The effects of CO2 on the components of breathing pattern

Experiments were performed on 12 rabbits in 4 experimental groups: A. breathing spontaneously; B. nonparalysed and ventilated by means of a pump driven by the integrated phrenic nerve activity; C. paralysed and ventilated as mentioned above; D. like in the group C, but subjected to bilateral vagotomy. The relationships were investigated between the chosen basic parameters describing the rhythm and depth of respiration in steady states during exposure to hypercapnic mixtures. A high correlation was found between the amplitude of the integrated phrenic nerve activity and the time of inspiration which is modified by the afferent activities from the lungs and thorax TI and TE seem to be controlled by different mechanisms, and the contribution of TE to the control of the cycle duration is greater than that of TI.     

Temporal variations in the pattern of breathing

Breath-to-breath variations in the pattern of breathing can occur as uncorrelated random variations ("white noise"), correlated random changes, or as one of two types of nonrandom variations: periodic oscillations or nonrandom nonperiodic fluctuations. White noise is probably present in all physiological processes. In many cases, periodic variations are due to oscillations originating in chemoreflex feedback loops. It has long been hypothesized that correlated random variations in breathing pattern are due to central neutral "memory" mechanisms, but part of this behavior might be due to chemoreflex mechanisms. Recently it has been concluded that nonlinear interactions between pulmonary and airway afferent activities and integrative central respiratory mechanisms can produce nonrandom nonperiodic (and also periodic) variability of the respiratory pattern. These latter studies have provided new insights about the behavioral relevance of the integrative character of central respiratory mechanisms and the time-varying nature of pulmonary afferent activities and have emphasized the importance of identifying the physiological bases for these phenomena. These and other findings are interpreted assuming that respiratory rhythm generation/pattern formation occurs via a nonlinear oscillator, and novel inferences concerning temporal variations of the breathing pattern are proposed.     

Thoracoabdominal pattern of breathing in neuromuscular disorders

STUDY OBJECTIVE: To assess abnormalities in thoracoabdominal pattern of breathing (TAPB) in neuromuscular disorders during spontaneous breathing, intermittent positive pressure ventilation (IPPV) with and without abdominal (AB) binder, and immediately after IPPV. DESIGN: Repeated measures design: Pre-IPPV spontaneous breathing, IPPV, IPPV with AB binder, and post-IPPV spontaneous breathing. In protocol 1, ventilator pressure was held constant at the individual value habitually adopted in sessions of IPPV. In protocol 2, it was increased stepwise from 5 to 30 cm H2O. SETTING: University hospital, Department of Pediatrics, Intensive Care, and Neuro-Ventilatory Rehabilitation. PATIENTS: Thirty-one patients with spinal muscular atrophy (SMA) and 19 patients with myopathy, mean age (+/- SD) 9.7 +/- 3 years. MEASUREMENTS: Tidal volume (VT), percent thoracic contribution to VT (%RC), the phase angle between the thoracic and the AB volume changes and the labored breathing index, which is an index of asynchrony taking into account both the phase relationships and relative volumes of rib cage and AB compartments. RESULTS: We observed marked abnormalities in TAPB during spontaneous breathing, especially in the SMA group. %RC, labored breathing index, and phase angle displayed nearly normal values during IPPV. IPPV pressures of 25 to 30 cm H2O were necessary to increase %RC above 80%. AB binding decreased VT, but led to larger thoracic volumes, especially in patients with SMA. Thoracic contribution to VT and thoracic volume after IPPV were higher than baseline levels. CONCLUSIONS: The quantitative assessment of TAPB enhances the ability to estimate pulmonary function in neuromuscular disorders, and the efficiency of mechanical ventilation.     

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.     

