Variations in the Volume of the Chest With Changes of Posture.

Livingstone, J. L.

doi:10.1016/s0140-6736(00)96838-7

Cited by 16 publications

(3 citation statements)

References 2 publications

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“…The postural changes in functional residual capacity observed here were similar to previous findings (5,6). …”

Section: Discussionsupporting

confidence: 92%

Lung Function Studies. Iv. Postural Changes in Respiratory Dead Space and Functional Residual Capacity 1

Fowler¹

1950

J. Clin. Invest.

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Various observers have noted postural changes in certain lung volumes, such as vital capacity, expiratory reserve and functional residual capacity. Comparative studies of the respiratory dead space in different postures apparently have not been made although the volume of the dead space, as measured by various methods, has been found to vary with the extent of lung inflation. The effect of change in posture upon the respiratory dead space is of interest, since pulmonary efficiency is evaluated clinically using various types of "dead space" measurements in different postures (1-3). The studies reported here indicate that the volume of the respiratory dead space (the volume of inspired gas which does not contribute to dilution of alveolar gas) is greater when the subject is sitting than when supine; these postural changes are associated with similar changes in functional residual capacity. METHODSThe subjects were five healthy male physicians, varying in age from 27 to 35 years. The "estimation" method of measuring respiratory dead space by the use of the Lilly nitrogen and flow meters (4) was used with one change: the calibration of the flow meter was obtained by passing expired gas through it to a recording spirometer so that the actual volume could be related to the area bounded by the flow record and its zero line. Details of the expiratory flow pattern cannot be recorded faithfully by this technique, but the flow tracings are satisfactory for the measurement of dead space.Each subject assumed, in varying order, three positions: (1) sitting in a chair, (2) lying in bed with the head and trunk elevated 45 60°above the bed, (3) supine in bed with one pillow under the head. After he had rested several minutes in a given position, the subject breathed 02 for at least one minute. Respiratory dead space was measured from the records of four successive expirations in each position. The mean values for each subject are given in Table I Changes in functional residual capacity were measured in the same subjects in the same three positions. Subjects rebreathed for an eight to ten minute period into a 6 liter recording Benedict-Roth type spirometer filled with 02 and containing a CO2 absorber. During this time they were placed in the various postures and maintained there until a fairly stable end-expiratory level was evident, usually within about ten breaths. Because a continuous spirometric record was necessary, these changes in position were made rapidly by using a chair with a hinged back. Best straight lines (slopes) were drawn on the record defining end-expiratory level for each position. Thus, if on changing from the sitting to the supine position, the volume of gas in the spirometer increased 800 ml, the volume of the functional residual capacity was considered to have decreased by a similar amount. RESULTSAll subjects had smaller functional residual capacities in the semi-reclining and supine positions than when sitting. The average decreases were respectively 556 and 787 ml.The respiratory dead space in all subje...

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“…The postural changes in functional residual capacity observed here were similar to previous findings (5,6). …”

Section: Discussionsupporting

confidence: 92%

Lung Function Studies. Iv. Postural Changes in Respiratory Dead Space and Functional Residual Capacity 1

Fowler¹

1950

J. Clin. Invest.

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“…If we assume an " average level " half way between the expiratory and inspiratory levels, we can examine the relation of this " average level during quiet breathing" to the highest and lowest levels in maximum expiration and inspiration. As Hofbauer (1921) and Livingstone (1928) have shown, the level of the diaphragm shifts upwards when the position and the patient changes from sitting to lying. This alteration, which is caused by the pressure of the abdominal contents, was confirmed in all our subjects.…”

Section: Resultsmentioning

confidence: 94%

The Influence of Costal and Abdominal Pressure on the Action of the Diaphragm in Normal and Emphysematous Subjects

