Augmentation of phrenic neural activity by increased rates of lung inflation

Pulmonary feedback and gestational age-dependent regulation of fetal breathing movements

Prenatal lung development requires fetal breathing movements (FBM). To investigate the dependence of FBM on feedback originating from the lung, we hypothesized that pneumonectomy stimulates FBM. Time-dated fetal sheep underwent bilateral pneumonectomy, unilateral pneumonectomy, or sham surgery at 125-130 days gestation. The incidence of FBM decreased in sham-operated fetuses at 142 days versus 130 days (p = 0.013), but was unchanged across all gestational ages in bilaterally pneumonectomized fetuses (p > or = 0.52). In unilaterally pneumonectomized fetuses, the incidence of FBM remained unchanged until 139 days and was higher than that of the bilaterally pneumonectomized fetuses at 130-136 days gestation (p < or = 0.03). The amplitude of integrated diaphragmatic electromyographic activity (integralEMG(di)) and total respiratory output (frequency of breathing x integralEMG(di)) were lower in pneumonectomized fetuses versus sham-operated fetuses at later gestational ages (p < 0.05). These decreases in integralEMG(di) and total respiratory output were most pronounced at 142 days in bilaterally pneumonectomized fetuses versus sham-operated fetuses (p = 0.006 and 0.016, respectively). Low-voltage electrocortical activity (ECoG) increased, and high-voltage ECoG decreased, in unilaterally pneumonectomized fetuses compared with sham-operated fetuses (p = 0.04). In conclusion, we provide new evidence that feedback from the fetal lung modulates the incidence and various components of phrenic nerve output, suggesting a positive feedback mechanism between FBM and lung development.

Bronchopulmonary C-fibers modulate the breathing pattern in surfactant-depleted juvenile cats

The aim of this study was to investigate the influence of nonmyelinated C-fibers on the breathing pattern by cooling the vagal nerves to temperatures at which myelinated nerve transmission from pulmonary stretch receptors is blocked (+7 degrees C) and further at which nonmyelinated fiber input is blocked (0 degrees C), in anaesthetized spontaneously breathing juvenile cats with normal (L(N)), surfactant-depleted (L(D)) and surfactant-treated (L(T)) lungs. In L(N), vagal cooling from +7 to 0 degrees C decreased respiratory frequency (f(R); -8%; p < 0.01), and increased tidal volume (V(T); +40%; p < 0.01). In the presence of shallow fast breathing in L(D), f(R) decreased (+38 to +7 degrees C: -26%; p < 0.015 and +7 to 0 degrees C: -24%; p < 0.001) and V(T) increased (+37%; p < 0.049 and +88%; p < 0.016). In L(T), f(R) decreased (+7 to 0 degrees C: -21%; p < 0.001), whereas V(T) remained the same at 0 degrees C (+12%; NS). These findings show for the first time that the activity of bronchopulmonary C-fibers have a prominent role in modulating the breathing pattern in juvenile cats with surfactant-depleted lungs.

Maintained inspiratory activity during proportional assist ventilation in surfactant-depleted cats early after surfactant instillation: phrenic nerve and pulmonary stretch receptor activity

BACKGROUND

Inspiratory activity is a prerequisite for successful application of patient triggered ventilation such as proportional assist ventilation (PAV). It has recently been reported that surfactant instillation increases the activity of slowly adapting pulmonary stretch receptors (PSRs) followed by a shorter inspiratory time (Sindelar et al, J Appl Physiol, 2005 [Epub ahead of print]). Changes in lung mechanics, as observed in preterm infants with respiratory distress syndrome and after surfactant treatment, might therefore influence the inspiratory activity when applying PAV early after surfactant treatment.

OBJECTIVE

To investigate the regulation of breathing and ventilatory response in surfactant-depleted young cats during PAV and during continuous positive airway pressure (CPAP) early after surfactant instillation in relation to phrenic nerve activity (PNA) and the activity of PSRs.

METHODS

Seven anesthetized, endotracheally intubated young cats were exposed to periods of CPAP and PAV with the same end-expiratory pressure (0.2-0.5 kPa) before and after lung lavage and after surfactant instillation. PAV was set to compensate for 75% of the lung elastic recoil.

RESULTS

Tidal volume and respiratory rate were higher with lower PaCO2 and higher PaO2 during PAV than during CPAP both before and after surfactant instillation (p < 0.05; both conditions). As an indicator of breathing effort, esophageal deflection pressure and PNA were lower during PAV than during CPAP in both conditions (p < 0.02). Peak PSR activity was higher and occurred earlier during PAV than during CPAP (p < 0.01), and correlated linearly with PNA duration in all conditions studied (p < 0.001). The inspiratory time decreased as tidal volume increased when CPAP was changed to PAV, with the highest correlation observed after surfactant instillation (r = -0.769). No apneic periods could be observed.

CONCLUSION

PSR activity and the control of breathing are maintained during PAV in surfactant-depleted cats early after surfactant instillation, with a higher ventilatory response and a lower breathing effort than during CPAP.

Inhibition of breathing after surfactant depletion is achieved at a higher arterial PCO2 during ventilation with liquid than with gas

Background

Inhibition of phrenic nerve activity (PNA) can be achieved when alveolar ventilation is adequate and when stretching of lung tissue stimulates mechanoreceptors to inhibit inspiratory activity. During mechanical ventilation under different lung conditions, inhibition of PNA can provide a physiological setting at which ventilatory parameters can be compared and related to arterial blood gases and pH.

