Respiratory-related neurons of the fastigial nucleus in response to chemical and mechanical challenges

Responses of cerebellar respiratory-related neurons (CRRNs) within the rostral fastigial nucleus and the phrenic neurogram to activation of respiratory mechano- and chemoreceptors were recorded in anesthetized, paralyzed, and ventilated cats. Respiratory challenges included the following: 1 ) cessation of the ventilator for a single breath at the end of inspiration (lung inflation) or at functional residual capacity, 2) cessation of the ventilator for multiple breaths, and 3) exposure to hypercapnia. Nineteen CRRNs having spontaneous activity during control conditions were characterized as either independent (basic, n = 14) or dependent (pump, n = 5) on the ventilator movement. Thirteen recruited CRRNs showed no respiratory-related activity until breathing was stressed. Burst durations of expiratory CRRNs were prolonged by sustained lung inflation but were inhibited when the volume was sustained at functional residual capacity; it was vice versa for inspiratory CRRNs. Multiple-breath cessation of the ventilator and hypercapnia significantly increased the firing rate and/or burst duration concomitant with changes noted in the phrenic neurogram. We conclude that CRRNs respond to respiratory inputs from CO2 chemo- and pulmonary mechanoreceptors in the absence of skeletal muscle contraction.     

Respiratory responses to tracheobronchial stimulation during sleep and wakefulness in the adult cat

The response to tracheal stimulation (50 microliters of tap water) during wakefulness, non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep was investigated in adult cats. In wakefulness, repetitive coughing occurred on 80% of the trials. In NREM and REM sleep, the most frequent response (approximately 69% and 58% of the trials, respectively) was arousal, followed by coughing. Apneas occurred following the stimulus and before arousal in 11% and 24% of the trials in NREM and REM sleep, respectively. In NREM sleep, the tracheal stimulus sometimes evoked expiratory efforts following a normal inspiratory effort (11% of the trials). These were much weaker than the expiratory efforts during coughing in wakefulness. In REM sleep, stimulation in 11% of the trials elicited increased inspiratory efforts. Although these may have been diminutive preparatory inspirations for coughing, they were much smaller than preparatory inspirations associated with coughing in wakefulness, and they were never followed by active expiratory efforts. Arousal from either NREM or REM sleep in response to tracheal stimulation was sometimes associated with an augmented breath. This response, which is common upon spontaneous arousal, may lead to deeper aspiration of the tracheal fluid. We conclude that in cats coughing requires wakefulness and that airway stimuli in sleep cause a variety of respiratory responses, some of which may be maladaptive.     

The determinants of respiratory rate during mechanical ventilation

The independent and interactive effect of feedback related to volume, CO2, inspiratory flow, and arousal state on the regulation of respiratory rate in mechanically ventilated humans is not well characterized. We examined the rate response of eight normal volunteers during both quiet wakefulness and non-rapid-eye-movement (NREM) sleep, while mechanically ventilated through a nasal mask in an assist/control mode with a machine back-up rate of 2 breaths/min. Tidal volume (VT) was set slightly above spontaneous VT and then increased by 0.2 L every 3 min up to 1.8 L or 25 ml/kg. Either an inspiratory flow of 40 L/min or an inspiratory time of 2 s (iso-T(I)) was set, with CO2 added (F(I)CO2 > 0) or F(I)CO2 = 0. Measurements were made during both quiet wakefulness and NREM sleep. We found that as VT increased, the respiratory rate decreased; the rate decline was observed during wakefulness and sleep, and under isocapnic as well as hypocapnic conditions. Increasing inspiratory flow raised the respiratory rate during wakefulness and NREM sleep. During NREM sleep, hypocapnia resulted in wasted ventilator trigger efforts. In summary, both VT and inspiratory flow settings affect the respiratory rate, and depending on state, can affect CO2 homeostasis. Ventilator settings appropriate for wakefulness may cause ventilatory instability during sleep.     

