Noninvasive measures of lung structure and ventilation heterogeneity

Airway function at different lung depths can be determined non-invasively via ventilation distribution tests, by measuring either gases or aerosols at the mouth. After having a subject inhale a well-characterized amount of gas or aerosol in a well-controlled breathing maneuver, the expired gas or aerosol trace can be analyzed to represent critical structural and functional features of the lung. One such feature is the asymmetry of the lung, both in terms of its ramification pattern and expansion characteristics, in the conductive and acinar lung zone. We discuss how these features will affect gas and aerosol behavior in specific ways, based on conceptual models and quantitative simulations where possible. This should help interpret non-invasive tests of ventilation distribution and recognize their pitfalls.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Decreased Surface Tension of Upper Airway Mucosal Lining Liquid Increases Upper Airway Patency in Anaesthetised Rabbits

The obstructive sleep apnoea syndrome (OSA) is a disorder characterised by repetitive closure and re-opening of the upper airway during sleep. Upper airway luminal patency is influenced by a number of factors including: intraluminal air pressure, upper airway dilator muscle activity, surrounding extraluminal tissue pressure, and also surface forces which can potentially act within the liquid layer lining the upper airway. The aim of the present study was to examine the role of upper airway mucosal lining liquid (UAL) surface tension (γ) in the control of upper airway patency. Upper airway opening (PO) and closing pressures (PC) were measured in 25 adult male, supine, tracheostomised, mechanically ventilated, anaesthetised (sodium pentabarbitone), New Zealand White rabbits before (control) and after instillation of 0.5 ml of either 0.9 % saline (n= 9) or an exogenous surfactant (n= 16; Exosurf Neonatal) into the pharyngeal airway. The γ of UAL (0.2 μl) was quantified using the ‘pull-off’ force technique in which γ is measured as the force required to separate two curved silica discs bridged by the liquid sample. The γ of UAL decreased after instillation of surfactant from 54.1 ± 1.7 mN m−1 (control; mean ±s.e.m.) to 49.2 ± 2.1 mN m−1 (surfactant; P < 0.04). Compared with control, PO increased significantly (P < 0.04; paired t test, n= 9) from 6.2 ± 0.9 to 9.6 ± 1.2 cmH2O with saline, and decreased significantly (P < 0.05, n= 16) from 6.6 ± 0.4 to 5.5 ± 0.6 cmH2O with surfactant instillation. Findings tended to be similar for PC. Change in both PO and PC showed a strong positive correlation with the change in γ of UAL (both r > 0.70, P < 0.001). In conclusion, the patency of the upper airway in rabbits is partially influenced by the γ of UAL. These findings suggest a role for UAL surface properties in the pathophysiology of OSA