Objective

To study lung mechanics and gas exchange at inhibition of PNA during controlled gas ventilation (GV) and during partial liquid ventilation (PLV) before and after lung lavage.

Methods

Nine anaesthetised, mechanically ventilated young cats (age 3.8 ± 0.5 months, weight 2.3 ± 0.1 kg) (mean ± SD) were studied with stepwise increases in peak inspiratory pressure (PIP) until total inhibition of PNA was attained before lavage (with GV) and after lavage (GV and PLV). Tidal volume (V_t), PIP, oesophageal pressure and arterial blood gases were measured at inhibition of PNA. One way repeated measures analysis of variance and Student Newman Keuls-tests were used for statistical analysis.

Results

During GV, inhibition of PNA occurred at lower PIP, transpulmonary pressure (Ptp) and Vt before than after lung lavage. After lavage, inhibition of inspiratory activity was achieved at the same PIP, Ptp and Vt during GV and PLV, but occurred at a higher PaCO₂ during PLV. After lavage compliance at inhibition was almost the same during GV and PLV and resistance was lower during GV than during PLV.

Conclusion

Inhibition of inspiratory activity occurs at a higher PaCO₂ during PLV than during GV in cats with surfactant-depleted lungs. This could indicate that PLV induces better recruitment of mechanoreceptors than GV.

Termination of inspiration by phase-dependent respiratory vagal feedback in awake normal humans

Imperceptible levels of proportional assist ventilation applied throughout inspiration reduced inspiratory time (TI) in awake humans. More recently, the reduction in TI was associated with flow assist, but flow assist also reaches a maximum value early during inspiration. To test the separate effects of flow assist and timing of assist, we applied a pseudorandom binary sequence of flow-assisted breaths during early, late, or throughout inspiration in eight normal subjects. We hypothesized that imperceptible flow assist would shorten TI most effectively when applied during early inspiration. Tidal volume, integrated respiratory muscle pressure per breath, TI, and TE were recorded. All stimuli (early, late, or flow assist applied throughout inspiration) resulted in a significant increase in inspiratory flow; however, only when the flow assist was applied during early inspiration was there a significant reduction in TI and the integrated respiratory muscle pressure per breath. These results provide further evidence that vagal feedback modulates breathing on a breath-by-breath basis in conscious humans within a physiological range of breath sizes.

High strength stimulation of the vagus nerve in awake humans: a lack of cardiorespiratory effects

Vagus nerve stimulation is used to reduce the frequency and intensity of seizures in patients with epilepsy. In the present study four such patients were studied while awake. We analyzed the physiological responses to vagus nerve stimulation over a broad range of tolerable stimulus parameters to identify vagal A-fiber threshold and to induce respiratory responses typical of C-fiber activation. A-fiber threshold was determined by increasing stimulation current until laryngeal motor A-fibers were excited (frequency=30 Hz). With A-fiber threshold established, C-fiber excitation was attempted with physiologically appropriate stimulus parameters (low frequency and high amplitude).

RESULTS

A-fiber thresholds were established in all patients, threshold currents ranged between 0.5 and 1.5 mA. Stimulation at lower frequency (2-10 Hz) and higher amplitudes (2.75-3.75 mA) did not produce cardiorespiratory effects consistent with C-fiber activation. It is possible that such effects were not observed because vagal C-fibers were not excited, because C-fiber effects were masked by the 'wakeful drive' to breathe, or because epilepsy or the associated therapy had altered central processing of the vagal afferent inputs.

Identification of respiratory vagal feedback in awake normal subjects using pseudorandom unloading

Evidence of the Hering-Breuer reflex has been found in humans during anesthesia and sleep but not during wakefulness. Cortical influences, present during wakefulness, may mask the effects of this reflex in awake humans. We hypothesized that, if lung volume were increased in awake subjects unaware of the stimulus, vagal feedback would modulate breathing on a breath-to-breath basis. To test this hypothesis, we employed proportional assist ventilation in a pseudorandom sequence to unload the respiratory system above and below the perceptual threshold in 17 normal subjects. Tidal volume, integrated respiratory muscle pressure per breath, and inspiratory time were recorded. Both sub- and suprathreshold stimulation evoked a significant increase in tidal volume and inspiratory flow rate, but a significant decrease in inspiratory time was present only during the application of a subthreshold stimulus. We conclude that vagal feedback modulates respiratory timing on a breath-by-breath basis in awake humans, as long as there is no awareness of the stimulus.

Effects of the inspiratory pressure waveform during patient-triggered ventilation on pulmonary stretch receptor and phrenic nerve activity in cats

OBJECTIVE

To examine the effects of square wave, sinusoidal, and linear inspiratory pressure waveforms during pressure-controlled assist/control ventilation on the firing pattern of pulmonary stretch receptors and phrenic nerve activity.

DESIGN

Experimental, comparative study.

SETTING

Research laboratory at a university biomedical center.

SUBJECTS

Nine anesthetized, endotracheally intubated young cats (2.5-3.4 kg).

