Acoustic estimation of the impact of a single dive using a closed-type breathing apparatus on the ventilatory function of the human lungs

Diving negatively affects the human respiratory system, especially if an oxygen breathing apparatus is used. The spirometry indices generally used to estimate the ventilatory function of the lung have a poor sensitivity to the toxic effect of hyperbaric hyperoxia. The goal of this study was to estimate the possibilities of using the forced expiratory (FE) tracheal noise duration. The study was done on 48 divers who had been tested before and after a single dive.     

Influence of changed gas media on acoustic parameters of human forced exhalation

In previous study it was shown that duration of tracheal forced expiratory noises is promising to reveal negative changes of lung function after dive. The objective is a study of parameters of tracheal forced expiratory noises in changed gas media. The first experiment involved 25 volunteers (22-60 years), performed forced exhalation under normal pressure with air, oxygen-helium and oxygen-krypton mixtures. The second experiment in the chamber involved 6 volunteers (25-46 years), which performed forced exhalation with air under normal pressure (0.1 MPa), and under elevated pressure 0.263 MPa with air and oxygen-helium mixture. In the first experiment the direct linear dependence on gas density was found for forced expiratory noises common duration in the band of 200-2000 Hz and for its durations in narrow 200-Hz bands, excluding high frequency range 1400-2000 Hz. In the second experiment a significant reversed dependence of high frequency durations and spectral energies in 200-Hz bands (1600-2000 Hz) on adiabatic gas compressibility. Individual dynamics of common duration of tracheal forced expiratory noises under model dive of 16.3 m (0.263 MPa) is more then the diagnostic threshold of this parameter for lung function decrease, previously obtained for divers under normal pressure.     

Influence of modified gas mixtures on the acoustic parameters of human forced exhalation

It was earlier demonstrated that the duration of tracheal noises of forced exhalation (FE) looks to be promising to determine adverse changes in the lung function after a dive. This study dealt with the parameters of tracheal expiratory noises (FE) as dependent of the composition of breathing gas mixtures. In the first type of experiments, 25 volunteers aged from 22 to 60 years carried out forced exhalation under a normal pressure of air or of an oxygen-helium or oxygen-krypton mixture. In the second type of experiments, six volunteers from 25 to 46 years of age performed forced exhalation with air in an altitude chamber under a normal pressure (0.1 MPa); the same subjects performed FE under an elevated pressure (0.263 MPa) while breathing air or an oxygen-helium mixture. In the first type of experiments, the total duration of tracheal FE noises in the frequency range 200?C2000 Hz and 200-Hz bands FE noises depended directly and linearly on the density of the gas mixture; this was not the case in the high-frequency band from 1400 to 2000 Hz. In the second type of experiments, the high-frequency durations and spectral energies of tracheal FE noises (1600?C2000 Hz) depended inversely and significantly on the adiabatic gas compressibility. In a simulated dive to a depth of 16.3 m (0.263 MPa), individual changes in the total duration of tracheal FE noises exceeded the diagnostic threshold of deterioration of the lung function in divers that was determined earlier under normal pressure.     

Dynamics of the duration of tracheal forced expiratory noises during long-term isolation in the Mars-500 experiment

The dynamics of the duration of tracheal forced expiratory noises in a group of volunteers were studied before, during, and after a 520-day confinement. The duration did not change in most volunteers. Two volunteers exhibited significant changes in the duration of tracheal sounds and some spirometric parameters. The increase in the duration of tracheal forced expiratory noises and the decrease in spirometric parameters reveal ventilation impairment of the obstructive type. Analysis of the duration of tracheal forced expiratory noise dynamics during prolonged confinement has proven to be a sensitive technique to test ventilation function changes.     

