Reflex recruitment of medullary gasping mechanisms in eupnoea by pharyngeal stimulation in cats

Resuscitation and auto resuscitation by airway reflexes in animals

Various diseases often result in decompensation requiring resuscitation. In infants moderate hypoxia evokes a compensatory augmented breath - sigh and more severe hypoxia results in a solitary gasp. Progressive asphyxia provokes gasping respiration saving the healthy infant - autoresuscitation by gasping. A neonate with sudden infant death syndrome, however, usually will not survive. Our systematic research in animals indicated that airway reflexes have similar resuscitation potential as gasping respiration. Nasopharyngeal stimulation in cats and most mammals evokes the aspiration reflex, characterized by spasmodic inspiration followed by passive expiration. On the contrary, expiration reflex from the larynx, or cough reflex from the pharynx and lower airways manifest by a forced expiration, which in cough is preceded by deep inspiration. These reflexes of distinct character activate the brainstem rhythm generators for inspiration and expiration strongly, but differently. They secondarily modulate the control mechanisms of various vital functions of the organism. During severe asphyxia the progressive respiratory insufficiency may induce a life-threatening cardio-respiratory failure. The sniff- and gasp-like aspiration reflex and similar spasmodic inspirations, accompanied by strong sympatho-adrenergic activation, can interrupt a severe asphyxia and reverse the developing dangerous cardiovascular and vasomotor dysfunctions, threatening with imminent loss of consciousness and death. During progressive asphyxia the reversal of gradually developing bradycardia and excessive hypotension by airway reflexes starts with reflex tachycardia and vasoconstriction, resulting in prompt hypertensive reaction, followed by renewal of cortical activity and gradual normalization of breathing. A combination of the aspiration reflex supporting venous return and the expiration or cough reflex increasing the cerebral perfusion by strong expirations, provides a powerful resuscitation and autoresuscitation potential, proved in animal experiments. They represent a simple but unique model tested in animal experiments.

Time-frequency energy distribution of phrenic nerve discharges during aspiration reflex, cough and quiet inspiration

Aspiration reflex (AspR) represents a specific inspiratory motor behavior expressed by short, powerful inspiratory activity without subsequent active expiration and characterized by the ability to interrupt strong tonic inspiratory activity, as well as hypoxic apnea and several other functional disorders. Multiresolution analysis-based determination of spectral features arising during AspR has not yet been satisfactorily investigated. The time-frequency energy distribution of phrenic nerve electrical activity was compared during the AspR, inspiratory phase of tracheobronchial cough and quiet inspiration. Data obtained from 16 adult cats anesthetized with chloralose or pentobarbital were analyzed using a wavelet transformation, a sensitive method suitable for processing of the non-stationary respiratory output signal. Phrenic nerve energy was accumulated within lower frequency bands in AspR bursts. In AspR, higher frequencies contributed less to the total power, when compared to cough inspiration. Moreover, AspR indicated a stable time-frequency energy distribution, regardless of which of the two types of anesthesia were used. Chloralose anesthesia induced a decrease of parameters in cough and quiet inspiration related to the quantity of energy. The results indicate a specific method of information processing during generation of AspR, underlying its powerful ability to influence various severe functional disorders with potential implications for model experiments and clinical practice.

Brainstem circuitry of tracheal-bronchial cough: c-fos study in anesthetized cats

The c-fos gene expression method was used to localize brainstem neurons functionally related to the tracheal-bronchial cough on 13 spontaneously breathing, pentobarbitone anesthetized cats. The level of Fos-like immunoreactivity (FLI) in 6 animals with repetitive coughs (170+/-12) induced by mechanical stimulation of the tracheobronchial mucosa was compared to FLI in 7 control non-stimulated cats. Thirty-four nuclei were compared for the number of labeled cells. Enhanced cough FLI was found bilaterally at following brainstem structures, as compared to controls: In the medulla, FLI was increased in the medial, interstitial and ventrolateral subnuclei of the solitary tract (p < 0.02), in the retroambigual nucleus of the caudal medulla (p < 0.05), in the ambigual, paraambigual and retrofacial nuclei of the rostral medulla along with the lateral reticular nuclei, the ventrolateral reticular tegmental field (p < 0.05), and the raphe nuclei (p < 0.05). In pons, increased FLI was detected in the lateral parabrachial and Kölliker-Fuse nuclei (p < 0.01), in the posteroventral cochlear nuclei (p < 0.01), and the raphe midline (p < 0.05). Within the mesencephalon cough-related FLI was enhanced at the rostral midline area (p < 0.05), but a decrease was found at its caudal part in the periaqueductal gray (p < 0.02). Results of this study suggest a large medullary - pontine - mesencephalic neuronal circuit involved in the control of the tracheal-bronchial cough in cats.