INTERVENTION

With interposed periods of continuous positive airway pressure (0.2 kPa), each cat was exposed to periods of assist/control ventilation with three different pressure waveforms, where the peak inspiratory pressure (0.74 +/- 0.13 kPa), end-expiratory pressure (0.2 +/- 0.02 kPa), and tidal volume (14.9 +/- 5.22 mL/kg) were kept constant. Preset controlled ventilator rate was set below the rate of spontaneous breathing, and the mechanical inflation time equaled the inspiratory time during spontaneous breathing on continuous positive airway pressure.

MEASUREMENTS AND MAIN RESULTS

Respiratory rate and arterial blood gases did not change between the three pressure waveforms during assist/control ventilation. Peak pulmonary stretch receptor activity was lower and mean phrenic nerve activity higher during continuous positive airway pressure than during assist/control ventilation (p <.05). Peak inspiratory pulmonary stretch receptor activity was the same with all three pressure waveforms (82 +/- 17 impulses.sec-1) but occurred earlier with square wave than with sinusoidal or linear pressure waveforms (p <.05). The total number of impulses in the phrenic nerve activity burst was smaller with square wave than with the other two pressure waveforms (0.21 +/- 0.17 vs. 0.33 +/- 0.27 and 0.42 +/- 0.30 arbitrary units; p <.05), and the phrenic nerve activity burst duration was shorter with square wave (1.10 +/- 0.45 vs. 1.54 +/- 0.36 and 1.64 +/- 0.25 secs; p <.05).

CONCLUSION

Square wave pressure waveform during pressure-controlled assist/control ventilation strongly inhibits spontaneous inspiratory activity in cats. One mechanism for this inhibition is earlier and sustained peak pulmonary stretch receptor activity during inspiration. These findings show that differences in inspiratory pressure waveforms influence the spontaneous breathing effort during assist/control ventilation in cats.

Effects of inspiratory flow on diaphragmatic motor output in normal subjects

Increasing inspiratory flow (V) has been shown to shorten neural inspiratory time (TI(n)) in normal subjects breathing on a mechanical ventilator, but the effect of V on respiratory motor output before inspiratory termination has not previously been studied in humans. While breathing spontaneously on a mechanical ventilator, eight normal subjects were intermittently exposed to 200-ms-duration positive pressure pulses of different amplitudes at the onset of inspiration. Based on the increase in V above control breaths (DeltaV), trials were grouped into small, medium, and large groups (mean DeltaV: 0.51, 1.11, and 1.65 l/s, respectively). We measured TI(n), transdiaphragmatic pressure (Pdi), and electrical activity (electromyogram) of the diaphragm (EMGdi). Transient increases in V caused shortening of TI(n) from 1.34 to 1.10 (not significant), 1.55 to 1.11 (P < 0.005), and 1.58 to 1.17 s (P < 0. 005) in the small, medium, and large DeltaV groups, respectively. EMGdi measured at end TI(n) of the pulse breaths was 131 (P < 0.05), 142, and 155% (P < 0.05) of the EMGdi of the control breaths at an identical time point in the small, medium, and large trials, respectively. The latency of the excitation was 126 +/- 42 (SD) ms, consistent with a reflex effect. Increasing V had two countervailing effects on Pdi: 1) a depressant mechanical effect due primarily to the force-length (11.2 cmH(2)O/l) relation of the diaphragm, and 2) an increase in diaphragm activation. For the eight subjects, mean peak Pdi did not change significantly, but there was significant intersubject variability, reflecting variability in the strength of the excitation reflex. We conclude that increasing inspiratory V causes a graded facilitation of EMGdi, which serves to counteract the negative effect of the force-length relation on Pdi.

Adaptation of guinea-pig vagal airway afferent neurones to mechanical stimulation

1. Intracellular and extracellular electrophysiological recording techniques were employed to examine the mechanisms involved in adaptation of guinea-pig airway sensory neurones to suprathreshold mechanical stimulation in vitro. Extracellular recordings performed using an in vitro airway preparation revealed two unambiguously distinct subsets of mechanically sensitive nerve endings in the trachea/bronchus. In one group of fibres, the mechanical stimulus caused a brief burst of action potentials, after which the nerve rapidly adapted. In the other group of fibres, repetitive action potentials were evoked as long as the stimulus was maintained above threshold. 2. The adaptation response strictly correlated with ganglionic origin of the soma. Those fibres derived from the nodose ganglion adapted rapidly, whereas those derived from the jugular ganglion were slowly or non-adapting. 3. Intracellular recordings from airway-identified neurones in isolated intact ganglia revealed that the majority of neurones within either the nodose or jugular ganglion adapted rapidly to prolonged suprathreshold depolarizing current injections. 4. The electrophysiological adaptation of nodose ganglion-derived neurones following prolonged suprathreshold current steps was greatly reduced by 4-aminopyridine. However, 4-aminopyridine did not affect the adaptation of rapidly adapting nodose ganglion-derived nerve endings in response to mechanical stimuli. 5. The data suggest that ganglionic origin dictates adaptive characteristics of guinea-pig tracheal and mainstem bronchial afferent neurones in response to mechanical stimulation. Also, the rapid adaptation of nodose nerve endings in the trachea observed during a mechanical stimulus does not appear to be related to the adaptation observed at the soma during prolonged suprathreshold depolarizing current injections.

