Mechanics Of Breathing

Index 405

neuromuscular disease, 188–189 intensive care, 106–111
qualitative descriptors, 185 lung ultrasound, 115
quantitative intensity, 185 spirometry and respiratory
restrictive lung disease, 188
verbal descriptors, 185 mechanics, 113–114
work/effort, 185 Lung function testing. See Pulmonary
Lanini, B., 162
Laplace’s law, 80 function tests (PFT)
Laveneziana, P, 73–90 Lung mechanics and COPD treatment
Layfield, D., 283–306
Lichtenstein, D., 111 airflow limitation, 311
Lima, C.S., 162 bronchodilator, 312–314
Limb muscles dynamic hyperinflation, 312
capillarization, 325 EELV, 312
contractility, 325–326 forced oscillation technique, 313
fiber-type distribution, 325 gas exchange, 314
metabolic and mitochondrial health status, 314
ICS and PDE4 inhibitor roflumilast, 314
alterations, 326 inspiratory muscle function, 312
muscle mass, 324 LABA, 314
muscle weakness, 328 multifrequency impedance spectra, 313
quadriceps fatigue, 328 pharmacological management, 311, 312
and respiratory muscle dysfunction, post-bronchodilator value, 311
and pulmonary artery pressure, 314
COPD, 328 residual volume, 312
upper and lower, 327–328 respiratory system, 313
Long-range apparent diffusion coefficient routine monitoring, 143
ventilatory support, assessment, 142–143
(LRADC) Lung recruitment
acini, 262 alveolar, 221
emphysematous, 261 during anesthesia, 105
longitudinal spin magnetization, 260 compartments, 221
lung airways, 259 conventional chest x-ray, 111–112
small-flip angle inspection image, 261 CT, 112–113
unilateral elastase-induced deformable image registration, 221–222
EIT, 115
emphysema, 261 gas exchange, 114
Louvaris, Z., 169–179 intensive care, 106–111
Low anabolism, 330 lung ultrasound, 115
LRADC. See Long-range apparent diffusion regional differences, ALI, 220
regional pulmonary air trapping, 222
coefficient (LRADC) spirometry and respiratory
Lung
mechanics, 113–114
ADC, 254–255 Lung ventilation, 250, 252, 254, 262
barriers, 254 Lung volume reduction surgery (LVRS)
diffusion-sensitizing gradients, 253
morphometry, 255–259 bullectomy, 274, 275
Lung collapse coronal slice, 276–277
airway closure, 101–103 hyperinflation, 274
disconnection lung–chest wall paradoxical and intermediate type, 275
respiratory failure, 278
(pneumothorax), 100, 102 sagittal slice, 277
external forces/lung compression, 104 sternotomy, 278
increased lung recoil/surfactant synchronized type, 274–275
vascular trees, 275
deficiency, 103–104 Lung volumes, 40–41, 130
Lung de-recruitment Luppi, F., 25–33
LVRS. See Lung volume reduction
during anesthesia, 105
conventional chest x-ray, 111–112 surgery (LVRS)
CT, 112–113
EIT, 115
gas exchange, 114