Effectiveness of controlled and spontaneous modes in nasal two-level positive pressure ventilation in awake and asleep normal subjects

STUDY OBJECTIVES: The purpose of the present study was to compare in awake and asleep healthy subjects, under nasal intermittent positive pressure ventilation (nIPPV) with a two-level intermittent positive pressure device (two-level nIPPV), the efficacy of the controlled and spontaneous modes, and of different ventilator settings in increasing effective minute ventilation (VE). PARTICIPANTS: Eight healthy subjects were studied. SETTING: In the controlled mode, inspiratory positive airway pressure (IPAP) was kept at 15 cm H2O, expiratory positive airway pressure (EPAP) at 4 cm H2O, and the inspiratory/expiratory (I/E) time ratio at 1. The respirator frequencies were 17 and 25/min. In the spontaneous mode experiment, IPAP was started at 10 cm H2O and progressively increased to 15 and 20 cm H2O; EPAP was kept at 4 cm H2O. MEASUREMENTS AND RESULTS: We measured breath by breath the effective tidal volume (VT with respiratory inductive plethysmography), actual respiratory frequency (f), and effective VE. Using the controlled mode, effective VE was significantly higher on nIPPV than during spontaneous unassisted breathing, except in stage 2 nonrapid eye movement sleep at 17/min of frequency; increases in f from 17 to 25/min led to a significant decrease in VT reaching the lungs, during wakefulness and sleep; effective VE was higher at 25 than at 17/min of frequency only during sleep; periodic breathing was scarce and apneas were never observed. Using the spontaneous mode, with respect to awake spontaneous unassisted breathing, two-level nIPPV at 10 and 15 cm H2O of IPAP did not result in any significant increase in effective VE either in wakefulness or in sleep; only IPAP levels of 20 cm H2O resulted in a significant increase in effective VE; during sleep, effective VE was significantly lower than during wakefulness; respiratory rhythm instability (ie, periodic breathing and central apneas) were exceedingly common, and in some subjects extremely frequent, leading to surprisingly large falls in arterial oxygen saturation. CONCLUSIONS: It appears that two-level nIPPV should be used in the controlled mode rather than in the spontaneous mode, since it seems easier to increase effective VE with a lower IPAP at a high frequency than at a high pressure using the spontaneous mode. We suggest that the initial respirator settings in the controlled mode should be an f around 20/min, an I/E ratio of 1, 15 cm H2O of IPAP, and EPAP as low as possible.     

Inhibitions mediated by glycine and GABAA receptors shape the discharge pattern of bulbar respiratory neurons

Experiments were performed to identify the glycinergic or GABAergic nature, and the timing of discharge, of the neurons which produce chloride-dependent inhibitions on other bulbar respiratory neurons (RNs) during their silent and active phases. RNs recorded extracellularly in pentobarbital-anesthetized or decerebrate cats, were subjected to iontophoretic applications of glutamate, of the glycine antagonist strychnine, and of the GABAA receptor antagonist bicuculline. Both antagonists induced discharge or increased discharge frequency in restricted parts of the respiratory cycle without affecting the discharge frequency in other parts of the cycle. Strychnine most often elicited activity in late-inspiration and early-expiration, but also in early inspiration and in late expiration. Bicuculline was most often effective throughout the entire discharge period of each neuron with no effect during the silent period, although it also acted selectively during late-inspiration in inspiratory neurons, an effect attributed to GABAA receptor blockade. The convergence of glycinergic afferent inputs during late inspiration and early expiration suggests that glycinergic neurons may play an important role in the inspiratory to expiratory phase transition.     

Vestibular inputs to bulbar respiratory interneurons in the cat

Vestibular inputs to medullary respiratory interneurons were studied in decerebrated and artificially ventilated cats. Extracellular recordings were made from 40 neurons located in the area of pre-B?tzinger complex and activated antidromically from the contralateral ventral respiratory group. Neuronal populations analyzed included inspiratory and expiratory neurons with augmenting, constant and decrementing firing patterns, and a late inspiratory neuron. Seventeen neurons responded to ipsilateral and/or contralateral vestibular nerve electrical stimulation. These responses were observed in all seven cell types. Most neuronal reflex responses consisted of inhibition, while a few consisted of either excitation or a combination of both inhibition and excitation. These results indicate that pre-B?tzinger respiratory interneurons, which may be involved in respiratory rhythmogenesis, also participate in vestibulorespiratory responses.     