Acoustic and spirometry parameters of forced expiratory sounds during a five-day dry immersion

The dynamic studies of the parameters of forced expiration under the conditions of a five-day dry immersion involved seven healthy male subjects aged 20 to 25 years. During forced expiration, spirometry tests were performed simultaneously with tracheal sounds being recorded by a microphone. A number of parameters, including the acoustic duration of the forced-expiration tracheal sounds, the lungs’ forced vital capacity, the 1-s forced expiration volume, the peak expiratory flow, and time of achieving the peak expiratory flow, were recorded before dry immersion, on days 1 and 4 of immersion, and the next day after the termination of immersion. There was a significant decrease (by 8.4%) in the peak expiratory flow on day 1 of immersion; however, by day 4 of immersion, the peak expiratory flow increased by 8.9%, reaching its baseline values. The lungs’ forced vital capacity and the forced expiration volume during 1 second, on the average, did not change throughout the experiment. There was a significant increase (by 17%) in the duration of the forced expiration tracheal sounds after the immersion, which suggests an increase in respiratory resistance and needs further studies. A moderate negative correlation between the duration of the forced expiration tracheal sounds and Gensler’s index (r = ?0.63) was found, whereas the correlation with other spirometry parameters was weak or absent.     

Hyperoxia-induced changes in mouse lung mechanics: forced oscillations vs. barometric plethysmography.

Hyperoxia-induced lung damage was investigated via airway and respiratory tissue mechanics measurements with low-frequency forced oscillations (LFOT) and analysis of spontaneous breathing indexes by barometric whole body plethysmography (WBP). WBP was performed in the unrestrained awake mice kept in room air (n = 12) or in 100% oxygen for 24 (n = 9), 48 (n = 8), or 60 (n = 9) h, and the indexes, including enhanced pause (Penh) and peak inspiratory and expiratory flows, were determined. The mice were then anesthetized, paralyzed, and mechanically ventilated. Airway resistance, respiratory system resistance at breathing frequency, and tissue damping and elastance were identified from the LFOT impedance data by model fitting. The monotonous decrease in airway resistance during hyperoxia correlated best with the increasing peak expiratory flow. Respiratory system resistance and tissue damping and elastance were unchanged up to 48 h of exposure but were markedly elevated at 60 h, with associated decreases in peak inspiratory flow. Penh was increased at 24 h and sharply elevated at 60 h. These results indicate no adverse effect of hyperoxia on the airway mechanics in mice, whereas marked parenchymal damage develops by 60 h. The inconsistent relationships between LFOT parameters and WBP indexes suggest that the changes in the latter reflect alterations in the breathing pattern rather than in the mechanical properties. It is concluded that, in the presence of diffuse lung disease, Penh is inadequate for characterization of the mechanical status of the respiratory system.     

Effects of hyperoxia on biomarkers of oxidative stress in closed-circuit oxygen military divers

Oxygen toxicity is a problem in diving which can have fatal consequences in the water. When divers use closed-circuit oxygen rebreathing apparatus they are taking only oxygen 100% and this hyperoxic exposure increases the generation of reactive oxygen species (ROS) in biological tissues. The objective of the present study is to evaluate the effects of hyperoxia on biomarkers of oxidative stress in closed-circuit oxygen military divers. Fifteen professional divers of Spanish Navy Diving Center participated in a training program which consisted of one-hour immersion at seven metres of depth breathing oxygen 100% with closed-circuit oxygen rebreathing apparatus. The training went on two or three times per week for the first six weeks and once a week for the last six weeks. Serum total antioxidant status (TAS), levels of glutathione peroxidase (GPx), nitrates (NO₃ ^?) and urinary concentrations of 15-isoprostane F_2t were measured. The results show that TAS decreased significantly after 6 weeks (mean 1.38 versus 1.23 mmol/l), with a slight increase at the end (mean 1.31 mmol/l). GPx and F₂-isoprostanes were significantly lower after 6 and 12 weeks and NO₃ ^? was significantly lower after 6 weeks and remained unchanged until the end. In summary, professional divers who use closed-circuit apparatus and therefore breathe oxygen 100%, do not suffer an important oxidative hyperoxia-induced stress, probably due an adaptive process after hyperoxia. The age and good physical form of the subjects studied could probably enhance the adaptive process to hyperoxia.     

Serum erythropoietin levels in healthy humans after a short period of normobaric and hyperbaric oxygen breathing: the "normobaric oxygen paradox".

