Role of inertia in the measurement of dynamic compliance

Effects of inertance on respiratory mechanics measurements in mechanically ventilated children

OBJECTIVE

The use of the first-order linear single compartment model when studying respiratory mechanics classically neglects inertance (Irs). We hypothesized that Irs would affect compliance (Crs) and resistance (Rrs) estimates in mechanically ventilated young children.

DESIGN

Prospective study; single-center evaluation.

SETTING

University-affiliated tertiary pediatric intensive care unit.

PATIENTS

Forty-four patients with and without respiratory disease.

INTERVENTIONS

Patients were studied during volume-controlled constant inspiratory flow ventilation.

MEASUREMENTS AND MAIN RESULTS

Pressure (PaO) and flow (V') were analyzed according to two different models: a one-compartment first-order linear model according to PaO = (1/Crs) x V + Rrs x V' and a one-compartment second-order linear model according to PaO = (1/Crs) x V + Rrs x V' + Irs x V''. Irs was higher in children with vs. those without respiratory disease (median 0.00224 cm H2O/L/sec2, Q1-Q3 0.00180-0.00321 vs. median 0.00133 cm H2O/L/sec2, Q1-Q3 0.00072-0.00210; p < .001)). A positive correlation between Irs and the difference of Crs estimates between the first- and the second-order model was found in both groups (r = .84, p < .05 and r = .67, p < .05). Rrs estimates were similar in both groups.

CONCLUSIONS

This study showed that the linear single-compartment model may not adequately estimate the respiratory mechanical properties in mechanically ventilated children, particularly in the presence of respiratory disease. Including an Irs term significantly diminished Crs estimates. A one-compartment second-order linear model might be a useful clinical tool in more adequately measuring respiratory mechanics and optimizing ventilatory settings in children with respiratory disease.

Effects of inhaled ipratropium bromide on breathing mechanics and gas exchange in exercising horses with chronic obstructive pulmonary disease

Six Warmblood horses suffering an acute exacerbation of COPD were tested to investigate whether inhalation of ipratropium bromide (IB) dry powder (2,400 microg) 30 min preexercise would improve their exercise capacity. A cross-over protocol with an inert powder placebo (P) was used. Mechanics of breathing and arterial blood gases were determined before treatment, after treatment but pre-exercise, and during an incremental exercise test. Oxygen consumption (VO2) was also measured before and during exercise, and the time to fatigue recorded. Inhalation of IB reduced total pulmonary resistance (RL) and maximum intrapleural pressure changes (deltaPpl(max)) and increased dynamic compliance before exercise. The onset of exercise was associated with a marked decrease in RL in P-treated horses but not those receiving IB, so that RL during exercise was not affected by treatment. Although deltaPpl(max) was lower at 8,9 and 10 m/s with IB, there were no treatment-related changes in VO2, blood gases, time to fatigue or any other measurement of breathing mechanics. Therefore, although inhalation of IB prior to exercise may have improved deltaPpl(max), it had no apparent impact on the horses' capacity for exercise.

Effects of inhalation of albuterol sulphate, ipratroprium bromide and frusemide on breathing mechanics and gas exchange in healthy exercising horses

The possibility that pre-exercise inhalation of a bronchodilator by healthy horses could improve their mechanics of breathing and enhance performance was investigated. Ipratropium bromide (0.35 microg/kg bwt; n = 7) was administered by nebulisation 30 min before exercise and frusemide (1 mg/kg bwt; n = 6) was given in the same manner 2 h before exercise. Albuterol sulphate (360 and 720 microg; n = 7) were administered with a metered dose inhaler 2 h before exercise. Each drug was investigated independently of the others using cross-over protocols. Horses completed incremental exercise tests and oxygen consumption, carbon dioxide production, arterial blood gases, heart rate and measures of breathing mechanics including total pulmonary resistance (RL) and nasopharyngeal resistance (RU) were determined for each exercise intensity. The resistance of the lower airways was calculated subsequently from the difference between RL and RU. None of the drugs tested had an effect on any of the variables measured, possibly because maximal bronchodilation is stimulated in healthy horses by the normal sympathoadrenergic response to exercise. Therefore, the pre-exercise inhalation of a bronchodilator by a healthy horse is unlikely to improve performance capacity.

Automated system for detailed measurement of respiratory mechanics

OBJECTIVE

The mechanical properties of the respiratory system (i.e., elastance and resistance) depend on the frequency, tidal volume, and shape of the flow waveform used for forcing. We developed a system to facilitate accurate measurements of elastance and resistance in laboratory and clinical settings at the frequencies and tidal volumes in the physiologic range of breathing.

METHODS

A personal computer (PC) is used to drive a common clinically used ventilator while simultaneously collecting measurements of airway flow, airway pressure, and esophageal pressure from the experimental subject or animal at different frequencies and tidal volumes. Analysis analogous to discrete Fourier transform at the fundamental frequency (i.e., ventilator setting) is used to calculate elastances and resistances of the total respiratory system and its components, the lungs and the chest wall. We have shown that this analysis is independent of the high-frequency harmonics that are present in the waveform from clinical ventilators.

