Respiratory inductive plethysmography: a comparative study between isovolume maneuver calibration and qualitative diagnostic calibration in healthy volunteers assessed in different positions

Objective: To compare two methods of respiratory inductive plethysmography (RIP) calibration in three different positions. Methods: We evaluated 28 healthy subjects (18 women and 10 men), with a mean age of 25.4 +/- 3.9 years. For all of the subjects, isovolume maneuver calibration (ISOCAL) and qualitative diagnostic calibration (QDC) were used in the orthostatic, sitting, and supine positions. In order to evaluate the concordance between the two calibration methods, we used ANOVA and Bland-Altman plots. Results: The values of the constant of proportionality (X) were significantly different between ISOCAL and QDC in the three positions evaluated: 1.6 +/- 0.5 vs. 2.0 +/- 1.2, in the supine position, 2.5 +/- 0.8 vs. 0.6 +/- 0.3 in the sitting position, and 2.0 +/- 0.8 vs. 0.6 +/- 0.3 in the orthostatic position (p < 0.05 for all). Conclusions: Our results suggest that QDC is an inaccurate method for the calibration of RIP. The K values obtained with ISOCAL reveal that RIP should be calibrated for each position evaluated

Comparison of physical properties of two exogenous surfactants: new parameter.

The pulmonary surfactant has essential physical properties for normal lung function. The most important property is the surface tension. In this work, it was evaluated the surface tension of two commercial exogenous surfactants used in surfactant replacement therapy, poractant alfa (Curosurf, Chiesi Farmaceuticals, Italy) and beractant (Survanta, Abbott Laboratories, USA) using new parameters. A Langmuir film balance (Minitrough, KSV Instruments, Finland) was used to measure surface tension of poractant alfa and beractant samples. For both samples, we prepared a solution of 1 mg/m dissolved in chloroform (100π`), which was applied over a subphase of milli-Q water (175 ml) in the chamber of the balance. The chamber has two moving barriers that can change its surface area between a maximal value of 112.5 cm 2 , and a minimal value of 22.5 cm 2, defining a balance cycle. Each surfactant had its surface tension evaluated during 20 balance cycles for three times. Four quantities were calculated from the experiment: Minimum Surface Tension (MTS), defined as the surface tension at minimal surface area during the first cycle; Mean Work Cycle (MWC), defined as the mean hysteresis area of the measured surface tension curve of the last 16 balance cycles; Critical Active Surface Area in Compression (CASAC) or in Expansion (CASAE), defined as the maximal chamber area where the surfactant is active on the surface in compression or expansion. The t-test was applied to verify for statistical significance of the results. Comproved with the MST is the same reported in literature, the differences between MWC, CASAC, and CASAE were statistically significant (p<0.001). The MWC, CASAC and CASAE were higher for poractant alfa than for beractant. A higher MWC for poractant alfa means higher elastic recoil of the lung in comparison with beractant. Using a different methodology, our results showed that poractant alfa is probably more effective in a surfactant replacement therapy than beractant due the use of poractant alfa in relation to the use of beractant in preterm infants with Respiratory Distress Syndrome (RDS).CNPqFAPES

An experimental rat model of ex vivo lung perfusion for the assessment of lungs after prostacyclin administration: inhaled versus parenteral routes