Renal (peritubular) tissue hypoxia is a well-known physiological trigger for erythropoietin (EPO) production. We investigated the effect of rebound relative hypoxia after hyperoxia obtained under normo- and hyperbaric oxygen breathing conditions. A group of 16 healthy volunteers were investigated before and after a period of breathing 100% normobaric oxygen for 2 h and a period of breathing 100% oxygen at 2.5 ATA for 90 min (hyperbaric oxygen). Serum EPO concentration was measured using a radioimmunoassay at various time points during 24-36 h. A 60% increase (P < 0.001) in serum EPO was observed 36 h after normobaric oxygen. In contrast, a 53% decrease in serum EPO was observed at 24 h after hyperbaric oxygen. Those changes were not related to the circadian rhythm of serum EPO of the subjects. These results indicate that a sudden and sustained decrease in tissue oxygen tension, even above hypoxia thresholds (e.g., after a period of normobaric oxygen breathing), may act as a trigger for EPO serum level. This EPO trigger, the "normobaric oxygen paradox," does not appear to be present after hyperbaric oxygen breathing.     

缩唇腹式呼吸联合呼吸操训练对慢性阻塞性肺疾病患者血气分析指标、肺功能和生活质量的影响

目的:探讨缩唇腹式呼吸联合呼吸操训练对慢性阻塞性肺疾病(COPD)患者血气分析指标、肺功能和生活质量的影响。方法:选取2020年1月-2021年4月期间就诊于我院的82例COPD患者,根据随机数字表法分为对照组(缩唇腹式呼吸训练,41例)和研究组(缩唇腹式呼吸结合呼吸操训练,41例),对比两组疗效、血气分析指标[动脉血二氧化碳分压(PaCO₂)、血氧分压(PaO₂)、血氧饱和度(SaO₂)]、肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV₁)、第1秒用力呼气容积所占FVC的比例(FEV₁/FVC)]、生活质量[圣乔治呼吸问卷(SGRQ)评分]、6分钟步行试验(6MWT)距离、BODE指数。结果:研究组的临床总有效率明显高于对照组(P<0.05)。研究组治疗3个月后PaO₂、SaO₂高于对照组,PaCO₂低于对照组(P<0.05)。研究组治疗3个月后FEV₁、FVC、FEV₁/FVC高于对照组(P<0.05)。研究组治疗3个月后6MWT距离长于对照组,SGRQ评分、BODE指数低于对照组(P<0.05)。结论:缩唇腹式呼吸联合呼吸操训练可改善COPD患者血气分析指标,提高肺功能和运动耐力,改善生活质量,疗效显著。     

Regression simulation of the dependence of forced expiratory tracheal noises duration on human respiratory system biomechanical parameters

BACKGROUND: Estimating the duration of forced exhalation tracheal noises shows promise for recognizing bronchial obstruction. OBJECTIVE: Experimental simulation of an influence of biomechanical parameters on the duration of normal forced exhalation tracheal noises. METHOD AND MATERIALS: Thirty-two healthy non-smoking men aged 16-22 years were examined. The duration of noises, the parameters of computer spirometry, and the maximum static expiratory pressure are recorded. These data were analyzed by means of multiple linear regression simulation for logarithms of the elements of the proportionality relation obtained with the use of a one-component biomechanical model of forced exhalation and a linearized approximation of flow-volume curve. RESULTS: Dependence between duration of the forced expiratory noises recorded on human trachea and the product of forced volume capacity (in power of 1.05 +/- 0.27), maximum static expiratory pressure (in power of 0.46 +/- 0.23), equivalent expiratory resistance in the stage of functional expiratory stenosis (in power of 0.72 +/- 0.15 in healthy is an estimate of the equivalent expiratory resistance of human bronchial tree in the functional expiratory stenosis phase, whereas in patients with bronchial obstruction it is supposed to take into account an excess of noise generation time compared with the time predicted from normal individual value of this resistance.     