RESULTS

The system has been used successfully to make measurements in anesthetized/paralyzed dogs and awake or anesthetized human volunteers in the laboratory, and in anesthetized human volunteers in the laboratory, and in anesthetized humans in the operating room and intensive care unit. Elastances and resistances obtained with this approach are the same as those obtained during more controlled conditions, e.g., sinusoidal forcing.

CONCLUSIONS

Accurate, standardized measurements of lung and chest wall properties can be obtained in many settings with relative ease with the system described. These properties, and their frequency and tidal volume dependences in the physiologic range, provide important information to aid in the understanding of changes in respiratory function caused by day-to-day conditions, clinical intervention and pathologies.

Contribution of viscoelastic stress to the rate-dependence of pulmonary dynamic elastance

To further characterize the contribution of the stresses accumulated during inflation in viscoelastic elements of the lungs to the rate-dependence of pulmonary dynamic elastance, we analyzed the changes in the pressures measured at the airway opening and in subpleural air spaces during airway occlusions performed at constant inflation rates of 5, 10, 20, and 40 ml/(kg sec) in 13 anesthetized piglets (mean age = 7 days). The analysis was repeated after saline lavage of the lungs and during intravenous infusion of histamine in 7 and 4 of the piglets, respectively. Viscoelastic stresses dissipated as stress relaxation were solely responsible for the differences between dynamic and static elastance before and after lung lavage and for more than 40% of this difference during histamine infusion (the remainder probably being caused by ventilation inequalities). The viscoelastic contribution to dynamic elastance increased by more than two-fold after lung lavage and was independent of inflation rate and only minimally dependent upon inflation volume. Our results demonstrate that viscoelastic stresses are primarily responsible for the dynamic stiffening of piglet lungs at low rates of inflation. They also support the notion that viscoelastic and elastic stresses are coupled as the lungs inflate.

Influence of waveform and analysis technique on lung and chest wall properties

To test an approach for measuring respiratory system resistance (R) and elastance (E) during non-sinusoidal forcing, we measured airway and esophageal pressures and flow at the trachea of 9 anesthetized-paralyzed dogs during sinusoidal forcing (SF) and 4 types of non-sinusoidal forcings at 0.15 and 0.6 Hz and 300 ml tidal volume. During SF, calculations of E and R of the lungs, chest wall or total system from discrete Fourier transform (DFT) and two other widely used methods (multiple regression and volume-pressure loop analysis) did not differ from each other (P > 0.05). During forcing with sinusoidal or step inspiration with passive expiration (inspiratory to expiratory ratio, I/E, = 1:1), Es from any analysis method were within 10% of values during SF. Although Rs of the lungs, chest wall or total system were not affected by waveform shape with DFT (P > 0.05), the other analysis methods gave values for R during non-SF that differed (P < 0.05) from those during SF by up to 77%. If I/E was changed to 1:2, with or without an added 10% inspiratory pause, values for E and R differed least from values during SF if DFT was used. During severe pulmonary edema induced by infusion of oleic acid in the right atrium, results for lung properties were similar to controls, despite large increases in E and R of the lungs. We conclude that E and R of the lungs and chest wall can be measured by DFT using nonsinusoidal forcing waveforms available on most clinical ventilators, incurring only modest error.

Effects of analysis method and forcing waveform on measurement of respiratory mechanics

The respiratory system has been shown to exhibit nonlinear mechanical properties in the frequency (f) range of normal breathing, manifested by tidal volume (Vt) dependence. Calculations of respiratory system resistance (R) and elastance (E) from pressure-flow measurements during external forcing at a given f may be ambiguous, especially if non-sinusoidal forcing waveforms are used. We evaluated the degree to which R and E depended upon: (1) analysis method (Fourier transform, multiple regression and pressure-volume loop analysis) and; (2) shape of the forcing waveform (sinusoidal, quasi-sinusoidal and step). We measured pressure and flow at the mouth of 5 healthy, awake subjects, relaxed at functional residual capacity, during forcing with the three different waveforms in the normal range of f (0.2-0.6 Hz) and Vt (250-750 ml). During sinusoidal forcing, E and R were not affected by analysis method (P greater than 0.2). With Fourier transform and multiple regression, E was not affected by waveform shape (P greater than 0.05); with loop analysis, E was slightly (less than 10%) higher during quasi-sinusoidal and step forcing than during the sine (P less than 0.05). R was least affected by waveform shape with Fourier transform. We conclude that, in the f and Vt range of normal breathing: (1) respiratory system impedance is 'quasi-linear,' i.e. despite dependencies of R and E on Vt, non-linearities are not large enough to restrict interpretation of R and E at a given f and Vt; (2) it may be possible to measure R and E using non-sinusoidal forcing waveforms available on most clinical ventilators, incurring only modest error.

