Airway occlusion pressures in awake and anesthetized goats

Some effects of vagal blockade on abdominal muscle activation and shortening in awake dogs

1. The mechanisms of abdominal muscle activation are thought to be different during expiratory threshold loading (ETL) compared with hypercapnia. Our objectives in the present study were to determine the effects of removing excitatory vagal feedback on abdominal muscle activation, shortening and pattern of recruitment during ETL and hypercapnia. Six tracheotomized dogs were chronically implanted with sonomicrometer transducers and fine wire EMG electrodes in each of the four abdominal muscles. Muscle length changes and EMG activity were studied in the awake dog during ETL (6 dogs) and CO2 rebreathing (3 dogs), before and after vagal blockade. 2. Following vagal blockade, the change in volume (increase in functional residual capacity, FRC) during ETL was greater and active phasic shortening of all the abdominal muscles was reduced, when shortening was compared with a similar change in lung volume. Similarly, at comparable minute ventilation, abdominal muscle active shortening was also reduced during hypercapnia. The internal muscle layer was recruited preferentially in both control and vagally blocked dogs during both ETL and hypercapnia. 3. The degree of recruitment of the abdominal muscles during ETL and hypercapnia in awake dogs is influenced by vagal feedback, but less so than in anaesthetized dogs. These results illustrate the importance of the vagi and abdominal muscle activation in load compensation. However, vagal reflexes are apparently not contributing to the preferential recruitment of the internal muscle layer. In awake dogs during vagal blockade abdominal muscle recruitment still occurs by extravagal mechanisms.

Abdominal muscle activation by expiratory threshold loading in awake dogs

Abdominal muscle activation produced by expiratory threshold loading (ETL) helps prevent an increase in FRC thus, optimizing diaphragm length and defending VT. However, anesthesia may affect abdominal muscle activation, and the pattern of recruitment and level of activation of individual abdominal muscles may well be dependent on body position. Therefore, individual abdominal muscle response to ETL was assessed in awake dogs, lying in the lateral decubitus position. Eight, tracheotomized dogs were chronically instrumented with sonomicrometer transducers and bipolar, fine wire EMG electrodes, in each of the four abdominal muscles. ETL produced increases in active, expiratory shortening of the transversus abdominis (TA), internal oblique (IO) and external oblique (EO). In addition, tonic activity, assessed from a decrease in baseline length, increased in the IO. There was a significant increase in FRC during ETL but it was less than would be expected without tonic and phasic abdominal muscle activation. Although FRC increased, VT and breathing frequency were maintained. As was found previously in supine, anesthetized dogs, the internal abdominal muscle layer (TA and IO) was recruited preferentially; substantiating its greater role in the defence of lung volume.

Type, diameter and distribution of fibres in some respiratory and abdominal muscles of the goat

This study was designed to determine the histochemical properties, size and composition of fibres in the diaphragm, intercostal and abdominal muscles of goats to clarify whether reported similarities in respiratory muscle physiology between goats and humans have a structural basis. Serial sections (10 microns) of muscular tissue from adult female goats were stained for myosin adenosine triphosphatase and reduced nicotinamide adenine dinucleotide dehydrogenase-tetrazolium reductase activities; the fibres were classified into type I, IIA and IIB; and their mean diameter and composition were determined. Abdominal and intercostal muscles contained types I, IIA and IIB fibres in the ratio 1:1:1, and the mean diameter of the fibres ranged from 49.2 to 62.2 microns. In contrast, the diaphragm contained 58.9% type I and 41.1% type II fibres, and the latter could not be differentiated into types IIA and IIB. Diaphragmatic fibres were also smaller (36.9-40.9 microns). These findings contrast with those in humans, where the diaphragm, intercostal and abdominal muscles contain > 50% type I fibres and have fibres of identical diameter. The differences in fibre characteristics between the diaphragm, intercostal and abdominal muscles of goats and the differences between goats and humans need to be taken into consideration in interpreting the results from studies in respiratory muscle physiology.

Effect of fatiguing resistive loads on the level and pattern of respiratory activity in awake goats

The effect of respiratory muscle fatigue on inspiratory muscle electrical activity (EMG), transdiaphragmatic pressure and ventilation during spontaneous breathing was examined in three awake goats. Studies were performed during progressive hypercapnia before and immediately after inspiratory muscle fatigue induced by flow resistive loading (IRL). IRL caused a decrease in the high-low ratio of the diaphragm and intercostal EMG and a decrease in Pdi during electrophrenic stimulation. After IRL, inspiratory time, the breathing duty cycle (inspiratory time/total breath cycle time), peak integrated activity of the diaphragm and external intercostal EMG per breath and per minute were all decreased at any given level of PCO2. Changes in the timing of respiratory motor activity and reduced muscle performance after IRL resulted in a decrease in transdiaphragmatic pressure and ventilation during hypercapnia. In conscious goats studied during spontaneous, chemically stimulated breathing, inspiratory muscle fatigue is associated with reductions in diaphragm and external intercostal muscle electrical activity and reductions in transdiaphragmatic pressure and ventilation.