The effect of sedation on oxygen uptake during spontaneous breathing

Sedation may be used in intensive care and emergency medicine to improve the oxygen demand/delivery ratio. The influence of sedation has most frequently been investigated in a dose-related manner. The aim of the present study was to determine the effect-related influence of different sedatives on oxygen uptake (VO2) in relation to defined resting conditions. METHODS. Forty ASA I patients who had to undergo a minor surgical procedure were investigated 1.5 h before surgery at basal energy-expenditure measurement conditions. One of the following substances was given with a preset bolus rate in a double-blind, randomised order until a defined level of sleep or side effects was encountered: propofol (n = 8), midazolam (n = 8), thiopentone (n = 8), sodium chloride (n = 8), and fentanyl (n = 8). The sleep level was defined as sluggish response to a loud voice or tapping on the forearm. The variables VO2, carbon dioxide elimination (VCO2), end tidal CO2 (p(et)CO2), oxygen saturation (SaO2), heart rate, systemic blood pressure, skin temperature, and skin resistance on the sole of the foot were documented on-line on a computer. All variables were compared using differences of averages from 10-min periods before and after sedation during which the VO2 was minimal. RESULTS. The mean VO2 before sedation was 264 +/- 60 ml/min, and the measured energy expenditure did differ by -0.2% (+/- 14%) from mean predicted values using the Harris-Benedict equation. The VO2 was reduced by 15 +/- 2% with propofol, by 12 +/- 8% with midazolam, and by 10 +/- 5% with thiopentone. This was statistically significant compared to placebo treatment, as was the difference between propofol and thiopentone effects. All patients in these groups reached the defined sleep level, which was not achieved by the placebo and fentanyl groups. Placebo treatment changed the VO2 by 0.1% (+/- 2%). Fentanyl increased the VO2 by 5% (+/- 8%), which did not reach significance. In the fentanyl group the bolus application had to be stopped at a p(et)CO2 of 50 mm Hg in all patients. In the propofol, midazolam, and thiopentone groups the phasic changes of skin resistance were reduced to zero and the skin temperature increased from 27 +/- 2 degrees C to 32 +/- 2 degrees C. The fentanyl group showed an increase in changes of skin resistance without changes in temperature. CONCLUSIONS. Sleep induced by propofol, midazolam, or thiopentone to a clinically maximal desirable level in spontaneously breathing patients reduced VO2 by 10% to 15%. This level of sedation did not induce a relevant change in P(et)CO2 or SaO2. The effect of propofol appeared to be the most pronounced and least variable. This may be attributable to a more pronounced reduction in single-organ VO2 or to an undetected difference in level of sedation. Fentanyl did, in contrast to most publications on opioid effects, seem to increase VO2. Underlying mechanisms may be sought in an increased rate-pressure product and sympathetic activity on the basis of hypercapnia and changes in muscle tension.     

Genetic control of differential baseline breathing pattern

The purpose of the present study was to determine the genetic control of baseline breathing pattern by examining the mode of inheritance between two inbred murine strains with differential breathing characteristics. Specifically, the rapid, shallow phenotype of the C57BL/6J (B6) strain is consistently distinct from the slow, deep phenotype of the C3H/HeJ (C3) strain. The response distributions of segregant and nonsegregant progeny were compared with the two progenitor strains to determine the mode of inheritance for each ventilatory characteristic. The BXH recombinant inbred (RI) strains derived from the B6 and C3 progenitors were examined to establish strain distribution patterns for each ventilatory trait. To establish the mode of inheritance, baseline breathing frequency (f), tidal volume, and inspiratory time (TI) were measured five times in each of 178 mature male animals from the two progenitor strains and their progeny by using whole body plethysmography. With respect to f and TI, the two progenitor strains were consistently distinct, and segregation analyses of the inheritance pattern suggest that the most parsimonious genetic model for response distributions of f and TI is a two-loci model. In similar experiments conducted on 82 mature male animals from 12 BXH RI strains, each parental phenotype was represented by one or more of the RI strains. Intermediate phenotypes emerged to confirm the likelihood that parental strain differences in f and TI were determined by more than one locus. Taken together, these studies suggest that the phenotypic difference in baseline respiratory timing between male B6 and C3 mice is best explained by a genetic model that considers at least two loci as major determinants.     

