Evaluation of various models for respiratory inductance plethysmography calibration

Comparison of Respiratory Calibration Methods for the Estimation of Lung Volume in Children With and Without Neuromotor Disorders

PURPOSE

The primary purpose of this study was to validate common respiratory calibration methods for estimating lung volume in children.

METHOD

Respiratory kinematic data were collected via inductive plethysmography from 81 typically developing children and nine children with neuromotor disorders. Correction factors for the rib cage and abdomen were calculated using three different methods: (a) least squares method with both rib cage and abdomen corrections (LsqRC/AB), (b) least squares method with rib cage correction only (LsqRC), and (c) a standard 2:1 rib-cage-to-abdomen ratio (Banzett). Correction factors for the LsqRC/AB and LsqRC methods were calculated with and without the use of the speech-like breathing calibration task. Lung volume estimation errors were calculated by comparing the estimated lung volumes based on the correction factors and the actual lung volumes acquired from a spirometer, normalized to each participant's vital capacity.

RESULTS

For typically developing children, the LsqRC/AB method resulted in significantly smaller lung volume estimation errors compared with other methods. Lung volume estimation errors decreased as age increased for each method. For the children with neuromotor disorders, the LsqRC/AB and LsqRC methods resulted in significantly smaller lung volume estimation errors than the Banzett method but were not significantly different from one another. There were no significant differences in lung volume estimation errors for the LsqRC/AB and LsqRC methods when the correction factors were calculated with and without the speech-like breathing calibration task.

CONCLUSION

The LsqRC/AB method exclusively utilizing the rest breathing calibration task is the most accurate and efficient respiratory calibration method for use with children with and without neuromotor disorders at this time.

Telemonitoring Techniques for Lung Volume Measurement: Accuracy, Artifacts and Effort

Telemonitoring becomes more important in pulmonary research. It can be used to decrease the pressure on the health care system, to lower the costs of health care and to increase quality of life of patients. Previous studies show contradictory results regarding the effectiveness of telemonitoring. According to multiple researchers, inefficiency can be a result of poor study design, low data quality and usability issues. To counteract these issues, this review proves for an in-depth explanation of four (potential) telemonitoring systems in terms of work principle, accuracy, disturbing factors and usability. The evaluated systems are portable spirometry/breath-by-breath analyzers, respiratory inductance and magnetic plethysmography and electrical impedance tomography. These insights can be used to select the optimal technique for a specific purpose in future studies.

End-expiratory lung volume remains stable during N2 MBW in healthy sleeping infants

We have previously shown that functional residual capacity (FRC) and lung clearance index were significantly greater in sleeping healthy infants when measured by N2 (nitrogen) washout using 100% O2 (oxygen) versus 4% SF6 (sulfur hexafluoride) washout using air. Following 100% O2 exposure, tidal volumes decreased by over 30%, while end-expiratory lung volume (EELV, i.e., FRC) rose markedly based on ultrasonic flow meter assessments. In the present study to investigate the mechanism behind the observed changes, N2 MBW was performed in 10 separate healthy full-term spontaneously sleeping infants, mean (range) 26 (18-31) weeks, with simultaneous EELV monitoring (respiratory inductance plethysmography, RIP) and oxygen uptake (V´O2 ) assessment during prephase air breathing, during N2 washout by exposure to 100% O2 , and subsequently during air breathing. While flow meter signals suggested a rise in ELLV by mean (SD) 26 (9) ml over the washout period, RIP signals demonstrated no EELV change. V'O2 /FRC ratio during air breathing was mean (SD) 0.43 (0.08)/min, approximately seven times higher than that calculated from adult data. We propose that our previously reported flow meter-based overestimation of EELV was in fact a physiological artifact caused by rapid and marked movement of O2 across the alveolar capillary membrane into the blood and tissue during 100% O2 exposure, without concomitant transfer of N2 to the same degree in the opposite direction. This may be driven by the high observed O2 consumption and resulting cardiac output encountered in infancy. Furthermore, the low resting lung volume in infancy may make this error in lung volume determination by N2 washout relatively large.