Powerful respiratory stimulation by thin muscle afferents

The ventilatory responses to electrical stimulation of phrenic afferents were examined in spontaneously breathing dogs at different levels of sodium pentobarbital anesthesia. High intensity stimulation (activation of all the afferents, including thin fibers) increased ventilation (V(E)). The increase in V(E) was comparable to that of breathing 10% CO2 and was inversely related to anesthesia level. Under light anesthesia, V(E) increased to 282+/-36% of the control value when the phrenic nerve was stimulated at 130 times the twitch threshold (n = 15; P < 0.01). The increase in V(E) was due to increases in breathing rate (193+/-19%) and tidal volume (V(T)) (143+/-8%). On the other hand, inspiratory time (T(I)) decreased. Thus, average airflow rate (V(T)/T(I)) increased to 204+/-23%. After administration of 20 and 40% of the initial dose of pentobarbital, V(E) response was attenuated to 157+/-21 and 121+/-4%, respectively. We conclude that thin muscle afferents are capable of eliciting pronounced ventilatory stimulation. The small responses observed earlier were likely due to depth of anesthesia.

Increased incidence of sighs (augmented inspiratory efforts) during synchronized intermittent mandatory ventilation (SIMV) in preterm neonates

A reflex resulting in a deep, sigh-like inspiratory effort (augmented breath) is frequently triggered during synchronized mechanical ventilation in preterm infants. We studied the incidence of augmented inspiratory efforts and their effect on ventilation and lung compliance during conventional IMV and synchronized IMV (SIMV) in 15 preterm neonates (GA 26.7 +/- 1.5 wks (mean +/- SD), BW 925 +/- 222 g, age 1-8 days). Augmentation of spontaneous inspiratory effort was defined as an esophageal pressure deflection occurring coincident with a synchronized mechanical breath and exceeding the previous unassisted spontaneous effort by more than 50%. The incidence of augmented breaths was higher during SIMV (11.1 +/- 7.7%; P < 0.01) than during conventional IMV (5.1 +/- 6.1%). However, when the synchronized breaths were triggered late (200-300 msec) after the onset of inspiration, augmented breaths occurred no more frequently than during conventional IMV (6.0 +/- 4.7%). The incidence of augmented breaths correlated inversely with dynamic lung compliance (P = 0.014), but was not significantly influenced by a change in PEEP. Although inspiratory effort increased nearly three times during the augmented breaths, tidal volume increased only 12%. The change in tidal volume was limited because the augmented effort reached its maximal negativity only approximately 500 ms after the beginning of the synchronized, mechanical breath and at a time when the mechanical breath had already ended. For this reason the augmented effort did not contribute significantly to minute ventilation, but only prolonged inspiration. Dynamic lung compliance did not change significantly after an augmented breath. The results indicate that augmented inspiratory efforts are more common in preterm neonates ventilated with SIMV than with conventional IMV, but do not contribute significantly to ventilation.

Ventilatory response to continuous incremental changes in respiratory resistance in patients with mild asthma

BACKGROUND

Conflicting results from previous studies on the effect of bronchial challenge on ventilatory patterns in asthmatics may be due to airflow obstruction present before induction of bronchospasm onset, as well as the different degrees of bronchoconstriction induced.

PURPOSE AND METHODS

We examined the ventilatory response to stepwise increments in respiratory resistance (Rrs) induced by continuous methacholine inhalation in eight patients with mild stable asthma without airway obstruction and eight normal subjects. Methacholine was inhaled continuously during tidal breathing until a nearly two-fold increase in Rrs was observed. Respiratory parameters, including tidal volume (VT), respiratory frequency (f), inspiratory ventilation (VI), mean inspiratory flow (VT/TI), and duty ratio (TI/TT), were measured simultaneously by respiratory inductive plethysmograph (RIP). Arterial oxygen saturation (SaO2) was examined by pulse oximetry. The end-tidal CO2 fraction (FETCO2) was measured with a rapid-response infrared analyzer at the mouthpiece.

RESULTS

Rrs, SaO2, FETCO2, and respiratory parameters, measured after saline solution inhalation, were not different between the two groups. Inhaled methacholine first decreased and then increased VI in both groups. However, changes in VI occurred earlier and to a greater extent in asthmatics than in normal subjects. At 200% Rrs (percent control), %VI was greater in asthmatics than in normal subjects (p<0.005) because of significant differences in %VT and %VT/TI between the two groups.

CONCLUSION

For a given degree of bronchoconstriction, the ventilatory response was more rapid and greater in patients with mild stable asthma without airway obstruction than in normal subjects. The different response to bronchial challenge between the two groups may be due to different increases in drive due to irritant receptor stimulation.

Effect of pulmonary lymphatic obstruction on respiratory rate and airway rapidly adapting receptor activity in rabbits

1. The effects on respiratory rate of obstruction of pulmonary lymph flow, reduction of plasma protein concentration and a combination of the two procedures were examined in anaesthetized rabbits. The former was achieved by raising the pressure in a pouch created from the right external jugular vein and the latter by batch plasmapheresis. 2. In spontaneously breathing rabbits, neither pulmonary lymphatic obstruction (n = 6) nor plasmapheresis (n = 5) produced a significant change in respiratory rate. However, their combination (n = 8) produced a significant increase in respiratory rate (P < 0.05). 3. Cooling of the cervical vagi to 8-9 degrees C (n = 4) and vagotomy (n = 7) abolished this response. 4. There was a significant increase in the activity of the airway rapidly adapting receptors (RARs; n = 9) during pulmonary lymphatic obstruction, plasmapheresis and their combination (P < 0.05). 5. It is concluded that in the rabbit, obstruction of lymphatic drainage from the lung after plasmapheresis causes a reflex increase in respiratory rate. The afferent pathway for this reflex response lies in the vagus nerve and the RARs are likely to be the receptors involved in this response.