OBJETIVO: Apresentar um modelo experimental de administração de prostaglandina I2 (PGI2) por via inalatória vs. parenteral e avaliar o desempenho funcional dos pulmões em um sistema de perfusão pulmonar ex vivo. MÉTODOS: Quarenta ratos Wistar foram anestesiados, ventilados, submetidos a laparotomia com ressecção do esterno e anticoagulados. O tronco da artéria pulmonar foi canulado. Todos os animais foram submetidos a ventilação mecânica. Os animais foram randomizados em quatro grupos (10 ratos/grupo): salina nebulizada (SN); salina parenteral (SP); PGI2 nebulizada (PGI2N); e PGI2 parenteral (PGI2P). A dose de PGI2 nos grupos PGI2N e PGI2P foi de 20 e 10 µg/kg, respectivamente. Os blocos cardiopulmonares foram submetidos in situ a perfusão anterógrada com solução de baixo potássio e dextrana a 4ºC via artéria pulmonar, extraídos em bloco e armazenados a 4ºC por 6 h. Os blocos foram ventilados e perfundidos em um sistema ex vivo por 50 min, sendo obtidas medidas de mecânica ventilatória, hemodinâmica e trocas gasosas. RESULTADOS: Houve redução da pressão arterial pulmonar média após a nebulização em todos os grupos (p < 0,001), sem diferença entre os grupos. Na perfusão ex vivo, a mecânica ventilatória não diferiu entre os grupos. Houve redução da capacidade relativa de oxigenação ao longo da perfusão nos grupos SN e SP (p = 0,04), e houve aumento significativo da pressão arterial pulmonar no grupo SN. CONCLUSÕES: O modelo experimental de administração de PGI2 na extração pulmonar é exequível e confiável. Na reperfusão, os resultados de hemodinâmica e de trocas gasosas demonstraram tendência a um melhor desempenho com o uso de PGI2 do que com solução salina.OBJECTIVE:To present a model of prostaglandin I2 (PGI2) administration (inhaled vs. parenteral) and to assess the functional performance of the lungs in an ex vivo lung perfusion system. METHODS: Forty Wistar rats were anesthetized and placed on mechanical ventilation followed by median sterno-laparotomy and anticoagulation. The main pulmonary artery was cannulated. All animals were maintained on mechanical ventilation and were randomized into four groups (10 rats/group): inhaled saline (IS); parenteral saline (PS); inhaled PGI2 (IPGI2); and parenteral PGI2 (PPGI2). The dose of PGI2 used in the IPGI2 and PPGI2 groups was 20 and 10 µg/kg, respectively. The heart-lung blocks were submitted to antegrade perfusion with a low potassium and dextran solution via the pulmonary artery, followed by en bloc extraction and storage at 4ºC for 6 h. The heart-lung blocks were then ventilated and perfused in an ex vivo lung perfusion system for 50 min. Respiratory mechanics, hemodynamics, and gas exchange were assessed. RESULTS: Mean pulmonary artery pressure following nebulization decreased in all groups (p < 0.001), with no significant differences among the groups. During the ex vivo perfusion, respiratory mechanics did not differ among the groups, although relative oxygenation capacity decreased significantly in the IS and PS groups (p = 0.04), whereas mean pulmonary artery pressure increased significantly in the IS group. CONCLUSIONS: The experimental model of inhaled PGI2 administration during lung extraction is feasible and reliable. During reperfusion, hemodynamics and gas exchange trended toward better performance with the use of PGI2 than that with the use of saline.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

The effects of individually ventilated cages on the respiratory systems of male and female Wistar rats from birth until adulthood

OBJECTIVE: To evaluate the respiratory systems of male and female rats maintained in individually ventilated cages (IVCs) from birth until adulthood. METHODS: Female Wistar rats were housed in individually ventilated cages or conventional cages (CCs) and mated with male Wistar rats. After birth and weaning, the male offspring were separated from the females and kept in cages of the same type until 12 weeks of age. RESULTS: The level of food consumption was lower in male offspring (IVC=171.7±9; CC=193.1±20) than in female offspring (IVC=100.6±7; CC=123.4±0.4), whereas the water intake was higher in female offspring (IVC=149.8±11; CC=99.2±0) than in male offspring (IVC=302.5±25; CC=249.7±22) at 11 weeks of age when housed in IVCs. The cage temperature was higher in individually ventilated cages than in conventional cages for both male (IVCs=25.9±0.5; CCs=22.95±0.3) and female (IVCs=26.2±0.3; CCs=23.1±0.3) offspring. The respiratory resistance (IVC=68.8±2.8; CC=50.6±3.0) and elastance (IVC=42.0±3.9; CC=32.4±2.0) at 300 µm/kg were higher in the female offspring housed in ventilated cages. The ciliary beat values were lower in both the male (IVCs=13.4±0.2; CC=15±0.4) and female (IVC=13.5±0.4; CC=15.9±0.6) offspring housed in individually ventilated cages than in those housed in conventional cages. The total cell (IVC=117.5±9.7; CC=285.0±22.8), neutrophil (IVC=13.1±4.8; CC=75.6±4.1) and macrophage (IVC=95.2±11.8; CC=170.0±18.8) counts in the bronchoalveolar lavage fluid were lower in the female offspring housed in individually ventilated cages than in those housed in conventional cages. CONCLUSIONS: The environmental conditions that exist in individually ventilated cages should be considered when interpreting the results of studies involving laboratory animals. In this study, we observed gender dimorphism in both the water consumption and respiratory mechanics of rats kept in ventilated cages

Assessment of transducers to human metabolic analysis.