The Accuracy of Respiratory Calibration Methods for Estimating Lung Volume During Speech Breathing: A Comparison of Four Methods Across Three Adult Cohorts

Purpose This study evaluated the accuracy of respiratory calibration methods for estimating lung volume during speech breathing. Method Respiratory kinematic data were acquired via inductance plethysmography in 32 young adults, 22 older adults, and 13 older adults with Parkinson's disease (PD). Raw rib cage (RC) and abdomen (AB) signals (V) were calibrated to liters using 4 correction methods: (a) isovolume maneuvers, (b) a constant 2:1 RC-to-AB ratio, (c) least squares method with RC correction only (LsqRC), and (d) least squares method with both RC and AB corrections (LsqRC/AB). Mean percent error, the absolute difference between estimated and actual lung volumes then normalized to each speaker's vital capacity, was calculated for each method. Results For young adults, the LsqRC/AB method significantly reduced mean percent error compared to all other methods. Although LsqRC/AB also resulted in smaller errors for older adults and adults with PD, LsqRC/AB and LsqRC were not significantly different from one another in these groups. Conclusion The LsqRC/AB method reduces errors across all cohorts, but older adults and adults with PD also have reduced errors when using LsqRC. Further research should investigate both least squares methods across larger age and disease severity ranges.

Respiratory modulation of startle eye blink: a new approach to assess afferent signals from the respiratory system

Current approaches to assess interoception of respiratory functions cannot differentiate between the physiological basis of interoception, i.e. visceral-afferent signal processing, and the psychological process of attention focusing. Furthermore, they typically involve invasive procedures, e.g. induction of respiratory occlusions or the inhalation of CO₂-enriched air. The aim of this study was to test the capacity of startle methodology to reflect respiratory-related afferent signal processing, independent of invasive procedures. Forty-two healthy participants were tested in a spontaneous breathing and in a 0.25 Hz paced breathing condition. Acoustic startle noises of 105 dB(A) intensity (50 ms white noise) were presented with identical trial frequency at peak and on-going inspiration and expiration, based on a new pattern detection method, involving the online processing of the respiratory belt signal. The results show the highest startle magnitudes during on-going expiration compared with any other measurement points during the respiratory cycle, independent of whether breathing was spontaneous or paced. Afferent signals from slow adapting phasic pulmonary stretch receptors may be responsible for this effect. This study is the first to demonstrate startle modulation by respiration. These results offer the potential to apply startle methodology in the non-invasive testing of interoception-related aspects in respiratory psychophysiology.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.

Monitoring Lung Volumes During Mechanical Ventilation

Respiratory inductive plethysmography (RIP) is a non-invasive method of measuring change in lung volume which is well-established as a monitor of tidal ventilation and thus respiratory patterns in sleep medicine. As RIP is leak independent, can measure end-expiratory lung volume as well as tidal volume and is applicable to both the ventilated and spontaneously breathing patient, there has been a recent interest in its use as a bedside tool in the intensive care unit.

Reducing the airflow waveform distortions from breathing style and body position with improved calibration of respiratory effort belts

Background

Respiratory effort belt measurement is a widely used method to monitor respiration. Signal waveforms of respiratory volume and flow may indicate pathological signs of several diseases and, thus, it would be highly desirable to predict them accurately. Calibrated effort belts are sufficiently accurate for estimating respiratory rate, but the respiratory volume and flow prediction accuracies degrade considerably with changes in the subject’s body position and breathing style.

Methods

An improved calibration method of respiratory effort belts is presented in this paper. It is based on an optimally trained FIR (Finite Impulse Response) filter bank constructed as a MISO system (Multiple-Input Single-Output) between respiratory effort belt signals and the spirometer in order to reduce waveform errors. Ten healthy adult volunteers were recruited. Breathing was varied between the following styles: metronome-guided controlled breathing rate of 0.1 Hz, 0.15 Hz, 0.25 Hz and 0.33 Hz, and a free rate that was felt normal by each subject. Body position was varied between supine, sitting and standing. The proposed calibration method was tested against these variations and compared with the state-of-the-art methods from the literature.

Results

Relative waveform error decreased 60-70% when predicting airflow under changing breathing styles. The coefficient of determination R² varied between 0.88-0.95 and 0.65-0.79 with the proposed and the standard method, respectively. Standard deviation of respiratory volume error decreased even 80%. The proposed method outperformed other methods.

Conclusions

Results show that not only the respiratory volume can be computed more precisely from the predicted airflow, but also the flow waveforms are very accurate with the proposed method. The method is robust to breathing style changes and body position changes improving greatly the accuracy of the calibration of respiratory effort belts over the standard method. The enhanced accuracy of the belt calibration offers interesting opportunities, e.g. in pulmonary and critical care medicine when objective measurements are required.

