Measurement of pulmonary mechanics in the newborn lamb: a comparison of three techniques

Although recent interest in neonatal respiratory mechanics has led to the development of a plethora of techniques for measuring lung compliance and resistance, a critical appraisal of the limitations of these techniques in the newborn has not been performed to date. We evaluated three techniques of measuring respiratory mechanics in the newborn lamb, with the reference method (method 1) being the Mead-Whittenberger technique using flow, volume, and esophageal pressure (Pes) by water-filled catheter, and the other two methods entailing the measurement of mouth pressure (Pm) during airway occlusion (method 2 using end-expiratory occlusion; method 3 using end-inspiratory occlusion). Each technique was evaluated during eupnea and tachypnea in intubated and nonintubated newborn lambs. We found that the use of Pes for the measurement of resistance and compliance gave the most reliable results during both eupnea and tachypnea in both the intubated and nonintubated subjects. The airway occlusion techniques that use Pm to derive resistance and compliance (methods 2 and 3) gave more variable results under all conditions of testing. Method 2 was the least precise method of measurement with a variability of greater than 30% compared with a variation of less than 20% for method 1. For all three methods, it was found that the number of breaths needed for reproducible measurements of mechanics was four to six during eupnea and seven to nine during tachypnea.     

Drug class effects on respiratory mechanics in animal models: access and applications

Assessment of respiratory mechanics extends from basic research and animal modeling to clinical applications in humans. However, to employ the applications in human models, it is desirable and sometimes mandatory to study non-human animals first. To acquire further precise and controlled signals and parameters, the animals studied must be further distant from their spontaneous ventilation. The majority of respiratory mechanics studies use positive pressure ventilation to model the respiratory system. In this scenario, a few drug categories become relevant: anesthetics, muscle blockers, bronchoconstrictors, and bronchodilators. Hence, the main objective of this study is to briefly review and discuss each drug category, and the impact of a drug on the assessment of respiratory mechanics. Before and during the positive pressure ventilation, the experimental animal must be appropriately sedated and anesthetized. The sedation will lower the pain and distress of the studied animal and the plane of anesthesia will prevent the pain. With those drugs, a more controlled procedure is carried out; further, because many anesthetics depress the respiratory system activity, a minimum interference of the animal’s respiration efforts are achieved. The latter phenomenon is related to muscle blockers, which aim to minimize respiratory artifacts that may interfere with forced oscillation techniques. Generally, the respiratory mechanics are studied under appropriate anesthesia and muscle blockage. The application of bronchoconstrictors is prevalent in respiratory mechanics studies. To verify the differences among studied groups, it is often necessary to challenge the respiratory system, for example, by pharmacologically inducing bronchoconstriction. However, the selected bronchoconstrictor, doses, and administration can affect the evaluation of respiratory mechanics. Although not prevalent, studies have applied bronchodilators to return (airway resistance) to the basal state after bronchoconstriction. The drug categories can influence the mathematical modeling of the respiratory system, systemic conditions, and respiratory mechanics outcomes.     

The transient relationship between pressure and volume in the pediatric pulmonary system

An accurate understanding of the relationship between pulmonary pressure and volume is required for modeling pulmonary mechanics in a variety of clinical applications. In this study the experimental techniques and mathematical formulations used to characterize viscoelastic materials are applied to characterize transient pulmonary compliance in juvenile swine. Fixed volumes of air were insufflated into 5 swine and held constant for 45 s while the transient decay in tracheal pressure was measured. An analytical model was developed using an optimization scheme that maximized the model fit to the experimental data over the entire time convolution. The initial injected volume was varied to assess the spatial and temporal linearity of the behavior. Model performance was assessed by comparing measured and predicted pressure during insufflations of erratic volume waveforms. It is concluded that the pulmonary impedance of healthy juveniles can be adequately described over a wide volume and frequency range using a relatively simple 5-parameter model that is linear both spatially and temporally.     

Model analysis of respiratory responses to inspiratory resistive loads

Based on experimental inspiratory driving pressure waveforms and active respiratory impedance data of anesthetized cats, we made model predictions of the factors that determine the immediate (first loaded breath) intrinsic (i.e., nonneural) tidal volume compensation to added inspiratory resistive loads. The time course of driving pressure (P) was given by P = atb, where a is the pressure at 1 s from onset of inspiration and represents the intensity of neuromuscular drive, t is time, and b is a dimensionless index of the shape of the driving pressure wave. For a given value of active respiratory impedance, tidal volume compensation to added resistive loads increases with increasing inspiratory duration and decreasing value of b but is independent of a. Model predictions of load compensation are compared to experimental results.     