406 Index

M CT, 259
Macklem, P.T., 3–9, 12 diffusion time, 257
Madsen, F., 123–137 emphysema stage, 258
Magnetic resonance imaging (MRI) FEV/FVC, 259
histological measurements, 258
chest wall, 269 lung microstructure, 255
diaphragm, 269 MR protocol and empirical
dyspnea, 273
emphysema, 252, 270–274 relationships, 258
hardware and software limitations, 248 PFT, 259, 260
hyperpolarized gas, 249 research and clinical tool, 256
left and right bullectomy, 279–280 Voronoi meshing techniques, 256
lower rib cage, 278 Mortensen, J., 123–137
lung morphometric parameters, 258 MRC scale. See Medical Research Council
LVRS, 274–278
Monte Carlo approach, 255 (MRC) scale
RV, 270 MRI. See Magnetic resonance
severe chronic obstructive pulmonary
imaging (MRI)
disease, 279 Multiple-breath washout (MBW)
TLC, 270
ventilation image, 249 test, 199–200, 202, 206–208
Mahler, D.A., 187 Muscle disuse, 329
Mair, R.W., 255 Muscle dysfunction, COPD
Maltais, F., 323–332, 348
Marin, J., 347 cigarette smoking, 330–331
Martinez, F.J., 347 hypoxia, 330
Martin, H.B., 232 inflammatory response, 329
MBW test. See Multiple-breath washout low anabolism, 330
medication, 330
(MBW) test muscle disuse, 329
MCh. See Methacholine (MCh) oxidative stress, 329–330
MCL. See Mean chord length (MCL) reversibility, 331
Mead, J., 155 Muscle fatigue
Mean chord length (MCL), 254, 256 definition, 12
Mechanical ventilation diaphragm, force output, 13
exercise performance, effects, 14–15
description, 353 intrathoracic pressures and cardiac
FOT, 381–382
invasive (see Invasive mechanical output, 19
nerve stimulation techniques, 12–13
ventilation) respiratory muscle metaboreflex, 15–17
non-invasive, 382–386 whole-body exercise effect, 13
Medical Research Council (MRC) scale, 190 Muscle mass
Metabolic and mitochondrial alterations limb muscles, 324
limb muscles, 326 respiratory muscles, 324
respiratory muscles, 326 Muscle sympathetic nerve activity
Methacholine (MCh)
challenge, 65–66 (MSNA), 17–18
inhalation, 187, 188, 295, 297 Muscle tone
ventilation distribution, 294
visible ventilation defects, 295, 296 cyclical volume oscillations, 57
Milic-Emili, J., 215 deep inspiration, effects, 58–59
Miller, G.W., 256 FRC, 59
6-Min walking test (6 MWT), 386 MCh challenge, 59
Mitochondrial transcription factor A tidal breathing, 57–58

(TFAM), 326 N
Morphometry NAVA. See Neurally adjusted ventilatory

acinar airways, 257 assist (NAVA)
alveolar ducts and sacs, 257 Navajas, D., 137–144, 381–392
Nava, S., 365–377

Index 407

Near-infrared spectroscopy (NIRS). respiratory mechanics, 366
See Respiratory muscle blood flow, respiratory resistance and reactance
NIRS–ICG
measurement, 382–383
Neurally adjusted ventilatory assist self-optimising PEEP device, 386
(NAVA), 359 trigger asynchronies, 369–370, 372–373
ventilator waveforms, 368
Neuromuscular disease, 188–189 ventilatory efficacy, 368
Nitric oxide (NO), asthma ventilatory pump and mechanical

bronchoprotection, DIs, 68 ventilator, 366
changes in VC, 70 VILI, 369
degree of AHR, 69–70
DI in pathogenesis, AHR, 65–67 O
exhaled NO, 67–68 O’Donnell, D.E., 73–90, 189
increased concentration from DIs, 70 OEP. See Optoelectronic plethysmography
inhaled Mch, 68
nNOS, diminished effectiveness, 68–69 (OEP)
NO diffusing capacity of airways Open lung, 100, 101
Optoelectronic plethysmography (OEP)
(Dno), 67–68
PC20 and FEV1, 68, 69 analysis, cameras, 151
proinflammatory cytokines, 69 breathing, 149
NIV. See Noninvasive mechanical chest wall motion (see Chest wall)
double, 156–157
ventilation (NIV) and EELV (see End-expiratory lung
Noisy PSV, 360–361
Nonconventional mechanical ventilation volume (EELV) approaches)
exercise, 149
HFPV, 361–362 measurement, pulmonary ventilation, 149
HFV, 361 variations, lung volume, 155–156
high-frequency oscillatory Osmanagic, E., 258
Osteogenesis imperfecta, 162–163
ventilation, 362–363 Otto, C.M., 106
Noninvasive mechanical ventilation (NIV) Owers-Bradley, J.R., 253
Oxidative stress, 329–330
alveolar ventilation, 369 Oxygenation
assisted mechanical ventilation, 365 examination, 170
balloon-catheter techniques, 376 tissue, 170
characteristics, 369 Oxygen cost diagram (OCD), 191
chronic respiratory failure, 375–376
COPD patients, 375 P
CPAP, 383 Paiva, M., 195–209
cycling off asynchronies, 374–375 Pathology, asthma/COPD
DH, 385
EFL (see Expiratory flow limitation (EFL)) conducting airways, 25–30
EMG-measured neural Ti, 366–367 fixed airflow obstruction, 32–33
end-expiratory pressure, 385 lung parenchyma, 30–32
in vivo and in vitro study, 376 Patient–ventilator asynchronies
and IMV, 365 computer-assisted detection, 368
ineffective breathing attempts, 370–372 delayed cycling, 375
inspiratory flow asynchrony, 373–374 ICU, 372
leaks and helmet, 376 NAVA, 375
mismatching type, 367 neural and preset ventilator respiratory
6 MWT, 386
and NAVA, 375 cycle, 366
neuromuscular blocking agents, 365 respiratory muscle weakness, 376
optimised PEEP, 386 PAV. See Proportional assist ventilation (PAV)
patient–ventilator asynchronies, 366, 368 PCV. See Pressure control ventilation (PCV)
patient–ventilator synchrony, 366 Peacock, A., 150
PEEP, 384–386
PEEPi, 384, 385
physiological study, 376