Excitation of phrenic and sympathetic output during acute hypoxia: contribution of medullary oxygen detectors

Severe brain hypoxia results in respiratory excitation and an increase in sympathetic nerve activity. Respiratory excitation takes the form of gasping which is characterized by an abrupt onset, high amplitude, short duration burst of inspiratory activity. Recent evidence suggests that centrally-mediated hypoxic respiratory and sympathetic excitation may result from direct hypoxic stimulation of discrete hypoxia chemosensitive sites in the medulla. Thus, medullary regions involved in the generation and modulation of respiratory and sympathetic vasomotor output may contain neurons which function as central oxygen detectors, acting as medullary analogs to the peripheral (arterial) chemoreceptors. This review focuses on the medullary sites and mechanisms proposed to mediate hypoxic respiratory and sympathetic excitation in anesthetized, chemodeafferented animals, and provides the evidence suggesting a role for central oxygen detectors in the control of breathing and sympathetic vasomotor output.

Pre-Bötzinger complex functions as a central hypoxia chemosensor for respiration in vivo

Recently, we identified a region located in the pre-Bötzinger complex (pre-BötC; the proposed locus of respiratory rhythm generation) in which activation of ionotropic excitatory amino acid receptors using DL-homocysteic acid (DLH) elicits a variety of excitatory responses in the phrenic neurogram, ranging from tonic firing to a rapid series of high-amplitude, rapid rate of rise, short-duration inspiratory bursts that are indistinguishable from gasps produced by severe systemic hypoxia. Therefore we hypothesized that this unique region is chemosensitive to hypoxia. To test this hypothesis, we examined the response to unilateral microinjection of sodium cyanide (NaCN) into the pre-BötC in chloralose- or chloralose/urethan-anesthetized vagotomized, paralyzed, mechanically ventilated cats. In all experiments, sites in the pre-BötC were functionally identified using DLH (10 mM, 21 nl) as we have previously described. All sites were histologically confirmed to be in the pre-BötC after completion of the experiment. Unilateral microinjection of NaCN (1 mM, 21 nl) into the pre-BötC produced excitation of phrenic nerve discharge in 49 of the 81 sites examined. This augmentation of inspiratory output exhibited one of the following changes in cycle timing and/or pattern: 1) a series of high-amplitude, short-duration bursts in the phrenic neurogram (a discharge similar to a gasp), 2) a tonic excitation of phrenic neurogram output, 3) augmented bursts in the phrenic neurogram (i.e., eupneic breath ending with a gasplike burst), or 4) an increase in frequency of phrenic bursts accompanied by small increases or decreases in the amplitude of integrated phrenic nerve discharge. Our findings identify a locus in the brain stem in which focal hypoxia augments respiratory output. We propose that the respiratory rhythm generator in the pre-BötC has intrinsic hypoxic chemosensitivity that may play a role in hypoxia-induced gasping.

Rostral medullary respiratory neuronal activities of decerebrate cats in eupnea, apneusis and gasping

Eupnea is generated by mechanisms within the pons and medulla. Following removal of pons or exposure to anoxia, gasping is elicited. Eupnea and gasping are markedly different ventilatory patterns. The genesis of gasping is dependent upon rostral medullary neuronal activities. To generate the gasp, these activities should commence before the phrenic burst. In decerebrate, vagotomized, paralyzed and ventilated cats, eupnea was altered to gasping in anoxia. Rostral medullary neuronal activities had inspiratory, expiratory and phase-spanning patterns in eupnea. During gasping, some inspiratory neuronal activities commenced before the phrenic gasp; these same neurons had commenced activities after the onset of the eupneic phrenic burst. Expiratory and phase-spanning neurons did not discharge. Neuronal activities which are consonant with a role in the neurogenesis of gasping had very different discharge patterns in eupnea. Results support the concept that medullary mechanisms for gasping are incorporated in the ponto-medullary circuit responsible for the neurogenesis and expression of eupnea.