Bench and mathematical modeling of the effects of breathing a helium/oxygen mixture on expiratory time constants in the presence of heterogeneous airway obstructions

ABSTRACT: BACKGROUND: Expiratory time constants are used to quantify emptying of the lung as a whole, and emptying of individual lung compartments. Breathing low-density helium/oxygen mixtures may modify regional time constants so as to redistribute ventilation, potentially reducing gas trapping and hyperinflation for patients with obstructive lung disease. In the present work, bench and mathematical models of the lung were used to study the influence of heterogeneous patterns of obstruction on compartmental and whole-lung time constants. METHODS: A two-compartment mechanical test lung was used with the resistance in one compartment held constant, and a series of increasing resistances placed in the opposite compartment. Measurements were made over a range of lung compliances during ventilation with air or with a 8/22% mixture of helium/oxygen. The resistance imposed by the breathing circuit was assessed for both gases. Experimental results were compared with predictions of a mathematical model applied to the test lung and breathing circuit. In addition, compartmental and whole-lung time constants were compared with those reported by the ventilator. RESULTS: Time constants were greater for larger minute ventilation, and were reduced by substituting helium/oxygen in place of air. Notably, where time constants were long due to high lung compliance (i.e. low elasticity), helium/oxygen improved expiratory flow even for a low level of resistance representative of healthy, adult airways. In such circumstances, the resistance imposed by the external breathing circuit was significant. Mathematical predictions were in agreement with experimental results. Time constants reported by the ventilator were wellcorrelated with those determined for the whole-lung and for the low-resistance compartment, but poorly correlated with time constants determined for the high-resistance compartment. CONCLUSIONS: It was concluded that breathing a low-density gas mixture, such as helium/oxygen, can improve expiratory flow from an obstructed lung compartment, but that such improvements will not necessarily affect time constants measured by the ventilator. Further research is required to determine if alternative measurements made at the ventilator level are predictive of regional changes in ventilation. It is anticipated that such efforts will be aided by continued development of mathematical models to include pertinent physiological and pathophysiological phenomena that are difficult to reproduce in mechanical test systems.     

The pattern of breathing and the ventilatory response to breathing through a tube and to physical exercise in sport divers

Well-trained divers can be expected to differ from healthy controls in their ventilatory response to breathing through a tube and to physical exercise. Therefore, we measured their minute ventilation (VE) at rest and during breathing through a tube combined with two levels of physical exercise (1 or 2 W.kg body weight-1). For breathing through a tube an additional dead space of 600 ml was used. All divers were trained in the breath-hold technique and in the use of the breathing apparatus. Their mean period of training as divers was 9 +/- 6 years. The approximate age of the subjects was 25 years. The pattern of breathing and the oxygen uptake were measured by spirometer, the end-tidal concentration of CO2 was measured and all experiments were carried out above sea level. The ventilation of the divers at rest was comparable to that of the controls. During physical exercise it was smaller whether during breathing through a tube or not. The inadequate increase of VE during exercise in divers was associated with hypercapnia only at a higher physical work intensity (of 2 W.kg-1). This finding is interpreted as a lower chemoregulatory response to the combined stimuli of hypercapnia, hypoxia and physical exercise. In some situations significant bradypnoea and higher tidal volumes were found in the divers.     

A test of the oxidative damage hypothesis for discontinuous gas exchange in the locust Locusta migratoria

The discontinuous gas exchange cycle (DGC) is a breathing pattern displayed by many insects, characterized by periodic breath-holding and intermittently low tracheal O(2) levels. It has been hypothesized that the adaptive value of DGCs is to reduce oxidative damage, with low tracheal O(2) partial pressures (PO(2) ≈ 2-5 kPa) occurring to reduce the production of oxygen free radicals. If this is so, insects displaying DGCs should continue to actively defend a low tracheal PO(2) even when breathing higher than atmospheric levels of oxygen (hyperoxia). This behaviour has been observed in moth pupae exposed to ambient PO(2) up to 50 kPa. To test this observation in adult insects, we implanted fibre-optic oxygen optodes within the tracheal systems of adult migratory locusts Locusta migratoria exposed to normoxia, hypoxia and hyperoxia. In normoxic and hypoxic atmospheres, the minimum tracheal PO(2) that occurred during DGCs varied between 3.4 and 1.2 kPa. In hyperoxia up to 40.5 kPa, the minimum tracheal PO(2) achieved during a DGC exceeded 30 kPa, increasing with ambient levels. These results are consistent with a respiratory control mechanism that functions to satisfy O(2) requirements by maintaining PO(2) above a critical level, not defend against high levels of O(2).     

