By using Siregnost FD 91 body plethysmograph. we measured thoracic gas volume (TGVe) at end of expiration in 19 healthy subjects aged 20-43 years in order to compare with functional residual capacity (FRC) measured by closed circuit method. The results obtained were as follows: 1. Mean values of TGVe and FRC were 3.395+/-0.585 liter, and 3.398+/-0.618 liter, respectively. 2. A advantage of the body physthysmographic method for measuring thoracic gas volume was that it were rapid, safe. and easy to perform, requires no gas sample for chemical analysis, and measured TGVe several times.
Functional Residual Capacity*

BACKGOUND: The effect of anesthetic techniques, such as closed circuit anesthesia (CCA) using semiclosed circuit system and semiclosed circuit anesthesia (SCCA), on the work of breathing has not been studied yet in detail. This study was purposed to compare the work of breathing according to anesthetic technique (CCA, SCCA). METHODS: Thirty patients were assigned to receive either SCCA group or CCA group (n = 15). Anesthesia was induced with propofol 2 mg/kg with 2% lidocaine 1 ml. Two percents isoflurane with O2 and N2O 2 L/min were given for 10 min to patients initially to wash in functional residual capacity and the breathing circuits. In SCCA group, anesthesia was maintained with 2% isoflurane in O2 2 L/min and N2O 2 L/min throughout the surgery. In CCA group, O2 was reduced to 200 ml/min and N2O to 100 ml/min with isoflurane vaporizer setting adjusted to 4% for anesthesia maintenance. When the operation was ended, the vaporizer setting of isoflurane deceased to zero and then O2 was increased to 4 L/min for the arousal of the patient. We measured the inspiratory/expiratory concentration of isoflurane, end-tidal CO2, the hemodynamic parameters, the change of airway pressure, the work of breathing, and compliance at anesthetic induction and emergence in both groups. RESULTS: There were no significant differences in the inspiratory/expiratory concentrations of isoflurane, the hemodynamic parameters, end-tidal CO2, airway pressure, the work of breathing and compliance between the groups. CONCLUSIONS: CCA using semiclosed circuit system does not increase the work of breathing compared to SCCA.
Anesthesia ; Anesthesia, Closed-Circuit* ; Arousal ; Compliance ; Functional Residual Capacity ; Hemodynamics ; Humans ; Isoflurane ; Lidocaine ; Nebulizers and Vaporizers ; Propofol ; Respiration ; Work of Breathing*

OBJECTIVETo study the development of pulmonary function of healthy children between 1-48 months.

METHODSA total of 295 healthy children at ages of 1-48 months were classified into 7 groups according to their age, i.e., 1-2 months, 3-4 months, 5-7 months, 8-12 months, 13-24 months, 25-36 months, and 37- 48 months. Pediatric pulmonary function laboratory type 2600 (Sensor Medics Corporation USA) was used to detect tidal flow volume curve, which can partially replace the maximum expiratory flow volume curve and reflect airway ventilation function. Passive expiratory flow volume technique was used to examine respiratory system static compliance and total airway resistance. Open nitrogen washout method was used to measure functional residual capacity.

RESULTSThe values of tidal, peak tidal expiratory flow, and respiratory system static compliance functional residual capacity increased with the increasing age and were significantly different among the 7 groups. However, respiratory rate and total airway resistance decreased with the increased age. The value of each parameter of tidal flow volume curve was stable during 1-48 months.

CONCLUSIONSThis study displayed the developmental characteristics of pulmonary function of healthy children at ages of 1-48 months, which is useful to observe the changes of pulmonary function in respiratory diseases.