Mechanisms and clinicophysiological implications of the sniff- and gasp-like aspiration reflex

Mechanical stimulation of the pharyngeal mucosa in cats and some other mammals evokes the 'aspiration reflex' (AR) characterized by rapid and strong inspiratory efforts not followed by active expirations. It resembles other spasmodic inspiratory acts such as the sniff, the gasp, and the sigh in several aspects, e.g. reflex or semireflex triggering from the upper airways, the sudden onset and termination of such inspirations, the massive recruitment, steep rise and high-peak amplitude of inspiratory unit activity, analogous ventilatory pattern, and contribution to arousal. The similarity of these spasmodic acts is manifested mainly in enhanced speed and volume of inhalation, although of different intensity, which is determined by the varying degree of forced inspiratory activity and a concomitant inhibition of expiratory activity. The extent of the inspiratory dilation of the glottis and the timing and range of late-inspiratory and/or postinspiratory glottal narrowing modulate the depth of aspiration. Thus, the inhalation can be moderate as in sniffing, which provides a transfer of odorants to the olfactory mucosa. In AR the airstream is presumably strong enough to tear off the mechanical particles from the naso- and oropharynx and to convey them into the hypopharynx to allow their subsequent elimination by reflex swallowing or coughing. Prolonged glottal opening allows either the transfer of some additional air to the bronchi by sighing to prevent the development of atelectasis, or redistribution of a larger amount of fresh air into the lungs by gasping to support autoresuscitation. Should aspiration be a common effective component in these spasmodic processes, then the easily elicitable AR could be beneficial as a simple model for studying their properties in health and disease.

Neurogenesis of patterns of automatic ventilatory activity

Normal respiration, termed eupnea, is characterized by periodic filling and emptying of the lungs. Eupnea can occur 'automatically' without conscious effort. Such automatic ventilation is controlled by the brainstem respiratory centers of pons and medulla. Following removal of the pons, eupnea is replaced by gasping, marked by brief but maximal inspiratory efforts. The mechanisms by which the respiratory rhythms are generated have been examined intensively. Evidence is discussed that ventilatory activity can be generated in multiple regions of pons and medulla. Eupnea and gasping represent fundamentally different ventilatory patterns. Only for gasping has a critical region for neurogenesis been identified, in the rostral medulla. Gasping may be generated by the discharge of 'pacemaker' neurons. In eupnea, this pacemaker activity is suppressed and incorporated into the pontile and medullary neuronal circuit responsible for the neurogenesis of eupnea. Evidence for ventilatory neurogenesis which has been obtained from a number of in vitro preparations is discussed. A much-used preparation is that of a 'superfused' brainstem of the neonatal rat. However, activities of this preparation differ greatly from those of eupnea, as recorded in vitro or in arterially perfused in vitro preparations. Activities of this 'superfused' preparation are identical with gasping and, hence, results must be reinterpreted accordingly. The possibility is present that mechanisms responsible for generating respiratory rhythms may differ from those responsible for shaping respiratory-modulated discharge patterns of cranial and spinal nerves. The importance of pontile mechanisms in the neurogenesis and control of eupnea is reemphasized.

The morphology and connections of neurons in the gasping centre of adult rats

Neuronal activities in the intermediate reticular nucleus and adjacent lateral tegmental field are critical for the neurogenesis of the ventilatory pattern of gasping. We report herein the anatomical features of these neurons, their axonal projections and the location of neurons providing afferent inputs. These neuroanatomical evaluations were performed by iontophoretic injection of the tracer Neurobiotin into the region of the intermediate reticular nucleus of the rat. At the site of injection, neurons having soma of 30-50 microns were filled. Labelled axons and terminals were observed in ipsilateral regions which contain neurons having established functions in the control of ventilatory activity. These regions include the nucleus ambiguous and motor nuclei of the hypoglossal and facial nerves. In addition, axonal projections extended to the contralateral region of the intermediate reticular nucleus. From this contralateral region, retrograde tracing revealed projections to the site of injection. Similarly, many ipsilateral regions which received axonal terminals from the region of the intermediate reticular nucleus had reciprocal projections to this region. These anatomical results support the physiological observation that the neurogenesis of gasping involves a synchronized activation of diverse components of the brainstem ventilatory control system.

Medullary regions for neurogenesis of gasping: noeud vital or noeuds vitals?

