Entropy Production and the Pressure-Volume Curve of the Lung

Pressure-volume mechanics of inflating and deflating intact whole organ porcine lungs

Pressure-volume curves of the lung are classical measurements of lung function and are impacted by changes in lung structure due to disease or shifts in air-delivery volume or cycling rate. Diseased and preterm infant lungs have been found to show heterogeneous behavior which is highly frequency dependent. This breathing rate dependency has motivated the exploration of multi-frequency oscillatory ventilators to deliver volume oscillation with optimal frequencies for various portions of the lung to provide more uniform air distribution. The design of these advanced ventilators requires the examination of lung function and mechanics, and an improved understanding of the pressure-volume response of the lung. Therefore, to comprehensively analyze whole lung organ mechanics, we investigate six combinations of varying applied volumes and frequencies using ex-vivo porcine specimens and our custom-designed electromechanical breathing apparatus. Lung responses were evaluated through measurements of inflation and deflation slopes, static compliance, peak pressure and volume, as well as hysteresis, energy loss, and pressure relaxation. Generally, we observed that the lungs were stiffer when subjected to faster breathing rates and lower inflation volumes. The lungs exhibited greater inflation volume dependencies compared to frequency dependencies. This study's reported response of the lung to variations of inflation volume and breathing rate can help the optimization of conventional mechanical ventilators and inform the design of advanced ventilators. Although frequency dependency is found to be minimal in normal porcine lungs, this preliminary study lays a foundation for comparison with pathological lungs, which are known to demonstrate marked rate dependency.

Positive- and Negative-Pressure Ventilation Characterized by Local and Global Pulmonary Mechanics

Rationale: There is continued debate regarding the equivalency of positive-pressure ventilation (PPV) and negative-pressure ventilation (NPV). Resolving this question is important because of the different practical ramifications of the two paradigms. Objectives: We sought to investigate the parallel between PPV and NPV and determine whether or not these two paradigms cause identical ventilation profiles by analyzing the local strain mechanics when the global tidal volume (Vt) and inflation pressure was matched. Methods: A custom-designed electromechanical apparatus was used to impose equal global loads and displacements on the same ex vivo healthy porcine lung using PPV and NPV. High-speed high-resolution cameras recorded local lung surface deformations and strains in real time, and differences between PPV and NPV global energetics, viscoelasticity, as well as local tissue distortion were assessed. Measurements and Main Results: During initial inflation, NPV exhibited significantly more bulk pressure-volume compliance than PPV, suggestive of earlier lung recruitment. NPV settings also showed reduced relaxation, hysteresis, and energy loss compared with PPV. Local strain trends were also decreased in NPV, with reduced tissue distortion trends compared with PPV, as revealed through analysis of tissue anisotropy. Conclusions: Apparently, contradictory previous studies are not mutually exclusive. Equivalent changes in transpulmonary pressures in PPV and NPV lead to the same changes in lung volume and pressures, yet local tissue strains differ between PPV and NPV. Although limited to healthy specimens and ex vivo experiments in the absence of a chest cavity, these results may explain previous reports of better oxygenation and less lung injury in NPV.

Modeling the influence of gravity and the mechanical properties of elastin and collagen fibers on alveolar and lung pressure-volume curves

The relationship between pressure (P) and volume (V) in the human lung has been extensively studied. However, the combined effects of gravity and the mechanical properties of elastin and collagen on alveolar and lung P-V curves during breathing are not well understood. Here, we extended a previously established thick-walled spherical model of a single alveolus with wavy collagen fibers during positive pressure inflation. First, we updated the model for negative pressure-driven inflation that allowed incorporation of a gravity-induced pleural pressure gradient to predict how the static alveolar P-V relations vary spatially throughout an upright human lung. Second, by introducing dynamic surface tension and collagen viscoelasticity, we computed the hysteresis loop of the lung P-V curve. The model was tested by comparing its predicted regional ventilation to literature data, which offered insight into the effects of microgravity on ventilation. The model has also produced novel testable predictions for future experiments about the variation of mechanical stresses in the septal walls and the contribution of collagen and elastin fibers to the P-V curve and throughout the lung. The model may help us better understand how mechanical stresses arising from breathing and pleural pressure variations affect regional cellular mechanotransduction in the lung.

Mechanical power during general anesthesia and postoperative respiratory failure: A multicenter retrospective cohort study

BACKGROUND

Mechanical power during ventilation estimates the energy delivered to the respiratory system through integrating inspiratory pressures, tidal volume and respiratory rate into a single value. It has been linked to lung injury and mortality in the acute respiratory distress syndrome, but little evidence exists whether the concept relates to lung injury in patients with healthy lungs. We hypothesized that higher mechanical power is associated with more postoperative respiratory failure requiring reintubation in patients undergoing general anesthesia.

METHODS

In this multicenter, retrospective study, 230,767 elective, non-cardiac adult surgical out- and inpatients undergoing general anesthesia between 2008 and 2018 at two academic hospital networks in Boston, MA, were included. The risk-adjusted association between the median intraoperative mechanical power (MP), calculated from median values of tidal volume (Vt), respiratory rate (RR), positive end-expiratory pressure (PEEP), plateau pressure (Pplat), and peak inspiratory pressure (Ppeak), using the formula MP (J/min)= 0.098*RR*Vt*[PEEP+½(Pplat-PEEP)+(Ppeak-Pplat)], and postoperative respiratory failure requiring reintubation within 7 days was assessed.