Age Factors ; Child, Preschool ; Female ; Functional Residual Capacity ; Humans ; Infant ; Lung ; physiology ; Male ; Peak Expiratory Flow Rate

To evaluate exercise capacity, treadmill test and exercise pulmonary function test with cycle ergometer were preformed in 52 patients(pts) (M/F : 18/34, mean age : 43+/-11 yrs) with mitral stenosis before and 5~10 days after percutaneous mitral balloon valvuloplasty(PMV). Twenty four pts had atrial fibrillation. The results are as follow : 1) The mitral valve area increased from 0.9+/-0.2 to 1.8+/-0.3cm2(P<0.001). 2) The duration of exercise time on treadmill test(modified Bruce protocol) increased from 7.7+/-3.3min to 11.1+/-2.6min(P<0.001), but peak heart rate(HR) and maximum double product(MDP) did not change significantly. After exclusion of the patients with atrial fibrillation, peak HR and MDP increased from 157+/-24beats/min and 22350+/-8220mmHg beat to 165+/-19beats/min and 26290+/-5770mmHg beat respectively(P<0.05). 3) Diffusion capacity and diffusing capacity/alveolar volume at rest decreased from 95+/-25% and 112+/-24% to 87+/-22% and 100+/-18% respectively(p<0.001). 4) FVC, FEV1, FEV1/FVC, FEF25~75% and maximum voluntary ventilation increased from 77+/-12%, 79+/-16%, 104+/-10%, 69+/-25%, and 68+/-14%, to 80+/-11%, 84+/-14%. 106+/-9%, 78+/-25%, and 74+/-12%, respectively(P<0.05). But total lung capacity, residual volume and functional residual capacity did not change significantly. 5) Maximum oxygen consumption, anaerobic threshold, oxygen pulse and maximum work load during exercise increased form 53+/-14%, 34+/-8%, 6.2+/-2.1ml/min and 48+/-18 watts to 61+/-13%, 39+/-7%, 7.3+/-2.0ml/min and 58+/-20 watts respectively(P<0.0005). We conclude that oxygen transport and exercise capacity improve within 10days after PMV and the improvement results from not only hemodynamic improvement but also improvement of static pulmonary function.
Anaerobic Threshold ; Atrial Fibrillation ; Balloon Valvuloplasty* ; Diffusion ; Exercise Test ; Functional Residual Capacity ; Heart ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Oxygen Consumption* ; Oxygen* ; Residual Volume ; Respiratory Function Tests ; Total Lung Capacity ; Ventilation

OBJECTIVE: To measure and compare the quantitative parameters of the lungs and airways in Korean never-smokers and current or former smokers (“ever-smokers”). MATERIALS AND METHODS: Never-smokers (n = 119) and ever-smokers (n = 45) who had normal spirometry and visually normal chest computed tomography (CT) results were retrospectively enrolled in this study. For quantitative CT analyses, the low attenuation area (LAA) of LAA(I-950), LAA(E-856), CT attenuation value at the 15th percentile, mean lung attenuation (MLA), bronchial wall thickness of inner perimeter of a 10 mm diameter airway (Pi10), total lung capacity (TLC(CT)), and functional residual capacity (FRC(CT)) were calculated based on inspiratory and expiratory CT images. To compare the results between groups according to age, sex, and smoking history, independent t test, one way ANOVA, correlation test, and simple and multiple regression analyses were performed. RESULTS: The values of attenuation parameters and volume on inspiratory and expiratory quantitative computed tomography (QCT) were significantly different between males and females (p < 0.001). The MLA and the 15th percentile value on inspiratory QCT were significantly lower in the ever-smoker group than in the never-smoker group (p < 0.05). On expiratory QCT, all lung attenuation parameters were significantly different according to the age range (p < 0.05). Pi10 in ever-smokers was significantly correlated with forced expiratory volume in 1 second/forced vital capacity (r = −0.455, p = 0.003). In simple and multivariate regression analyses, TLC(CT), FRC(CT), and age showed significant associations with lung attenuation (p < 0.05), and only TLC(CT) was significantly associated with inspiratory Pi10. CONCLUSION: In Korean subjects with normal spirometry and visually normal chest CT, there may be significant differences in QCT parameters according to sex, age, and smoking history.
Female ; Forced Expiratory Volume ; Functional Residual Capacity ; Humans ; Lung* ; Male ; Reference Values ; Respiratory Function Tests ; Retrospective Studies ; Smoke ; Smoking ; Spirometry ; Thorax ; Tomography, X-Ray Computed ; Total Lung Capacity ; Vital Capacity