Estimation of respiratory impedance and source pressure using a Thévenin equivalent circuit model

The objective of this paper is to present a new technique which can provide both active respiration source pressure and lung impedance in a single noninvasive test. The method is based upon a Thévenin equivalent circuit model of respiratory mechanics. Using this model, the equivalent source pressure and source impedance can be computed from the measured changes of respiratory pressures and flows in two consecutive cycles before and after addition of purely resistive loads to the mouth. In maximal breathing the source parameters were reproducible in six normal human subjects. The total respiratory resistance during maximal breathing had an average value of 3.46 cmH2O l-1 s-1, and the total dynamic compliance had an average value of 0.078 l cmH2O-1. The airway resistances measured using a plethysmographic method were within the range of 45-65% of the estimated total respiratory resistances. These two resistances were related with a correlation coefficient of 0.98. An average value of the magnitudes of the fundamental components of the source pressure was 6.73 cmH2O during maximal breathing and 2.09 cmH2O during spontaneous breathing.     

Liquid-filled esophageal catheter for measuring pleural pressure in preterm neonates

The precise measurement of esophageal pressure (Pes) as a reflection of pleural pressure (Ppl) is crucial to the measurement of lung mechanics in the newborn. The fidelity of Pes as a measurement of Ppl is determined by the occlusion test in which, during respiratory efforts against an occlusion at the airway opening, changes in pressure (delta Pao) (Pao is assumed to be equal to alveolar pressure) are shown to be equal to changes in Pes (delta Pes). Eight intubated premature infants (640-3,700 g) with chest wall distortion were studied using a water-filled catheter system to measure Pes. During the occlusion test, all patients had a finite region of the esophagus where delta Pes equaled delta Pao, which corresponded to points in the esophagus above the cardia but below the carina. In conclusion, even in the presence of chest wall distortion, a liquid-filled catheter with the tip between the cardia and carina can provide an accurate measurement of Ppl, even in the very small premature infant with chest wall distortion.     

IL-6 increases airway resistance in the rat

The end-inspiratory occlusion method was applied in anesthetized, paralyzed, positive pressure-ventilated rats to assess the possible effects of interleukin IL-6 on respiratory mechanics in normal rats. Measurements were made in control rats and in experimental animals before and after IL-6 intraperitoneal administration (15 ng/100 g), including static respiratory system elastance, the resistance to airflow and to the movement of respiratory system tissues, and the resistance due to lung stress–relaxation and mechanical inhomogeneity. Respiratory system hysteresis was also measured, and total mechanical breathing work rate and its elastic and resistive components calculated.Control rats did not exhibit alteration in respiratory mechanics during the observation period (30 min), while the experimental animals showed an increase in resistive pressure dissipations starting 15 min after IL-6 administration. Dose-dependent effects were also investigated.In a rather delayed effect, IL-6 increased the resistance to airflow and to the movement of respiratory system tissues, the resistance due to lung stress–relaxation and mechanical inhomogeneity, and the related resistive mechanical breathing work rate, and left the elastic pressure dissipation unaltered. The mechanisms by which IL-6 may contribute to the airways resistance increase which is seen in different respiratory diseases are likewise discussed.     

EPG waveform characteristics of solenopsis mealybug stylet penetration on cotton

The solenopsis mealybug, Phenacoccus solenopsis Tinsley (Hemiptera: Pseudococcidae), is a polyphagous insect known to cause severe damage to cotton (especially transgenic varieties) in South Asia, and currently poses a serious threat in Asia and potentially elsewhere. Stylet penetration behavior of P. solenopsis on cotton was monitored using the electrical penetration graph (EPG) technique (DC system) and the EPG characteristics were compared with those previously published from Phenacoccus manihoti Matile‐Ferrero and Planococcus citri (Risso). We identified and further characterized typical waveforms of A, B, C, and pd (together pathway), E1 and E2 (phloem), F (derailed stylet mechanics), and G (xylem). Five novel EPG aspects were distinguished in the EPG waveforms from P. solenopsis: (1) obvious B waveforms occurred following waveform A, (2) during waveform C, some aphid‐like E1e waveforms were observed, (3) prolonged potential drops (pd) up to >1 h occurred with two continuously alternating sub‐phases pd1 and pd2, (4) the pd1 waveform always occurred as the first waveform related to phloem sieve elements, preceding the other phloem waveforms (E), the labeling of which we changed to achieve a better comparison to the aphid E waveforms, and (5) waveform F, related to derailed stylet mechanics occurred but was not reported from other mealybugs so far. This is mainly a waveform morphology study to extend existing knowledge on mealybug EPGs to investigate mealybug‐host plant interactions. Further experimental verification of waveform correlations with plant tissue positions of stylet tips and insect activities is still needed.     

