Ventilation by high-frequency chest wall compression in dogs with normal lungs

Effects of changes in lung volume on oscillatory flow rate during high-frequency chest wall oscillation

BACKGROUND

The effectiveness of high-frequency chest wall oscillation (HFCWO) in mucolysis and mucous clearance is thought to be dependant on oscillatory flow rate (Fosc). Therefore, increasing Fosc during HFCWO may have a clinical benefit.

OBJECTIVES

To examine effects of continuous positive airway pressure (CPAP) on Fosc at two oscillation frequencies in healthy subjects and patients with airway obstruction.

METHODS

Five healthy subjects and six patients with airway obstruction underwent 12 randomized trials of HFCWO (CPAP levels of 0 cm H2O, 2 cm H2O, 4 cm H2O, 6 cm H2O, 8 cm H2O and 10 cm H2O at frequencies of 10 Hz and 15 Hz) within a body plethysmograph, allowing measurements of changes in lung volume. Fosc was measured by reverse plethysmography using a 20 L isothermic chamber near the mouth. At the end of each randomized trial, an inspiratory capacity manoeuvre was used to determine end-expiratory lung volume (EELV).

RESULTS

EELV increased significantly (P<0.05) with each level of CPAP regardless of oscillation frequency. Fosc also significantly increased with CPAP (P<0.05) and it was correlated with EELV (r=0.7935, P<0.05) in obstructed patients but not in healthy subjects (r=0.125, P=0.343). There were no significant differences in perceived comfort across the levels of CPAP.

CONCLUSIONS

Significant increases in Fosc with CPAP-induced increases in lung volume were observed, suggesting that CPAP may be useful as a therapeutic adjunct in patients who have obstructive airway disease and who require HFCWO.

Regional alveolar pressure during periodic flow. Dual manifestations of gas inertia

We measured pressure excursions at the airway opening and at the alveoli (PA) as well as measured the regional distribution of PA during forced oscillations of six excised dog lungs while frequency (f[2-32 Hz]), tidal volume (VT [5-80 ml]), and mean transpulmonary pressure (PL [25, 10, and 6 cm H2O]) were varied. PA's were measured in four alveolar capsules glued to the pleura of different lobes. The apex-to-base ratio of PA's was used as an index of the distribution of dynamic lung distension. At low f, there was slight preferential distension of the lung base which was independent of VT, but at higher f, preferential distension of the lung apex was found when VT's were small, whereas preferential distension of the lung base was found when VT's approached or exceeded dead space. These VT-related changes in distribution at high frequencies seem to depend upon the branching geometry of the central airways and the relative importance of convective momentum flux vs. unsteady inertia of gas residing therein, which, in this study, we showed to be proportional to the ratio VT/VD*, where VD* is an index of dead space. Furthermore, they imply substantial alteration in the distribution of ventilation during high frequency ventilation as f, VT, and PL vary. The data also indicate that alveolar and airway opening pressure costs per unit flow delivered at the airway opening exhibit weakly nonlinear behavior and that resonant amplification of PA's, which has been described previously for the case of very small VT's, persists but is damped as VT's approach dead space values.