Gasping is a critical mechanism for survival in that it serves as a mechanism for autoresuscitation when eupnea fails. Eupnea and gasping are separable patterns of automatic ventilatory activity in all mammalian species from the day of birth. The neurogenesis of the gasp is dependent on the discharge of neurons in the rostroventral medulla. This gasping center overlaps a region termed "the pre-Bötzinger complex." Neuronal activities of this complex, characterized in an in vitro brain stem spinal cord preparation of the neonatal rat, have been hypothesized to underlie respiratory rhythm generation. Yet, the rhythmic activity of this in vitro preparation is markedly different from eupnea but identical with gasping in vivo. In eupnea, medullary neuronal activities generating the gasp and the identical rhythm of the in vitro preparation are incorporated into a portion of the pontomedullary circuit defining eupneic ventilatory activity. However, these medullary neuronal activities do not appear critical for the neurogenesis of eupnea, per se.

The sniff-like aspiration reflex evoked by electrical stimulation of the nasopharynx

Forced inspiratory efforts resembling the sniff-like aspiration reflex (AR) were evoked by single-shocks or trains of electrical impulses to the dorsal pharyngeal and nasal mucosal surfaces in 12 anaesthetized spontaneously breathing cats. The strongest ARs determined by diaphragmatic (DIA) EMG and peak-inspiratory flows were elicited from the dorsolateral nasopharyngeal wall close to the torus tubalis. Highly responsive sites were also detected in the posterolateral nasal cavity and in the rostrolateral oropharynx. Repetitive stimulation at threshold strength evoked ARs exclusively in the late inspiration and early expiration. Suprathreshold responses abolished and replaced the tidal respiration. ARs exhibited a two-phase response in DIA EMG: a short latency (25.2 +/- 2.4 msec, M +/- SD) powerful excitation (69.7 +/- 10.7 msec) followed by an voltage-dependent inhibition (63.9 +/- 11.3 msec). Irrespective of voltage repetitive ARs were attenuated at rates above 7-9 Hz. In conclusion, electrical stimulation within the large receptive area of the nasal-pharyngeal airway evokes sniff-like efforts with biphasic inspiratory pattern and marked phase-dependent properties.

Reflex reversal of apnoeic episodes by electrical stimulation of upper airway in cats

Respiratory effects of electrical stimulation of the upper airways (UAW) before and during apnoeic episodes induced by nitrogen inhalation were studied in 9 anaesthetized cats. In eupnoeic animals these electrically-evoked reflexes comprise rapid and powerful inspiratory efforts characterized by strong maximal airway occlusion pressures (Pmax = 635 +/- 39 mm H2O) and rapid peak inspiratory flow rates (PIF = 536 +/- 36 ml.sec-1) similar to the sniff-like aspiration reflex elicited mechanically. Electrical stimulation of the UAW mucosa can elicit reflex inspirations and sniff-like aspiration reflexes even during reversible hypoxic apnoea but their intensity and reproducibility are transiently reduced. When repeated adequately, the electrically-induced reflexes can increase the reactivity of respiratory centre and interrupt or terminate apnoeic episodes as do other types of UAW stimulation. Reflex mechanisms and respiratory centre activations seem to be involved in these effects. The results suggest that electrical stimulation of UAW could be useful for testing the respiratory centre reactivity as well as for reflex reversal of apnoeic episodes and restoration of normal breathing in animal experiments and clinico-physiological studies. Such investigation of the role of UAW reflexes in the pathogenesis and therapy of apnoeic syndromes might also be possible by using a cardiostimulator adapted as respiratory pacemaker.

Medullary neuronal activities in gasping induced by pharyngeal stimulation and hypoxia

We examined the hypothesis that medullary respiratory-related and non-respiratory-related neuronal activities are similarly altered with the "aspiration reflex", induced by mechanical stimulation of the epipharyngeal mucosa, and gasping, induced by severe hypoxia. Extracellular neuronal activities were recorded in decerebrate, paralyzed and ventilated cats. Phrenic activity and neuronal activities were monitored in eupnea and gasping. Seventy-one unit activities were recorded in the lateral medulla including the nucleus tractus solitorii (NTS), lateral tegmental field (LTF) and the nucleus ambiguus (NA). The respiratory modulation of a neuronal activity was quantified by a eta 2 statistic (Orem, J. and Dick, T., 1983, J. Neurophysiol. 50: 1098-1107). The eta 2 values of the units ranged from 0.02 to 0.93. Inspiratory-related activities with relative high eta 2 values (n = 16) were recorded in the region closed to the NTS. Phase-spanning (n = 7) and expiratory-related activities (n = 10) were recorded in the ventral medullary region. Units with low eta 2 values (n = 29) and with no spontaneous activity (n = 9) in eupnea were recorded in the region of the LTF. In both "aspiration reflex" and gasping, inspiratory-related activities were augmented and expiratory-related activities were suppressed. Tonic units were activated and additional activities were recruited. The modulation of the neuronal activities to gasping induced by anoxia was identical to that induced by pharyngeal stimulation in either hyperoxia or severe hypoxia. We concluded that medullary gasping mechanism is recruited by pharyngeal stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Power spectral analysis of respiratory responses to pharyngeal stimulation in cats: comparisons with eupnoea and gasping