Control of expression of the gene for the arginine transporter Cat-1 in rat liver cells by glucocorticoids and insulin

A general mathematical model for the dynamic behaviour of a single-compartment respiratory system in response to an arbitrary applied inspiratory airway pressure and arbitrary respiratory muscle activity is investigated. The model is used to compute explicit expressions for ventilation and pressure variables of clinical interest for clinician-selected and impedance-determined inputs. The outcome variables include tidal volume, end-expiratory pressure, minute ventilation, mean alveolar pressure, average pleural pressure, as well as the work performed by the ventilator and the respiratory muscles. It is also demonstrated that under suitable conditions, there is a flow reversal that can occur during inspiration.     

Medullary respiratory neuronal activity modulated by stimulation of the fastigial nucleus of the cerebellum

The ability of the rostral fastigial nucleus (FNr) of the cerebellum to modulate medullary respiratory neuronal activity was examined in 17 anesthetized, paralyzed and ventilated cats. A bipolar stimulating electrode was positioned into the FNr and tungsten microelectrodes used to record units within the nucleus tractus solitarius (NTS), nucleus ambiguus (NA) and nucleus retroambigualis (NRA). Transient stimuli (< 150 microA, 5-200 Hz) were delivered during inspiration or expiration, and the effects noted on medullary neuronal activity and the phrenic neurogram. The results showed that FNr stimulation: (1) modulated inspiratory and expiratory neuronal (ramp-, early- and late-inspiratory and stage I and II expiratory) discharges recorded from the NTS, NA and NRA (n = 67, 14 and 28) when stimuli (> or = 20-50 Hz) were delivered during either the inspiratory or expiratory phases; (2) terminated the burst durations of inspiratory (77%) and expiratory (94%) neurons with stimulus-response latencies of 28.2 +/- 3.1 ms (inspiratory) and 29.4 +/- 3.6 ms (expiratory); (3) elicited changes in phrenic neurogram concomitant with the effects noted on medullary neuronal activities; (4) failed to change heart rate and arterial blood pressure; and (5) did not affect medullary neuronal and phrenic nerve activity following kainic acid injection into the FNr. We conclude that activation of the FNr (likely its cell bodies) can modulate the respiratory output via influences on medullary respiratory-related neurons. The primary cerebellar effect across all sub-types of respiratory neurons was early termination.     

Differential sensitivity of laryngeal and pharyngeal motoneurons to iontophoretic application of serotonin

Serotonergic neurons decrease their activity during sleep, especially rapid eye movement sleep, thereby reducing their facilitatory effect on upper airway motoneurons. The magnitude of teh sleep-related loss of tone varies among upper airway muscles (e.g., pharyngeal dilator motoneurons are more suppressed than laryngeal motoneurons). We hypothesized that these differences may be related to the sensitivity of different groups of upper airway motoneurons to serotonin. Experiments were done on decerebrate, vagotomized, paralysed and artificially-ventilated cats. Hypoglossal and laryngeal motoneurons were recorded extracellularly using five-barrel pipettes filled with: serotonin, glutamate and methysergide (serotonergic antagonist) for iontophoresis, and NaCl for recording and current balancing. All but two of the 65 hypoglossal motoneurons (45 inspiratory, 10 expiratory, 10 tonic) and 27 out of 32 laryngeal motoneurons (14 inspiratory, 18 expiratory) were excited by serotonin, and the excitation was abolished by methysergide. To compare the magnitude of the excitatory effect among distinct motoneuronal groups, we applied small ejection currents in a standardized manner (+15 nA for 3 min; 10 mM serotonin in 150 NaCl) onto spontaneously active motoneurons (13 inspiratory hypoglossal, 11 inspiratory laryngeal and 11 expiratory laryngeal). Serotonin increased the number of spikes per respiratory burst of inspiratory hypoglossal motoneurons from 19 +/- 4.0 (S.E.M.) to 35 +/- 4.8, of inspiratory laryngeal motoneurons from 44 +/- 8.3 to 55 +/- 8.8, and of expiratory laryngeal motoneurons from 23 +/- 4.8 to 33 +/- 6.2. The relative increases in activity (to 220% +/- 24, 147% +/- 23 and 148% +/- 9 of control, respectively) were significantly higher in hypoglossal than in laryngeal motoneurons. In addition, the excitatory effect developed significantly faster in hypoglossal than in laryngeal motoneurons. Methysergide reduced the spontaneous activity of about half the hypoglossal and laryngeal motoneurons to 66% +/- 5 of control. Thus, the sensitivity to the excitatory effects of serotonin varies among different pools of upper airway motoneurons. These differences correlate with the pattern of airway muscle hypotonia seen during sleep.     