A calorimetria indireta para análise do metabolismo humano tem se mostrado um método não invasivo de crescente importância no estudo mais preciso das respostas metabólicas e cardio-respiratórias. Entretanto, o alto custo dos equipamentos aliado à falta de conhecimento das técnicas tem impedido a disseminação do uso de analisadores metabólicos no Brasil. Este trabalho foi desenvolvido com o intuito de oferecer uma visão global dos procedimentos de calorimetria indireta aplicados à avaliação do metabolismo humano sob a abordagem de Engenharia Biomédica. Foram avaliados três transdutores tipicamente utilizados em equipamentos de calorimetria indireta para análise metabólica humana: um transdutor eletroquímico de oxigênio, um transdutor de dióxido de carbono por radiação infravermelha e um transdutor de fluxo em volume tipo turbina. O transdutor de oxigênio mostrou-se bastante confiável, mas com um tempo de resposta bastante elevado para aplicações em análises de respiração a respiração. A principal deficiência do transdutor de dióxido de carbono está no fato de sua configuração proporcionar um aumento significativo na resistência à respiração do indivíduo. Verificou-se que o transdutor de fluxo em volume apresenta um melhor comportamento para um fluxo em torno de 20 litros/minuto. Apesar das limitações apresentadas pelos transdutores, os resultados dos ensaios foram úteis e representativos para a compreensão do funcionamento de um analisador metabólico humano porcalorimetria indireta, evidenciando quais deficiências devem ser sanadas em pesquisas futuras e os cuidados a serem considerados na implantação do laboratório para análise metabólica/respiratória sendo instalado no Laboratório de Engenharia Biomédica da Escola Politécnica da Universidade de São Paulo.The indirect calorimetry for analysis of the human metabolism has been a no invasive method of increasing importance in the study of metabolic and cardiorespiratory responses. However, the high cost of the equipment ally to the lack of knowledge of the techniques have been obstacles to the use of metabolic analysers in Brazil. This research was developed with the intention to offer a global vision of the applied procedures of indirect calorimetry to the evaluation of the human metabolism under the prism of the Biomedical Engineering. Three transducers typically used in equipment of indirect calorimetry for metabolic analysis had been evaluated: an electrochemical transducer of oxygen, a carbon dioxide transducer by infrared absorption and a turbine flowmeter. The oxygen transducer revealed sufficiently trustworthy, but a too high response time for applications in breath by breath analyses. The main deficiency of the transducer of carbon dioxide is to provide a significant increase in the flow resistance. It was verified that the flowmeter presents one better behavior for a stream around 20 litres/minute. Despite the limitations presented for the transducers, the results of the assays had been useful and representative for the understanding of the functioning of a human metabolic analyser for indirect calorimetry, evidencing which points have to be improved in future researches and to be considered in the implantation of the laboratory for metabolic and respiratory analysis being installed in the Laboratório de Engenharia Biomédica da Escola Politécnica da Universidade de São Paulo

Assessment of transducers to human metabolic analysis.