408 Index

Peak expiratory flow (PEF), 127 Positron emission tomography (PET)
Pedersen, O.F., 123–137 albuterol, 295–298
Pedotti, A., 149–165 asthma, 291–294, 303–305
PEEP. See Positive end-expiratory automatic device, 287
functional, mechanical and structural
pressure (PEEP) characteristics, 283, 284
PEEPe. See Extrinsic PEEP (PEEPe) gas exchange predictions, 288, 289
PEEPi. See Intrinsic PEEP (PEEPi) infection/injury, 283
PEF. See Peak expiratory flow (PEF) isotopes, 284
Pelosi, P., 353–363 MCh, 294–295
Pennati, F., 215–227 nitrogen-13, 287
Perez-Sanchez, J.M., 256 PET-CT (see Positron emission
Perfusion tomography-computerized
tomography (PET-CT))
aerated compartment, 290 pulmonary shunt, 289–291
apnea, 289 single-compartment model, 288
blood flow, 287 tracer gas, 287, 288
bronchoconstricted lung, 288
tracer retention fraction, 294 Positron emission tomography-computerized
Peripheral muscles tomography (PET-CT)
biochemical changes, 348
COPD, 347–348 aerosol deposition, 298, 299
CS and HADH, 348 central and peripheral airways, 299, 300
Perlman, C.E., 108 oscillatory mechanics and regional
Permutt, S., 65–71, 232
Peslin, R., 383 ventilation distribution, 298
PET. See Positron emission tomography (PET) physical principles, 284–285
PET-CT. See Positron emission tomography- pulmonary imaging, 299
pulmonary inflammation, 300–303
computerized tomography temporal and spatial characteristics,
(PET-CT)
PFT. See Pulmonary function tests (PFT) 285–286
PGC-1α. See Proliferator-activated receptor-γ Pressure control ventilation (PCV), 356, 357
coactivator (PGC-1α) Pressure-cycled ventilation modes
Pillow, J.J., 391
Pinelli, A., 37 APRV, 357–358
Pisani, L., 365–377 characterization, 356
Plasticity PCV, 356, 357
actin filaments, 59–60 PSV, 356–358
actin polymerization, 60–61 Pressure support ventilation (PSV), 356–358
adhesion junction signaling proteins, Pressure–volume (P–V) relation,
60–61
ASM (see Airway smooth muscles (ASM)) 84, 86, 100, 101
cyclical volume oscillations, 57 Proliferator-activated receptor-γ coactivator
cytoskeletal reorganization, 59–60
DI, effects, 58–59 (PGC-1α), 326
FRC, 59 Proportional assist ventilation (PAV), 359, 360
lung volume changes, 62 PSV. See Pressure support ventilation (PSV)
membrane adhesion junction Pulmonary function tests (PFT)
(adhesome), 61
methacholine (MCh) challenge, 59 diagnostics, monitoring, severity,
tidal breathing, 57–58 and prognosis, 131
Pleural pressure (Ppl), 4
Plotkowiak, M., 256 diseases with lung manifestations, 132
Pompe disease, 162 legal indications, 132
Pompilio, P.P., 381–392 prevention and treatment, 132
Positive end-expiratory pressure (PEEP), symptoms, 131
104, 106, 384–391 Pulmonary inflammation
cigarette smoke, 300, 301
graphs, 300, 302
heterogeneity, 302, 303
neutrophilic, 300, 301
regional lung function, 300, 301
regional shunt fraction plot, 302, 303