An ultrasound imaging method for in vivo tracheal bulk and Young's moduli of elasticity

Alterations in neonatal airway mechanical properties resulting from ventilatory therapies such as mechanical ventilation have been implicated in airway collapse and chronic disease. Advances in ultrasound (US) technology allow for real-time imaging and accurate measurement of tracheal dimensions in vivo; thus, changes in mechanical properties can be tracked longitudinally. In this report we introduce an adaptation of engineering concepts using US imaging data to study airway mechanics in vivo. In this protocol, tracheal segments are isolated in a spontaneously breathing newborn lamb model and the segments are exposed to time-cycled, pressure-limited mechanical ventilation. Serially, tracheal segments are filled with saline and pressure-volume relationships are recorded with stepwise volume infusions. US dimensional measurements of the segments are made while static (no distending pressure) and at pressure limits during dynamic ventilator cycling. US measurements are used to normalize pressure-volume data for resting volume, calculation of bulk modulus, stress-strain relationships and the adapted Young's modulus associated with tangential wall stress. Temporal changes in bulk and Young's moduli demonstrate the time dependence of alterations in conducting airway mechanical properties in vivo during the course of mechanical ventilation. This methodology will provide a means to evaluate respiratory therapies with respect to airway mechanics.     

Probabilistic finite element prediction of knee wear simulator mechanics

Computational models have recently been developed to replicate experimental conditions present in the Stanmore knee wear simulator. These finite element (FE) models, which provide a virtual platform to evaluate total knee replacement (TKR) mechanics, were validated through comparisons with experimental data for a specific implant. As with any experiment, a small amount of variability is inherently present in component alignment, loading, and environmental conditions, but this variability has not been previously incorporated in the computational models. The objectives of the current research were to assess the impact of experimental variability on predicted TKR mechanics by determining the potential envelope of joint kinematics and contact mechanics present during wear simulator loading, and to evaluate the sensitivity of the joint mechanics to the experimental parameters. In this study, 8 component alignment and 4 experimental parameters were represented as distributions and used with probabilistic methods to assess the response of the system, including interaction effects. The probabilistic FE model evaluated two levels of parameter variability (with standard deviations of component alignment parameters up to 0.5mm and 1 degrees ) and predicted a variability of up to 226% (3.44mm) in resulting anterior-posterior (AP) translation, up to 169% (4.30 degrees ) in internal-external (IE) rotation, but less than 10% (1.66MPa) in peak contact pressure. The critical alignment parameters were the tilt of the tibial insert and the IE rotational alignment of the femoral component. The observed variability in kinematics and, to a lesser extent, contact pressure, has the potential to impact wear observed experimentally.     

Pulse wave propagation in a model human arterial network: assessment of 1-D numerical simulations against in vitro measurements

A numerical model based on the nonlinear, one-dimensional (1-D) equations of pressure and flow wave propagation in conduit arteries is tested against a well-defined experimental 1:1 replica of the human arterial tree. The tree consists of 37 silicone branches representing the largest central systemic arteries in the human, including the aorta, carotid arteries and arteries that perfuse the upper and lower limbs and the main abdominal organs. The set-up is mounted horizontally and connected to a pulsatile pump delivering a periodic output similar to the aortic flow. Terminal branches end in simple resistance models, consisting of stiff capillary tubes leading to an overflow reservoir that reflects a constant venous pressure. The parameters required by the numerical algorithm are directly measured in the in vitro set-up and no data fitting is involved. Comparison of experimental and numerical pressure and flow waveforms shows the ability of the 1-D time-domain formulation to capture the main features of pulse wave propagation measured throughout the system test. As a consequence of the simple resistive boundary conditions used to reduce the uncertainty of the parameters involved in the simulation, the experimental set-up generates waveforms at terminal branches with additional non-physiological oscillations. The frequencies of these oscillations are well captured by the 1-D model, even though amplitudes are overestimated. Adding energy losses in bifurcations and including fluid inertia and compliance to the purely resistive terminal models does not reduce the underdamped effect, suggesting that wall visco-elasticity might play an important role in the experimental results. Nevertheless, average relative root-mean-square errors between simulations and experimental waveforms are smaller than 4% for pressure and 19% for the flow at all 70 locations studied.     