The normal response of the pulmonary vasculature to one-lung atelectasis is an increase in pulmonary vascular resistance (PVR). The mechanism of the increase in PVR is thought to be due almost entirely to hypoxic pulmonary vasoconstriction (HPV). Regional HPV results in blood flow diversion from hypoxic regions to normoxic regions. The expected pulmonary shunt is thereby reduced and the arterial oxygen tension increased. PEEP improves the arterial oxygen tension as a result of increasing functional residual capacity (FRC) and decreasing intrapulmonary shunt. The aims of the present studies were to observe blood flow diversion from atelectatic lung to normoxic lung and to prove a sustained redistribution of pulmonary blood flow from ventilated with PEEP to atelectatic regions. This study evaluated the interactions between HPV and PEEP. Eight mongrel dogs were anesthetized with pentobarbital. Left pulmonary blood flow was measured with eletromagnetic flow probes following left lateral thoracotomy. Pulmonary arterial pressures, PCWP, systemic arterial pressures were measured via indwelling catheter. Cardiac output was determined by thermodilution in triplicate. The right lung was ventilated continuosly with 100% O2, while left lung was ventilated with 100 O2 (control phase), and unventilated for 60 min. of atelectasis. PEEP of 5 and 10 cmH2O was ed to the right lung. During two-lung ventilation with 100 oxygen, cardiac output was 2890+/-880 ml/min. (mean SD) and left pulmonary blqod flow was 1100+/-220 ml/min. Left lung atelectasis resulted in a reduction of the percent left blood flow compared with cardiac output from 41+/-10% to 29+/-7% at 15 min and to 22+/-9% at 60 min (p<0.05). The ratio of left pulmonary blood flow to mean pulmonary artery pressure decreased from 51+/-25 ml/min/ mmHg in control to 19+/-7 ml/min/mmHg at 60 min (p<0.05). Left pulmonary vascular resistance increased gradually (p<0.01). Arterial oxgen tension was the lowest at 15 min (165+/-66 mmHg) and increased subsequently (p<0.01). Intrapulmonary shunt was 27+/-6% in, control phase and abruptly increased to 37+/-6% at 15 min after atelectasis and decreased to 34+/-10% at 60 min. When 10 cmH2O PEEP was applied to the right hung during left lung atelectasis, the percent ratio of left pulmonary blood flow to cardiac output was significantly increased from 22+/-9% at 60 min of left lung atelectasis to 34+/-8% (p<0.05). Left pulmonary vascular resistance significantly decreased as compared with 45 and 60,min of left lung atelectasis (p<0.05). Arterial oxygen tension incresed by PEEP of 5 and 10 cmH to 257+/-74 mmHg and 252+/-92 mmHg compared with 164+/-65 mmHg and 177+/-28 mmHg at 15 and 30 min. of left lung atelectasis (p<0.05). The present study demonstrated that the response to acute atelectasis is a regional increase in pulmonary vascular resistance and a sustained diversion of blood flow away from the atelectatic lung. In this study, the application of 10 cmH2O PEEP resulted in a redistribution of pulmonary blood flow from normoxic lung to atelectatic lung and didn't affect arterial oxygenation. We conclude that when employing the technique of one-lung anesthesia, PEEP to improve oxygenstion should be cautiously applied and a search for the maximum oxygenation and a minimum redistribution might be started, in an attempt to find the optimal PEEP.
Anesthesia ; Animals ; Arterial Pressure ; Cardiac Output ; Catheters, Indwelling ; Dogs ; Functional Residual Capacity ; Lung* ; One-Lung Ventilation ; Oxygen ; Pentobarbital ; Pulmonary Artery ; Pulmonary Atelectasis* ; Thermodilution ; Thoracotomy ; Vascular Resistance ; Vasoconstriction ; Ventilation

