Respiratory regulation after elastic loading and CO2 rebreathing in normal term infants

Studies of airway pressure, tidal volume, respiratory duration, and total breath duration before and after elastic loading airway occlusions were carried out on ten full-term, normal infants on two occassions in the first week of life. Using these noninvasive techniques we infer that static compliance and the Hering-Breuer reflex are unchanged during the first week; that infants may increase sensitivity to chemical drive toward the end of the first week; and that there may be a volume related threshold for vagal inhibition of inspiration in some infants.

Regional distribution of a 133Xe labelled gas volume inspired at constant flow rates

We measured the regional distribution of 480 ml of 133Xe labelled gases inspired from FRC at constant inspiratory flow rates ranging from 0.1 to 6 litres/s. The gases used were air and 20% O2 in helium. At low inspiratory flow rates the gas was preferentially delivered to the dependent region of the lung. At maximal inspiratory flows, all regions of the lung were more evenly ventilated. The rate of redistribution was found to be slower and more even than in previous studies using smaller volumes of inspired gas. Assuming equal and synchronous changes of pleural surface pressure, these results can be reasonably predicted by the mechanical time constant theory applied to a simple two-compartment lung model based on equal regional resistances. Breathing the HeO2 mixture did not significantly change ventilation distribution at any flow rate.

Control of depth and frequency of breathing during baroreceptor stimulation in cats

In 10 tracheotomized anesthetized cats during steady-state inhalation of various concentrations of CO2 and O2, the acute respiratory response to baroreceptor stimulation produced by transient inflation of a balloon placed in the descending aorta was studied. The latter induced a sudden rise in mean arterial pressure, ranging from 62 to 95 mmHg. At all PACO2 levels above 30 mmHg, elevation in arterial pressure was accompanied by an immediate drop in tidal volume (VT) and prolongation of the durations of inspiration (Ti) and total breath (Ttot). Breaths obtained during baroreceptor stimulation fell along the same VT vs. Ti and VT vs. Ttot relationships obtained in the normotensive state, suggesting that the lung volume-related vagal control of Ti and Ttot is unaffected by changes in arterial pressure. Since, for a given change in arterial pressure, a constant reduction in VT was obtained at all PACO2 levels above 30 mmHg, it can be concluded that the interaction between PACO2 and arterial pressure is additive. In three cats, at PACO2 levels below 30 mmHg, aortic obstruction resulted in brief periods of apnea. Following apnea, the control of Ti and Ttot was transiently offset, describing hysteresis pathways on the VT vs. Ti and VT vs. Ttot relationships.

The progressive response of the newborn infant to added respiratory loads

The responses of 10 normal full-term infants to 10-sec airway occlusions at functional residual capacity were studied. The responses were quantified by measuring the pressure generated on successive inspiratory efforts following occlusions in room air and 100% oxygen. The response after oxygen breathing was 30-40% less than after air breathing, indicating that hypoxia accounted for part of the response. There was an increase in the response in air from the first to the fourth day of life. Endtidal carbon dioxide tension was shown to increase during the occlusion, but the response remaining after hypoxia was eliminated may not have been due entirely to hypercapnea. We conclude that the compensatory response of the infant to added respiratory loads is in part due to hypoxia, and that the hypoxic response increases over the first week of life.

Regulation of frequency and depth of breathing during expiratory threshold loading in cats

In six spontaneously breathing anesthetized cats, intermittently subjected to inspiratory elastic loads, we have studied the relationships between tidal volume (VT) and the durations of inspiration (Ti) and breath duration (Ttot) obtained during spontaneous ventilation from resting lung volume (FRCc) and from elevated end-expiratory levels. The latter was elevated by submerging the expiratory breathing line into a column of water, representing the addition of an expiratory threshold load (ETL). The VT vs. Ti relationships obtained at different end-expiratory levels were similar, indicating that during ETL the vagal mechanism regulating Ti responds only to lung volume changes above the new end-expiratory level and is independent of the absolute end-expiratory lung volume. Single vagal fiber recordings suggest that this effect on Ti control may be explained on the basis of adaptation occurring at the level of the pulmonary stretch receptors. The control of Ttot, on the other hand, was found to depend both on the Ti of the preceding breath (phasic component) and on a separate vagal mechanism specifically affecting the duration of expiration (Te) in response to changes in the absolute end-expiratory lung volume. The latter mechanism is functionally inoperative at FRCc.

