Control of tidal volume and respiratory frequency in anesthetized cats

Driving pressure during proportional assist ventilation: an observational study

Background

During passive mechanical ventilation, the driving pressure of the respiratory system is an important mediator of ventilator-induced lung injury. Monitoring of driving pressure during assisted ventilation, similar to controlled ventilation, could be a tool to identify patients at risk of ventilator-induced lung injury. The aim of this study was to describe driving pressure over time and to identify whether and when high driving pressure occurs in critically ill patients during assisted ventilation.

Methods

Sixty-two patients fulfilling criteria for assisted ventilation were prospectively studied. Patients were included when the treating physician selected proportional assist ventilation (PAV+), a mode that estimates respiratory system compliance. In these patients, continuous recordings of all ventilator parameters were obtained for up to 72 h. Driving pressure was calculated as tidal volume-to-respiratory system compliance ratio. The distribution of driving pressure and tidal volume values over time was examined, and periods of sustained high driving pressure (≥ 15 cmH₂O) and of stable compliance were identified and analyzed.

Results

The analysis included 3200 h of ventilation, consisting of 8.8 million samples. For most (95%) of the time, driving pressure was < 15 cmH₂O and tidal volume < 11 mL/kg (of ideal body weight). In most patients, high driving pressure was observed for short periods of time (median 2.5 min). Prolonged periods of high driving pressure were observed in five patients (8%). During the 661 periods of stable compliance, high driving pressure combined with a tidal volume ≥ 8 mL/kg was observed only in 11 cases (1.6%) pertaining to four patients. High driving pressure occurred almost exclusively when respiratory system compliance was low, and compliance above 30 mL/cmH₂O excluded the presence of high driving pressure with 90% sensitivity and specificity.

Conclusions

In critically ill patients fulfilling criteria for assisted ventilation, and ventilated in PAV+ mode, sustained high driving pressure occurred in a small, yet not negligible number of patients. The presence of sustained high driving pressure was not associated with high tidal volume, but occurred almost exclusively when compliance was below 30 mL/cmH₂O.

Electronic supplementary material

The online version of this article (10.1186/s13613-018-0477-4) contains supplementary material, which is available to authorized users.

The human ventilatory response to stress: rate or depth?

Many stressors cause an increase in ventilation in humans. This is predominantly reported as an increase in minute ventilation (V̇E). But, the same V̇E can be achieved by a wide variety of changes in the depth (tidal volume, V_T ) and number of breaths (respiratory frequency, ƒ_R ). This review investigates the impact of stressors including: cold, heat, hypoxia, pain and panic on the contributions of ƒ_R and V_T to V̇E to see if they differ with different stressors. Where possible we also consider the potential mechanisms that underpin the responses identified, and propose mechanisms by which differences in ƒ_R and V_T are mediated. Our aim being to consider if there is an overall differential control of ƒ_R and V_T that applies in a wide range of conditions. We consider moderating factors, including exercise, sex, intensity and duration of stimuli. For the stressors reviewed, as the stress becomes extreme V̇E generally becomes increased more by ƒ_R than V_T . We also present some tentative evidence that the pattern of ƒ_R and V_T could provide some useful diagnostic information for a variety of clinical conditions. In The Physiological Society's year of 'Making Sense of Stress', this review has wide-ranging implications that are not limited to one discipline, but are integrative and relevant for physiology, psychophysiology, neuroscience and pathophysiology.

The effects of positioning on the Hering-Breuer reflex in the preterm infant

The aim of this study was to determine the effect of positioning on the Hering-Breuer inflation reflex (HBIR) in the preterm infant. Seven, non-intubated, premature infants, ranging in birthweight from 732 to 1450 g with post-conceptual ages of 32-36 weeks were studied. In each infant, pulmonary function testing, including the HBIR was obtained using the SensorMedics 2600 during quiet sleep in the supine and prone position. The strength of the HBIR was quantified by the measurement of the percent prolongation of expiration after an occluded breath. Sleep states were categorized by the criteria of Prechtl. There was a significant difference in Hering-Breuer activity in the prone position versus the supine position with a consistently stronger reflex in the prone position. The mean percent prolongation of expiration was 237 +/- 108% in the prone position versus 95 +/- 32% in the supine position. Analysis of the data, using paired t-testing revealed a mean difference of 142 +/- 119% between prone and supine positions (P=0.028). Significant differences in the strength of the HBIR occur in relation to positioning in the preterm infant. Newborn positioning may affect pulmonary reflexes and may play a role in control of breathing.

Effect of medetomidine on respiration and minimum alveolar concentration in halothane- and isoflurane-anesthetized dogs

OBJECTIVE

To evaluate the effect of medetomidine on minimum alveolar concentration (MAC), respiratory rate, tidal volume, minute volume (V(M)), and maximum inspiratory occlusion pressure (IOCP(max)) in halothane- and isoflurane-anesthetized dogs.

ANIMALS

6 healthy adult dogs (3 males and 3 females).

PROCEDURE

The MAC of both inhalants was determined before and 5, 30, and 60 minutes after administration of medetomidine (5 microg/kg, IV). Dogs were subsequently anesthetized by administration of halothane or isoflurane and administered saline (0.9% NaCl) solution IV or medetomidine (5 microg/kg, IV). Respiratory variables and IOCP(max) were measured at specific MAC values 15 minutes before and 5, 30, and 60 minutes after IV administration of medetomidine while dogs breathed 0% and 10% fractional inspired carbon dioxide (FICO2). Slopes of the lines for VM/FICO2 and IOCP(max)/FICO2 were then calculated.