Neuronal gagging activity patterns may be generated by neurons in the reticular area dorsomedial to the retrofacial nucleus in dogs

Expulsion is induced when hypercapnea and hypoxia develop during retching, or when the oropharyngeal mucosa is irritated (the gag reflex). The central pattern generator (CPG) for expulsion has been suggested to coexist with the CPG for retching in the reticular area dorsomedial to the retrofacial nucleus, which may correspond to the Botzinger complex (BOT). However, its participation in gagging induced by oropharyngeal irritation is unclear. To elucidate such participation, the firing patterns of BOT neurons were observed during gagging induced by stimulation of superior laryngeal afferents in decerebrate, paralyzed dogs. Only 23% of inspiratory and 34% of expiratory BOT neurons increased their firing in response to stimulation of the superior laryngeal nerve. In contrast, 75% of nonrespiratory BOT neurons showed enhanced firing with this stimulation. During gagging, each nonrespiratory, inspiratory, and expiratory BOT neuron fired with the same pattern that they exhibited during expulsion caused by changes in blood gases. These firing patterns could be classified into five types and are thought to be appropriate for generating neuronal gagging activity. These results suggest that the CPG for expulsion in the BOT produces gagging when it is activated by oropharyngolaryngeal afferents.     

Effect of sleep on changes in breathing pattern accompanying sigh breaths

We studied the effect of sleep on the characteristics of sigh breaths and the associated changes in breathing pattern in breaths following spontaneous sighs in 4 unrestrained dogs with an intact upper airway. The sigh breath was characterized by its large tidal volume (VT), long TI and TE in comparison with the control breath. The volume of the sigh breath was larger in awake sighs than in those recorded during non-REM (NREM) and REM sleep. The strength of Hering-Breuer reflex as determined by duration of the post-sigh apnea was similar in NREM and REM sleep. Sighs occurring during wakefulness, NREM and REM sleep were associated with augmented activity of the parasternal muscles during inspiration, and a persistent tonic abdominal muscle activity during the expiratory period. Breathing pattern in the post-sigh period was characterized by a smaller VT and longer TE in the first post-sigh breath in all sleep states (compared with the control breath), but the pattern returned to control level within the second or third post-sigh breath in both NREM and REM sleep. Sighs did not precipitate periodic breathing or other forms of abnormal breathing patterns in either wakefulness or sleep. We conclude that the respiratory control mechanisms stabilizing breathing after a sigh in the awake dog are intact in NREM and REM sleep.     

Respiratory-related pharyngeal constrictor muscle activity in normal human adults

Electromyographic activity of the superior, middle, and inferior pharyngeal constrictor (PC) muscles was examined in 10 normal adult humans during wakefulness and sleep. Wire electrodes were inserted close to the midline of the posterior pharyngeal wall at the level of the soft palate (superior PC), tip of the epiglottis (middle PC), and corniculate tubercle (inferior PC). In general, the three PC muscles exhibited similar patterns of activation. The PCs were activated during swallows, repetitive "pa" sounds, changes in head position, and the last portions of slow inspiratory and expiratory vital capacity maneuvers. Respiratory-related PC activity was infrequent during quiet breathing during wakefulness; variable and inconsistent phasic activation in expiration in one or more of the PCs was present in seven of the 10 subjects, particularly after a swallow. Progressive hyperoxic hypercapnia and progressive isocapnic hypoxia were associated with recruitment of phasic PC activity, which was predominantly expiratory; however, variable discharge patterns were observed within a given muscle and a given subject. When phasic PC activity was present, preactivation during late inspiration was frequently observed. PC activity was absent in NREM sleep and exhibited sporadic, nonrespiratory-related bursts of activity during REM sleep. Passively induced hypocapnic hyperventilation in NREM sleep was not associated with PC activation. The results indicate that the PCs have very similar patterns of activation and exhibit phasic expiratory activity during relatively high ventilatory output states in wakefulness.     