Index 409

Q Respiratory muscle blood flow, NIRS–ICG
Quiet breathing (QB) at rest, 6 and BFI, 173–175
Quirk, J.D., 259 COPD, 176–179
difficulties, 170
R exercise, 170
Radiation dose, lung ventilation humans, 169, 174
limitations, 175
absorbed, effective and CTDI, 218 locomotor, 175
CT scan, 217–218 measurements, 170–171
measures, 218 metabolic and haemodynamic
Radioactive gases, regional ventilation responses, 176, 177
lung volume, 215–216 traditional techniques, 170
measures, 215 validation, 171–173
pleural pressure, 215 work and exercise, 175–176
pulmonary blood flow, 215
and spirometry, 215 Respiratory muscle metaboreflex
Rapid breathing, 186 diaphragmatic fatigue, 16–17
Rausch, S.M.K., 108 electrical or pharmacological
Reactance stimulation, 17
elastic and inertial properties, 383 limb vascular conductance, 15–16
frequency dependency, 390 MSNA, 17–18
measurements, 384, 387 resting or mildly exercising canine, 17
non-aerated tissue, 391 vasoconstrictor outflow, 17, 19
and resistance, 382–383
respiratory, 140, 143 Respiratory muscles
Recruitment abdominal muscles, 8–9, 346
lung units, 387 air exhalation, 327
manoeuvres and surfactant automatic and voluntary ventilatory
pathways, 346
administration, 391 capillarization, 325
and overdistention during ventilation, 387 classification, 345
pressure amplitudes/tidal volumes, 389 contractility, 325
RM, 386 cranial nerve 11 (C-11), 346
Regional ventilation diaphragm, 5, 346
evolution, CT, 216–217 diaphragmatic force, 327
imaging, 218–219 dyssynchrony, 346
lung aeration and recruitment, 220–222 exercise type, 346
radiation dose, 217–218 fiber-type distribution, 324–325
radioactive gases, 215–216 hypercapnic respiratory
specific volume changes, 222–224 failure, 326–327
SVg, 224–227 inspiratory muscle, 327
Xe-CT, 219–220 lung resistance and elastance, 327
Regions of interests (ROIs), 290 metabolic and mitochondrial
Residual volume (RV) alterations, 326
air trapping, 276 muscle mass, 324
anterior zone, 272 patients with COPD, 327
diaphragm, 272 primary inspiratory muscle, 327
expiratory flow rates, 75, 77 qualitative systematic review, 327
lung volumes, 130 rib cage muscles, 4–5
xiphoid process, 271 scalene and parasternal intercostal
zone of apposition, 270 muscles, 346
Resistance, 140–141 upper airway muscles, 345–346
Resistance, elastance, and inertance
Resting lung hyperinflation
(R-I-E model), 140 chronic lung hyperinflation, 81
Respiratory inductive plethysmography diaphragmatic function, 79–80
and heart, 80–81
(RIP), 150 rib cage muscles, 80

410 Index

Restrictive lung disease, 188 Single-breath washout (SBW) tests,
Rib cage muscles 195–196, 199, 202, 204, 206–208