RESULTS

Administration of medetomidine decreased MAC of both inhalants. Slope of V(M)/FICO2 increased in dogs anesthetized with halothane after administration of medetomidine, compared with corresponding values in dogs anesthetized with isoflurane. Administration of medetomidine with a simultaneous decrease in inhalant concentration significantly increased the slope for V(M)/FICO2, compared with values after administration of saline solution in dogs anesthetized with halothane but not isoflurane. Values for IOCP(max) did not differ significantly between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Equipotent doses of halothane and isoflurane have differing effects on respiration that are most likely attributable to differences in drug effects on central respiratory centers. Relatively low doses of medetomidine decrease the MAC of halothane and isoflurane in dogs.

Effect of medetomidine on breathing and inspiratory neuromuscular drive in conscious dogs

OBJECTIVE

To evaluate the effects of the alpha2-adrenoceptor agonist medetomidine on respiratory rate (RR), tidal volume (V(T)), minute volume (V(M)), and central respiratory neuromuscular drive as determined by inspiratory occlusion pressure (IOP) during increasing fractional inspired concentrations of carbon dioxide (FiCO2) in conscious dogs.

ANIMALS

6 healthy dogs (3 males and 3 females).

PROCEDURE

Dogs were administered 0, 5, or 10 microg of medetomidine/kg i.v. We measured RR, V(T), V(M), and IOP for the first 0.1 second of airway occlusion (IOP0.1) during FiCO2 values of 0%, 2.5%, 5.0%, and 75% at 15 minutes before and 5, 30, and 60 minutes after administration of medetomidine.

RESULTS

Increases in FiCO2 significantly increased RR, V(T), and V(M). The i.v. administration of 5 and 10 microg of medetomidine/kg significantly decreased RR and V(M) at 5, 30, and 60 minutes for FiCO2 values of 2.5% and 5.0% and at 30 and 60 minutes for an FiCO2 value of 75%. The IOP0.1 was decreased after 30 minutes only for an FiCO2 value of 7.5% in dogs administered 5 and 10 microg of medetomidine/kg. The IOP0.1 was decreased at 60 minutes after administration of 10 microg of medetomidine/kg for an FiCO2 value of 7.5%.

CONCLUSIONS AND CLINICAL RELEVANCE

The i.v. administration of medetomidine decreases RR, V(M), and central respiratory drive in conscious dogs. Medetomidine should be used cautiously and with careful monitoring in dogs with CNS depression or respiratory compromise.

Hering-Breuer reflex and sleep state in the preterm infant

The aim of this study was to determine the effect of sleep state on the Hering-Breuer inflation reflex in the preterm infant. Seventeen nonintubated, premature infants, ranging in birth weight from 980-2,440 g with postconceptual ages of 30-36 weeks, were studied. In each infant, pulmonary function testing, including the Hering-Breuer inflation reflex, was obtained using the SensorMedics 2600 during active and quiet sleep states in supine position. The strength of the Hering-Breuer inflation reflex was quantified by the measurement of the percent prolongation of expiration after an occluded breath. Sleep states were categorized by the criteria of Prechtl. There was a significant difference in Hering-Breuer activity in active (REM) vs. quiet (non-REM) sleep, with a consistently stronger reflex in the active sleep state. The mean percent prolongation of expiration was 419% in active sleep vs. 87% in quiet sleep. Analysis of the data, using a paired t-test, revealed a mean difference of 331 +/- 185% between active and quiet sleep (P = 0.000). In conclusion, significant differences in the strength of the Hering-Breuer inflation reflex occur in relation to sleep state, and may explain the variability of the reflex described in previous studies. Measurement of the Hering-Breuer inflation reflex may be affected by pulmonary stretch receptors as well as chest wall afferents in the preterm infant.

Effect of ventilator mode on sleep quality in critically ill patients

To determine whether sleep quality is influenced by the mode of mechanical ventilation, we performed polysomnography on 11 critically ill patients. Because pressure support predisposes to central apneas in healthy subjects, we examined whether the presence of a backup rate on assist-control ventilation would decrease apnea-related arousals and improve sleep quality. Sleep fragmentation, measured as the number of arousals and awakenings, was greater during pressure support than during assist-control ventilation: 79 +/- 7 versus 54 +/- 7 events per hour (p = 0.02). Central apneas occurred during pressure support in six patients; heart failure was more common in these six patients than in the five patients without apneas: 83 versus 20% (p = 0.04). Among patients with central apneas, adding dead space decreased sleep fragmentation: 44 +/- 6 versus 83 +/- 12 arousals and awakenings per hour (p = 0.02). Changes in sleep-wakefulness state caused greater changes in breath components and end-tidal CO2 during pressure support than during assist-control ventilation. In conclusion, inspiratory assistance from pressure support causes hypocapnia, which combined with the lack of a backup rate and wakefulness drive can lead to central apneas and sleep fragmentation, especially in patients with heart failure.

Endothelin involvement in respiratory centre activity

To evaluate the role of endothelin (ET) in respiratory homeostasis we studied the effects of the ET(A) and ET(B) receptor blocking agent bosentan on respiratory mechanics and control in seven anaesthetised spontaneously breathing pigs, for 180 min after single bolus administration (20 mg/kg i.v.). The results show that the block of ET receptors induced a significant increase in compliance and decrease in resistance of the respiratory system, entailing a significant reduction of diaphragmatic electromyographic activity, without affecting the centroid frequency of the power spectrum. Bosentan administration induced a significant increase in tidal volume (V(T)), accompanied by a significant decrease in respiratory frequency, without any significant change in pulmonary ventilation, CO(2) arterial blood gas pressure or pH. Since the relationship between V(T) and inspiratory time remained substantially constant after bosentan administration, the changes in respiratory pattern appear to be the result of an upward shift in inspiratory off-switch threshold. Both inspiratory and expiratory times during occluded breathing were increased by block of ET receptors, suggesting also a central respiratory neuromodulator effect of ET. In conclusion the present results suggest that the block of ET receptors in spontaneously breathing pigs exerts a role on mechanical properties of the respiratory system as well as on peripheral and central mechanisms of breathing control.