The effect of sodium nitrite on the realization of defensive and inhibitory conditioned reflexes

In recent years there has been a strong emphasis from both medical and nonmedical communities to improve overall cardiovascular health. Continued attention has been focused on finding improved treatment regimens, and, encouragingly, increased attention is being directed toward prevention strategies for coronary heart disease. Emphasis on heart-healthy diets, fitness, and the now commonplace free blood pressure and cholesterol screenings have become part of our daily life. Multiple studies have demonstrated that atherosclerosis begins in childhood, and increasingly, the need for prevention to begin during childhood is being highlighted. Preventive cardiology in children, however, has long relied on adult data for definitions of risk factors, study protocols, and norms. Gradually, the pediatric data is becoming available. Elevated cholesterol levels, hypertension, obesity, and other risk factors defined in adults are all areas of intense interest in the pediatric population. This brief review of preventive cardiology in children provides a look at the risk factors for adult coronary heart disease as they relate to children, the current recommendations (and associated controversies), and a summary of some of the most recent clinical trials.     

Neck influences on the spatial properties of vestibulospinal reflexes in decerebrate cats: role of the cerebellar anterior vermis

Ten West African Dwarf (WAD) female goats and twelve Djallonké ewes were artificially infected with a West African strain of Trypanosoma congolense and monitored during 36 weeks over an acute phase (weeks 0-12) and chronic phase (weeks 13-36) to evaluate their haematological and immunological response. Parasitaemia, packed cell volume, red blood cells, haemoglobin, white blood cells and trypanosomal antibodies were assessed. Mean corpuscular volume and mean corpuscular haemoglobin concentration were calculated. The infected animals showed a persistent parasitaemia together with a chronic anaemia and significantly lower packed cell volume, red blood cell count and haemoglobin. The infected sheep developed a macrocytic, hypochromic anaemia during the acute phase changing to normocytic, hypochromic during the chronic phase, whereas, the infected goats developed a normocytic, normochromic anaemia during the acute phase and normocytic, hypochromic during the chronic phase. A significant increase in WBC counts was observed only in the infected sheep during the chronic phase. Trypanosomal antibody titres were significantly higher in the infected sheep than in the infected goats. Both species are regarded as trypanotolerant but Djallonké sheep mount a better haematopoietic and immunological response to infection with T. congolense than WAD goats.     

The effect of limb movements on the regulation of depth and rate of breathing

The mature annelid cuticle contains orthogonally oriented collagen in a matrix capped superficially by a dense epicuticle with external corpuscles. The underlying epidermis is a simple columnar epithelium with two major cell types, mucous-secreting cells which secrete through channels in the cuticle to the exterior of the worm, and "supportive" cells which presumably produce and increase the cuticle by secreting into it. The structures of supportive cells, previously interpreted as specialized for establishing interfibrillar collagen order, are revealed by glutaraldehyde fixation as common cellular components without the qualities deemed useful to align collagen. Cell processes which penetrate and sometimes pass completely through the cuticle are not stable, not in geometric order, and lack cilia-like structure. Cilia, unlike the ubiquitous cellular processes, are highly restricted to regions of the epidermis with specialized functions. Cellular control, or other control, of collagen fibrillogenesis remains unestablished.     

Grooming reflexes and Brown-Séquard epilepsy in cats with pontile lesions.

The literature on the relation between the scratch reflex and Brown-Séquard epilepsy in the guinea pig indicates that the scratch reflex is a stimulus-induced myoclonus that is the 1st component of a complete seizure. In the present experiment, with 26 male cats, Ss with pontile or frontal neocortical lesions exhibited the scratch reflex and other grooming reflexes. The grooming reflexes in Ss with pontile lesions developed over a period of a year or more into complete seizures that were similar to Brown-Séquard epilepsy. Cinematographic analyses revealed that the scratch reflex in Ss with pontile or frontal neocortical lesions had the same frequency and the same complex spatial and temporal pattern as normal scratching behavior. The myoclonus of the complete seizures was identified as the scratch reflex, representing a vigorous and long-lasting afterdischarge. Reconstructions of the pontile lesions indicated that the lateral and rostral portions of the paralemniscal tegmental fields were destroyed along with portions of the pontile gray and pyramidal tract. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of low flow oxygen on sleep-disordered breathing and oxygen desaturation. A study of patients with chronic obstructive lung disease