Regulation of respiration under conditions of inhibition of carbonic anhydrase activity by diamox]

The functional state of the respiratory center and the mechanism of increase in pulmonary ventilation before and after inhibition of activity of carbonic anhydrase by diamox were studied in anesthetized cats. During the inhibition, activity of bulbar inspiratory neurons functionally connected with motoneurons of the diaphragm was markedly reduced and that of the neurons connected with motoneurons of intercostal muscles was sharply increased. A steady thoracic respiration occurred. The aferents from the carotid sinus nerve and vagus nerve did not affect the steady thoracic respiration. Increased efferent influence upon the intercostal muscles led to forced thoracic respiration which ensured a high pulmonary ventilation during the whole period of action of the diamox.     

Effects of nasal continuous positive airway pressure on breathing pattern and respiratory drive in patients with obstructive sleep apnea syndrome

To examine the influence of continuous positive airway pressure (CPAP) therapy on respiratory center drive in patients with obstructive sleep apnea syndrome (OSAS), 20 normocapnic OSAS patients (group 0) and 20 simple snoring patients were studied. In the first night, diagnostic polysomnography (PSG) was performed. Before and after PSG monitoring, mouth occlusion pressure (P0.1), tidal volume (VT), minute ventilation (VE), respiratory rate (RR), inspiratory time (Ti), expiratory time (Te), total cycle duration (Ttot), inspiratory duty cycle (Ti/Ttot), mean inspiratory flow (VT/Ti) and effective inspiratory impedance (P0.1/VT/Ti, Ieff) were measured while they were breathing room air. In the following night the OSAS patients were treated with nasal CPAP and PSG monitoring and the above mentioned measurements were repeated. The results showed that pre-PSG values of P0.1, RR and P0.1/VT/Ti in the OSAS patients were significantly higher than those in the snoring patients, while VT, Ti, Te and Ttot values were lower. In the first night, the post-PSG P0.1 value in the OSAS patients increased markedly as compared with the pre-PSG. After overnight nasal CPAP therapy, the respiratory disorder index in the OSAS patients decreased markedly, the nadir SaO2 increased markedly, but the post-PSG P0.1 value did not increase significantly. It is concluded that, before sleep, OSAS patients exhibit a higher respiratory drive and a shallow and frequent breathing pattern as compared with simple snoring patients. After nocturnal sleep, the respiratory drive of OSAS patients increases significantly, the breathing pattern becomes more shallow and frequent. Nasal CPAP may effectively relieve the sleep apnea and hypopnea as well as the resulting hypoxemia and therefore correct the changes in breathing pattern and respiratory drive through nocturnal sleep in patients with OSAS.     

Development of a monoclonal antibody to immuno-cytochemical analysis of the cellular localization of the peripheral benzodiazepine receptor

We measured dorsal hippocampal activity accompanying sighs and apnea using reflectance imaging and electrophysiologic measures in freely behaving cats. Reflected 660-nm light from a 1-mm2 area of CA1 was captured during sighs and apnea at 25 Hz through a coherent image conduit coupled to a charge coupled device camera. Sighs and apnea frequently coincided with state transitions. Thus, state transitions without apnea or sighs were separately assessed to control for state-related activity changes. All dorsal hippocampal sites showed discrete regions of activation and inactivation during transient respiratory events. Imaged hippocampal activity increased 1-3 s before the enhanced inspiratory effort associated with sighs, and before resumption of breathing after apnea. State transitions lacking sighs and apnea did not elicit analogous optical activity patterns. The suprasylvian cortex, a control for site, showed no significant overall reflectance changes during phasic respiratory events, and no discrete regions of activation or inactivation. Spectral estimates of hippocampal electroencephalographic activity from 0-12 Hz showed significantly increased power at 3-4 Hz rhythmical slow activity before sighs and apnea, and increased 5-6 Hz rhythmical slow activity power during apnea, before resumption of breathing. Imaged activity and broadband hippocampal electroencephalogram power decreased during sighs. We propose that increased hippocampal activity before sigh onset and apnea termination indicates a role for the hippocampus in initiating inspiratory effort during transient respiratory events.     