Lung vagal afferent activity in rats with bleomycin-induced lung fibrosis

Bleomycin treatment in rats results in pulmonary fibrosis that is characterized by a rapid shallow breathing pattern, a decrease in quasi-static lung compliance and a blunting of the Hering-Breuer Inflation Reflex. We examined the impulse activity of pulmonary vagal afferents in anesthetized, mechanically ventilated rats with bleomycin-induced lung fibrosis during the ventilator cycle and static lung inflations/deflations and following the injection of capsaicin into the right atrium. Bleomycin enhanced volume sensitivity of slowly adapting stretch receptors (SARs), while it blunted the sensitivity of these receptors to increasing transpulmonary pressure. Bleomycin treatment increased the inspiratory activity, while it decreased the expiratory activity of rapidly adapting stretch receptors (RARs). Pulmonary C-fiber impulse activity did not appear to be affected by bleomycin treatment. We conclude that the fibrosis-related shift in discharge profile and enhanced volume sensitivity of SARs combined with the increased inspiratory activity of RARs contributes to the observed rapid shallow breathing of bleomycin-induced lung fibrosis.

An overview of the anatomy and physiology of slowly adapting pulmonary stretch receptors

Since the original work of by Hering and Breuer in 1868 numerous studies have demonstrated that slowly adapting pulmonary stretch receptors (SARs) are the lung vagal afferents responsible for eliciting the reflexes evoked by moderate lung inflation. SARs play a role in controlling breathing pattern, airway smooth muscle tone, systemic vascular resistance and heart rate. Both anatomical and physiological studies support the contention that SARs, by their close association with airway smooth muscle, continuously sense the tension within the myoelastic components of the airways caused by lung inflation, smooth muscle contraction and/or tethering of small intrapulmonary airways to the lung parenchyma. In addition, intrapulmonary SAR discharge activity is sensitive to changes in P(CO2) within the physiological range. Despite this extensive characterization of SARs, their role in determining breathing pattern and airway tone in individuals with respiratory diseases is only recently being appreciated.

Control of respiration in the isolated central nervous system of the neonatal opossum, Monodelphis domestica

Respiration represents an unusual motor activity with respect to its development. As newly born mammals enter the world, their limb movements are not coordinated; time and experience are required for effective performance to be achieved. Yet the rhythm of respiration is of necessity functionally perfected and unfailing at birth. Inspiratory and expiratory motor neurons are already able to fire at appropriate rates, under the command of rhythmically active neurons in the medulla. In this review, we discuss refinements of control present in the newborn opossum, particularly with respect to mechanisms that allow adaptation of respiration to changes in the level of activity or in the outside environment. Our own studies have been aimed at analyzing respiration at the earliest stages, and at establishing the way in which important variables influence inspiration and expiration. To this end, we have used the central nervous system (CNS) of a neonatal opossum, isolated in its entirety and maintained in culture. Although the opossum is unable to walk and highly immature at birth, its respiration is regular and unfailing. The isolated CNS survives, undergoes development, and maintains its neural activity and fine structure in vitro. Moreover, fictive respiration persists for over a day or longer at rates similar to those of the intact pup. The effects of altered pH, of increased temperature, and of drugs known to alter respiratory rhythm in intact animals can be measured directly, by electrical recordings made from medullary neurons or ventral roots. As in a slice, fluids of different composition can be applied focally, through micropipettes to the surface of the ventral medulla, or diffusely to the brainstem, With highly localized application of procaine hydrochloride (2%) to selected areas of the ventral medulla, the respiratory rhythm is reduced or abolished. As in adult mammals, both the rate and the amplitude of respiration simultaneously increase in response to lowered pH (6.5-.7.1) or to topical application of 1.0 microM carbachol. Conversely, as expected, the rate and amplitude decrease in response to increased pH (pH 7.5-7.7), or 100 microM scopolamine. Two characteristic features of the control of respiration in the neonatal opossum are evident from such tests. First, changes in rate are achieved by changes in the duration of the expiratory phase of respiration. This result suggests that the timing of the respiratory cycle in the neonatal opossum is controlled by an expiratory instead of an inspiratory "off-switch". Second, the rate and the amplitude of the respiratory excursions can be controlled independently, depending on the stimulus. For example, an increase in temperature increases the rate of fictive respiration without changing its amplitude, whereas noradrenaline decreases the rate while increasing the amplitude. Thus, changes of timing and amplitude need not go hand in hand. The opossum CNS offers a favorable preparation for the analysis of neural mechanisms that generate and modulate a motor rhythm, as the animal develops from embryonic to adult stages.

Ventilatory responses to changes in temperature in mammals and other vertebrates

This article reviews the relationship between pulmonary ventilation (VE) and metabolic rate (oxygen consumption) during changes in ambient temperature. The main focus is on mammals, although for comparative purposes the VE responses of ectothermic vertebrates are also discussed. First, the effects of temperature on pulmonary mechanics, chemoreceptors, and airway receptors are summarized. Then we review the main VE responses to cold and warm stimuli and their interaction with exercise, hypoxia, or hypercapnia. In these cases, mammals attempt to maintain both oxygenation and body temperature, although conflicts can arise because of the respiratory heat loss associated with the increase in ventilation. Finally, we consider the VE responses of mammals when body temperature changes, as during torpor, fever, sleep, and hypothermia. In ectotherms, during changes in temperature, VE control becomes part of a general strategy to maintain constant relative alkalinity and ensure a constancy of pH-dependent protein functions (alphastat regulation). In mammals on the other hand, VE control is aimed to balance metabolic needs with homeothermy. Therefore, alphastat regulation in mammals seems to have a low priority, and it may be adopted only in exceptional cases.

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.