Pulmonary and upper airway afferent influences on the motor pattern of vocalization evoked by excitation of the midbrain periaqueductal gray of the cat

It has been established previously that natural-sounding vocalization is evoked by excitation of the midbrain periaqueductal gray (PAG). It is not known, however, whether the motor output for such vocalization is invariant, or whether it is influenced by afferent discharge. We have investigated, in the unanesthetized precollicular decerebrate cat, the patterns of upper airway and respiratory EMG activity evoked by microinjection into the PAG of the excitatory amino acid D,L-homocysteic acid (6 to 40 nmol in 30-200 nl), under conditions of varied pulmonary and upper airway afferent input. The PAG-evoked pattern in the control state consisted of a 1- to 2-min sequence of episodic vocalizations (hiss or howl-like) with expiratory (vocalization) durations of generally less than 2 s, separated by one or more inspirations. During such PAG-evoked vocalization, a significant prolongation of the expiratory duration and an extended discharge in laryngeal, intercostal and abdominal muscles was evoked by the application of warm, humidified static air pressures (5-30 cm H2O) either: (i) to the lungs and tracheo-bronchial tree via a tracheostomy, or (ii) as an airflow through the upper airways in an expiratory direction. In contrast, if the development of the usual vocalization-related air pressures (5-45 cm H2O) in the lungs and airways was prevented by opening a tracheal cannula to the atmosphere, shortened respiratory durations (inspiratory and expiratory) occurred. The effects evoked by static pressure inflations of the lungs could be blocked by bilateral vagotomy or reversibly blocked by unilateral vagotomy combined with vagal cooling sufficient to abolish Hering-Breuer reflexes. These results indicate that the motor pattern for vocalization evoked by excitation of PAG is exquisitely sensitive to pulmonary and upper airway afferent input.

Methacholine-induced bronchoconstriction and phrenic motoneuron activity in dogs

To evaluate the effect of changes in bronchomotor tone on the firing pattern of single phrenic motoneurons, efferent activity of both the C5 branch phrenic nerve and a single fiber from the contralateral phrenic nerve were studied in dogs anesthetized (chloralose/urethane) and breathing spontaneously (65% O2). Bronchoconstriction was induced by inhalation of methacholine (MCh) aerosol, which increased total lung resistance, decreased dynamic lung compliance and tidal volume. The rate of rise of phrenic activity was significantly increased by the changes in pulmonary mechanics induced by MCh. Single phrenic motoneurons could be separated into early (EOM) and late (LOM) onset types based on the onset time of firing relative to the beginning of whole phrenic nerve activity. The increased phrenic nerve activity was due primarily to the recruitment of LOMs. The recruitment of LOMs consisted of a shift in the time of onset to an earlier portion in inspiration, a longer firing duration, and an increase in the number of spikes per inspiratory cycle. After bilateral cervical vagotomy, all the responses of phrenic nerve to changes in pulmonary mechanics induced by aerosolized MCh were attenuated. These results suggest that phrenic motoneurons activity is modulated by alterations in pulmonary mechanics via a reflex mediated by the vagus nerve and that LOM play an important part in this response.

Responses of diaphragm and external oblique muscles to flow-resistive loads during sleep

Although it is generally agreed that rapid respiratory compensation for externally applied inspiratory loads is impaired or absent during sleep, the individual components of the "load-compensating reflex" may not be inhibited by sleep to the same degree. We studied the effect of inspiratory flow-resistive loading (18 cm H2O/L/s) for two consecutive breaths on inspiratory (diaphragm) and expiratory (external oblique) muscle activity, and respiratory timing, in six awake and sleeping goats. During the first loaded breath in the awake state, peak integrated diaphragmatic electromyogram activity (EMGdi) increased 16.7 +/- 3.9% (p less than 0.01), peak integrated external oblique EMG activity (EMGeo) increased 21.0 +/- 7.5% (p less than 0.001), and electrical inspiratory time (Ti) increased 18.1 +/- 2.1% (p less than 0.01). In contrast, loading did not significantly change peak EMGdi or EMGeo on the first or second breaths in any sleep state. However, Ti was significantly increased during loading in all sleep states (p less than 0.01) to a similar degree seen during wakefulness. Loading did not significantly alter electrical expiratory time. No significant differences were noted between the first and second loaded breaths. We conclude that the reflex increases in peak EMG of both inspiratory and expiratory muscles in response to inspiratory flow-resistive loading during the awake state are absent during all stages of sleep; however, one aspect of load compensation, prolongation of Ti, is preserved during sleep and aids in maintaining tidal volume.

Animal ventilator controlled by central respiratory phases

An animal ventilator based on the principle of constant gas flow is described. The ventilator can operate either in a fixed cycle mode or in cycle-triggered mode. In the first case the built-in generator allows the setting of respiration rate and of the ratio of inspiratory duration to total respiratory cycle duration. When operated in cycle-triggered mode, phrenic nerve activity by means of an external respiratory phase detector controls the action of the pump. An internal circuitry allows precise no-inflation maneuvers. The device provides logical timing signals suitable for cycle-triggered averaging of respiration-related neuronal activity. The ventilator has proven its usefulness in experiments on reflex control of central respiration in paralyzed rabbits.