RESULTS

The median intraoperative mechanical power was 6.63 (interquartile range: 4.62-9.11) J/min. Postoperative respiratory failure occurred in 2,024 (0.9%) patients. The median (IQR) intraoperative mechanical power was higher in patients with postoperative respiratory failure than in patients without (7.67 [5.64-10.11] vs. 6.62 [4.62-9.10] J/min; p<0.001). In adjusted analyses, a higher mechanical power was associated with greater odds of postoperative respiratory failure (adjusted odds ratio [ORadj] 1.31 per 5 J/min increase; 95%CI 1.21-1.42; p<0.001). The association between mechanical power and postoperative respiratory failure was robust to additional adjustment for known drivers of ventilator-induced lung injury, including tidal volume, driving pressure and respiratory rate, and driven by the dynamic elastic component (ORadj 1.35 per 5 J/min; 95%CI 1.05-1.73; p=0.02).

CONCLUSIONS

Higher mechanical power during ventilation is statistically associated with a greater risk of postoperative respiratory failure requiring reintubation.

Perspectives on Complexity, Chaos and Thermodynamics in Environmental Pathology

Though complexity science and chaos theory have become a common scientific divulgation theme, medical disciplines, and pathology in particular, still rely on a deterministic, reductionistic approach and still hesitate to fully appreciate the intrinsic complexity of living beings. Herein, complexity, chaos and thermodynamics are introduced with specific regard to biomedical sciences, then their interconnections and implications in environmental pathology are discussed, with particular regard to a morphopathological, image analysis-based approach to biological interfaces. Biomedical disciplines traditionally approach living organisms by dissecting them ideally down to the molecular level in order to gain information about possible molecule to molecule interactions, to derive their macroscopic behaviour. Given the complex and chaotic behaviour of living systems, this approach is extremely limited in terms of obtainable information and may lead to misinterpretation. Environmental pathology, as a multidisciplinary discipline, should grant privilege to an integrated, possibly systemic approach, prone to manage the complex and chaotic aspects characterizing living organisms. Ultimately, environmental pathology should be interested in improving the well-being of individuals and the population, and ideally the health of the entire ecosystem/biosphere and should not focus merely on single diseases, diseased organs/tissues, cells and/or molecules.

Performance analysis of human respiratory system based on the second law of thermodynamics

The purpose of this study is to develop a comprehensive thermodynamic model of the human respiratory system and quantify the effects of inspiratory air temperature, relative humidity (RH), lung capacity and O₂ fluctuation in metabolic reaction on the human respiratory system under three different physiological conditions, i.e. rest, moderate level of physical activity and extreme level of physical activity. Therefore, a second law-based analysis has carried out for the human respiratory system. It is observed that exergetic efficiency decreases by 21% and 16.5% during moderate and extreme level of activity respectively as compared to the physical condition of rest. The respiratory efficiency also increases with the increase in inspiratory air temperature and RH. For a given inspiratory air temperature, an increase in lung volume leads to a reduction in the efficiency. Increase in TV with a high airflow rate gives a higher magnitude of efficiency, such a situation appearing when a person's lung compliance harmed due to diseases. The respiratory efficiency decreases up to 2% with the increase in O₂ percentage. The efficiency of the respiratory system is in maximum during rest followed by an extreme and moderate level of activity. However, with the controlled supply of O₂, the efficiency of the human respiratory performance increases with the decrease in O₂ percentage. Due to partial oxidation of glucose at a reduced O₂ level, exergy input from the metabolic reaction is less leading to increased exergetic efficiency.

Perfluorooctanoic acid-induced cellular and subcellular alterations in fish hepatocytes

Liver perfluorooctanoic acid (PFOA) pathophysiology and related morphofunction disturbances were studied in common carp at the cellular and subcellular level and with box-counting fractal analysis of ultrathin sections to assess the effect of PFOA exposure on hepatocyte structure complexity and heterogeneity. Three experimental groups were investigated: unexposed; low exposure (200 ng L^-1 PFOA); high exposure (2 mg L^-1 PFOA). PFOA-exposed cells showed differences from controls at both tested concentrations, manifested mainly as cloudy swelling and reversible vacuolar degeneration. Subcellular modifications primarily involved mitochondria and secondarily endoplasmic reticulum, with evidence of increased subcellular turnover. The alterations were consistent with oxidative stress related pathophysiology. Fractal analysis discriminated exposed from unexposed fish and low from high PFOA exposure based on lacunarity and fractal dimension, respectively. The absence of irreversible organelle alterations and apoptosis/necrosis, along with the increase of cellular complexity, led to the conclusion that the patterns observed represented an adaptive recovery response.

Theoretical open-loop model of respiratory mechanics in the extremely preterm infant

Non-invasive ventilation is increasingly used for respiratory support in preterm infants, and is associated with a lower risk of chronic lung disease. However, this mode is often not successful in the extremely preterm infant in part due to their markedly increased chest wall compliance that does not provide enough structure against which the forces of inhalation can generate sufficient pressure. To address the continued challenge of studying treatments in this fragile population, we developed a nonlinear lumped-parameter respiratory system mechanics model of the extremely preterm infant that incorporates nonlinear lung and chest wall compliances and lung volume parameters tuned to this population. In particular we developed a novel empirical representation of progressive volume loss based on compensatory alveolar pressure increase resulting from collapsed alveoli. The model demonstrates increased rate of volume loss related to high chest wall compliance, and simulates laryngeal braking for elevation of end-expiratory lung volume and constant positive airway pressure (CPAP). The model predicts that low chest wall compliance (chest stiffening) in addition to laryngeal braking and CPAP enhance breathing and delay lung volume loss. These results motivate future data collection strategies and investigation into treatments for chest wall stiffening.