Hering-Breuer reflex in conscious newborn rats: effects of changes in ambient temperature during hypoxia

In a previous study in conscious normoxic newborn rats, we found that the strength of the Hering-Breuer reflex (HB reflex) was greater (188%) at high (36 degrees C) than at low (24 degrees C) ambient temperature (T(a); D. Merazzi and J. P. Mortola. Pediatr. Res. 45: 370-376, 1999). We now asked what the effect would be of changes in T(a) during hypoxia. Rat pups at 3-4 days of age were studied in a double-chamber airflow plethysmograph. The HB reflex was induced by negative body surface pressures of 5 or 10 cmH(2)O and quantified from the inhibition of breathing during maintained lung inflation. Rats were first studied at T(a) = 32 degrees C in normoxia, followed by hypoxia (10% O(2) breathing). During hypoxia, oxygen consumption (VO(2)) averaged 47%, and HB reflex 115%, of the corresponding normoxic values, confirming that in the newborn, differently from the adult, hypoxia does not decrease the strength of the HB reflex. As hypoxia was maintained, lowering T(a) to 24 degrees C or increasing it to 36 degrees C, on average, had no significant effects on VO(2) and the HB reflex. However, with 5-cmH(2)O inflations, the HB reflex during the combined hypoxia and hyperthermia was significantly stronger than in normoxia. We conclude that in conscious newborn rats during normoxia the T(a) sensitivity of the HB reflex is largely mediated by the effects of T(a) on thermogenesis and VO(2); in hypoxia, because thermogenesis is depressed and VO(2) varies little with T(a), the HB reflex is T(a) independent. The observation that the reflex response to lung inflations during hypoxic hyperthermia can be greater than in normoxia may be of importance in the pathophysiology of apneas during the neonatal period.

Implementation of a respiratory drive monitor on a Servo Ventilator

OBJECTIVE

To design and evaluate a clinical monitor of respiratory drive (P0.1) and other respiratory variables in a simple way, using a commercial ventilator.

METHODS

Nine healthy males were studied as they were breathing spontaneously in a Servo 900C Ventilator, at rest and during light exercise (50 W). The ventilator was slightly modified to improve its mechanical performance during spontaneous breathing, and was used as a measuring instrument. All the relevant information was retrieved, calculated and monitored by a PC. Respiratory drive was assessed as occlusion pressures from the inspiratory airway pressure signal. The equipment was compared with a two-way non-rebreathing laboratory system. Furthermore, negative and positive inspiratory pressures were applied from the ventilator, to study respiratory responses to mechanical loads.

RESULTS

At rest, the ventilator introduced a minor influence on inspiratory time and P0.1, but not in ventilation, tidal volume, expiratory duration and respiratory frequency. During exercise, the influence was more evident. This effect could also be noticed in the coefficients of variation. The responses to mechanical loads were easily recorded and can be used as a simple test of central load-compensating mechanisms. CONCLUSIONS. The ventilator, with limitations, may be an alternative to conventional techniques, especially in clinical studies of the central inspiratory activity with and without respiratory loading.

Effects of changes in ambient temperature on the Hering-Breüer reflex of the conscious newborn rat

We questioned to what extent changes in temperature could affect the newborn's ventilatory inhibition provoked by lung inflation, or Hering-Breüer (HB) inflation reflex. Conscious newborn rats (3-4 d old) were studied in a double chamber airflow plethysmograph at ambient temperatures of 32 degrees C (slightly below their thermoneutrality), 24 degrees C (cold), and 36 degrees C (warm). At these ambient temperatures, the corresponding body temperatures averaged 35.4, 31.0, and 37 degrees C. The HB reflex was triggered by negative body surface pressures of 5 or 10 cm H2O, and quantified as the duration of the expiratory time during the maintained inflation, either in absolute values or in relation to the control expiratory time. In cold the HB reflex decreased to 80%, and in warm it increased to 150%, of the values measured at 32 degrees C. Oxygen consumption, measured by an open flow system, averaged 59, 47, and 29 mL x kg(-1) x min(-1) at, respectively, 24, 32, and 36 degrees C. In cold, the ventilatory response to hypoxia (10% O2) was almost absent, that to hypercapnia (5% CO2) was greater, and that to hypoxia and hypercapnia combined was less than in warm. We conclude that in newborn rats the strength of the vagal inhibition on breathing, evaluated in the form of the HB reflex, is sensitive to temperature, becoming stronger as temperature increases. One contributing factor is the temperature-induced change in metabolic rate, whereas the role of temperature-induced changes in ventilatory chemosensitivity is variable. The strong temperature-dependency of the neonatal HB reflex implies that in newborns exposed to a warm environment breathing is more susceptible to inhibitory inputs.

Effect of ventilator flow rate on respiratory timing in normal humans

Respiratory rate (RR) increases as a function of ventilator flow rate (V). We wished to determine whether this is due to a decrease in neural inspiratory time (T In), neural expiratory time (TEn), or both. To accomplish this, we ventilated 15 normal subjects in the assist, volume cycled mode. Ventilator flow rate was varied at random, at four breaths with each step, over the flow range from 0.8 (Vmin) to 2.5 (Vmax) L/s. V T was kept constant. The pressure developed by respiratory muscles (Pmus) was calculated with the equation of motion (Pmus = V. R + V. E - Paw, where R = resistance, V = volume, E = elastance, and Paw = airway pressure). Electromyography of the diaphragm (Edi) was also done in five subjects. TIn and TEn were determined from the Pmus or Edi waveform. TIn decreased progressively as a function of V, from 1.44 +/- 0.34 s at Vmin to 0.62 +/- 0.26 s at Vmax (p < 0.00001). Changes in TEn were inconsistent and not significant. TIn/Ttot decreased significantly (0.30 +/- 0.06 at Vmin to 0.18 +/- 0.09 at Vmax; p < 0. 00001). We conclude that TI is highly sensitive to ventilator flow, and that the RR response to V is primarily related to this T In response. Because an increase in V progressively reduces T In/Ttot, and this variable is an important determinant of inspiratory muscle energetics, we further conclude that inspiratory muscle energy expenditure is quite sensitive to V over the range from 0.8 to 2.5 L/s.