Oxygen desaturation occurs during sleep in many patients with chronic obstructive lung disease (COLD) and is often caused by sleep-disordered breathing (SDB). Nocturnal oxygen therapy should improve nighttime hypoxemia, but might also worsen SDB. Using standard polysomnographic techniques, we evaluated the frequency and duration of oxygen desaturation and SDB during sleep in 11 patients with stable COLD. During half of the night the patients breathed air through a nasal cannula and during the other half of the night they breathed oxygen at 2 liters per minute. Five patients had arterial lines inserted for determination of arterial blood gas levels during periods of SDB or desaturation. The ten men and one woman slept 70 minutes (52 percent of time in bed) while on air and 111 minutes (80 percent of time in bed) while on oxygen (p < 0.001). Oxygen therapy reduced the number of episodes of desaturation per hour and the time spent in desaturation. However, there was no difference between air and oxygen in episodes of SDB per hour, the duration of episodes of SDB, baseline sleeping PaCO2 or PaCO2 during episodes of desaturation or SDB. Therefore, in most patients with stable COLD, administration of oxygen at 2 liters per minute improves oxygenation, prolongs sleep, but does not adversely affect SDB.     

The effect of temperature on the pattern of torpor in a marsupial hibernator

The feeling that life has had no meaning is an impediment to a peaceful death. Life review enables a person to identify events that have been of worth and so enhances self-esteem. This approach has been extended and formalized by establishing a biographer service to compile oral and written biographies of patients who may be expected to benefit from such a re-examination of their lives. The service is now also being offered to patients whose disability precludes most other forms of activity. The value of biography as therapy is considered and it is concluded that it has much to offer in the circumstances described.     

Dynamics of lung collapse and recruitment during prolonged breathing in porcine lung injury

Oleic acid (OA) injection, lung lavage, and endotoxin infusion are three commonly used methods to induce experimental lung injury. The dynamics of lung collapse and recruitment in these models have not been studied, although knowledge of this is desirable to establish ventilatory techniques that keep the lungs open. We measured lung density by computed tomography during breath-holding procedures. Lung injury was induced with OA, lung lavage, or endotoxin in groups of six mechanically ventilated pigs. After a stabilization period, repetitive computed tomography scans of the same slice were obtained during prolonged expirations with and without positive end-expiratory pressure and during prolonged inspirations after 5 and 30 s of expiration. Lung collapse and recruitment occurred mainly within the first 4 s of breath-holding procedures in all three lung injury models, and some collapse and recruitment occurred even within 0.6 s. OA-injured lungs were significantly more unstable than lungs injured by bronchoalveolar lavage or endotoxin infusion. In this experimental setting, expiration times <0.6 s are required to avoid cyclic alveolar collapse during mechanical ventilation without extrinsic positive end-expiratory pressure.     

Effects of negative pressure assisted ventilation on dyspnoeic sensation and breathing pattern

Although negative pressure assisted ventilation with an assist-control mode may have a potential therapeutic role in the treatment of severe dyspnoea, the effects of negative pressure assisted ventilation with the assist-control mode on dyspnoea and breathing patterns have not been examined. We examined the effects of negative pressure assisted ventilation with the assist-control mode on dyspnoea and breathing patterns produced by a combination of resistive loading and hypercapnia in nine healthy subjects breathing spontaneously. Subjects were asked to rate their sensation of respiratory discomfort using a visual analogue scale. Negative pressure assisted ventilation caused a significant reduction in sensation of respiratory discomfort from a visual analogue scale score of 74 (55-91) (median (range)) before negative pressure assisted ventilation to 34 (15-53) during negative pressure assisted ventilation (p<0.01). During negative pressure assisted ventilation, there were significant changes in breathing patterns characterized by an increase in tidal volume and a decrease in respiratory frequency, while neither minute ventilation nor end-tidal carbon dioxide tension changed. Our results indicate that negative pressure assisted ventilation with the assist-control mode is effective in relief of dyspnoea and that negative pressure assisted ventilation influences the control of breathing to minimize respiratory discomfort.     