Breathing patterns in anesthetized cats and the concept of minimum respiratory effort

Theoretical studies dealing with the principle of minimal respiratory effort usually make use of sinusoidal or saw-tooth-like breathing patterns. Recent observations in anesthetized cats have shown that the driving pressure waveform for inspiration can be described by a power function of time and that most of expiration is passive. This driving pressure waveform, however, results in breathing patterns that differ from those described above. For this reason, we have reevaluated in anesthetized cats the principle of minimal respiratory effort by computing optimal duration of inspiration (TI) and optimal tidal volume (VT) for different ventilatory conditions using actual driving pressure waveforms. The results are in qualitative agreement with the experimental observations; i.e., optimal TI decreases and optimal VT increases with increasing minute ventilation. On the average, a good agreement is found between measured and computed values of TI. In some cats, however, there are substantial differences between observed and predicted values of TI, which can probably be ascribed to inaccuracies in the data used in our computations. Despite its limitations, the present model analysis is more realistic than previous ones because actual driving pressure waveforms are used together with actual values of effective inspiratory impedance.     

A nonlinear viscoelastic model of lung tissue mechanics.

There have been a number of attempts recently to use linear models to describe the low-frequency (0-2 Hz) dependence of lung tissue resistance (Rti) and elastance (Eti). Only a few attempts, however, have been made to account for the volume dependence of these quantities, all of which require the tissues to be plastoelastic. In this paper we specifically avoid invoking plastoelasticity and develop a nonlinear viscoelastic model that is also capable of accounting for the nonlinear and frequency-dependent features of lung tissue mechanics. The model parameters were identified by fitting the model to data obtained in a previous study from dogs during sinusoidal ventilation. The model was then used to simulate pressure and flow data by use of various types of ventilation patterns similar to those that have been employed experimentally. Rti and Eti were estimated from the simulated data by use of four different estimation techniques commonly applied in respiratory mechanics studies. We found that the estimated volume dependence of Rti and Eti is sensitive to both the ventilation pattern and the estimation technique, being in error by as much as 217 and 22%, respectively.     

A review of the effects of some endocrinological factors on respiratory mechanics

Context: Endocrinological factors have been recently described to affect respiratory mechanics.

Objective: To review recent literature data, most of all obtained by the end-inflation occlusion method, describing the effects of molecules of endocrinological interest such as endothelin, erythropoietin and renin-angiotensin, on respiratory mechanics parameters.

Methods: The papers considered in this review were found by inserting in Pubmed/Medline the following indexing terms: hormones, endothelin, erythropoietin, angiotensin and respiratory mechanics.

Results: It was found that the above cited molecules, beside their well known physiological main effects, exhibit influences on respiratory mechanics, most of all on the airflow resistance, which was described to be increased by endothelin and angiotensin, and decreased by erythropoietin.

Conclusions: A number of molecules of biological interest exhibit unexpected influences on respiratory mechanics. The clinical effects depend on the consequences of modified inspiratory pressure values the respiratory muscles have to perform for a given breathing pattern.     

Pulmonary mechanics during the ventilatory response to hypoxemia in the newborn monkey

Dynamic lung compliance (CL), inspiratory pulmonary resistance (RL), and functional residual capacity (FRC) were measured in 10 unanesthetized 48 h-old newborn monkeys and seven 21-day-old infant monkeys during acute exposures to an equivalent level of hypoxemia. End-expiratory airway occlusions were performed and the pressure developed by 200 ms (P0.2) was utilized as an index of central respiratory drive. P0.2 demonstrated a sustained increase throughout the period of hypoxemia on day 2 despite the fact that minute ventilation (VI) initially increased but then fell back to base-line levels. Dynamic lung compliance fell and FRC increased by 5 min of hypoxemia in the newborns. The 21-day-old monkeys exhibited a sustained increase in both VI and P0.2 throughout the hypoxic period with no change in CL and FRC. RL did not change at either postnatal age during hypoxemia. These data indicate that the neonatal monkey is subject to changes in pulmonary mechanics (decreased CL and increased FRC) during hypoxemia and that these changes are eliminated with maturation.     