The Hering-Breuer reflex in anesthetized infants: end-inspiratory vs. end-expiratory occlusion technique

Both end-inspiratory (EIO) and end-expiratory (EEO) occlusions have been used to measure the strength of the Hering-Breuer inflation reflex (HBIR) in infants. The purpose of this study was to compare both techniques in anesthetized infants. In each infant, HBIR activity was calculated as the relative prolongation of expiratory and inspiratory time during EIO and EEO, respectively. Respiratory drive was assessed from the change in airway pressure during inspiratory effort against the occlusion, both at a fixed time interval of 100 ms (P0.1) and a fixed proportion (10%) of the occluded inspiratory time (P10%). Twenty-two infants [age 14.3 +/- 6. 4 (SD) mo] were studied. No HBIR activity was present during EIO [-11.8 +/- 15.9 (SD) %]. By contrast, there was significant, albeit weak, reflex activity during EEO [HBIR: 27.2 +/- 17.4%]. A strong HBIR (up to 310%) was elicited in six of seven infants in whom EIO was repeated after lung inflation. P0.1 was similar during both types of occlusions, whereas mean +/- SD P10% was lower during EEO than during EIO: 0.198 +/- 0.09 vs. 0.367 +/- 0.15 kPa, respectively (P < 0.01). These data suggest a difference in the central integration of stretch receptor activity in infants during anesthesia compared with during sleep.

Respiratory response to CO2 during pressure-support ventilation in conscious normal humans

The respiratory response to CO2 during pressure-support ventilation (PSV) was studied in 16 conscious normal humans. The subjects breathed through a mouthpiece connected to a ventilator in PSV mode, with pressure set to the highest comfortable level for each subject (10.1 +/- 0.6 cm H2O, mean +/- SE). Compared with breathing spontaneously through the ventilator (CPAP mode with zero positive end-expiratory pressure), with PSV, tidal volume (VT) increased significantly (1.16 +/- 0.1 versus 0.85 +/- 0.04 L), whereas breathing frequency (f) remained stable (16.0 +/- 0.9 versus 15.6 +/- 1.1 breaths/min). As a result, the subjects hyperventilated, decreasing significantly end-tidal PCO2 (PETCO2, 23.5 +/- 1.2 versus 35.5 +/- 1.1 mm Hg). Fraction of inspired CO2 (FICO2) was then increased in steps, and changes in respiratory motor output were quantitated from changes in f, VT, ventilation (VI), peak inspiratory flow (Vpeak), and muscle pressure (Pmus). Pmus was calculated by the equation of motion, based on respiratory system mechanics, which were measured previously by airway occlusion at end-inspiration, VT, VI, and Pmus increased significantly with increasing PETCO2, and the response was detectable even below eupneic levels; f remained relatively stable over a wide range of PETCO2 (23 to 45 mm Hg) and increase significantly only when PETCO2 approached 50 mm Hg. These results indicate that in conscious normal humans during PSV, CO2 responsiveness extends well into hypocapnia and is expressed principally as an increase in intensity of respiratory motor output with little change in respiratory rate.

A new method for P0.1 measurement using standard respiratory equipment

The airway occlusion pressure, P0.1, is an index for the neuro-muscular activation of the respiratory system. It has been shown to be a very useful indicator for the ability of patients receiving ventilatory support to be weaned from mechanical ventilation. Since the standard measurement technique for P0.1 determination is technically complex, it is not widely available for clinical purposes. For that reason a P0.1 measurement technique was developed as an integrated function in a standard respirator (Evita, Dräger, Lübeck, Germany). This technique is easy to use and does not need any further equipment. We validated this new technique by comparing it to standard P0.1 measurements in a mechanical lung model as well as in ventilated patients. In the lung model we found a correlation between the Evita measurement and standard measurements of r = 0.99. In 6 ventilated patients the correlation was r = 0.78. Since the Evita P0.1 and the standard measurement had to be performed during two different breaths, this little poorer correlation in patients may be due to a significant breath-by-breath variability in P0.1. Comparing the Evita P0.1 and the standard measurement within one breath resulted in a clearly better correlation (r = 0.89). We conclude that this new measurement technique provides an easy and accurate P0.1 measurement using standard respiratory equipment when tested in a lung model. In patient measurements the method is less precise, which is probably due to the variable waveforms of the inspiratory driving pressure seen in patients, for example when intrinsic PEEP is present.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of salicylate on respiratory mechanics and postinspiratory muscle pressure

In 5 spontaneously breathing anesthetized dogs, sodium salicylate (250 mg/kg) was administered. Air flow, volume, and tracheal pressure were measured. The passive mechanical properties of the respiratory system, control of breathing parameters, and the postinspiratory pressure generated by the inspiratory muscles (PmusI) were computed both before and during progressive salicylate-induced hyperventilation. Resistance fell, whereas elastance and time constant were not altered with increased ventilation (VE). The relationship between PmusI and expiratory duration (TE) presented a sigmoidal decay rate, which did not vary with hyperventilation. PmusI at TE = 0 (PmusI, 0); the times for PmusI to decay to 50 (T50), 25 (T25), and 0 percent (TZ) of PmusI, 0; inspiratory (TI), expiratory (TE) and total cycle duration (TT) decreased with increasing VE. As expiration shortened more than inspiration and TI fell more than VT rose, TI/TT and VT/TI increased during hyperventilation. In conclusion, in the face of salicylic intoxication: Rrs diminished, TI and TE decreased markedly, yielding higher values of TI/TT and VT/TI, and although T50, T25, and TZ fell, the relative time profile of PmusI remained unaltered.