Diaphragmatic contraction during assisted mechanical ventilation

Indirect evidence from airway pressure recordings in mechanically ventilated patients suggests that the diaphragm exhibits contractile activity beyond that required to trigger a ventilator-assisted breath. We used the diaphragmatic EMG to provide direct evidence of persistent contractile activity and studied the effects of alterations in ventilator-delivered flow rate and tidal volume on the duration of diaphragmatic contraction. The duration of contraction was expressed in terms of inspired volume. During a single breath, diaphragmatic force generation ceases at the point of peak electromyographic activity; hence, the inspired volume at peak EMG is the volume at the diaphragmatic off-switch (Voff). Ventilator-delivered flow rate and tidal volume were varied during assisted (patient-initiated) and controlled (ventilator-initiated) breaths while diaphragmatic EMG and inspired volume were recorded simultaneously in ten patients with a variety of illnesses requiring mechanical ventilation. Spontaneous ventilator-unassisted breaths were also recorded for comparison. We found that (1) during assisted breaths, diaphragmatic activity continued after the ventilator was triggered, (2) Voff was usually close to spontaneous tidal volume, (3) Voff increased significantly as ventilator-delivered flow rate increased, and (4) controlled breaths may also be associated with phasic electromyographic activity. The data have implications for resting patients on assisted ventilation.

The differential organization of medullary post-inspiratory activities

Membrane potential trajectories of 68 bulbar respiratory neurones from the peri-solitary and peri-ambigual areas of the brain-stem were recorded in anaesthetized cats to explore the synaptic influences of post-inspiratory neurones upon the medullary inspiratory network. A declining wave of inhibitory postsynaptic potentials resembling the discharge of post-inspiratory neurones was seen in both bulbospinal and non-bulbospinal inspiratory neurones, including alpha- and beta-inspiratory, early-inspiratory, late-inspiratory and ramp-inspiratory neurones. Activation of laryngeal and high-threshold pulmonary receptor afferents excited bulbar post-inspiratory neurones, whilst in the case of inspiratory neurones such stimulation produced enhanced postsynaptic inhibition during the same period of the cycle. Activation of post-inspiratory neurones and enhanced post-inspiratory inhibition of inspiratory bulbospinal neurones was accompanied by suppression of the after-discharge of phrenic motoneurones. These results suggest that a population of post-inspiratory neurones exerts a widespread inhibitory function at the lower brain-stem level. Implications of such an inhibitory function for the organization of the respiratory network are discussed in relation to the generation of the respiratory rhythm.

Role of the ventrolateral region of the nucleus of the tractus solitarius in processing respiratory afferent input from vagus and superior laryngeal nerves

The role of respiratory neurons located within and adjacent to the region of the ventrolateral nucleus of the tractus solitarius (vlNTS) in processing respiratory related afferent input from the vagus and superior laryngeal nerves was examined. Responses in phrenic neural discharge to electrical stimulation of the cervical vagus or superior laryngeal nerve afferents were determined before and after lesioning the vlNTS region. Studies were conducted on anesthetized, vagotomized, paralyzed and artificially ventilated cats. Arrays of 2 to 4 tungsten microelectrodes were used to record neuronal activity and for lesioning. Constant current lesions were made in the vlNTS region where respiratory neuronal discharges were recorded. The region of the vlNTS was probed with the microelectrodes and lesions made until no further respiratory related neuronal discharge could be recorded. The size and placement of lesions was determined in subsequent microscopic examination of 50 micron thick sections. Prior to making lesions, electrical stimulation of the superior laryngeal nerve (4-100 microA, 10 Hz, 0.1 ms pulse duration) elicited a short latency increase in discharge of phrenic motoneurons, primarily contralateral to the stimulated nerve. This was followed by a bilateral decrease in phrenic nerve discharge and, at higher currents, a longer latency increase in discharge. Stimulation of the vagus nerve at intensities chosen to selectively activate pulmonary stretch receptor afferent fibers produced a stimulus (current) dependent shortening of inspiratory duration. Responses were compared between measurements made immediately before and immediately after each lesion so that changes in response efficacy due to lesions per se could be distinguished from other factors, such as slight changes in the level of anesthesia over the several hours necessary in some cases to complete the lesions. Neither uni- nor bi-lateral lesions altered the efficacy with which stimulation of the vagus nerve shortened inspiratory duration. The short latency excitation of the phrenic motoneurons due to stimulation of the superior laryngeal nerve was severely attenuated by unilateral lesions of the vlNTS region ipsilateral to the stimulated nerve. Neither the bilateral inhibition nor the longer latency excitation due to superior laryngeal nerve stimulation was reduced by uni- or bi-lateral lesions of the vlNTS region.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of end-expired pressure on phrenic output in servo-ventilated dogs

The pattern of breathing induced by increases in end-expired lung volume (EEVL) was determined in 9 anesthetized dogs. The pulmonary and systemic circulations were separately pump-perfused and the lungs were ventilated with a servo-ventilator actuated from the phrenic neurogram. EEVL was increased as a continuous ramp by slowly raising end-expired transpulmonary pressure from 1.5 to 12 cm H2O. Tidal volume (VT), inspiratory time (TI), and expiratory time (TE) were measured at vagal temperatures of 39 degrees C and 7 degrees C and following vagotomy. At a vagal temperature of 39 degrees C, increasing EEVL produced significant reductions in VT and TI while greatly prolonging TE. Vagal cooling to 7 degrees C, substantially altered the reflex response to increased EEVL. At 7 degrees C, VT decreased as EEVL increased, but the reduction was not so pronounced as at 39 degrees C. In addition, both TI and TE shortened. Increasing EEVL following vagotomy had no consistent effects on breathing pattern. We conclude that increasing EEVL stimulates tachypneic promoting pulmonary afferent nerves, most likely pulmonary C-fibers, but at normal vagal temperature their effect is masked by the stronger reflex inhibition of slowly adapting pulmonary stretch receptors.