1. Based on similarities between properties of gasping and the aspiration reflex, we hypothesized that this reflex activates the central pattern generator for gasping. To evaluate this hypothesis, we have analysed high-frequency oscillations in phrenic and hypoglossal neural activities. These oscillations, analysed by power and coherence spectra, are considered as signatures of the central pattern generators for automatic ventilatory activity. 2. In decerebrate, vagotomized, paralysed and ventilated cats, the aspiration reflex was elicited in eupnoea and gasping by mechanical stimulation of the pharynx and electrical stimulation of the glossopharyngeal nerve. 3. Compared with eupnoeic values, the peaks in the power spectra occurred at higher frequencies in spontaneous gasping. Peaks in the coherence spectra showed identical changes. 4. Power and coherence spectra of inspiratory neural activities during the aspiration reflex differed markedly from those of eupnoea, but were similar to those in gasping. 5. We conclude that mechanical stimulation of the pharynx or electrical stimulation of the glossopharyngeal nerve activates a reflex by which the central pattern generator for eupnoea is depressed, and that for gasping is activated. Our results also support the concept that separate brainstem mechanisms generate ventilatory activity in eupnoea and gasping.

Expiratory neural activities in gasping induced by pharyngeal stimulation and hypoxia

The purpose was to characterize expiratory neural activities in gasping elicited during the aspiration reflex (AR) in hyperoxia and during hypoxia-induced gasping. In decerebrate, vagotomized and paralyzed cats, we recorded activities of inspiratory and expiratory cranial and spinal nerves. The AR was elicited by touching the epipharyngeal mucosa. In eupnea, spinal expiratory activities were greatly decreased during AR whereas laryngeal expiratory activities were increased. In hypoxia-induced gasping, both the laryngeal and spinal expiratory activities were reduced. All of the inspiratory activities were increased during both gasping and the AR. In addition, neural activities were below control levels following AR; activities gradually recovered to control levels. We conclude that spinal expiratory activities are inhibited during the AR and gasping. Results are consistent with the concept that medullary mechanisms for gasping are recruited by mechanical stimulation of the epipharynx. In hypoxia-induced gasping, the hypoxia, per se, causes a separate suppression of laryngeal expiratory activities.

Sniff-like aspiration reflex evoked by pressure pulses from the upper airways in cats

Respiratory effects of single positive and negative pressure pulses (PPP, NPP) applied to the functionally isolated upper airways (UA) were studied in 11 anaesthetized cats breathing spontaneously through a tracheal tube. The UA pressure and the changes of tracheal airflow were recorded and the blood pressure and electrocardiogram were occasionally monitored. Sniff-like aspiration reflexes comprising powerful spasmodic inspirations could be elicited by PPP or NPP of 20 to 110 cm H2O or -14 to -140 cm H2O. The responses to NPP but also to PPP characterized by high peak inspiratory flow, mean inspiratory flow and tidal volume (PIF = 312.5 +/- 64.3 and 231.1 +/- 21.7 ml.sec-1; VTI = 178.3 +/- 46.7 and 110.1 +/- 14.4 ml.sec-1; VT = 40.9 +/- 8.3 and 22.5 +/- 1.7 ml) resembled closely the aspiration reflex elicited by mechanical stimulation of the pharyngeal wall. Occasionally, sneezing, minor modifications of breathing pattern and solitary forced inspirations could be induced by lower pressures. The results indicate that sudden pressure stimulation of the UA evokes vigorous respiratory responses including the aspiration reflex. These reflexes and their alterations may contribute to development or release of both UA obstruction and apnoea, at least in cats.