Improved regression models for ventilation estimation based on chest and abdomen movements

Non-invasive estimation of minute ventilation is important for quantifying the intensity of physical activity of individuals. In this paper, several improved regression models are presented, based on the measurement of chest and abdomen movements from sensor belts worn by subjects (n = 50) engaged in 14 types of physical activity. Five linear models involving a combination of 11 features were developed, and the effects of different model training approaches and window sizes for computing the features were investigated. The performance of the models was evaluated using experimental data collected during the physical activity protocol. The predicted minute ventilation was compared to the criterion ventilation measured using a bidirectional digital volume transducer housed in a respiratory gas exchange system. The results indicate that the inclusion of breathing frequency and the use of percentile points instead of interdecile ranges over a 60 s window size reduced error by about 43%, when applied to the classical two-degrees-of-freedom model. The mean percentage error of the minute ventilation estimated for all the activities was below 7.5%, verifying reasonably good performance of the models and the applicability of the wearable sensing system for minute ventilation estimation during physical activity.

A novel, non-invasive method of respiratory monitoring for use with stereotactic procedures

Accurate monitoring of respiration is often needed for neurophysiological studies, as either a dependent experimental variable or an indicator of physiological state. Current options for respiratory monitoring of animals held in a stereotaxic frame include EMG recordings, pneumotachograph measurements, inductance-plethysmography, whole-body plethysmography (WBP), and visual monitoring. While powerful, many of these methods prevent access to the animal's body, interfere with experimental manipulations, or require deep anesthesia and additional surgery. For experiments where these issues may be problematic, we developed a non-invasive method of recording respiratory parameters specifically for use with animals held in a stereotaxic frame. This system, ventilation pressure transduction (VPT), measures variations in pressure at the animal's nostril from inward and outward airflow during breathing. These pressure changes are detected by a sensitive pressure transducer, then filtered and amplified. The output is an analog signal representing each breath. VPT was validated against WBP using 10% carbon dioxide and systemic morphine (4mg/kg) challenges in lightly anesthetized animals. VPT accurately represented breathing rate and tidal volume changes under both baseline and challenge conditions. This novel technique can therefore be used to measure respiratory rate and relative tidal volume when stereotaxic procedures are needed for neuronal manipulations and recording.

Development of statistical regression models for ventilation estimation

Estimation of ventilation volume from dimensional changes of the rib cage and abdomen is of interest to researchers interested in quantifying internal exposure to environmental pollutants in the atmosphere. In this paper, we present different statistical regression models for estimating ventilation volume during free-living activities. The movements of the rib cage and abdomen were measured by piezoelectric sensor belts. Multiple linear regression as the calibration method was applied. Five regression models with different combinations out of thirteen features were developed and the performance of these models was compared through experimental study of 11 subjects. The effect of training approaches - model trained for each subject and for all subjects, and the effect of time intervals for computing features were also investigated. The results indicate that Model 2, combining respiratory features and breathing frequency, with a longer time intervals will lead to a higher accuracy.

Respiratory inductive plethysmography accuracy at varying PEEP levels and degrees of acute lung injury

BACKGROUND AND OBJECTIVE

This study was performed to assess the accuracy of respiratory inductive plethysmographic (RIP) estimated lung volume changes at varying positive end-expiratory pressures (PEEP) during different degrees of acute respiratory failure.

METHODS

Measurements of inspiratory tidal volume were validated in eight piglets during constant volume ventilation at incremental and decremental PEEP levels and with increasing severity of pulmonary injury. RIP accuracy was assessed with calibration from the healthy state, from the disease state as the measurement error was assessed, and at various PEEP levels.

RESULTS

Best results (bias 3%, precision 7%) were obtained in healthy animals. RIP accuracy decreased with progressing degrees of acute respiratory failure and was PEEP dependent, unless RIP was calibrated again. When calibration was performed in the disease state as the measurement error was assessed, bias was reduced but precision did not improve (bias -2%, precision 9%).

CONCLUSIONS

RIP accuracy is within the accuracy range found in monitoring devices currently in clinical use. Most reliable results with RIP are obtained when measurements are preceded by calibration in pulmonary conditions that are comparable to the measurement period. When RIP calibration is not possible, fixed weighting of the RIP signals with species and subject size adequate factors is an alternative. Measurement errors should be taken into account with interpretation of small volume changes.

Circadian affective, cardiopulmonary, and cortisol variability in depressed and nondepressed individuals at risk for cardiovascular disease