A two-component simulation model to teach respiratory mechanics

Interactive learning has been proven instrumental for the understanding of complex systems where the interaction of interdependent components is hard to envision. Due to the mechanical properties and mutual coupling of the lung and thorax, respiratory mechanics represent such a complex system, yet their understanding is essential for the diagnosis, prognosis, and treatment of various respiratory disorders. Here, we present a new mechanical model that allows for the simulation of respiratory pressure and volume changes in different ventilation modes. A bellow reflecting the "lung" is positioned within the inverted glass cylinder of a bell spirometer, which is sealed by a water lock and reflects the "thorax." A counterweight attached to springs representing the elastic properties of the chest wall lifts the glass cylinder, thus creating negative "pleural" pressure inside the cylinder and inflating the bellow. Lung volume changes as well as pleural and intrapulmonary pressures are monitored during simulations of spontaneous ventilation, forced expiration, and mechanical ventilation, allowing for construction of respiratory pressure-volume curves. The mechanical model allows for simulation of respiratory pressure changes during different ventilation modes. Individual relaxation curves constructed for the lung and thorax reflect the basic physiological characteristics of the respiratory system. In self-assessment, 232 medical students passing the physiology laboratory course rated that interactive teaching at the simulation model increased their understanding of respiratory mechanics by 70% despite extensive prior didactic teaching. Hence, the newly developed simulation model fosters students' comprehension of complex mechanical interactions and may advance the understanding of respiratory physiology.     

Effects of vagotomy on respiratory mechanics in newborn and adult pigs

We have examined breathing patterns and respiratory mechanics in anesthetized tracheostomized newborn piglets and adult pigs and the changes determined by cervical bilateral vagotomy. Piglets had a respiratory system compliance and resistance, on a per kilogram basis, respectively, higher and smaller than the adults. After vagotomy neither variable changed in the newborn, but resistance dropped in the adult. This may suggest that efferent vagal control of bronchomotor tone is more pronounced in the adult. Respiratory system time constant was longer in newborns both before and after vagotomy. The distortion of the chest wall, examined as the ratio between the volume inhaled spontaneously and the passive volume for the same abdominal motion, was more marked in newborns, reflecting their higher chest wall compliance. The work per minute, computed from the pressure and volume changes, was larger in piglets. After vagotomy the external work per minute was not different; however, the larger tidal volumes were accompanied by a larger chest distortion. This may indicate that vagal control of the breathing pattern, by limiting the depth of inspiration and hence the amount of chest distortion, has implications on the energetics of breathing.     

Postnatal development of the Hering-Breuer reflex in the rat

The intensity of the Breuer-Hering inflation reflex was studied in newborn (1 day old), in young (8 days old) and in adult rats (90 days old) under urethane general anaesthesia (1.3 g/kg i.p.). The inflation pressure was adjusted with the aid of a water-valve. The reflex was present in all 3 age groups. An inflation pressure of 0.2 kPa applied in the course of expiration produced a long lasting apnoea in newborn rats which lasted 48 normal respiratory cycles. An inflation pressure of 0.5 kPa in young rats induced an apnoea lasting for only 3 normal respiratory cycles, whereas a pressure of 1 kPa in adult rats led to an apnoea which lasted for 20 normal respiratory cycles. The compliance of the respiratory system in relation to lung weight is approximately 5 times higher in adult rats compared with that of newborn rats. It is approximately double in comparison with young rats. The pressures of inflation mentioned in the 3 age categories can be considered as equieffective from the point of stimulation pulmonary stretch receptors. It can be concluded from these findings that the reflex of Breuer-Hering in newborn rats is more potent in comparison with adult rats, but it is lower in young rats at the age of 8 days. It is suggested that the differences observed are due to functional and anatomical maturation.     

Optimal control aspects of left ventricular ejection dynamics

A model of the ejecting left ventricle is developed in which ventricular elastance as a function of time is optimized with respect to a simple performance index selected on an energetic basis. The model correctly predicts a number of well known experimental findings concerning the effects of preload and afterload conditions and varying system parameters on left ventricular pressure and elastance waveforms and on the ejection period. The results characterize ventricular systolic elastance as dependent on both end-diastolic volume and mean aortic pressure.