Effects of inspiratory flow waveforms on arterial blood gases and respiratory mechanics after open heart surgery

The clinical usefulness of inspiratory flow pattern manipulation during mechanical ventilation remains unclear. The aim of this study was to investigate the effects of different inspiratory flow waveforms, i.e. constant, sinusoidal and decelerating, on arterial blood gases and respiratory mechanics, in mechanically ventilated patients. Eight patients recovering after open heart surgery for valvular replacement and/or coronary bypass were studied. The ventilator inspiratory flow waveform was changed according to a randomized sequence, keeping constant the other variables of the ventilator settings. We measured arterial blood gases, flow, volume and pressure at the proximal (airway opening pressure (Pao)) and distal (Ptr) ends of the endotracheal tubes before and after 30 min of mechanical ventilation with each inspiratory flow waveform. We computed breathing pattern, respiratory mechanics (pressures and dynamic elastance) and inspiratory work, which was then partitioned into its elastic and resistive components. We found that: 1) arterial oxygen tension (Pa,O2) and arterial carbon dioxide tension (Pa,CO2) were not affected by changes in the inspiratory flow waveform; and 2) peak Pao and Ptr were highest with sinusoidal inspiratory flow, whilst mean Pao and Ptr and total work of breathing were least with constant inspiratory flow, mainly because of a concomitant decrease in resistive work during constant flow inflation. The effects of the inspiratory flow profile on Pao, Ptr and total inspiratory work performed by the ventilator were mainly due to the resistive properties of the endotracheal tubes. We conclude that the ventilator inspiratory flow waveform can influence patients' respiratory mechanics, but has no impact on arterial oxygen and arterial carbon dioxide tension.     

Neuronal mechanisms of respiratory rhythm generation: an approach using in vitro preparation

The respiratory network in the ventrolateral medulla of the brainstem-spinal cord preparation from newborn rat involves pre-inspiratory (Pre-I) neurons, three types of inspiratory (Insp I, II, III) neurons and two types of expiratory (Exp-i, Exp-p-i) neurons as major subtypes, which were classified according to patterns of postsynaptic potentials. The neuronal respiratory-related membrane potential fluctuations of these cells indicate at least four distinguishable phases of the in vitro respiratory cycle: pre-inspiratory, inspiratory, post-inspiratory (E1), and late-expiratory (E2). A current hypothesis for the central pattern generator of respiration proposed by our group is that Pre-I neurons in the rostral ventrolateral medulla, with intrinsic burster properties, produce the primary respiration rhythm. This rhythm triggers an inspiratory pattern generator composed of Insp neurons in the rostral and caudal ventrolateral medulla. Respiratory neurons possess several types of ionic channels which are involved in the generation of rhythm and burst pattern. Particularly, P-type Ca2+ channels and TTX-sensitive persistent Na+ channels are postulated to contribute to the intrinsic burst generation of Pre-I neurons. N-type Ca2+ channels may be involved in the maintenance and termination of inspiratory burst activity via the activation of Ca2(+)-dependent K+ channels. Respiratory neuron networks in this preparation were compared with those of different in vitro preparations, like rhythmic slices or perfused brainstems and of adult mammals in vivo. Many types of synaptic connections among respiratory neurons in adult mammals were also found in the (rostral) ventrolateral medulla of a brainstem-spinal cord preparation from newborn rat. The characteristics of the inspiratory burst pattern and inspiratory off switch mechanisms in newborn rat preparations might be explained by insufficient inhibitory (or excitatory) synaptic inputs to the inspiratory pattern generator due to an immature neuron network and/or deafferentiation.     

Serum DDT and DDE levels in Singapore general population

Stimulation of afferents in the superior laryngeal nerve (SLN) leads to apnea and evokes reflexes in sympathetic neurons. It is not clear whether these reflexes are secondary to changes in the brainstem respiratory network or due directly to the afferent input on neurons belonging to central sympathetic pathways. To clarify this question, single thoracic preganglionic sympathetic neurons projecting into the cervical sympathetic trunk (CST) were classified as described previously and then tested for their responses to electrical stimulation of the superior laryngeal nerve (SLN) in chloralose-anesthetized, paralysed and artificially ventilated cats. SLN stimulation was performed with intensities sufficient to suppress central inspiratory activity detected by phrenic and recurrent laryngeal nerve recordings. Sympathetic neurons were tested under different levels of respiratory drive. Thirteen group I (putative muscle vasoconstrictor) neurons were mostly activated by SLN stimulation when respiratory drive was low, but depressed when it was high; this was due to the change in inspiration-related activity. Ten of eleven group II (putative cutaneous vasoconstrictor) neurons were depressed during SLN stimulation. This inhibition was independent of central respiratory drive. Inhibition also occurred in those neurons which predominantly discharged during postinspiration. Eight group III neurons which showed a discharge confined to inspiration were inhibited but mostly not silenced by SLN stimulation. Group IV (functionally unclassified) neurons either showed no response (n = 5) or were slightly inhibited (n = 2). The responses of group I neurons, but not the responses of group II and group III neurons, showed a significant positive correlation with those of systemic blood pressure. The observed responses corroborate the classification made previously. The results also demonstrate that the responses of sympathetic neurons to SLN stimulation are not merely due to the respiratory modulation of their activity, but rather consist of two components, one occurring independently of and the other secondary to, the changes in respiration.     

Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea

In 11 ventilator-dependent patients, we undertook a head-to-head comparison of patient-ventilator interaction during four ventilator modes: assist-control ventilation (ACV), intermittent mandatory ventilation (IMV), pressure support (PS), and a combination of IMV and PS. Progressive increases in IMV rate and PS level each decreased inspiratory pressure-time product (PTP) (p < 0.0001). These reductions in PTP were greater with PS than with IMV at lower but proportional levels of maximal assistance (p < 0.005). When PS 10 cm H2O was added to a given level of IMV, greater reductions in PTP were achieved not only during intervening (PS) breaths (p < 0.001), but also during mandatory (volume-assisted) breaths (p < 0.0005); this additional unloading during mandatory breaths was proportional to the decrease in respiratory drive (dP/dt) during intervening breaths (r = 0.67, p < 0.0001). Maximal unloading occurred with ACV, achieving more than a fivefold decrease in PTP compared with unassisted breathing. Decreases in PTP were confined to the post-trigger phase, and PTP of the post-trigger phase correlated with dP/dt (r = 0.78, p < 0.0001). Effort during the trigger phase remained constant despite marked changes in drive and intrinsic positive end-expiratory pressure (PEEPi). Ineffective triggering occurred with all modes, and wasted PTP increased with increasing levels of assistance as a result of the accompanying decrease in drive and increase in volume. Breaths preceding nontriggering efforts had shorter respiratory cycle times (p < 0.0005) and expiratory times (p < 0.0001) and higher PEEPi (p < 0.0001), indicating that neural-mechanical asynchrony resulted from inspiratory activity commencing prematurely before elastic recoil pressure had fallen to a level that could be overcome by a patient's muscular effort. Thus, increases in the level of ventilator assistance produced progressive decreases in inspiratory muscle effort and dyspnea,which were accompanied by increases in the rate of ineffective triggering.     

Influence of sleep states on laryngeal and abdominal muscle response to upper airway occlusion in lambs

This study was aimed at describing abdominal and laryngeal muscle responses to upper airway occlusion (UAO) in early life and the effect of sleep states on these responses. Twelve nonsedated, 9-26-d-old lambs were studied. We simultaneously recorded 1) airflow (pneumotachograph + face mask); 2) sleep states (electrocorticogram and electrooculogram); 3) abdominal muscle (external obliquus) electromyogram (EMG); and 4) glottic constrictor (thyroarytenoid) and dilator (posterior cricoarytenoid and cricothyroid) muscle EMGs. The pneumotachograph was repeatedly occluded for 15-30 s in wakefulness and natural sleep. We analyzed 90 occlusions during wakefulness (11 lambs), 28 during non-rapid eye movement (nREM) sleep (six lambs), and 23 during rapid eye movement (REM) sleep (five lambs). A phasic expiratory external obliquus EMG was present during baseline and progressively increased throughout UAO in wakefulness and nREM sleep, but not in REM sleep. Phasic thyroarytenoid EMG progressively increased during inspiratory efforts throughout UAO in wakefulness and nREM sleep, paralleling the increase in glottic dilator (posterior cricoarytenoid and cricothyroid) EMG. In contrast, glottic muscle response to UAO in REM sleep was severely blunted or disorganized by frequent swallowing movements. We conclude that UAO triggers complex and coordinated laryngeal and abdominal muscle responses during wakefulness and nREM sleep in lambs; these responses are largely absent, however, in REM sleep. These unique results, together with the defective arousal response in REM sleep, suggest that vulnerability to airway occlusion could be increased during REM sleep in early life. Possible implications for understanding severe postnatal apneas are discussed.