A calorimetria indireta para análise do metabolismo humano tem se mostrado um método não invasivo de crescente importância no estudo mais preciso das respostas metabólicas e cardio-respiratórias. Entretanto, o alto custo dos equipamentos aliado à falta de conhecimento das técnicas tem impedido a disseminação do uso de analisadores metabólicos no Brasil. Este trabalho foi desenvolvido com o intuito de oferecer uma visão global dos procedimentos de calorimetria indireta aplicados à avaliação do metabolismo humano sob a abordagem de Engenharia Biomédica. Foram avaliados três transdutores tipicamente utilizados em equipamentos de calorimetria indireta para análise metabólica humana: um transdutor eletroquímico de oxigênio, um transdutor de dióxido de carbono por radiação infravermelha e um transdutor de fluxo em volume tipo turbina. O transdutor de oxigênio mostrou-se bastante confiável, mas com um tempo de resposta bastante elevado para aplicações em análises de respiração a respiração. A principal deficiência do transdutor de dióxido de carbono está no fato de sua configuração proporcionar um aumento significativo na resistência à respiração do indivíduo. Verificou-se que o transdutor de fluxo em volume apresenta um melhor comportamento para um fluxo em torno de 20 litros/minuto. Apesar das limitações apresentadas pelos transdutores, os resultados dos ensaios foram úteis e representativos para a compreensão do funcionamento de um analisador metabólico humano porcalorimetria indireta, evidenciando quais deficiências devem ser sanadas em pesquisas futuras e os cuidados a serem considerados na implantação do laboratório para análise metabólica/respiratória sendo instalado no Laboratório de Engenharia Biomédica da Escola Politécnica da Universidade de São Paulo.The indirect calorimetry for analysis of the human metabolism has been a no invasive method of increasing importance in the study of metabolic and cardiorespiratory responses. However, the high cost of the equipment ally to the lack of knowledge of the techniques have been obstacles to the use of metabolic analysers in Brazil. This research was developed with the intention to offer a global vision of the applied procedures of indirect calorimetry to the evaluation of the human metabolism under the prism of the Biomedical Engineering. Three transducers typically used in equipment of indirect calorimetry for metabolic analysis had been evaluated: an electrochemical transducer of oxygen, a carbon dioxide transducer by infrared absorption and a turbine flowmeter. The oxygen transducer revealed sufficiently trustworthy, but a too high response time for applications in breath by breath analyses. The main deficiency of the transducer of carbon dioxide is to provide a significant increase in the flow resistance. It was verified that the flowmeter presents one better behavior for a stream around 20 litres/minute. Despite the limitations presented for the transducers, the results of the assays had been useful and representative for the understanding of the functioning of a human metabolic analyser for indirect calorimetry, evidencing which points have to be improved in future researches and to be considered in the implantation of the laboratory for metabolic and respiratory analysis being installed in the Laboratório de Engenharia Biomédica da Escola Politécnica da Universidade de São Paulo

Non-linear contributions and time domain approximation of the constant phase model in mice respiratory

A avaliação das propriedades mecânicas do sistema respiratório é tipicamente realizada oscilando-se um fluxo nos pulmões através da traquéia, medindo-se a pressão resultante gerada na traquéia e relacionando-se os dois sinais em termos de alguns modelos matemáticos. Se o sinal de fluxo de perturbação tem seu espectro em banda larga e não apresenta uma amplitude muito elevada, assume-se que o sistema respiratório está se comportando de forma linear e calcula-se sua impedância de entrada. Alternativamente, alguns pesquisadores tem utilizado sinais de fluxo que apresentam um espectro em banda estreita, mas com altos valores de amplitude, e aplicam modelos paramétricos não-lineares para quantificar as relações entre fluxo e pressão. Pouco tem sido feito, entretanto, para considerar dados relativos ao sistema respiratório quando a excitação é de banda larga e o sistema reflete não-linearidades. Nesta pesquisa, esta categoria de dados foi considerada realizando-se experimentos com camundongos. Para interpretar estes dados, desenvolveu-se uma aproximação no domínio do tempo de um modelo muito empregado para descrever a impedância respiratória de entrada. Este modelo foi então estendido para incluir termos de resistência e elastância não-lineares. Descobriu-se que o modelo com termo de elastância não-linear estima melhor os dados experimentais quando amplitudes altas são utilizadas, relativamente ao modelo linear e ao modelo com termo resistivo não-linear. Este modelo pode também ser útil para detecção de hiperinsuflação dos pulmões durante a ventilação mecânica.The assessment of the mechanical properties of the respiratory system is typically done by oscillating flow into the lungs via the trachea, measuring the resulting pressure generated at the trachea, and relating these two signals to each other in terms of some suitable mathematical model. If the perturbing flow signal is broadband and not too large in amplitude, linear behavior is usually assumed and the input impedance calculated. Alternatively, some researchers have used flow signals that are narrow band but large in amplitude, and invoked nonlinear lumped-parameter models to account for the relationship between flow and pressure. There has been little attempt, however, to deal with respiratory data that is both broadband and reflective of system nonlinearities. In the present study, it was collected such data from mice. To interpret these data, it was first developed a time-domain approximation to a widely used model of respiratory input impedance. It was then extended this model to include nonlinear resistive and elastic terms. It was found that the nonlinear elastic term fit the data better than the linear model or the nonlinear resistance model when amplitudes were large. This model may also be useful for detecting over inflation of the lung during mechanical ventilation