Salient features of acute respiratory failure are reduction of functional residual capacity, decreasedlung compliance and increased right to left shunt; and pneumonia, pulmonary congestion, atelectasis pulmonary edema and fibrosis are revealed clinically. PEEP is able to prevent alveolar collapse and avoid atelectatic change and increase functivnal residual capacity and lung compliance with increment of arterial oxygen content. Decreased cardiac output and pulmonary parenchymal damages were noted during high PEEP. Blood gases were observed with IL 213 Blood Gas Analyzer during 5cm H2O of PEEP and general anesthesia in 10 healthy persons. Following results were obtained: 1) 5 cm H2O of PEEP increased PaO2 from 221 torr to 275 torr and PaCO2 from 38. 8 torr to 42. 1 torr. 2) 5 cm H2O of PEEP increased PvO2 from 40 torr to 48 torr and PvCO2 from 44. 1 torr to 49. 3 torr. 3) 5 cm H2O of PEEP increased mean arterial pressure but had no effect on heart rate. 4) 5 cm H2O of PEEP increased C(a-v)DO2 from 5. 306 cc/100ml to 5. 433 cc/100ml. 5) It is noted that 5 cm H2O of PEEP is safe in healthy persons.
Anesthesia, General* ; Arterial Pressure ; Cardiac Output ; Compliance ; Estrogens, Conjugated (USP) ; Fibrosis ; Functional Residual Capacity ; Gases* ; Heart Rate ; Humans ; Lung Compliance ; Oxygen ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiratory Insufficiency

Pulmonary function testing (PFT) is an important and fundamental method in the evaluation and treatment of respiratory diseases. Airway responsiveness assessed using histamine or methacholine by PFT is meaningful for the diagnosis of asthma. Spirometry is simple, and has been the most commonly used technique. However, in younger or uncooperative children, other commercially available tools such as impulse oscillometry (IOS), gas dilution, and plethysmography have been used. IOS is a noninvasive method that allows the measurement of airway mechanics (resistance [R] and reactance [X]) with minimal patient cooperation. Functional residual capacity (FRC) is one of the most important measurements obtained by gas dilution. Plethysmography is a gold standard to measure airway resistance and useful for lung function testing in infants. The purpose of this review is to help pediatric physicians being familiar with PFT techniques used in young children by discussing their principles, clinical applications, limitations, and current accessibility in Korea.
Airway Resistance ; Asthma ; Child* ; Diagnosis ; Functional Residual Capacity ; Histamine ; Humans ; Infant ; Korea ; Lung* ; Mechanics ; Methacholine Chloride ; Oscillometry ; Patient Compliance ; Plethysmography ; Respiratory Function Tests ; Spirometry