Occlusion pressure as a measure of respiratory center output in conscious man

The output of the "respiratory centers" has been estimated by measuring ventilation, inspiratory muscle power, EMG of the diaphragm, and by various other means, each of which has serious disadvantages. The static pressure generated by the inspiratory muscles at FRC against an obstructed airway is here suggested as a useful alternative. Ten conscious, normal, sitting human subjects were subjected to CO2 rebreathing (Read, 1967) and their airways were occluded at end-expiration at intervals without the subjects being aware in advance. The inspiratory pressure waves so generated were found to be distorted by conscious or unconscious responses to the occlusion which had a minimum latency of 0.15 sec. The pressure generated at 0.1 sec after the onset of inspiration (P0.1) was nevertheless easy to measure and was reproducible in each subject. The CO2 response obtained by plotting P0.1 against PCO2, was curvilinear, the P0.1 increasing more rapidly at high PCO2. The P0.1 is independent of pulmonary mechanics. Since it measures the rate of rise of inspiratory activity and not the peak activity it is also independent of mechanisms that alter the respiratory pattern by affecting inspiratory duration, in particular the vagal volume-related inspiratory-inhibitory reflex. It is concluded that measurements of P0.1 represent a useful index of the output of the respiratory centers.

A method for the assessment of phasic vagal influence on tidal volume

Vagal influence related to lung volume changes results in reduction in tidal volume during spontaneous breathing due primarily to premature termination of inspiration. The strength of this vagal influence was traditionally assessed by the duration of apnea following lung inflation, a method recently shown to be inadequate and potentially misleading. An alternate method is described utilizing analysis of the volume tracing of spontaneous breaths and the tracheal pressure tracing during the first breath following airway occlusion at FRC. A formula was devised which, on the basis of previous observations, should predict the tidal volume to be obtained in the absence of phasic vagal influence. The formula was tested in four pentobarbital-anesthetized rabbits using a technique of vagal cooling which rapidly eliminated the vagal influence under study. It was found that the tidal volume obtained following vagal block could be accurately predicted provided allowances were made for the vagally mediated terminal inhibition during spontaneous breathing and the relative stiffness of the respiratory system at high lung volumes.

Effect of added elastances on the first loaded breath in man

Tidal volume together with end-inspiratory pressure was measured in four seated healthy men, during normal breathing and during single inspirations taken from a series of rigid containers which provided added elastances (range: 5-70 cmH2O/l). Experiments were performed both during quiet breathing and during ventilation increased by added dead space. Added elastic loads always resulted in a decreased tidal volume. This decrease was partly compensated by increased pressure developed by the inspiratory muscles; being more so with greater added elastance, control ventilation, or both. Analysis of our results indicates that the load-compensatory response may be attributed to changes in mechanical impedance of the ventilatory pump, due to the mechanical arrangement and the intrinsic properties of the inspiratory muscles (force-length and force-velocity relationships), changes in respiratory frequency with increasing ventilation, and to vagally mediated load compensation.

Inspiratory flow rate and ventilation distribution in normal subjects and in patients with simple chronic bronchitis

1. Seated subjects stopped ventilation briefly at end expiration while a 5 ml bolus of 133Xe was injected close to the mouth. They then inspired air at different flow rates and the distribution of radioactivity in the lungs was measured with a scanning technique during a period of breath-holding at maximal inspiration.

2. In five normal subjects the dependent zones received a greater fraction of the 133Xe bolus than the apex during slow inspirations, but apical distribution exceeded basal for fast inspirations. The volume history of the lungs before the bolus injection had no effect on the slow/fast difference in four out of five subjects.

3. In five patients with clinical bronchitis but normal forced expired volume, dependent zone ventilation was much reduced on a slow inspiration compared with normals, but at fast flow rates the distribution was normal.

4. Insofar as the bolus in the fast inspiration was distributed according to regional airway conductances, these results suggest that in normal subjects differences in airway resistance exist between the upper and lower zones of the upright lung. An early abnormality in bronchitis appears to be a reduction of compliance in the dependent zones, as judged from the decrease in basal ventilation on a slow inspiration.

Regional lung function in patients with hepatic cirrhosis

The lung volume at which the dependent lung zones begin to trap gas as a result of airway closure (i.e., the "closing volume") was measured with (133)Xe in 10 seated patients with hepatic cirrhosis. In all of them the closing volume was increased above normal, and in eight it was greater than the functional residual capacity, indicating the presence of airway closure and gas trapping during resting tidal volume breathing. Direct measurements made with (133)Xe in five cirrhotic patients (a) confirmed the presence of increased gas trapping in the lower lung zones both at residual volume and at functional residual capacity, and (b) indicated that in liver cirrhosis the ventilation-perfusion ratio of the dependent lung zones may be very low, primarily as a result of decreased ventilation due to airway closure. It is concluded that in hepatic cirrhosis, gas trapping in the dependent lung zones may be an important cause of impaired gas exchange within the lungs. It is suggested that the premature airway closure observed in this disease may be due to mechanical compression of small airways by dilated blood vessels and/or interstitial pulmonary edema.