Depression is a risk factor for cardiovascular disease (CVD) perhaps mediated by hypothalamic-pituitary-adrenal (HPA) axis or vagal dysregulation. We investigated circadian mood variation and HPA-axis and autonomic function in older (55 years) depressed and nondepressed volunteers at risk for CVD by assessing diurnal positive and negative affect (PA, NA), cortisol, and cardiopulmonary variables in 46 moderately depressed and 19 nondepressed volunteers with elevated CVD risk. Participants sat quietly for 5-min periods (10:00, 12:00, 14:00, 17:00, 19:00, and 21:00), and then completed an electronic diary assessing PA and NA. Traditional and respiration-controlled heart rate variability (HRV) variables were computed for these periods as an index of vagal activity. Salivary cortisols were collected at waking, waking+30min, 12:00, 17:00, and 21:00h. Cortisol peaked in the early morning after waking, and gradually declined over the day, but did not differ between groups. PA was lower and NA was higher in the depressed group throughout the day. HRV did not differ between groups. Negative emotions were inversely related to respiratory sinus arrhythmia in nondepressed participants. We conclude that moderately depressed patients do not show abnormal HPA-axis function. Diurnal PA and NA distinguish depressed from nondepressed individuals at risk for CVD, while measures of vagal regulation, even when controlled for physical activity and respiratory confounds, do not. Diurnal mood variations of older individuals at risk for CVD differ from those reported for other groups and daily fluctuations in NA are not related to cardiac autonomic control in depressed individuals.

The influence of fundamental frequency and sound pressure level range on breathing patterns in female classical singing

PURPOSE

This study investigated the influence of fundamental frequency (F0) and sound pressure level (SPL) range on respiratory behavior in classical singing.

METHOD

Five trained female singers performed an 8-s messa di voce (a crescendo and decrescendo on one F0) across their musical F0 range. Lung volume (LV) change was estimated, and chest-wall kinematic behavior (dimensional change in ribcage [RC] and abdominal [AB] wall) was recorded using triaxial magnetometry.

RESULTS

The direction of F0 influence on LV excursion (LVE) varied among singers, but SPL range appeared to be less important than duration to LVE. LVE was generally evenly divided between crescendo and decrescendo. Kinematic patterns differed markedly among singers, despite task consistency, and RC and AB paradoxing was widespread.

CONCLUSION

Each singer maintained her characteristic kinematic pattern regardless of F0 or SPL range, although these did influence aspects of RC and AB behavior. Given the essential role of breathing in classical singing, further work is needed to understand how singers develop their highly individual respiratory strategies and the principles by which each singer's breathing strategy can be optimized.

An inexpensive, MRI compatible device to measure tidal volume from chest-wall circumference

Mouthpieces and masks change breathing, and distract the subject. Accepted non-invasive methods avoid this problem, inductive plethysmographs and respiratory magnetometers, but are expensive and unusable in magnetic resonance imaging (MRI) scanners. Because changes in ventilation affect arterial gases, and thus cerebral blood flow, measurement of breathing is desirable during many functional MRI studies. Using an old principle, we constructed an inexpensive, non-invasive device unaffected by magnetic fields. We adapted a simple calibration method to reduce error and make the method accessible to more users. 'Pneumobelts' consist of flexible corrugated silicon tubes worn around the rib cage (RC) and the abdomen (AB). Changes in RC and AB are determined from pressure changes within the 'pneumobelts'. Estimates of tidal volume are generated from the sum of the RC and AB changes. We empirically determined the appropriate RC weighting as 1.3:1 (RC:AB). Volume estimation was tested (n = 9) in different body positions and during different breathing maneuvers. The weighted sum of the two signals gave an accurate estimate of tidal volume with tidal volumes less than 1200 ml (mean error = 6-7%). Breaths over 1900 ml produced larger errors (mean error = 11-16%). Our results are generalizable to any linear circumference measuring device.

Imagined risk of suffocation as a trigger for hyperventilation

OBJECTIVE

Although hyperventilation has been hypothesized to play a role in many pathologies, its critical triggers remain poorly understood. The present experiment aimed to test whether stronger hyperventilation responses occur in response to suggested risk of suffocation compared with other fearful situations in high- and low-trait anxious women.

METHODS

Fractional end-tidal CO2-concentration (FetCO2), respiratory frequency, and inspiratory volume were measured nonintrusively in high- (n = 24) and low- (n = 24) trait anxious women during imagery of 3 fear, 1 tension, 1 depressive, and 3 relaxation scripts. The fear scripts were equal in ratings of unpleasantness and arousal but differed regarding the inclusion of suggested risk of suffocation and entrapment. After each imagery trial, participants rated the emotional dimensions of pleasantness, arousal, and dominance and the vividness of their imagery.

RESULTS

Decreases in FetCO2 occurred in all fear scripts. High-trait anxious women showed a stronger reduction in FetCO2 compared with low-trait anxious women during the fear script suggesting risk of suffocation but not during the other fear scripts. This effect was unrelated to any of the self-reported fear ratings. Self-reported fear of entrapment was associated with an overall lower FetCO2 but not with enhanced reactivity to imagined entrapment.

CONCLUSION

High-trait anxiety is associated with stronger respiratory responsivity to imagined risk of suffocation and may constitute a specific vulnerability factor for the development of panic disorder and claustrophobia.