New assessment of airway responsiveness. Effect of pretreatment with procaterol on allergen-induced bronchoconstriction

We examined airway responsiveness to allergen inhalation using a novel technique by which dynamic compliance (Cdyn) and pulmonary resistance (Rl) are simultaneously calculated by Fourier-series analysis of flow and transpulmonary pressure during tidal breathing. C0 and C0.5 (Cdyn at the frequency of zero and 0.5 Hz, respectively) were computed using the regression line of Cdyn versus frequency measured at the fundamental and first three harmonics in each breathing cycle. First, the validity of this system was tested by comparing Rl, C0 and C0.5 during five consecutive breaths with those obtained by the conventional method. A good correlation was seen in Rl, C0 and C0.5 between the two methods. Second, we studied airway response to allergen inhalation before and after oral administration of a long-acting beta 2-stimulant (procaterol, 50 micrograms or 100 micrograms) or placebo in a double-blind crossover trial in six atopic asthmatic subjects. In control allergen inhalation tests by administration of placebo, Rl increased progressively, and C0.5, expressed as percentage of control compliance at zero frequency (C0.5/COcont), decreased progressively. After 100 micrograms procaterol, Rl response to allergen was almost completely inhibited. However, a decrease in C0.5/C0cont was still observed. These findings suggest that pretreatment of asthmatic patients with procaterol can release allergen-induced bronchoconstriction of the central airways, but cannot release that of the peripheral airways.

Pulmonary mechanics during treadmill exercise in race ponies

Exercise-induced variations in their ventilatory mechanics were studied in 8 healthy ponies 4.2 +/- 1.4 years old and weighing 282 +/- 11 kg. Airflow (V), tidal volume (VT), esophageal pressure, mask pressure and electrocardiogram were simultaneously recorded before, during and after a treadmill (incline 8.3 degrees) exercise which consisted of 2 min walking (1.5 m.sec-1), 3 min slow trotting (3.0 m.sec-1) and 3 min fast trotting (3.5 m.sec-1). The results of three consecutive daily measurements were averaged for each pony. Heart rate, minute volume (Ve), respiratory frequency (f) and peak inspiratory and expiratory V, mean inspiratory and expiratory V, and peak to peak changes in transpulmonary pressure (maxdPtp) increased linearly and significantly with increasing velocity (v) (R2 = 0.99). Tidal volume and the inspiratory time to total breathing time ratio showed a curvilinar relation with v (R2 = 0.99). Minute volume, maxdPtp, total pulmonary resistance (RL) and VT increased from rest to fast trot 6.7, 5.7, 1.5 and 1.6 times respectively. When the ponies stopped all these values decreased significantly. After 5 min recovery, the Ve was approximately doubled, VT and max dPtp unchanged and RL 30% smaller than their respective resting values. The exercise-induced increase in Ve was achieved by an increase in f at both low and high intensity of work.

Influence of inertance on measurements of the mechanical properties of the bovine respiratory system

The observation that dynamic compliance (Cdyn) tended to rise with respiratory frequency (f) in adult cattle led us to reassess the importance of inertial pressures in measuring Cdyn in large animals. Five healthy Friesian cows were selected for their ability to show an increase of f without significant change in tidal volume (VT). Dynamic compliance was measured three times, both at the resting f (21 +/- 1 cpm), and at higher f (49 +/- 3 cpm), obtained by an artificial increase in the dead space of the breathing mask. Frequency-response characteristics of the measuring instruments were matched up to 12 Hz. The inertia of the lungs and gas stream (In) was calculated as the ratio of the accelerative pressure change to the simultaneous change in volume acceleration. Inertance was also estimated from the dimensions of the bovine airways and from the relative linear flow velocities reported by Rohrer (1915). Dynamic compliance measured during rapid breathing was significantly higher (p less than or equal to 0.01) than base-line values. Dynamic compliance was strongly correlated with f (r = +0.96). Measured and estimated In were 0.002 and 0.003 kPa.sec2.L-1 respectively. Dynamic compliance did not differ significantly from base-line values when it was corrected for the estimated inertance effect.

Dynamic respiratory mechanics in monkeys measured by forced oscillations

We measured impedances of the lungs (ZL) and respiratory system (Zrs) by discrete frequency (f) forced oscillations in adult bonnet monkeys at two lung volumes, FRC and at transrespiratory system pressure (Prs) of -5 cm H2O. Measurements were made from 2 to 32 Hz to study f dependence of effective resistances (Reff) and reactances, and from 1 to 8 Hz to study f dependence of effective pulmonary compliance (Ceff,L). Estimates of resistances (R), inertances (I) and compliances (C) of the lungs (L), chest wall (W) and respiratory system (rs) were obtained by fitting the 2-32 Hz data to a series RIC network model. Reff,L, Reff,W and Reff,rs were found to be f dependent. The magnitude of ZL was small relative to that of Zrs at all f with RL only 30% of Rrs and CL six times Crs. Decreasing lung volume from FRC to Prs = -5 cm H2O increased RL, RW and Rrs, slightly decreased CL, CW and Crs, slightly increased resonance frequencies, and increased the f dependent behavior of Ceff,L. Our results indicate both similarities and differences between the respiratory system of these primates and man.