Inspiratory timing regulation of PGF2 alpha in newborn pigs

In intact and vagotomized anesthetized, spontaneously breathing piglets, we investigated the regulation of inspiratory timing evoked by i.v. administration of prostaglandin (PG) F2 alpha. The inspiratory time was evaluated from the flow trace as an index of mechanical inspiratory time (Ti) and from costal and crural diaphragmatic EMG (TiEMG) as an index of neural inspiratory time. Our results under control conditions showed that TiEMG was shorter than Ti. Vagotomy abolished the difference, inducing a change in the power spectrum without modifying the centroid frequency (Cf). PGF2 alpha lengthened TiEMG, causing a postinspiratory diaphragmatic discharge to appear, while mechanical inspiratory time decreased significantly. Postvagotomy i.v. administration of PGF2 alpha did not cause any significant changes in inspiratory time and did not evoke the postinspiratory discharge. The i.v. administration of PGF2 alpha before and after vagotomy did not change the centroid frequency in spite of recruitment of new motor units synchronized with those that are active under control conditions.

PAF and the role of the vagus nerve in the breathing pattern of the pig

In 14 anesthetized, spontaneously breathing pigs we examined the changes in breathing pattern, in respiratory mechanics and in systemic and pulmonary vascular parameters after i.v. PAF administration. In another 3 pigs, the effects of PAF were also examined after bilateral vagotomy. In intact pigs, PAF induces apnea, bronchoconstriction, pulmonary hypertension and systemic hypotension. Our results also show that administration of PAF alters the phasic vagal activity, modifying the slope of VT vs TI and TE vs TI relationships and the TI0/TI ratio. These effects and apnea are vagus-dependent. The central excitatory timing effect of PAF on inspiratory duration (TI0) was correlated with a decrease in passive compliance but not with active compliance. We postulate that the activation by vagal input strengthens the mechanisms that counteract the bronchoconstrictor effect of PAF.

Preservation of integrative function in a perfused guinea pig brain

The mammalian brain has been one of the most difficult organs to maintain using artificial perfusion. Normal biochemistry, histology, and electrophysiology of the brain have been demonstrated for limited periods in vitro, but it has been more difficult to maintain complex, integrative neuronal activity such as the electroencephalogram (EEG) or programmed motor output. Normal motor output, other than reflex activity, has not previously been demonstrated in a perfused brain preparation. This paper reports the first preservation of normal function in a complete motor network, including intact afferent and efferent pathways, during perfusion of the mammalian brain. The brain, rostral spinal cord and peripheral nervous system of the guinea pig were perfused in situ using an artificial blood containing the oxygen carrier, perfluorotributylamine (FC-43). This preparation was maintained normothermic, whereas many other perfused brain preparations have been maintained hypothermic to prolong viability. Survival was enhanced by the addition of HEPES buffer to the perfusion medium, probably by increasing carbon dioxide transport. The duration of normal EEG was extended to 8 h. Spontaneous respiratory motor output with normal waveform and temporal pattern was recorded from the phrenic nerve for an average of 6 h. The respiratory motor output responded appropriately to blood pCO2, temperature, blood flow, drug concentrations, and electrical stimulation of vagal afferent fibers. This preparation represents a significant advance in the ability to preserve neural function during perfusion, and should offer advantages for studying cellular electrophysiology of intact, functioning neural networks, as well as neurochemistry and neuropharmacology.

Non-invasive technique for examining the respiratory proprioceptor system in man

Our technique enables non-invasive experiments to be conducted on the proprioceptor part of respiratory control, while eliminating misleading responses due to interaction with the chemoreceptor system; interaction was prevented by stabilizing arterial PO2 and PCO2 with the aid of an optimal regulator based on a mini-computer which controlled the inspired gas mixture. The proprioceptor system in a human was disturbed by applying positive pressure pulses at the mouth, responses were derived from continuous air-flow measurement. The classical inflation inhibiting reflex and an effect akin to Head's paradoxical reflex were demonstrated.

Effect of upper airway pressure pulses on breathing pattern

Importance of the time of application of upper airway pressure pulses on breathing pattern was investigated in 19 anesthetized, spontaneously breathing rabbits. The upper airway was functionally isolated into a closed system. A servo-respirator, triggered by the inspiratory activity of the diaphragm, was used to apply pressure pulses to the isolated upper airway. Negative pressure pulses of -5, -10, and -15 cm H2O when applied in early inspiration (within the first half) produced a reversible inhibition of inspiration in most trails (86.2%). This resulted in a prolongation of inspiratory duration (TI) and a decrease in mean inspiratory drive (P.Dia/TI) whereas peak diaphragm (P.Dia) activity and expiratory duration (TE) remained largely unaffected. In the remaining 13.8% of trials, an irreversible inhibition with short TI and reduced P.Dia activity was observed. In contrast, with late application of negative pressure pulses the only significant change was a shortening of TI. When positive pressure pulses were applied during expiration, no significant change in TE occurred with either early or late application. A significant prolongation of subsequent TI was seen irrespective of the time of positive pressure application. These results indicate that time of application during the respiratory cycle is an important variable in determining the response to upper airway pressure pulses.

A centrally elicited respiratory stimulant effect by bombesin in the rat

The effects of the tetradecapeptide bombesin on respiratory regulation in the rat were studied using a whole body plethysmographic model. Application of the peptide was made intracerebroventricularly (i.c.v.) as well as via microinjections into specific brainstem areas. I.c.v. injection (0.1-5 micrograms) resulted in a dose-dependent increase in tidal volume while respiratory frequency was decreased only at higher doses. The respiratory duty cycle remained unchanged while the respiratory drive was significantly increased. The respiratory effects were blunted by bilateral section of the tenth cranial nerve. Studies employing the occluded breath technique indicated a change in the threshold to afferent vagal signals while the time-setting for inspiration remained unchanged. Similar ventilation changes were elicited when the peptide was injected into the area of the nucleus ambiguous but not in several other areas of the brainstem. Such bombesin sensitive areas are consistent with a recent immunohistochemical study describing a dense pattern of immunoreactive somata in this area of the brainstem. The ventilatory stimulant effect seems to depend on an intact afferent vagal innervation.