Leg-extension strength and chair-rise performance in elderly women with Parkinson's disease

The lower extremity performance in elderly female patients with mild to moderate Parkinson's disease (PD; n = 12) and controls (n = 16) was compared. Isometric dynamometry and force-plate measurements were used. PD patients had lower (p < .05) bilateral (BL) maximal isometric leg-extension force (MF), BL isometric MF relative to body mass, and maximal rate of isometric force development than control participants. BL strength deficit was greater (p < .05) in PD patients than in controls. A significantly longer chair-rise time and lower maximal rate of vertical-ground-reaction-force development while rising from a chair was found in PD patients than in controls. These findings suggest that elderly women with PD have lowered voluntary isometric force-generation capacity of the leg-extensor muscles. Reduced BL leg-extension strength might contribute to the difficulty of individuals with PD to rise from a chair.

Influence of tidal volume and thoraco-abdominal separation on the respiratory induced variation of the photoplethysmogram

OBJECTIVE

The present study was aimed at determining the relative influences of tidal volume and thoraco-abdominal separation (relative thoracic and abdominal contribution to the tidal volume) on the respiratory induced intensity variation (RIIV) of the photoplethysmographic signal. The effects were studied in two body positions.

METHODS

Respiratory inductive plethysmography was used for quantifying thoraco-abdominal separation and for assessing tidal volumes. 10 subjects were trained to perform widely varying degrees of thoraco-abdominal separation at different tidal volumes. The relationship between the RIIV signal peak-to-peak value (measured at the forearm), and the tidal volume and thoraco-abdominal separation was investigated in two body positions with the use of multiple linear regression.

RESULTS

Larger tidal volume and more thoracic contribution to respiration were found to increase the RIIV peak-to-peak value (p < 0.0005). In the supine position, the tidal volume influence was stronger than that of thoraco-abdominal separation, and in the sitting position, the opposite was seen.

CONCLUSIONS

The effects on the RIIV signal following changes in thoraco-abdominal separation and tidal volume are of the same order of magnitude. In the supine position, the influence of thoracic versus abdominal contribution to the tidal volume is not as significant as in the sitting position. Photoplethysmography is a promising technique for combined monitoring of several respiratory parameters, including tidal volume. In situations where the relative thoracic and abdominal contributions are likely to vary, the tidal volume information becomes less reliable.

Phonospirometry for noninvasive measurement of ventilation: methodology and preliminary results

We measured tracheal flow from tracheal sounds to estimate tidal volume, minute ventilation (VI), respiratory frequency, mean inspiratory flow (VT/TI), and duty cycle (TI/Ttot). In 11 normal subjects, 3 patients with unstable airway obstruction, and 3 stable asthmatic patients, we measured tracheal sounds and flow twice: first to derive flow-sound relationships and second to obtain flow-volume relationships from the sound signal. The flow-volume relationship was compared with pneumotach-derived volume. When subjects were seated, facing forward and with neck rotation, flexion, and standing, flow-volume relationship was within 15% of pneumotach-derived volume. Error increased with neck extension and while supine. We then measured ventilation without mouthpiece or nose clip from tracheal sounds during quiet breathing for up to 30 min. Normal results +/- SD revealed tidal volume = 0.37 +/- 0.065 liter, respiratory frequency = 19.3 +/- 3.5 breaths/min, VI = 6.9 +/- 1.2 l/min, VT/TI = 0.31 +/- 0.06 l/s, and TI/Ttot = 0.37 +/- 0.04. Unstable airway obstruction had large VI due to increased VT/TI. With the exception of TI/Ttot, variations in ventilatory parameters were closer to log normal than normal distributions and tended to be greater in patients. We conclude that phonospirometry measures ventilation reasonably accurately without mouthpiece, nose clip, or rigid postural constraints.

[Development of a flexible cardiorespiratory monitor based on induction plethysmography]