Non-linear contributions and time domain approximation of the constant phase model in mice respiratory

A avaliação das propriedades mecânicas do sistema respiratório é tipicamente realizada oscilando-se um fluxo nos pulmões através da traquéia, medindo-se a pressão resultante gerada na traquéia e relacionando-se os dois sinais em termos de alguns modelos matemáticos. Se o sinal de fluxo de perturbação tem seu espectro em banda larga e não apresenta uma amplitude muito elevada, assume-se que o sistema respiratório está se comportando de forma linear e calcula-se sua impedância de entrada. Alternativamente, alguns pesquisadores tem utilizado sinais de fluxo que apresentam um espectro em banda estreita, mas com altos valores de amplitude, e aplicam modelos paramétricos não-lineares para quantificar as relações entre fluxo e pressão. Pouco tem sido feito, entretanto, para considerar dados relativos ao sistema respiratório quando a excitação é de banda larga e o sistema reflete não-linearidades. Nesta pesquisa, esta categoria de dados foi considerada realizando-se experimentos com camundongos. Para interpretar estes dados, desenvolveu-se uma aproximação no domínio do tempo de um modelo muito empregado para descrever a impedância respiratória de entrada. Este modelo foi então estendido para incluir termos de resistência e elastância não-lineares. Descobriu-se que o modelo com termo de elastância não-linear estima melhor os dados experimentais quando amplitudes altas são utilizadas, relativamente ao modelo linear e ao modelo com termo resistivo não-linear. Este modelo pode também ser útil para detecção de hiperinsuflação dos pulmões durante a ventilação mecânica.The assessment of the mechanical properties of the respiratory system is typically done by oscillating flow into the lungs via the trachea, measuring the resulting pressure generated at the trachea, and relating these two signals to each other in terms of some suitable mathematical model. If the perturbing flow signal is broadband and not too large in amplitude, linear behavior is usually assumed and the input impedance calculated. Alternatively, some researchers have used flow signals that are narrow band but large in amplitude, and invoked nonlinear lumped-parameter models to account for the relationship between flow and pressure. There has been little attempt, however, to deal with respiratory data that is both broadband and reflective of system nonlinearities. In the present study, it was collected such data from mice. To interpret these data, it was first developed a time-domain approximation to a widely used model of respiratory input impedance. It was then extended this model to include nonlinear resistive and elastic terms. It was found that the nonlinear elastic term fit the data better than the linear model or the nonlinear resistance model when amplitudes were large. This model may also be useful for detecting over inflation of the lung during mechanical ventilation

Assessment of the mechanics of a tissue-engineered rat trachea in an image-processing environment

OBJECTIVES: Despite the recent success regarding the transplantation of tissue-engineered airways, the mechanical properties of these grafts are not well understood. Mechanical assessment of a tissue-engineered airway graft before implantation may be used in the future as a predictor of function. The aim of this preliminary work was to develop a noninvasive image-processing environment for the assessment of airway mechanics.METHOD: Decellularized, recellularized and normal tracheas (groups DECEL, RECEL, and CONTROL, respectively) immersed in Krebs-Henseleit solution were ventilated by a small-animal ventilator connected to a Fleisch pneumotachograph and two pressure transducers (differential and gauge). A camera connected to a stereomicroscope captured images of the pulsation of the trachea before instillation of saline solution and after instillation of Krebs-Henseleit solution, followed by instillation with Krebs-Henseleit with methacholine 0.1 M (protocols A, K and KMCh, respectively). The data were post-processed with computer software and statistical comparisons between groups and protocols were performed.RESULTS: There were statistically significant variations in the image measurements of the medial region of the trachea between the groups (two-way analysis of variance [ANOVA], p<0.01) and of the proximal region between the groups and protocols (two-way ANOVA, p<0.01).CONCLUSIONS: The technique developed in this study is an innovative method for performing a mechanical assessment of engineered tracheal grafts that will enable evaluation of the viscoelastic properties of neo-tracheas prior to transplantation