and abdominal, 151, 154, 159 Single-photon emission tomography
chest wall motion, 150 (SPECT), 283, 298
COPD, 161
deformities, 155, 163 Skloot, G., 234
displacements and distortions, 4 Sleep apnea-hypopnea syndrome
expansion, 159
fall in Pab, 4–5 (SAHS), 143
inspiratory, 4, 163 Smokers, 205
lung-and diaphragm-apposed SNR. See Signal-to-noise ratio (SNR)
Specific volume of gas (SVg), 224–227
parts, 155 SPECT. See Single-photon emission
negative Ppl, 4
pulmonary, 152, 154, 155, 159 tomography (SPECT)
separation, 154 Spirometry
thoracic surgery, 161
tidal volume, 159 end of test criteria, 126
Rib cage muscles pressure (Prcm), 8–9 equipment, 127
RIP. See Respiratory inductive FRC, 124
FVC test, 124
plethysmography (RIP) PEF, 127
ROIs. See Regions of interests (ROIs) start criteria, 124–125
Romer, L.M., 11–21 Stendardi, L., 183–191
Roughton, F.J., 129 “Stress index” method, 113
Roussos, C.S., 12 Sullivan, K.J., 390
RV. See Residual volume (RV) Symptoms
asthma, 187
S BDI–TDI, 190–191
Saetta, M., 25–33 dyspnoea, 190–191
Saey, D., 323–332 MRC scale, 190
Salito, C., 215–227 Synchronized intermittent mandatory
Samb, A., 68
Saumarez, R.C., 150 ventilation (SIMV), 355–356
SBW test. See Single-breath washout
T
(SBW) tests Tarabini Fraticelli, A., 376
Scano, G., 183–191 Tassaux, D., 375
Scichilone, N., 231–243 Tawhai, M.H., 198
Sensation, dyspnoea, 187–188 Tiffeneau, R., 37
Sensory-perceptual experience TLC. See Total lung capacity (TLC)
Tobin, M.J., 365
category-ratio Borg scale, 184–185 Total lung capacity (TLC)
language dyspnoea (see Language
description, 77–78
dyspnoea) Di,dome, 271
VAS, 184 hyperinflation, 272
Shunt, pulmonary VF, 276
apnea, 289 xiphoid process, 271
blood gases, 291, 293 Transdiaphragmatic pressure (Pdi) tracing, 367
heart, 290, 291 Triggering
nonlinear optimization techniques, 290 autotriggering, 373
ROIs, 290 delayed, 373
sheep, 290, 292 description, 369
tracer kinetics, 289, 290 double, 372–373
Signal-to-noise ratio (SNR), 249, 250 remifentanil, 370
Similowski, T., 81 respiratory drive, reduction, 369–370
Simon, B.A., 222 Tschumperlin, D.J., 107
Single-breath method, 129 Tsuda, A., 256
Turato, G., 25–33

Index 411

U Vignaux, L., 374
The University of Cincinnati Dyspnea VILI. See Ventilator-induced lung injury

Questionnaire (UCDQ), 191 (VILI)
Vinogradskiy, Y.Y., 224
V Visual analogue scale (VAS), 184
VAI/Q. See Inspired alveolar ventilation/ Vitacca, M., 372
Vital capacity (VC), 37, 130
perfusion ratio (VAI/Q) Vogiatzis, I., 158, 169–179
Van Muylem, A., 197 Volume
Vargas, M., 353–363
VAS. See Visual analogue scale (VAS) abdominal, 155
Vastus lateralis, 323–326, 329, 330 chest wall (see Chest wall)
VC. See Vital capacity (VC) EELV (see End-expiratory lung volume
VC maneuver, 105
Venegas, J.G., 283–306 (EELV) approaches)
Ventilation tidal, 149
variations, lung, 149, 150, 155–156
breathing, 288 Volume-cycled ventilation modes
cardiac output, 12, 13 assist-control (AC), 354–355
gas phase, 287 description, 354
inhalation, 295 SIMV, 355–356
local shunt fraction, 290 volume control ventilation, 354, 355
O2 consumption of respiratory
W
muscles, 12 Wagner, P.D., 102
patchy, 291–294 Wang, W., 259
respiratory muscle blood flow, Wave-speed equation, 39
Webb, K.A., 73–90
quantitation, 12 Weibel, E.R., 257
right lung, 294 West, J.B., 102, 215
ventilatory demands, 11 WOB. See Work of breathing (WOB)
Ventilation fraction (VF), 276, 277 Woods, J.C., 247–262
Ventilation heterogeneity Work of breathing (WOB), 359
aerosol bolus tests, 205–208
analysis, 208–209 X
asthmatics, 204–205 Xenon-CT ventilation imaging
breath cycle, 195
bronchoprovocation, 202–204 density-time curve, 219, 220
COPD, 196, 204 description, 219
FEV1, 195 dual-energy, 220
gas washout (see Gas washout tests) limitations, 220
N2 concentration, 196 quantification, 219–220
pulmonary, 196 single and multi-breath
SBW test, 195–196
smokers, 205 technique, 219, 220
transport mechanisms, 195
Ventilation modes Y
advantages, 358–359 Yablonskiy, D.A., 247–262
NAVA, 359 Yamamoto, T., 223
noisy PSV, 360–361
PAV, 359, 360 Z
pressure-cycled, 356–358 Zakynthinos, S., 169–179
volume-cycled, 354–356 Zannin, E., 381–392
Ventilator-induced lung injury Zocchi, L., 80

(VILI), 106–107
Verbanck, S., 256
VF. See Ventilation fraction (VF)