Load compensation during positive pressure breathing in anesthetized man

To investigate the mechanisms by which human subjects prevent or compensate for the change in respiratory muscle length imposed by applying continuous positive pressure to the airways, six men were studied under general anesthesia with methoxyflurane at the end of a minor surgical procedure (rhinoplasty). Ventilatory and occlusion pressure response to carbon dioxide was measured by a rebreathing technique with no bias pressure, or with 16 cm H2O positive pressure produced by adding weights to a spirometer bell. Static pressure-volume curves of the respiratory system were obtained while the subjects were paralyzed with succinyl choline. In contrast to awake subjects described in other studies, the anesthetized patients did not activate expiratory muscles to combat the rise in end-expiratory level caused by pressure, and showed little evidence of enhanced activation of inspiratory muscles that in the conscious state compensates for the disadvantage of their shorter length. A change in the shape of the occlusion pressure wave, however, suggested that positive pressure had some effect on the neural discharge to inspiratory muscles. The mechanisms by which the respiratory system defends itself against a pressure load that tends to change end-expiratory level are sensitive to anesthesia and may require consciousness.

Effects of slow wave sleep on ventilatory compensation to inspiratory elastic loading

We determined the effects of slow wave sleep on ventilatory compensation to inspiratory elastic loads (18 cm H2O/L). Multiple loading trials of variable duration were applied in three healthy adult humans in wakefulness and during NREM sleep. During wakefulness, ventilatory response over 5 loaded breaths were highly variable. Tidal volume (VT), mean inspiratory flow (VT/TI), and minute ventilation (VE) were preserved or increased in 2 of the 3 subjects in whom mouth occlusion pressure (P0.1) was augmented in the immediate (second breath) response to the load. In the third subject who showed no change in P0.1, VE was not preserved during loading. During NREM sleep, the loading response was highly consistent in all trials and in all 3 subjects. P0.1 on the second loaded breath was not increased; thus VE, VT and VT/TI were reduced over five loaded breaths. This absence of immediate load compensation during NREM sleep was similar during normoxia, hyperoxia, and hypercapnia. During sustained loading in NREM sleep VE and VT returned toward control levels coincident with an increase in end tidal CO2. We conclude that augmentation of inspiratory neural drive sufficient for immediate compensation to elastic loads requires wakefulness. Compensatory responses to loading do not occur during NREM sleep until inspiratory effort is augmented by chemical stimuli.

Sleep deprivation decreases ventilatory response to CO2 but not load compensation

Because sleep is known to reduce ventilatory drive, and sleep deprivation is a common accompaniment to ventilatory failure, we tested ventilatory response to carbon dioxide (delta V1/delta PCO2) and response to an inspiratory flow resistive load (change in delta P100/delta PCO2 with load) after both a normal night of sleep and after 24 hours of sleep deprivation in 13 healthy volunteers. Sleep deprivation was associated with a significant decrease in delta V1/delta PCO2 from 2.51 +/- .36 to 2.09 +/- .34 L/min/mm Hg (p less than 0.02). However, load compensation was preserved during sleep deprivation. Since many acutely-ill patients are sleep deprived, an associated reduction of ventilatory drive may play a role in progressive respiratory insufficiency.

Mechanisms underlying CO2 retention during flow-resistive loading in patients with chronic obstructive pulmonary disease

The present study examined the respiratory responses involved in the maintenance of eucapnea during acute airway obstruction in 12 patients with chronic obstructive disease (COPD) and 3 age-matched normal subjects. Acute airway obstruction was produced by application of external flow-resistive loads (2.5 to 30 cm H2O/liter per s) throughout inspiration and expiration while subjects breathed 100% O2. Application of loads of increasing severity caused progressive increases in PCO2 in the patients, but the magnitude of the increase in PCO2 varied substantially between subjects. On a resistance of 10 cm H2O/liter per s, the highest load that could be tolerated by all COPD patients, the increase in PCO2 ranged from 1 to 11 mm Hg, while none of the normal subjects retained CO2. Based on the magnitude of the increase in PCO2 the patients could be divided into two groups: seven subjects whose PCO2 increased by less than or equal to 3 mm Hg (group I) and five subjects whose PCO2 increased by greater than 6 mm Hg (group II). Base-line ventilation and the pattern of breathing were similar in the two groups. During loading group I subjects maintained or increased tidal volume while all group II patients decreased tidal volume (VT). The smaller tidal volume in group II subjects was mainly the result of their shorter inspiratory time as the changes in mean inspiratory flow were similar in the two groups. The magnitude of CO2 retention during loading was inversely related to the magnitude of the change in VT (r = -0.91) and inspiratory time (Ti) (r = -0.87) but only weakly related to the change in ventilation (r = -0.53). The changes in PCO2, VT, and Ti during loading correlated with the subjects' maximum static inspiratory pressure, which was significantly lower in group II as compared with group I patients. These results indicate that the tidal volume and respiratory timing responses to flow loads are impaired in some patients with COPD. This impairment, presumably due to poor inspiratory muscle function, appears to lead to CO2 retention during loaded breathing.

