The American review of respiratory disease
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Am. Rev. Respir. Dis. · Apr 1987
Randomized Controlled Trial Comparative Study Clinical TrialRespiratory stimulants and sleep periodic breathing at high altitude. Almitrine versus acetazolamide.
We studied the effects of almitrine, acetazolamide, and placebo on the hypoxic ventilatory response (HVR), sleep periodic breathing, and arterial oxygen saturation (SaO2) in 4 healthy climbers. In a laboratory on Denali (Mt. McKinley) at 4,400 m (PB = 440 mm Hg), we used a double-blind, randomized, three-way crossover design. ⋯ The HVR (delta VE/delta SaO2%) was doubled with almitrine (p less than 0.05), but unchanged with acetazolamide. The HVR was positively related to periodic breathing (p less than 0.05). We conclude that periodic breathing during sleep at high altitude is related to the hypoxic ventilatory response, and that acetazolamide is a superior agent to almitrine for ameliorating periodic breathing.
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Am. Rev. Respir. Dis. · Apr 1987
Comparative StudyChronic exposure to sulfur dioxide. Physiologic and histologic evaluation of dogs exposed to 50 or 15 ppm.
Seven adult mongrel dogs were exposed to SO2 gas at 2 different concentrations (15 and 50 ppm) on a daily basis for 5 to 11 months. Mucous hypersecretion and airway obstruction (a sustained increase in pulmonary resistance) developed in 4 dogs exposed to 50 ppm SO2. Histologic examination of the dogs' airways demonstrated epithelial thickening and an increase in size of the mucous glands. ⋯ In the present study, with a lower exposure level to SO2 (50 versus 200 ppm), we found similar histologic findings associated with airway obstruction, but in the absence of airway inflammation, responsiveness to inhaled bronchoconstrictors was unchanged. This supports the theory that chronic airway inflammation may be associated with decreased responsiveness to inhaled bronchoconstrictors. This contrasts with the hyperresponsiveness induced by acute exposure to irritant gases noted by others.
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Am. Rev. Respir. Dis. · Mar 1987
Bronchoalveolar lavage does not alter airway responsiveness in asthmatic subjects.
Bronchoalveolar lavage (BAL) during fiberoptic bronchoscopy is being used increasingly for the investigation of asthma. Airway responsiveness to methacholine is a sensitive indicator of the presence and severity of asthma. Therefore, we studied the effect of BAL on methacholine airway responsiveness in stable asthmatics. ⋯ These symptoms were rapidly relieved by inhaled bronchodilator. There was no relationship between the occurrence of symptoms and the amount of topical lidocaine used for local anaesthesia or the volume of lavage fluid returned. The absence of an effect of BAL on airway responsiveness supports the safety of this procedure in the controlled asthmatic patient with near normal FEV1, irrespective of the level of baseline airway responsiveness.
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Am. Rev. Respir. Dis. · Mar 1987
The prone position improves arterial oxygenation and reduces shunt in oleic-acid-induced acute lung injury.
The arterial oxygen tension (PaO2) may increase when patients with the adult respiratory distress syndrome are turned from supine to prone. We sought to reproduce this observation in dogs with acute lung injury to study the physiologic mechanism by which the improvement in oxygenation might occur. Twenty anesthetized dogs were ventilated with a constant tidal volume (20 ml/kg) of 100% oxygen. ⋯ Dogs in Groups I and II were then turned supine or prone every 30 min 5 times. Cardiac output and pulmonary vascular pressures, functional residual capacity (helium dilution), and regional diaphragmatic motion (determined by dorsal and ventral diaphragmatic markers relative to markers on the chest wall seen on lateral chest radiographs taken at FRC and at end-inspiration) were obtained in each position. Eleven dogs were kept supine (Group III, n = 6) or prone (Group IV, n = 5) for 2 h after oleic acid infusion, after which intrapulmonary shunt (Qs/QT) and ventilation-perfusion heterogeneity were measured in the supine and prone positions using the multiple inert gas elimination technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am. Rev. Respir. Dis. · Feb 1987
Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study.
We explored the pulmonary effects of continuous mechanical ventilation (MV) at a peak inspiratory pressure of 50 cm H2O in healthy, paralyzed, and anesthetized adult sheep during a period of 48 h. The 9 control sheep (Group A) were ventilated with 40% oxygen at a tidal volume of about 10 ml/kg and a peak inspiratory pressure of 15 to 20 cm H2O. All these animals remained stable throughout the 48 h of MV with no change in lung function. ⋯ All sheep in Group B developed severe respiratory failure and died or were killed within 2 to 35 h, and showed parenchymal consolidation at autopsy. The 9 sheep in Group C were ventilated as in Group B, except that 3.8% CO2 was added to the inspired gases: the Group C animals deteriorated more slowly, with little change in PaO2 but with a severely reduced FRC, VT, total static lung compliance, and grossly abnormal lungs at autopsy. We conclude that in this model, mechanical ventilation at peak airway pressure of 50 cm H2O will lead to progressive impairment in pulmonary mechanics, lung function, acute respiratory failure, and alveolar cellular dysfunction, as demonstrated by highly abnormal minimal surface tension values of saline lung lavage fluid in both study groups.