Atlantic. Finally, the simulated processes are integrated into a recent carbon burial framework to document the principal control of the regional gateway evolution on the progressive shift from the prevailing saline and oxygen-depleted subtropical water masses to the dominance of ventilated high-latitude deep waters.