Induction plethysmography (IP) utilizes changes in the inductance of sinusoidal wires embedded in elastic bands placed around the chest and abdomen to detect volume changes in the two compartments. These changes can be attributed to respiration or heart beat. To date, most applications have been tailored to an investigation of respiration. More sensitive systems have been employed for the detection of cardiac activity. The wires within the bands, which function as the coil in a resonant circuit, are excited by an oscillator. Among other factors, the inductance of the coil depends on the cross-sectional area of the coie, and changes with respiration in coils placed around the chest and abdomen. Using LabView software, the biosignals obtained undergo an analog-to-digital conversion prior to processing. The system was calibrated using the isovolume method. In 10 adults, IP was tested against a pneumotachograph (PNT) in different body positions (standing, sitting, supine, prone). Correlation between tidal volumes measured with IP and PNT was of r > or = 0.96 on average, recalibration being done after each change in position. The absolute mean error ranged between 3.7 and 8.5%, depending on body position. The smallest error (3.7%) and greatest agreement between the two methods was found in the supine position (93.3% of the IP measurements within +/- 10% of the PNT measurements). An IP application that could be used to collect data over the long term and which is in good agreement with PNT was developed by employing a "virtual instrument" (VI, LabView) for flexible data acquisition and data processing. Agreement was best when the volunteer adopted a supine position. A smaller correlation was found in standing or seated subjects. This might be due to the fact that in the latter two positions, the respiratory system may have more than 2 degrees of freedom, and thus cannot be adequately monitored by only two bands around the thorax and abdomen. Signals produced by cardiac activity were detectable on the surface of the body.

Error analysis of a natural breathing calibration method for respiratory inductive plethysmography

Respiratory volumes are measured non-invasively by recording rib cage and abdominal motions using respiratory inductive plethysmography (RIP). Qualitative diagnostic calibration (QDC) of RIP is based on the natural variability in the relative rib-cage-to-abdomen contribution during tidal breathing. ODC does not require subject cooperation but it has previously been shown that accuracy may deteriorate when breathing pattern changes. The aim of this study was to investigate the causes and situations where QDC accuracy deteriorates. The QDC method was compared to PRA (calibration during voluntarily preferential rib cage or abdomen breathing) in ten adults. A reference RIP calibration was obtained from all validation data (REF). The PRA method had better accuracy than the ODC method (p<0.01). The volumetric error ranged between 10% and 136% with QDC and between 5% and 33% with PRA. The PRA calibration factors were within 6% of those from REF, while the QDC rib-cage factor was underestimated by 15% and the abdominal factor was overestimated by 38%. Small natural variability in the relative rib-cage-to-abdomen contribution was related to poor accuracy. Each compartment's variability depended on its magnitude, which is a violation of the QDC assumptions.

Lung volume recruitment in lambs during high-frequency oscillatory ventilation using respiratory inductive plethysmography

Monitoring lung volume is important in the treatment of acute hypoxemic respiratory failure. However, there are no tools available for lung volume measurement to guide ventilator management during high-frequency oscillatory ventilation (HFOV) and during dynamic changes in conventional ventilation (CV). We studied the performance of a new respiratory inductive plethysmograph (RIP) with modified software. We measured Delta changes in lung volume above end-expiratory volume (V(RIP)) during HFOV and studied whether changes in V(RIP) parallel changes in mean airway pressure. Calibration of the plethysmograph was made by serial injections of a known gas volume in six term (140 d gestation) and eight preterm (125 d gestation) lambs. Linear regression analysis of the relationship between injected gas volume and V(RIP) showed strong correlation (r(2) = 0.93-1.00 term animals, r(2) = 0.86-1.00 preterm animals). The pressure volume curves from the calibration with the injected gas volumes also correlated well with the pressure volume curves extrapolated from changes in V(RIP). Lung hysteresis was clearly demonstrated with RIP after changes in mean airway pressure during HFOV and after changes in positive end-expiratory pressure during CV. We conclude that measurements of lung volume in term and preterm lambs by use of modified RIP correlate well with changes in mean airway pressure during HFOV, with static pressure volume curves and with changes in positive end-expiratory pressure during CV. We speculate that this technique may provide clinically useful information about changes in lung volume during HFOV and CV. However, evaluation of the precision and chronic stability of RIP measurements over prolonged periods will require further studies.

Thoracoabdominal asynchrony in small children with lung disease--methodological aspects and the relationship to lung mechanics

Thoracoabdominal asynchrony (TAA) has been regarded as a clinical sign of lung disease. A measure of TAA is the phase angle (phi) between ribcage (RC) and abdominal (ABD) respiratory motion. The aim of this study was to assess the effect of the points chosen for phi calculation. The influence of correct respiratory timing was assessed by calculating TAA indices using a pneumotachometer (PTM) as timing reference and using the calibrated respiratory inductive plethysmograph (RIP) signal for respiratory timing. The relationship between TAA and lung mechanics was studied in 15 young children 9 months to 2.5 years of age with a wide span of restrictive and/or obstructive lung disease. phi as calculated from mid-RC points was poorly related to phi as calculated from the top RC and ABD positions, indicating non-sinusoidal respiratory motions. The estimation of the TAA indices depended on correct respiratory timing, which in the case of severe asynchrony cannot be inferred from the RIP signals alone. An external source for respiratory timing, such as the airway flow measured by a PTM, is needed. The degree of asynchronous chest wall movement was only a weak indicator of pathological lung mechanics. We conclude that the usefulness of TAA indices as indicators of impaired lung mechanics is limited by the sensitivity to the points used for their calculation (phi) and the need of an external source for respiratory timing. It was therefore not surprising that a rather weak relationship was seen between TAA indices and lung mechanics.