Comparison of the respiratory responses to external resistive loading and bronchoconstriction

The effects of resistive loads applied at the mouth were compared to the effects of bronchospasm on ventilation, respiratory muscle force (occlusion pressure), and respiratory sensations in 6 normal and 11 asthmatic subjects breathing 100% O2. External resistive loads ranging from 0.65 to 13.33 cm H2O/liter per s were applied during both inspiration and expiration. Bronchospasm was induced by inhalation of aerosolized methacholine. Bronchospasm increased ventilation, inspiratory airflow, respiratory rate, and lowered PACO2. External resistive loading, on the other hand, reduced respiratory rate and inspiratory flow, but left ventilation and PACO2 unaltered. FRC increased to a greater extent with bronchospasm than external flow resistive loads. With both bronchospasm and external loading, occlusion pressure increased in proportion to the rise in resistance to airflow. However, the change in occlusion pressure produced by a given change in resistance and the absolute level of occlusion pressure at comparable levels of airway resistance were greater during bronchospasm than during external loading. These differences in occlusion pressure responses to the two forms of obstruction were not explained by differences in chemical drive or respiratory muscle mechanical advantage. Although the subjects' perception of the effort involved in breathing was heightened during both forms of obstruction to airflow, at any given level of resistance the sense of effort was greater with bronchospasm than external loading. Inputs from mechanoreceptors in the lungs (e.g., irritant receptors) and/or greater stimulation of chest wall mechanoreceptors as a result of increases in lung elastance may explain the differing responses elicited by the two forms of resistive loading.

Disordered breathing and oxygen desaturation during sleep in patients with chronic obstructive lung disease (COLD)

Seven patients with chronic obstructive lung disease (COLD) were monitored during their overnight sleep to determine the occurrence of disordered breathing and oxygen desaturation. Nasal and oral airflows were sensed by thermistor probes, chest wall movement by impedance pneumography and arterial oxygen saturation by ear oximetry. These variables were correlated with electroencephalographic and electrooculographic tracings. The subjects had a mean base line oxygen saturation of 89.2 per cent and slept an average of 218 minutes. Six of these seven subjects had one to 30 episodes of oxygen desaturation (decrease more than 4 per cent), 4 seconds to 30 minutes in duration, with declines in saturation as great as 36 per cent. In two subjects, saturation dropped to less than 50 per cent. Breathing was disordered in five of the seven subjects and included apnea and hypopnea. Subjects experienced from nine to 37 episodes of disordered breathing. Disordered breathing caused 42 per cent of the episodes of desaturation, all of which were less than 1 minute in duration. The mean maximum decline in saturation was 7.6 per cent. All episodes of desaturation lasting longer than 5 minutes occurred in rapid eye movement (REM) sleep and were not caused by disordered breathing. The mean maximal decrease in saturation was 22 per cent. This study reveals that disordered breathing is common in subjects with COLD and often causes desaturation but that it cannot explain all episodes of sleep desaturation.

Ventilatory and occlusion pressure response to CO2 and hypoxia with resistive loads

Steady-state responses to hyperoxic hypercapnia and eucapnic hypoxia were measured both as minute ventilation (VE) and as inspiratory mouth occlusion pressure (P0.1) with and without 25 cm H2O/I/s added resistance (R). Reduction in slope of the ventilatory response to CO2 with R was highly significant in all 3 subjects whereas the response to hypoxia was barely significantly reduced in 1 subject and not significantly decreased in two. Although P0.1 was higher with than without R under all conditions, the slope of the P0.1 response to CO2 with R was not increased in two subjects and only slightly increased in the third. The slope of the P0.1 response to hypoxia was significantly greater in all subjects with R. Expiratory reserve volume was increased with R but the change was the same with hypoxia and hypercapnia. We conclude that ventilation is better maintained with resistive loading during hypoxia than during hypercapnia and that this results from a greater force output of inspiratory muscles as reflected by a higher P0.1. This suggests a greater neural output to these muscles.