Neural elements subserving pulmonary stretch receptor-mediated facilitation of phrenic motoneurons

The neural elements responsible for facilitation of phrenic nerve activity by lung inflation were investigated in cats by the simultaneous recording of individual pulmonary stretch receptor afferents, respiratory neurons of the ventrolateral nucleus of the tractus solitarius and phrenic nerve activity. Monosynaptic excitation of I beta neurons by slowly adapting pulmonary stretch receptors was demonstrated by cross-correlational analysis. It was also demonstrated that the majority of these same I beta neurons projected to the contralateral C5 phrenic motoneuron pool. Thus, this study has shown that I beta neurons can act as central neural elements to mediate the facilitatory effect of lung inflation upon phrenic nerve activity.

Responses of recurrent laryngeal motoneurons to changes of pulmonary afferent inputs

In decerebrate, paralyzed cats ventilated with a cycle-triggered pump, the discharges of the recurrent laryngeal (whole nerve or single fibers) and phrenic nerves, and the changes produced by pulmonary afferent inputs (lung inflation), were compared. When lung inflation was in phase with neural inspiration, four types of laryngeal fiber activities were observed: (a) phasic-inspiratory; (b) tonic-inspiratory; (c) expiratory-inspiratory; (d) early-expiratory. The firing patterns during inspiration were plateau-like, whereas the phrenic pattern was augmenting. When inflation was withheld, the plateau patterns usually became augmenting, indicating inhibition of laryngeal inspiratory activity by pulmonary afferents. Secondary effects of withholding inflation were (a) increases of early-expiratory activity (both whole nerve and individual fiber), indicating increased post-inhibitory rebound excitation; (b) decreased activity of tonic-inspiratory and expiratory-inspiratory fibers during early neural expiration, indicating increased inhibition by early-expiratory neurons. The discharge patterns of different types of laryngeal motoneuron, as well as their changes with inflation, are interpreted in relation to the function of regulating airway resistance.

Responses of early and late onset phrenic motoneurons to lung inflation

In anesthetized or decerebrate cats that were paralyzed and ventilated with a cycle-triggered pump, we produced changes in activity of the whole phrenic nerve and of individual phrenic motoneurons (fibers or cells in the spinal cord) by withholding lung inflation during the inspiratory (I) phase. The neurons were classified into early- and late-onset types (discharge onset less or greater than 80 msec, respectively, after whole phrenic onset). Both unit and whole phrenic activity exhibited a variety of responses to inflation (excitation, depression, or no effect); but there were no consistent differences between responses of early- and late-onset neurons. The distribution of responses was quite different from that of dorsal respiratory group (DRG) I neurons (Cohen and Feldman, 1984); in particular there was no group of phrenic neurons corresponding to the late-onset I-beta neurons (I neurons excited by inflation). We conclude that the inputs to late-onset phrenic neurons are not predominantly or exclusively from late-onset DRG neurons.

Effects of bronchoconstriction on breathing during normoxia and hypoxia in anesthetized cats

The effect of an increase in bronchomotor tone on control of breathing during both normoxia and hypoxia, and the role of vagal afferents in regulating these responses were studied in 15 anesthetized cats. Minute ventilation (VE) was measured with a pneumotachograph connected in series with a tracheal cannula. Total diaphragmatic EMG activity per minute (means p X f, peak EMG moving average X respiratory frequency) was measured to assess the central inspiratory drive. Bronchoconstriction was generated by inhalation of methacholine aerosol (10-30 breaths, 0.5% solution) which increased total lung resistance to approximately 400% of the control value. Transient hypoxia was induced by allowing the cats to rebreathe a hypoxic gas mixture (4.5% O2 balanced N2) for approximately 1 min. During normoxia, bronchoconstriction increased VE from a baseline of 100 to 129 +/- 7% (mean +/- SEM; P less than 0.05) and increased (means p X f) from 100 to 174 +/- 16% (P less than 0.01). During hypoxia, the response of (means p X f) to bronchoconstriction (404 +/- 40%) was still greater than without bronchoconstriction (306 +/- 35%; P less than 0.01), but the responses of VE were not significantly different between these two conditions (P greater than 0.05). After sectioning both vagus nerves the bronchoconstriction-induced increase in central inspiratory drive was either reduced (during normoxia) or abolished (during hypoxia). These results suggest that stimulation of vagal bronchopulmonary afferents are involved in regulating the ventilatory responses to bronchoconstriction. Other non-vagal factors, such as intrinsic properties and reflex responses of the respiratory muscles, may also contribute, in part, to the observed responses.

