Forty years of closing volume

Drummond, Gordon B.; Milic–Emili, J.

doi:10.1093/bja/aem330

Cited by 12 publications

(5 citation statements)

References 36 publications

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“…It generally occurs in small airways near the end of expiration. The lung volume at which closure initiates is called the closing volume, a routine pulmonary function test which varies with disease, age, and gender [10,11]. For an upright lung in gravity, the lower regions have compressed airway diameters from the weight of the lung above, so closure tends to occur there initially.…”

Section: Introductionmentioning

confidence: 99%

Liquid plug formation in an airway closure model

et al. 2019

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Section: Introductionmentioning

confidence: 99%

Liquid plug formation in an airway closure model

et al. 2019

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“…An additional decrease (0.4−0.5 L) is observed upon anesthesia induction [36]. As atelectasis progresses, the volume at which the small airways close at end-expiration, the closing volume, increases above the FRC [90] (Fig. 2 in [36]) and reduces the area available for O 2 diffusion at end-expiration (small airway closure).…”

Section: Diffuse Vs Focal Ardsmentioning

confidence: 99%

“…2 in [36]) and reduces the area available for O 2 diffusion at end-expiration (small airway closure). A supine position, obesity, aging, pregnancy, abdominal surgery and heart failure worsen the possibility of the closing volume increasing above the FRC [90]. A functional ventilation-perfusion mismatch (Fig.…”

Section: Diffuse Vs Focal Ardsmentioning

confidence: 99%

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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Severe acute respiratory distress syndrome (ARDS, PaO 2 /FiO 2 < 100 on PEEP ≥ 5 cm H 2 O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set £ 6 mL kg -1 , the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic. This implies that the management of the ventilator may be a life-saver by reducing the duration of mechanical ventilation, or detrimental by extending this duration, leading into critical care-acquired diseases. Indeed, a high PEEP (10−24 cm H 2 O) appears to be a life-saver in the context of early severe diffuse ARDS; c) tidal volume and plateau pressure cannot be identical for all patients; d) the only remaining rationale for CMV and muscle relaxation is to suppress patient-ventilator asynchrony and to lower VO 2 , during the acute cardio-ventilatory distress. Therefore, in early severe diffuse ARDS, this review argues for a combination of a high PEEP (preferably titrated on transpulmonary pressure) with spontaneous ventilation + pressure support (or newer modes of ventilation). However, conditionalities are stringent: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone. As these propositions require evidence-based demonstration, the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation, and prone position.

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“…The volume at which phase IV begins is termed closing volume, and reflects small airways abnormalities. Despite being an easily performed and sensible technique [40], it suffered from poor reproducibility and predictability in the past [41]. This is no longer a limitation; sbN 2 has been employed in studies specifically addressing the relationship between asthma severity and small airways dysfunction [42].…”

Section: Functional Assessment Of Peripheral Airwaysmentioning

confidence: 99%

Assessing and accessing the small airways; implications for asthma management

Scichilone

Contoli

Paleari

et al. 2013

Pulmonary Pharmacology & Therapeutics

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a b s t r a c tDespite the wealth of experience in the management of asthma, the disease remains inadequately controlled in some patients, who face long-term respiratory impairment and disability. The disease has been characterised as an inflammatory condition affecting first the larger airways and eventually the smaller airways, but there is evidence that peripheral airway involvement defines a particular and more severe phenotype of asthma. For this reason, assessing functional and biological parameters reflective of small airways involvement is important prognostically. No assessment method is universally and directly representative of peripheral airway function, but the traditional spirometric tests, including vital capacity, residual volume and forced vital capacity, are somewhat correlated with this function; useful methods for further assessment include the single-breath nitrogen wash-out test, impulse oscillometry, nitrous oxide and exhaled breath concentrate measurements, as well as computed tomography to reflect air trapping and response to treatment. Formulation advancements have made for easier treatment access to the smaller airways, with the new extrafine formulations resulting in better asthma control compared with non-extrafine formulations.

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Forty years of closing volume

Abstract: The fundamental features of 'airway closure' were described in a landmark paper by Dollfuss and colleagues,

Cited by 12 publications

References 36 publications

Liquid plug formation in an airway closure model

Liquid plug formation in an airway closure model

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Assessing and accessing the small airways; implications for asthma management

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