BACKGROUND: Ischemia-reperfusion injury and ventilation/perfusion mismatch are the major complication of lung transplantation. Application of positive end-expiratory pressure(PEEP) on reperfused lung can prevent hypoxemia, because it increases functional residual capacity and improves oxygenation without contralateral dynamic hyperexpansion. To identify which differential lung ventilation with PEEP reduces ischemia-reperfusion lung injury, PaO2, intrapulmonary shunt, pulmonary compliance and water content of lung tissue were measured and compared with those of conventional two lung ventilation. METHODS: Nineteen Korean mongrel dogs were included for study. Double lumen endotracheal tube was inserted via tracheostomy site. Femoral arterial catheter and Swan-Ganz catheter were inserted for hemodynamic data and thoracotomy was done. The right pulmonary artery, vein, and main bronchus were clamped for 90 minutes and released to produce unilateral warm ischemia-reperfusion lung injury. In control group(C), conventional two lung ventilation was applied, and in experimental group(P), the right lung was ventilated with 10 cmH2O PEEP independent of the left lung. PaO2, intrapulmonary shunt, pulmonary compliance and water content of lung tissue were measured. RESULT: At 60 min after reperfusion, PaO2 in group P was higher than in group C(512.4+/-58.8 mmHg vs 263.6+/-165.8 mmHg), and intrapulmonary shunt was smaller(9.8+/-3.4 vs 25.9+/-11.3%). Dynamic and static pulmonary compliance in group P were higher than in group C(42.3+/-9.4, 95.2+/-14.7 vs 29.2+/-1.4, 60.2+/-17.1 dyne, sec/cm5). Water content of the right lung in group P was lower than in group C(81.1+/-1.6 vs 85.1+/-3.9%). CONCLUSION: In conclusion, these data suggest that application of positive end-expiratory pressure on reperfused lung is more effective to improve ventilation/perfusion mismatch and oxygenation, so it is thought to be a good treatment for ischemia-reperfusion lung injury.
Animals ; Anoxia ; Bronchi ; Catheters ; Compliance ; Dogs* ; Functional Residual Capacity ; Hemodynamics ; Lung Injury* ; Lung Transplantation ; Lung* ; Oxygen ; Positive-Pressure Respiration* ; Pulmonary Artery ; Reperfusion ; Reperfusion Injury ; Thoracotomy ; Tracheostomy ; Veins ; Ventilation*

Preoxygenation is a standard anesthetic technique for preventing a significant hypoxemia during the induction of anesthesia. Complete denitrogenation is especially important in clinical situations of difficult intubation or in patients with decreased functional residual capacity, and in situations where oxygen saturation is critical. Oxygen consumption in pregnancy is markedly increased at term as compaired to the nonpregnant stage. It is important to evaluate how long parturient women can withstand apneic hypoxemia during induction of general anesthesia. This study was carried out to measure the duration of time required to decrease the SaO2 to 90% After written informed consent was obtained from six healthy parturients who were to under go elective Cesarean section and six healthy non-pregnant women who were to have total abdominal hysterectomies. All subjects had a tight fitting anesthesia mask applied and breathed 100% oxygen, and a single isolated apnea was carried out. Arterial oxygen saturation and gas tensions were measured at a time SaO2 decreased to 90%, also blood gas data of 4 minutes after apnea in the non-pregnant women were obtained. From these, arterial oxyhemoglobin content was calculated, and mean desaturation rate from denitrogenation to the time SaO2 decreased to 90% was calculated. The mean time to obtain 90% saturation was 7.5+/-0.9 minutes in the nonpregnant women and 3.6+/-0.8 minutes in the parturient group. The mean slope of desaturation was steeper in the paturient(-3.336) than the nonpregnant (-1.52). The PaO2 inereased over 400mmHg in both the groups after denitrogenatio. After 4 minutes of apnea, the mean PaO2 decreased to 200mmHg in the non-pregnant women. The rate of rise of alveolar PCO2 during apnea were alower in the non-pregnant women(2.8+/-1.2mmHg/minute) than in the parturient women(6.8+/-1.8mmHg/minute). This study demonstrates that the rate of oxygen desaturation is faster in the parturients than the nonpregnant women. It is suggested that those results came out because of pregnancy-in-duced increase of oxygen consumption rate and decrease in FRC. The results of this study show the induction for term parturients should be speeded up with caution after full oxygenation in comparison with non-pregnant patients.
Anesthesia ; Anesthesia, General ; Anoxia ; Apnea* ; Cesarean Section ; Female ; Functional Residual Capacity ; Humans ; Hysterectomy ; Informed Consent ; Intubation ; Masks ; Oxygen Consumption ; Oxygen* ; Oxyhemoglobins ; Pregnancy