Effects of body temperature on ventilatory response to hypoxia and breathing pattern in man

The ventilatory response to hypoxia (PAO2 55 and 45 Torr) at each of four levels of PACO2 was studied in five healthy subjects before and after a rise in rectal temperature of 1.4 degrees C had been induced by means of a heated flying suit. At a given level of chemical drive both ventilation and mean inspiratory flow increased after heating, frequency relatively more than tidal volume. In isoventilation comparisons mean inspiratory flow was identical in normo- and hyperthermia, whereas the durations of inspiration (TI) and expiration (TE) were proportionately shortened. It is suggested that a rise in temperature shortens TI by affecting a central "clock" and that TE changes are secondary to changes in end-inspiratory volume. The euoxic CO2 response in hyperthermia was suggestive of multiplication between CO2 and temperature. Hypoxic sensitivity was significantly increased, indicating a temperature effect on the arterial chemoreceptors. The breathing pattern was in either temperature condition identical in euoxia and in hypoxia.     

The effect of the anticipatory startle pattern on aiming a rifle.

"Photographic apparatus previously found not to affect marksmanship was used to investigate the anticipatory startle pattern. Records were taken of nine men firing eight live rounds, eight times with an empty firing chamber and eight blank rounds… . The results… suggest that the anticipatory startle pattern did not seriously affect the marksmanship of the subjects used." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of electrical stimulation on colonic transit following spinal cord injury in cats

The distribution of type I collagen, the major component of human dermis, was characterized by immunohistochemistry in skin lesions of chromoblastomycosis, a chronic cutaneous mycosis, before and after a specific antifungal treatment with terbinafine to study the changes induced in the lesions by the treatment. Newly synthesized type I collagen was studied with an antibody directed against the aminoterminal propeptide of the molecule (PINP), whereas mature, cross-linked type I collagen was detected with an antibody against the carboxyterminal telopeptide of type I collagen (ICTP). The isopeptide N epsilon gamma-glutamyl lysine (N epsilon gamma GL), synthesized by transglutaminase and able to cross-link several components of the extracellular matrix, has also been investigated with two monoclonal antibodies to determine if it is involved in the stabilisation of the fibrotic cutaneous lesions. The degradative process involved in the remodelling has also been assessed by immunohistochemistry with anti-metalloproteinase (MMP-1 and MMP-9) and anti-tissue inhibitor (TIMP-1) antibodies. All tissue macrophages stained for CD68 and MMP-9, but not for MMP-1, while the polymorphonuclear neutrophils had an elastase and a weak MMP-9 phenotype. The fibroblasts of fibrotic areas stained constantly for N epsilon gamma GL and PINP. The immunostaining of extracellular matrix for ICTP and N epsilon gamma GL, and the number of PINP-positive fibroblasts, decreased significantly after one year of antifungal treatment. Terbinafine treatment decreases the synthesis of type I collagen and leads to a partial reversal of the cutaneous fibrotic lesions, independently of the cure of the fungal infection.     

The pattern and effect of on call work in transplant coordinators in the United Kingdom

About 75 transplant coordinators are employed in the United Kingdom to ensure the process of organ donation to transplantation. Seventy six per cent of coordinators are drawn from the nursing profession. The participation of coordinators in on call rotas allows service provision to be maintained throughout the 24 hour period. The precise pattern of work and effect on participating individuals of this round the clock service provision have not been previously described. This study aimed to establish the existing pattern of on call rotas and to explore the effects, on health and performance, as perceived by coordinators. The findings revealed that 11% (n = 6) of coordinators were working 1 in 1 rotas and a further 6% (n = 3) a virtual 1 in 1. Where 1 in 2 and 1 in 3 rotas were reported this was at best as respondents also routinely covered a colleagues absence. The main effects of on call work were identified as fatigue and a reduction in performance-occasionally in 79% (n = 42) and frequently in 11% (n = 6) of cases. Findings related to sleep difficulties, meal regularity and quality of off call time suggest a potential for compromised health. These data provide a grounding of knowledge into the effect on health and performance of on call work, in this group of health service workers, warranting further investigation. It is recommended that the frequency of on call work should not exceed 1 in 3 with prospective holiday cover and that options such as a partial shift system and locum cover should be considered.