Evaluation of respiratory inductive plethysmography: accuracy for analysis of respiratory waveforms

OBJECTIVE

To assess the accuracy of respiratory inductive plethysmography (RIP) waveforms to those obtained with whole body plethysmograph (BP) as this device gives a plethysmographic signal and a pneumotachograph (PNT).

DESIGN

Randomized controlled trial.

SETTING

Physiologic laboratory in a university hospital.

PARTICIPANTS

Eleven subjects from the laboratory staff.

INTERVENTIONS

This study was achieved during four consecutive periods in subjects breathing spontaneously and through different added resistive loads. Using the least square method calibration, two RIP waveforms, VRIP.BP(t) and VRIP.PNT(t), were simultaneously calculated with coefficients obtained from BP and from PNT volume waveforms, respectively VBP(t) and VPNT(t). For each recording, to compare volume waveforms, we calculated their differences in term of distances, DRIP-BP and DRIP-PNT, between the normalized RIP volume signal (respectively, VRIP.BP[t] and VRIP.PNT[t]) and its normalized reference (respectively, VBP[t] and VPNT[t]). We also calculated the distance DPNT-BP between the two normalized references VBP(t) and VPNT(t).

RESULTS

No significant effect of load or time on the distance occurred. Including all the recordings, the mean distance DRIP-BP (3.4+/-1.1%) appears significantly lower than both the mean distance DRIP-PNT (4.5+/-1.3%; p<0.04) and the mean distance DPNT-BP (4.6+/-0.9%; p<0.008). For each period or load level, DRIP-BP appears to be lower than DRIP-PNT and DPNT-BP.

CONCLUSION

The RIP seems reasonably accurate for analysis of respiratory waveform while subjects subsequently breathe against resistive loads.

A method for measuring the CO2 dead space volume in facial visors and respiratory protective devices in human subjects

The external CO2 dead space volume (Vd) in facial visors and respiratory protective devices is difficult, but important, to measure in human subjects. The lack of proper methods for its assessment has hampered the development of standards and the improvement of visor and device design. We have improved and evaluated a method for measuring Vd and the mean inspired fraction of CO2 (FI,CO2) in human subjects wearing facial visors or respiratory protective devices. The method is based on indirect measurements of inspiratory volumes using a calibrated respiratory inductive plethysmograph (RIP), and measurements of FCO2 with a mass spectrometer. The accuracy of the RIP method was assessed in eight subjects and its repeatability was studied during nasal and oral breathing, at rest and after bicycle ergometer work. We related the Vd,RIP results to two known external VdS (with the effective Vd equal to the geometric volume; 15 ml and 320 ml), through which the subjects breathed, using RIP and a pneumotachometer (PTM) simultaneously (Vd,RIP and Vd,PTM). The repeatability of Vd and mean FI,CO2 results was determined from duplicate recordings during the wearing of a welding visor. Initial RIP calibration was accepted if the inspiratory tidal volume error was < or = 10%. This resulted in an acceptable Vd,RIP error (< or = 20%; Vd = 320 ml) in six eight subjects. The validation technique allowed us to separate the Vd,RIP error into a volumetric error and an error related to CO2 measurement. Poor RIP volumetric accuracy over the initial portion of inspiration was detrimental to Vd accuracy. Using the welding visor, Vd and mean FI,CO2 were less at rest than after work and less during nasal breathing than during oral breathing. The intra-individual variability of Vd and mean FI,CO2 were lower during nasal breathing than during oral breathing. To summarize, the improved RIP based method can accurately (< or = 20% error) assess Vd and mean FI,CO2 in facial visors and respiratory protective devices in standardized work situations. A meticulous RIP calibration procedure and repeated validations of RIP volume and CO2 measurement accuracy must, however, be applied.