Expiratory flow pattern and respiratory mechanics

During resting breathing, expiration is characterized by the narrowing of the vocal folds which, by increasing the expiratory resistance, raises mean lung volume and airway pressure. This is even more pronounced in the neonatal period, during which expirations with short complete airway closure are commonly occurring. We asked to which extent differences in expiratory flow pattern may modify the inspiratory impedance of the respiratory system. To this aim, newborn puppies, piglets, and adult rats were anesthetized, paralyzed, and ventilated with different expiratory patterns, (a) no expiratory load, (b) expiratory resistive load, and (c) end-inspiratory pause. The stroke volume of the ventilator and inspiratory and expiratory times were maintained constant, and the loads were adjusted in such a way that inflation always started from the resting volume of the respiratory system. After 1 min of each ventilatory pattern, mean inspiratory impedance and compliance of lung and respiratory system were measured. The values were unchanged or minimally altered by changing the type of ventilation. We conclude that the expiratory laryngeal loading is not primarily aimed to decrease the work of breathing. It is conceivable that the expiratory pattern is oriented to increase and control mean airway pressure in the regulation of pulmonary fluid reabsorption, distribution of ventilation, and diffusion of gases.     

Breathing hypoxic gas affects the physiology as well as the diving behaviour of tufted ducks

We measured the effects of exposure to hypoxia (15% and 11% oxygen) and hypercapnia (up to 4.5% carbon dioxide) on rates of respiratory gas exchange both between and during dives in tufted ducks, Aythya fuligula, to investigate to what extent these may explain changes in diving behaviour. As found in previous studies, the ducks decreased dive duration (t(d)) and increased surface duration when diving from a hypoxic or hypercapnic gas mix. In the hypercapnic conditions, oxygen consumption during the dive cycle was not affected. Oxygen uptake between dives was reduced by only 17% when breathing a hypoxic gas mix of 11% oxygen. However, estimates of the rate of oxygen metabolism during the foraging periods of dives decreased nearly threefold in 11% oxygen. Given that tufted ducks normally dive well within their aerobic dive limits and that they significantly reduced their t(d) during hypoxia, it is not at all clear why they make this physiological adjustment.     

Control of breathing at elevated lung volumes in anesthetized cats

We monitored the steady-state ventilatory responses of anesthetized cats to increases in lung volume produced by expiratory threshold loads (ETL) to study the roles of peripheral and central neural mechanisms in controlling respiration at elevated lung volumes. Application of an ETL of 5 cmH2O produced a significant decrease in respiratory frequency (-18%) but no change in minute ventilation (VE) due to a significant increase in tidal volume (VT) (19.3%). The drop in frequency was due solely to an increase in expiratory duration. ETL of 10 cmH2O significantly reduced VE (-17.5%) for the same reason. VT was maintained or increased at elevated lung volumes due to both an increase in the rate of rise of phrenic activity and a maintenance of inspiratory duration (TI) despite increases in both chemical drive and pulmonary stretch receptor (PSR) activity. No PSR adapted completely to the maintained change in lung volume. The sensitivity of the inspiratory off-switch mechanism to increases in lung volume, given by the reciprocal of the VT-TI relationship, decreased significantly during breathing on ETL. The results are consistent with the hypothesis that central habituation, not just peripheral adaptation of PSR, determines breathing pattern at elevated lung volumes.     