Effects of thoracic dorsal rhizotomy or vagotomy on inspiratory muscle activity at various levels of chemical drive

The relationship between relative peak activity (moving average EMG) of the diaphragm (Adi) and of the cranial (2nd and 3rd) external intercostal or parasternal muscles (Aic) was assessed during rebreathing in animals before and after bilateral thoracic (T1-T4) dorsal rhizotomy (TDR) and/or bilateral vagotomy (VGT). The relationship had the form Aic=a Adib under all conditions. In intact rabbits and cats mean values for b were 1.48 and 1.79, respectively, a being unity by definition. Neither TDR nor VGT changed b; a decreased to about 0.15 with TDR and halved with VGT only if performed before TDR. Selective reflex facilitation of inspiratory intercostals with occlusions at FRC was observed after VGT and was abolished by TDR. Neither VGT nor TDR affected Adi time course. Hence: (1) central command to alpha-motoneurones of the major inspiratory muscles differs; (2) proprioceptive feedback markedly increases external intercostal activity, apparently by multiplying Aic due to central command to alpha-motoneurones by a factor independent of chemical drive; (3) vagally mediated augmentation of Aic depends entirely on intact proprioceptive feedback. The possible role of fusimotor drive is discussed.

The effect of vagal blockade on the variability of ventilation in the awake dog

The present study examined the variability of breathing in five (5) awake tracheostomized dogs with the vagi intact and during complete vagal blockade produced by cooling exteriorized cervical vagal loops (VC). Breath by breath variations in both respiratory timing (assessed from the airflow signal) and the drive to the respiratory muscles (as assessed from the rate of inspiratory airflow (VI/TI) and occlusive pressure (P100) were examined. The degree of variability in the parameters characterizing breathing was evaluated from frequency distribution histograms and by calculation of the standard deviation. VC increased the mean values of VT, TI, TE, TI/TTOT, and decreased VT/TI and occlusion pressure, but had no consistent effect on the mean value of VE. The variability of VE, PACO2, VT, TI, TE, TI/TTOT was greater during VC in 4 of the 5 dogs. The increased variability of VE and PACO2 during VC appeared to be due to a poorer correlation between TI and TE. The present study suggests that vagal mechanoreceptors, presumably pulmonary stretch receptors, minimize breath by breath fluctuations in both the level and pattern of ventilation by controlling respiratory timing. An explanation, based on the model of inspiratory off-switching proposed by Beadley et al. (1975) is invoked.

Reflex effects of aerosolized histamine on phrenic nerve activity

Studies were conducted in anesthetized, paralyzed dogs on the effect of aerosolized histamine on phrenic nerve activity. The paralyzed dogs were ventilated in phase with their recorded phrenic nerve activity at a constant inspiratory flow-rate, using a cycle-triggered ventilator. Phrenic nerve activity was measured before and during administration of aerosolized histamine while the inspiratory flow-rate and arterial blood gases were kept constant. In addition, before and after histamine, phrenic nerve activity was recorded for single bursts during which the ventilator was switched off. The effects of histamine on respiratory resistance were prevented by prior administration of isoproterenol and atropine. Although no changes occurred in respiratory resistance, histamine increased the instantaneous magnitude of phrenic nerve activity. The effect was evident early in the inspiratory period and was found even when the lungs were not inflated. Inflation of the lungs excited phrenic nerve activity; this effect increased after histamine. All of these actions of histamine were abolished by vagotomy. We conclude that histamine increased phrenic nerve activity during inspiration by a vagal reflex.

A low continuous positive airway pressure induces regular breathing and increased inspiratory activity in newborn lambs

To determine the lowest continuous positive airway pressure (CPAP) at which breathing becomes regular and to determine whether the phrenic nerve activity changes simultaneously, breathing pattern and phrenic nerve activity were studied in spontaneously breathing newborn lambs at various levels of CPAP. A CPAP of 0.25 kPa decreased the variability of phrenic burst interval, i.e. made the breathing regular. This CPAP also increased the mean impulse frequency within the phrenic nerve bursts, indicating greater inspiratory activity. A high CPAP did not offer any further advantages to the breathing pattern or to the inspiratory activity.

Positive feedback facilitation of external intercostal and phrenic inspiratory activity by pulmonary stretch receptors

Both in lightly pentobarbitone anesthetized and decerebrate cats increments in lung volume (V) during inspiration caused facilitation of inspiratory activity both in phrenic (Phr) and external intercostal (EI) motoneurons. This effect had low volume threshold, well below eupnoeic tidal volumes. It was readily reduced or abolished by small additional doses of pentobarbitone. This facilitatory effect appeared with considerably greater magnitude in EI than in Phr. The response magnitude was linearly related to the corresponding increments in V but not to increments in airflow (V). Sustained elevation of V at zero V caused sustained facilitation of EI and Phr. This positive feedback facilitation which was similarly obtained in spontaneously breathing and paralysed cats occurred continuously with great regularity in every breath. It was abolished by bilateral vagotomy but could then be elicited by electrical stimulation of the central end of the vagus nerve at the same threshold strengths required to elicit a just detectable shortening of inspiratory duration. The results indicate that the slowly adapting pulmonary stretch receptors are responsible for this positive feedback facilitation prior to the negative feedback effect on the inspiratory 'off-switch' elicited by the same receptors. Clear distinctions are described between the reflex characteristics of this 'low-threshold' volume dependent facilitatory reflex and the 'high-threshold' transient excitatory reflex effects provoked by large and rapid inflations.