Breathing pattern variability during bronchial histamine and methacholine challenges in asthmatics

Breathing pattern variability was determined in 10 asthmatic adolescents during repeated bronchial histamine and methacholine challenges (HiCh/MeCh). The purpose was to provide information on ventilatory control in asthmatics by comparing the variability of the various breathing pattern parameters at rest and during induced bronchial obstruction. Changes in variability during bronchial obstruction might be explained by either anxiety effects causing increased variability or by the minimization of the work of breathing causing decreased variability. Ventilation was monitored by respiratory inductive plethysmography in order to minimize the effects on the spontaneous pattern of breathing. Breath-to-breath and day-to-day variability were determined concerning respiratory frequency (fR), inspiratory tidal volume (VTI), inspiratory ventilation (V'I), inspiratory time to total cycle time ratio (TI/TTOT), mean inspiratory flow (VTI/TI, an index of ventilatory drive), rib cage fraction of VTI (VRC/VTI), and maximum compartmental amplitude to VTI ratio (MCA/VTI; an index of rib cage and abdominal phasing). No difference in any parameter was found regarding breath-to-breath coefficient of variation (CV = SD/mean) between recordings at baseline, after saline inhalation and after threshold dose of the provocative agents, i.e. > 20% fall in FEV1. Variability was less for MCA/VTI and VRC/VTI (mean CV 1.3 and 7.7%, respectively) than for TI/TTOT, fR, VTI/TI, VTI, and V'I (14.2, 15.8, 20.9, 22.2 and 21.1%, respectively) (P < 0.01). Likewise, the day-to-day variability did not differ in any parameter between recordings at baseline, after saline inhalation and after threshold dose. The variability was less for MCA/VTI (0.7%) than for TI/TTOT, VRC/VTI, V'I, VTI/TI, fR and VTI (7.1, 12.1, 12.8, 14.2, 13.0 and 15.4%) (P < 0.05). Furthermore, TI/TTOT was less variable than VTI (P < 0.05). Thus, the ventilatory pattern was quite reproducible on a day-to-day basis, despite considerable breath-to-breath variability. Ventilatory drive and tidal volumes were more variable than the rib cage and abdominal phasing, the respiratory timing and the rib cage fraction of tidal volume. The lack of difference in variability between rest and induced bronchial obstruction indicates that other factors than anxiety or minimization of the work of breathing are important for the control of respiration in asthmatics during bronchial challenge.

Hyperventilation during bronchial challenges in asthmatics: reproducibility and assessment of contributing factors

Among asthmatics, the ventilatory response is heterogeneous during bronchial challenge. This study aimed to investigate the reproducibility of the response and to assess possible causes for hyperventilation. Repeated bronchial histamine and methacholine challenges (HiCh/MeCh) were performed in 10 asthmatic adolescents. Ventilation was monitored by respiratory inductive plethysmography (RIP), in order to minimally affect the spontaneous breathing pattern. FEV1 and the volume of trapped gas (measured as the volume of air mobilized by five maximal breaths after a multiple breath nitrogen washout to 2% N2), were used to assess mainly central and peripheral airways obstruction, respectively. When FEV1 had decreased by at least 20%, mean inspiratory flow (VTI/TI) increased by 21% and minute ventilation (V'I) by 21% and 23% during HiCh and MeCh, respectively (both P < 0.05). No correlation was found between the magnitude of the ventilatory response and either: the degree of FEV1 decline, the increase in gas trapping, SaO2 decline or the increase in dyspnoea score. Histamine challenge after beta 2-agonist pre-treatment was associated with increased ventilatory drive in one patient despite the absence of bronchial obstruction, indicating that histamine might directly stimulate afferent airway nerves which cause hyperventilation. The intra-individual variability of the ventilatory response (increase in V'I and VTI/TI) was more than 100% of the mean ventilatory response, while the variability of the bronchomotor response was about 25% of the mean bronchomotor response. Thus, during induced bronchial obstruction in asthmatics, the occurrence of hyperventilation and its intensity are not related to either the degree of central or peripheral airways obstruction, or to the degree of dyspnoea. The reproducibility of the ventilatory response is poor. The ventilatory response appears to be the result of a complex interaction between several afferent stimuli and central ventilatory control.

A bioacoustic method for timing of respiration at cardiac investigations

At cardiac investigations Doppler echocardiography is an established technique for the recording of intracardial and intravascular flow velocities. Transvalvular and venous flows are, however, markedly influenced by respiration. Since the start of inspiration is the important time of reference, accurate recording of the respiratory phase is important when analysing these flow velocities. A bioacoustic technique was therefore adopted to meet this demand and was tested in 10 normal subjects. Oesophageal balloon technique was used as a reference, and the bioacoustic technique was compared with a respiratory inductive plethysmograph. The average delay for the acoustic sensor signal compared to the oesophageal pressure changes was 205 +/- 46 (SD) ms, ranging from 160 to 320 ms for normal breathing, and is comparable to that of the respiratory inductive plethysmograph (210 +/- 90 ms). The bioacoustic technique is easier to apply than the respiratory inductive plethysmograph. The sensitivity to disturbances can be further reduced by signal processing and the method has clinical potential for the future.