Adenosine mechanisms in the regulation of breathing in the rat

The central respiratory effects of various adenosine (A) analogues were studied in halothane-anesthetized rats. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) injections of the A analogues (2-Cla, L-PIA, CHA and NECA) reduced minute ventilation (VE) due to decreases in respiratory frequency (f) as well as tidal volume (VT). Dose-dependent effects were seen after i.c.v. L-PIA in both normal and vagotomized rats. Analysis of the A-induced changes using the occluded breath technique revealed an increase in expiratory time (TE) as well as a decrease in inspiratory drive. NECA, a relatively specific A2 agonist seemed to be somewhat more potent in eliciting respiratory depression than a relatively specific A1 agonist like L-PIA. Pretreatment with the methylxanthine theophylline completely antagonized the respiratory depression induced by L-PIA. It is concluded that central A receptors are involved in the central regulation of breathing and that A interacts with the respiratory control system mainly by decreasing inspiratory neural drive and prolonging expiratory time.

Respiratory volume-timing relationship during sustained elevation of functional residual capacity

In 7 spontaneously breathing dial-urethane anesthetized cats a negative pressure was produced around the thorax and abdomen to increase the functional residual capacity (FRC) by about 1 tidal volume for up to 60 min. A tracheal cannula was connected to a resistive manifold for selective loading of inspiration or expiration. Two resistive loads and tracheal occlusion were presented six times each at control FRC (FRCc), after 60 min at elevated FRC (FRCe) and 30 min after return to FRCc. Inspiratory and expiratory durations (TI and TE) were measured from diaphragmatic EMG. We observed that TI at FRCe (0.88 +/- 0.11 sec) was not significantly shorter than TI at FRCc (1.06 +/- 0.14 sec). Tracheal occlusion at FRCe caused a shorter TI (1.37 +/- 0.15 sec) than at FRCc (1.79 +/- 0.21 sec) (P less than 0.05). The slope (m) of the VI-TI relationship generated by the resistive loads at FRCe was steeper (m = -65 +/- 7 ml X sec-1) and shifted upward from the VI-TI curve at FRCc (-50 +/- 6 ml X sec-1) (P less than 0.05). The VE-TE relationship at FRCe was not significantly changed from control. Thirty minutes following return to FRCc, TI was still slightly shorter (0.96 +/- 0.11 sec) than the initial TI at FRCc. We conclude: (1) The slope of the VI-TI relationship is determined to a great extent by the total lung volume. However, under the conditions of sustained elevation of FRC, this relationship is influenced by the partial adaptation of slowly adapting pulmonary receptors SARs. (2) The increased SAR activity at end expiration during FRCe may not influence the control of TE.

Respiratory afferent activity in the superior laryngeal nerves

This study evaluates the afferent activity in the superior laryngeal nerve (SLN) during breathing as well as during occluded inspiratory efforts. Experiments were performed in 11 anesthetized and spontaneously breathing dogs. Electroneurographic activity was recorded from the peripheral cut end of the SLN and, in 3 dogs, also from the contralateral vagus nerve. A tracheal cannula with a side arm allowed the bypass of the larynx during breathing and occluded efforts. A clear inspiratory modulation was present in all experimental conditions. Both peak and duration of the SLN activity decreased (87% and 89%) when breathing was diverted from the upper airway to the tracheostomy. Peak and duration of the SLN activity (as % of upper airway breathing) increased during occluded efforts; however, the increase was greater when the larynx was not by-passed (peak = 118% vs 208%, duration = 143% vs 178%). Section of the ipsilateral recurrent laryngeal nerve reduced the inspiratory modulation. Vagal afferent activity increased equally during tracheostomy and upper airway breathing and decreased markedly during tracheal and upper airway occlusions. Our results indicate that collapsing pressure in the larynx is the major stimulus in activating laryngeal afferents.

Respiratory frequency and the oxygen cost of exercise

Although many studies indicate that the spontaneous breathing frequency minimizes breathing work, the consequences of this for exercise energetics have never been investigated. To see if the spontaneous exercise breathing frequency minimizes oxygen uptake, we compared VO2 during treadmill walking (2/3 VO2 max) at several alternative frequencies. The alternative frequencies ranged from the lowest sustainable to a frequency twice the spontaneous value. All eight subjects adjusted tidal volume to comfort. Exercise oxygen uptake was constant, independent of breathing frequency. At the same time, minute ventilation rose to be 65% greater at the highest frequency than at the lowest (P less than 0.01). We then reproduced the various exercise frequencies, tidal volumes, and ventilations during seated isocapnic hyperpnea to measure VO2 with locomotory muscles at rest. Once again, oxygen uptake was constant, independent of breathing frequency. We conclude that the spontaneous exercise breathing frequency fails to minimize VO2 during either exercise or resting reproduction of exercise ventilation.

