Respiratory input impedance up to 256 Hz in healthy humans breathing foreign gases

Ventilation Mechanics

A fundamental task of the respiratory system is to operate as a mechanical gas pump ensuring that fresh air gets in close contact with the blood circulating through the lung capillaries to achieve O2 and CO2 exchange. To ventilate the lungs, the respiratory muscles provide the pressure required to overcome the viscoelastic mechanical load of the respiratory system. From a mechanical viewpoint, the most relevant respiratory system properties are the resistance of the airways (R aw), and the compliance of the lung tissue (C L) and chest wall (C CW). Both airflow and lung volume changes in spontaneous breathing and mechanical ventilation are determined by applying the fundamental mechanical laws to the relationships between the pressures inside the respiratory system (at the airway opening, alveolar, pleural, and muscular) and R aw, C L, and C CW. These relationships also are the basis of the different methods available to measure respiratory mechanics during spontaneous and artificial ventilation. Whereas a simple mechanical model (R aw, C L, and C CW) describes the basic understanding of ventilation mechanics, more complex concepts (nonlinearity, inhomogeneous ventilation, or viscoelasticity) should be employed to better describe and measure ventilation mechanics in patients.

Regional Gas Transport During Conventional and Oscillatory Ventilation Assessed by Xenon-Enhanced Computed Tomography

Enhanced intrapulmonary gas transport enables oscillatory ventilation modalities to support gas exchange using extremely low tidal volumes at high frequencies. However, it is unknown whether gas transport rates can be improved by combining multiple frequencies of oscillation simultaneously. The goal of this study was to investigate distributed gas transport in vivo during multi-frequency oscillatory ventilation (MFOV) as compared with conventional mechanical ventilation (CMV) or high-frequency oscillatory ventilation (HFOV). We hypothesized that MFOV would result in more uniform rates of gas transport compared to HFOV, measured using contrast-enhanced CT imaging during wash-in of xenon gas. In 13 pigs, xenon wash-in equilibration rates were comparable between CMV and MFOV, but 21 to 39% slower for HFOV. By contrast, the root-mean-square delivered volume was lowest for MFOV, increased by 70% during HFOV and 365% during CMV. Overall gas transport heterogeneity was similar across all modalities, but gravitational gradients and regional patchiness of specific ventilation contributed to regional ventilation heterogeneity, depending on ventilator modality. We conclude that MFOV combines benefits of low lung stretch, similar to HFOV, but with fast rates of gas transport, similar to CMV.

Diffusion-weighted 19F-MRI of lung periphery: Influence of pressure and air-SF6 composition on apparent diffusion coefficients

Lung functional magnetic resonance imaging (MRI) has become a reality using different inert hyperpolarized gases, such as 3He and 129Xe, which have provided an extraordinary boost in lung imaging and has also attracted interest to other chemically inert gaseous contrast agents. In this context, we have recently demonstrated the first diffusion-weighted images using thermally polarized inhaled sulfur hexafluoride (SF6) in small animals. The aim of this study was to evaluate whether or not the diffusion coefficient of this fluorinated gas is sensitive to pulmonary structure, gas concentration and air pressure in the airways. Diffusion coefficients of SF6 (both pure and in air mixtures) measured in vitro at different pressures and 20 degrees C showed an excellent agreement with theoretical values. Measurements of diffusion coefficients were also performed in vivo and post-mortem on healthy rats, achieving satisfactory signal-to-noise ratios (SNRs), and SF6 gas was found to be in an almost completely restricted diffusion regime in the lung, i.e., the transport by molecular diffusion is delayed by collisions with barriers such as the alveolar septa. This observed low diffusivity means that this gas will be less sensitive to structural changes in the lungs than other magnetic resonance sensitive gas such as 3He, particularly at human scale. However, it is still possible that SF6 plays a role since it opens a new structural window. Thus, the interest of researchers in delimiting the important limiting technical factors that makes this process very challenging is obvious. Among them, T2 relaxation is very fast, so gradient systems with very fast switching rate and probably large radiofrequency (RF) power and high field systems will be needed for hexafluoride to be used in human studies.