Effect of hyperoxia on phosphatidylcholine synthesis, secretion, uptake and stability in the newborn rabbit lung

The effects of breathing greater than 95% oxygen from birth for 48 h of life on surfactant phosphatidylcholine synthesis and secretion, as well as uptake and stability of exogenous phosphatidylcholine were studied using rabbit lung tissue slices. Lung slices from animals breathing greater than 95% oxygen for 48 h exhibited a decreased rate of [14C]phosphatidylcholine release (30%) in comparison to lung slices from air-exposed controls. In vitro incorporation of [14C]choline into phosphatidylcholine was decreased by a similar amount in lung slices from pups exposed to greater than 95% oxygen. Uptake of exogenous [14C]phosphatidylcholine by lung slices from hyperoxic-exposed and control groups was not different, and the stability of extracellular phosphatidylcholine was likewise unaffected by hyperoxia. Turnover of labelled phosphatidylcholine taken up by tissue slices from medium was apparently decreased in association with hyperoxic exposure. These results are consistent with multiple sites of effect of hyperoxia on the pulmonary surfactant system in the newborn. These effects of hyperoxia on the lung surfactant system occur at a time of critical adaption to extrauterine life, and thus may have major consequences on lung function and ultimate survival of the premature infant with respiratory distress syndrome.     

Effects of hyperoxia and allergic airway inflammation on cough reflex intensity in guinea pigs

Toxic influence of high oxygen concentration on pulmonary function and structures has been known for many years. However, the influence of high oxygen concentration breathing on defensive respiratory reflexes is still not clear. In our previous experiments, we found an inhibitory effect of 100 % oxygen breathing on cough reflex intensity in healthy guinea pigs. The present study was designed to detect the effects of hyperoxia on cough reflex in guinea pigs with allergic airway inflammation. In the first phase of our experiment, the animals were sensitized with ovalbumin. Thirty-two sensitized animals were used in two separate experiments according to oxygen concentration breathing: 100 % or 50 % oxygen for 60 h continuously. In each experiment, one group of animals was exposed to hyperoxia, another to ambient air. The cough reflex was induced both by aerosol of citric acid before sensitization, then in sensitized animals at 24 h and 60 h of exposition to oxygen/air in awake animals, and by mechanical stimulation of airway mucosa in anesthetized animals just after the end of the experiment. In contrast to 50 % oxygen, 100 % oxygen breathing leads to significant decrease in chemically induced cough in guinea pigs with allergic inflammation. No significant changes were present in cough induced by mechanical stimulation of airways.     

Influence of hyperbaric stress on metabolic reactions of the organism of divers, prevention

Research of metabolic rates is conducted in a blood of the subjects whose professional work is connected with the systematic implementation of diving on the large and medium depths. For restoration of working capacity and preservation of health of divers was carried pharmacological prophylaxis with supplementation "Kalifen", which is the total polyphenol complex isolated from viburnum (Viburnum sargentii Koehne). The blood plasma of divers, investigated after a dive, there was hypertriglyceridemia and hypercholesterolemia, the suppression of esterified liver function, an imbalance of fractional content of phospholipids, the strain of antioxidant defense of an organism and increased lipid peroxidation. Preventive administration supplementation "Kalifen" for 2 months before the dive will help remove metabolic disorders caused by hyperbaric factors, and also to store up of anabolic reserves and increase body resistance level in extreme conditions.     

Effect of normobaric hyperoxia on airways of normal subjects

Airway responsiveness to inhaled cholinergic agonist during the early stage of pulmonary O2 toxicity was examined to determine whether normobaric hyperoxia alters airway function. Eight healthy nonsmoking males with moderate base-line methacholine responsiveness breathed normobaric O2 (greater than or equal to 95%) over 12 h and on another occasion breathed air in an identical protocol. Vital capacity, expiratory flow, airway responsiveness to methacholine, and respiratory symptoms were measured at 0, 4, 8, and 12 h while subjects breathed O2 and 12 h afterwards. After 12 h, forced vital capacity was significantly decreased with O2 breathing but not with air breathing. At 4, 8, or 12 h of exposure and 12 h after exposure, there was no difference in methacholine sensitivity or reactivity between O2 and air-exposure trials. The earliest manifestations of pulmonary normobaric O2 toxicity in normal adults include diminished vital capacity and the onset of respiratory symptoms, but early O2 toxicity does not produce altered responsiveness to inhaled methacholine.