Effects of body temperature, passive limb motion and level of anesthesia on the activity of the inspiratory muscles

The relationships between relative tidal activity (moving average EMG) of the diaphragm (AdiT) and of the external intercostal or parasternal muscles (AicT) and between the rate of rise of these activities (Adi and Aic) were assessed during rebreathing in rabbits with various body temperatures (BT: 34-41 degrees C) before and after vagotomy (VGT), at rest and during passive limb motion (PLM), and in vagotomized rabbits with or without thoracic dorsal rhizotomy (TDR) under light (LBA) or deep barbiturate anesthesia (DBA). Both relationships had the form AicT = a AdiTb and Aic = a' Adib'. In intact normothermic animals under LBA mean values for b and b' were 1.47 and 1.37, a and a' being unity by definition. No changes in b or b' occurred even with TDR: this suggests that the relation between the central command to phrenic and to inspiratory intercostal alpha-motoneurones was the same under all conditions. Neither BT nor PLM modified a', but a changed owing to BT and PLM dependence of the relation between central inspiratory drive and off-switch threshold. Both VGT, independently of BT, and DBA decreased a and a' before but not after TDR, when a and a' reached the lowest values (0.12 and 0.22). Hence VGT and DBA, but not BT and PLM, change the relation between the central command to inspiratory intercostal alpha- and gamma-motoneurones, the multiplicative effect of alpha-gamma linkage on AicT and Aic being prevented by TDR.

Breathing pattern and lung volumes during exercise

The interrelationships of ventilation (V), tidal volume (VT), inspiratory (T1), expiratory (TE) and total breath (Ttot) durations, mean inspiratory (VT/TI) and expiratory (VT/TE) flows, and lung volumes were studied in normal subjects at rest and during exercise on a cycle ergometer. The ergometric load was increased by 10 W every minute, from zero W to 200 W. The TI/Ttot ratio increased with V in the range 15 to 60 1 X min-1, indicating that with increasing V the rate of increase of VT/TI decreased whereas that of VT/TE increased. Possible mechanisms responsible for the difference in behaviour of VT/TI and VT/TE are discussed. The VT-TI and VT-TE relationships both displayed three ranges with breakpoints at tidal volumes of about 1.4 and 2.4 1. The relations of TI and TE to end-inspiratory volume were approximately linear over the entire VT range studied, whereas the relations of TI and TE to end-expiratory volume showed three ranges with different characteristics. We conclude that the termination of inspiration during cycle exercise is dependent on volume-related afferent feedback from the lungs and/or chest walls, not only in the high but also in the low volume range.

Effects of taurine and a taurine antagonist on some respiratory and cardiovascular parameters

Respiratory performance, heart rate and blood pressure were studied in halothane anesthetized rats after administration of taurine and the putative taurine antagonist 6-aminomethyl-3-methyl-4H-1,2,4-benzothiadiazine-1, 1-dioxide hydrochloride (TAG). Intracerebroventricular (i.c.v.) taurine depressed ventilation due to decreased inspiratory neural drive and depression of respiratory timing mechanisms. I.c.v. administration of 1-100 micrograms TAG caused no changes in the respiratory and circulatory parameters studied except at the highest dose interval where respiratory frequency and minute ventilation were depressed. The respiratory depression induced by taurine (0.2 mg) or beta-alanine (1 mg) was antagonized by administration of TAG (100 micrograms). However, TAG did not antagonize the respiratory effects induced by i.c.v. glycine or gamma-aminobutyric acid (GABA) in equipotent respiratory depressant doses. The decline in inspiratory neural drive as well as in "respiratory timing" after i.c.v. taurine was restituted toward control values by TAG. The hypotension and bradycardia induced by taurine were also antagonized by TAG. It is concluded that TAG seems to antagonize the depressant action of taurine and beta-alanine but not of GABA and glycine on respiratory performance. TAG might also possess some partial agonist activity in higher doses.

Effects of induced hypotension on breathing pattern in halothane-anaesthetized man

The effects of hypotension induced by trimetaphan on ventilatory control were assessed in sixteen normal subjects under halothane anaesthesia. The breathing pattern, mouth occlusion pressures, lung mechanics, acid-base balance, and arterial blood gases were analysed before and during trimetaphan infusion. During induced hypotension, the only significant change in the ventilatory variables was an increase in the ratio of inspiratory duration to total cycle duration from 0.39 +/- 0.05 (SD) to 0.42 +/- 0.03; P less than 0.01. The average minute ventilation remained unchanged. No modification in lung mechanics was observed, but all subjects developed a slight but significant hypocapnic alkalosis: PaCO2 was reduced from 5.5 +/- 0.4 to 5.2 +/- 0.4 kPa (P less than 0.001) and pH increased from 7.34 to 7.36 (P less than 0.05), without change in standard bicarbonate concentration. Our data indicate that the reduction in sympathetic nervous system activity induced by trimetaphan infusion in spontaneously breathing man causes only a minor alveolar hyperventilation. The weak respiratory response to hypotension suggests that changing peripheral afferent activity has little influence on the typically rapid breathing pattern induced by halothane.

Upper airway dynamics during breathing and during apnoea in fetal lambs

We have done experiments to determine the site(s) of resistance to the outward flow of lung fluid during apnoea and the inward flow of fluid during breathing in fetal lambs. Pressures were measured at various sites in the upper airway of ten chronically instrumented fetal lambs. Three fetuses were tracheostomized, two fetuses had nasopharyngeal tubes, one fetus had a tube through the body of its larynx only and four fetuses were studied with their upper airway intact. During apnoea, oropharyngeal pressure as well as tracheal pressure was greater than amniotic pressure. Tracheostomy or insertion of a nasopharyngeal tube (that extended from the amniotic cavity to the oropharynx) eliminated the standing pressure gradient between trachea and amniotic cavity. During normal breathing, negative phasic changes in oropharyngeal pressure occurred only when there was substantial posterior cricoarytenoid activity. Tracheostomy substantially attenuated phasic changes in tracheal pressure during breathing. From these data we conclude that the larynx provides a substantial resistance to the movement of fluid towards the lungs during normal breathing despite the presence of laryngeal abductor activity but does not offer a resistance to the secretion of lung fluid. The small positive tracheal pressure during apnoea most likely results from the secretion of lung fluid into a closed pharyngeal and buccal cavity or against a high nasal and oral resistance.