Broadband frequency dependence of respiratory impedance in rats

Past studies in humans and other species have revealed the presence of resonances and antiresonances, i.e., minima and maxima in respiratory system impedance (Zrs), at frequencies much higher than those commonly employed in clinical applications of the forced oscillation technique (FOT). To help understand the mechanisms behind the first occurrence of antiresonance in the Zrs spectrum, the frequency response of the rat was studied by using FOT at both low and high frequencies. We measured Zrs in both Wistar and PVG/c rats using the wave tube technique, with a FOT signal ranging from 2 to 900 Hz. We then compared the high-frequency parameters, i.e., the first antiresonant frequency (far,1) and the resistive part of Zrs at that frequency [Rrs(far,1)], with parameters obtained by fitting a modified constant-phase model to low-frequency Zrs spectra. The far,1 was 570 ± 43 (SD) Hz and 456 ± 16 Hz in Wistar and PVG/c rats, respectively, and it did not shift with respiratory gases of different densities (air, heliox, and a mixture of SF6). The far,1 and Rrs(far,1) were relatively independent of methacholine-induced bronchoconstriction but changed significantly with increasing transrespiratory pressures up to 20 cmH2O, in the same way as airway resistance but independently of changes to tissue parameters. These results suggest that, unlike the human situation, the first antiresonance in the rat is not primarily dependent on the acoustic dimensions of the respiratory system and can be explained by interactions between compliances and inertances localized to the airways, but this most likely does not include airway wall compliance.

Respiratory input impedance measurement: forced oscillation methods

The paper reviews how forced oscillation techniques (FOT) for measuring respiratory input impedance Zrs,in have recently been used in clinical applications. Zrs,in is clinically relevant, as it provides data on both the resistive, Rrs, and nonresistive, Xrs, components of the respiratory system. Additionally, when excitatory test signals extending into low- (<4 Hz) or high-frequency (>100 Hz) ranges are used, reliable partitioning of lung tissue from airway components is feasible. Adult and paediatric studies examining the use of Zrs,in for routine lung-function assessment, sleep and mechanical ventilation are reviewed. For clinicians, Zrs,in repeatable and sensitive to airway resistance. It is helpful for assessing unco-operative and severely obstructed patients, for monitoring mechanics during artificial ventilation and for tracking airway closure during sleep studies. For paediatricians, longitudinal studies of the growth and development of the respiratory system can also be made using Zrs,in. Forced oscillation techniques, however, require further standardisation, and Zrs,in is limited by upper-airway shunt artifacts. In conclusion, measurement of Zrs,in using FOT is an important and sophisticated non-invasive lung-function test, showing good potential for future clinical applications.

Effect of gas density variations on respiratory input impedance in humans

The forced oscillation technique is a widely-used non-invasive method of characterizing the dynamic behaviour of the respiratory system. We used the forced oscillation technique to investigate respiratory mechanics in healthy subjects during simulated dives in dry hyperbaric chambers. We observed frequency dependence of input impedance, which was mainly density-dependent. To explain this result, we propose a model of the respiratory system, based on flow redistribution in a two-pathway circuit. This model, using the electrical analogue, is composed of two Resistance-Self Inductance-Capacitance (R-I-C) pathways set up in parallel. It allowed us to explain the dynamic behaviour of respiratory impedance under hyperbaric conditions in healthy subjects. Changes in respiratory impedance according to frequency vary with the relative importance of the inequalities of the two time constants RC and I/R between the two pathways. With low values of density, RC inequality predominates, whereas I/R inequality tends to predominate with high values of density.

Visually discernible myocardial echocardiographic contrast after intravenous injection of sonicated dextrose albumin microbubbles containing high molecular weight, less soluble gases

OBJECTIVES

The central hypothesis of this study was that microbubble survival, and subsequent left ventricular and myocardial ultrasound contrast, could be improved by altering microbubble gas to consist of a higher molecular weight (less diffusible) and less soluble gas.

BACKGROUND

Microbubble survival after intravenous injection is shortened because of rapid diffusion of blood-soluble room air gases (nitrogen and oxygen) across the permeable bubble membrane into blood.

METHODS

Thirteen open chest dogs received intravenous injections of a constant dose of sonicated dextrose albumin that was incubated with either room air or 100% nitrogen, 100% helium or 100% sulfur hexafluoride. Nitrogen (100%) is less blood soluble than room air, whereas helium and sulfur hexafluoride are the least soluble. Sulfur hexafluoride has the slowest diffusion rate. To further decrease the diffusion rate, each sample was administered during inhalation of room air and again during brief inhalation of the same gas with which it had been incubated.

RESULTS

The highest peak videointensity in the left ventricular cavity was produced by the sonicated dextrose albumin incubated with sulfur hexafluoride, the gas having lowest blood solubility and diffusion rate, while sulfur hexafluoride was briefly inhaled during the period of intravenous injection (peak videointensity 139 +/- 10 vs. 54 +/- 11 for room air-exposed sonicated dextrose albumin, p < 0.001). Myocardial contrast was visually evident in > 80% of the intravenous injections of sulfur hexafluoride-exposed sonicated dextrose albumin when the agent was given as an 8-fold concentrated sample during brief inhalation of sulfur hexafluoride.

CONCLUSIONS

Visual myocardial echocardiographic contrast is possible after intravenous injection of sonicated dextrose albumin if the microbubbles contain a gas with low blood solubility and diffusivity.