Closing Capacity and Gas Exchange in Chronic Heart Failure

Torchio, Roberto; Gulotta, Carlo; P, Greco-Lucchina; Perboni, Alberto; Montagna, Laura; Guglielmo, Marco; Milic–Emili, J.

doi:10.1378/chest.129.5.1330

Cited by 36 publications

(30 citation statements)

References 28 publications

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“…The vital capacity SBW maneuver is also regularly used to simply determine the closing volume (or closing capacity) as a measure of small airways closure, which can also have a preferential topographical distribution. Closing volume or closing capacity has mostly been used to study the effect of inhaled or systemic asthma therapy [28,37,88,89,90,91], but also to characterize asthma and COPD patients [33,77,79] and to look for links with peripheral inflammation [83,85], or as a measure of peripheral airway abnormality in patients with chronic heart failure [92]. …”

Section: Washout Testsmentioning

confidence: 99%

Physiological Measurement of the Small Airways

Verbanck¹

2012

Respiration

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Noninvasive physiological measurements are reviewed that have been reported in the literature with the specific aim being to study the small airways in lung disease. This has mostly involved at-the-mouth noninvasive measurement of flow, pressure or inert gas concentration, with the intent of deriving one or more indices that are representative of small airway structure and function. While these measurements have remained relatively low-tech, the effort and sophistication increasingly reside with the interpretation of such indices. When aspiring to derive information at the mouth about structural and mechanical processes occurring several airway generations away in a complex cyclically changing cul-de-sac structure, conceptual or semi-quantitative lung models can be valuable. Two assumptions that are central to small airway structure-function measurement are that of an average airway change at a given peripheral lung generation and of a parallel heterogeneity in airway changes. While these are complementary pieces of information, they can affect certain small airways tests in confounding ways. We critically analyzed the various small airway tests under review, while contending that negative outcomes of these tests are probably a true reflection of the fact that no change occurred in the small airways. Utmost care has been taken to not favor one technique over another, given that most current small airways tests still have room for improvement in terms of rendering their content more specific to the small airways. One way to achieve this could consist of the coupling of signals collected at the mouth to spatial information gathered from imaging in the same patient.

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Section: Washout Testsmentioning

confidence: 99%

Physiological Measurement of the Small Airways

Verbanck¹

2012

Respiration

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“…One major factor involved in the development of tidal EFL in the supine position is the reduction in lung recoil secondary to the decrease in lung volume that occurs because of the expiratory action of the abdomen and shift of blood into the thoracic cavity. The changes in ERV occurring in the present patients should closely reflect those in functional residual capacity, since changes in residual volume between the upright posture and recumbency are very small in normal subjects, and the residual volume in seated CHF patients is within normal limits [17,20]. In stable CHF patients, the ERV can be reduced even in the sitting position (table 1), presumably because of the increased volume of the heart, blood vessels and pulmonary interstitium [2,13].…”

Section: Tidal Flow Limitationmentioning

confidence: 50%

“…Several studies on CHF patients have documented a restrictive pattern of pulmonary impairment [2,13], caused by an increase in vascular or interstitial lung water [14,15], heart enlargement [13,16] and a decrease in the force of the inspiratory muscles [17].…”

Section: Patient Populationmentioning

confidence: 99%

“…The MMRC score also correlated closely with IC (p50.006). A reduction in IC can reflect an increase in functional residual capacity due to loss of lung recoil, as in COPD patients [5], or a decrease in TLC because of an increased volume of nonpulmonary intrathoracic structures, as in CHF patients [17]. It may be speculated that, in the latter case, the volume of the chest wall could even be increased, depending on the combined effect of the volumetric increase in nonpulmonary intrathoracic structures and the decrease in lung compliance.…”

Section: Patient Populationmentioning

confidence: 99%

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Effect of heliox breathing on flow limitation in chronic heart failure patients

Pecchiari¹,

Anagnostakos²,

D’Angelo³

et al. 2009

Eur Respir J

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Patients with chronic heart failure (CHF) exhibit orthopnoea and tidal expiratory flow limitation in the supine position. It is not known whether the flow-limiting segment occurs in the peripheral or central part of the tracheobronchial tree. The location of the flow-limiting segment can be inferred from the effects of heliox (80% helium/20% oxygen) administration. If maximal expiratory flow increases with this low-density mixture, the choke point should be located in the central airways, where the wave-speed mechanism dominates. If the choke point were located in the peripheral airways, where maximal flow is limited by a viscous mechanism, heliox should have no effect on flow limitation and dynamic hyperinflation.Tidal expiratory flow limitation, dynamic hyperinflation and breathing pattern were assessed in 14 stable CHF patients during air and heliox breathing at rest in the sitting and supine position.No patient was flow-limited in the sitting position. In the supine posture, eight patients exhibited tidal expiratory flow limitation on air. Heliox had no effect on flow limitation and dynamic hyperinflation and only minor effects on the breathing pattern.The lack of density dependence of maximal expiratory flow implies that, in CHF patients, the choke point is located in the peripheral airways.

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“…Such conditions could occur if airway closure were to occur during tidal breathing, in other words when closing capacity was greater than functional residual capacity, as might occur in the supine position, in pregnancy, 12 obesity, 13 with ageing, 14 voluntary reduction of lung volume, 15 after abdominal surgery, 16 and in heart failure. 17 Later, the direct evidence of airway closure reinforced the initial deductions. Since oxygenation is impaired during anaesthesia, and studies had been published about that time showing how FRC was reduced by anaesthesia, the relationship between CV and impaired oxygenation during anaesthesia was also studied.…”

mentioning

confidence: 90%