Herxheimer¹

1948

Thorax

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The use of pressure on the abdomen by an abdominal belt has been advocated by Christie (1933) and by Alexander and Kountz (1934) for the treatment of emphysema. Warner and Doidge (1939) have employed a costal belt for the same purpose. Both kinds of treatment were successfully used in some patients only, and as it is the aim of the treatment to influence the range of the diaphragm it seemed useful to examine this influence in a number of normal and emphysematous subjects. METHODThe level of the diaphragm was determined by its distance from the iliac crests (Warner and Doidge, 1939). The details of this method, which we have used previously for the mreasurement of the diaphragmatic level in emphysema, are described elsewhere (Grossmann and Herxheimer, 1948). In the present experiments the highest and the lowefst level that could be reached by the diaphragm in maximum expiration and inspiration, and also the range of movement during quiet breathing, were measured in the sitting and in the supine positions. The same measuremnents were taken during costal and abdominal pressure. The pressure was applied by a canvas belt 12 cm. in width, which was fastened round the chest with its upper margin in the axillae or round the abdomen. In order to produce sufficient compression a pad was placed underneath the abdominal belt. ment of the oxygen used; a horizontal tracing was thus obtained. The vital capacity was recorded three times in each position and the mean of these three values was taken. The subjects had been trained previously to breathe through mouthpiece and valves; subjects_ who could not reproduce consistently the same vital capacity (within an arbitrary range of 150 ml.) were excluded. Eight medical students (six men and two women), who were in normal health, and thirty-four patients were investigated. Of the latter, sixteen suffered from severe and nine from moderate emphysema; nine others were obese asthmatics. The diagnosis " emphysema " was supported in all cases by a typical history of long-standing cough and incre'asing breathlessness on exercise: congestive failure, tuberculosis, and malignant disease of the chest were excluded. In many cases the typical clinical signs of emphysema were present. The differentiation between severe and moderate emphysema was made according to the disability of the patient. Those who showed breathlessness on moderate exertion-walking at normal speed on even ground-were regarded as severe; those who only showed breathlessness, at increased speed or on the up-grade were regarded as moderate. As a rule in the latter the vital capacity was normal or approximately normal, whilst in the former it was much reduced.A further group includes nine obese asthmatic patients. They were in a subacute asthmatic state, b-ut their history of asthma was comparatively short and did not exceed ten years. It was assumed that some degree of emphysema was present. RESULTSMaximum range of diaphragmatic movement.-The average results for each group of patients are given in Fig.'1. In this figure the ...

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“…IBriscoe (4), froiii careful observations, conicludeed that in this positioln there is a considerable reduction, and that this is affected chiefly by an elevation of the diaphragm, while the lateral and anteroposterior diameters of the chest show very slight increase. Livingstoine (9) in 1928 reported that in normal individuals the capacity of the chest is least in the supine posture, andl that this correspond(ls with a higher level of the (liaphragm and with practically no chanige in the diameters of the thorax.…”

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confidence: 97%

Studies of total pulmonary capacity and its subdivisions. III. Changes with body posture

1933

American Heart Journal

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It has been known for nmany years that the posture of the body has an influenice on pulmonary capacity. More than 25 years ago Bohr (3) andl Plesch (10) found that the residual air increases in the recumbent l)ositioll. Christie and Beams (6) \e have shown in a previous paper (8) that there is a definite correlation between the total capacity and its sulbdivisions andl the size of the chest cavity. It will be interestinig, therefore, to discover whether clhanges in position are also accompanied by similar and(I proportional alterations in size and expansion of the chest. Hamiltoni and -Morgan (7), in a recent communicatioln, reported that in five normiial subjects there was nio chanlge in the volume of resi(lual air in the recumbent position, but they observed a moderate (lecrease in the vital cap)acity, an(l consequenitly a corresponding dimintution in the total capacity when lying was compared with the sitting l)osture. These investigators, nmeasuring the lateral anid anteroposterior

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Variations in the Volume of the Chest With Changes of Posture.

Cited by 16 publications

References 2 publications

Lung Function Studies. Iv. Postural Changes in Respiratory Dead Space and Functional Residual Capacity 1

Lung Function Studies. Iv. Postural Changes in Respiratory Dead Space and Functional Residual Capacity 1

The Influence of Costal and Abdominal Pressure on the Action of the Diaphragm in Normal and Emphysematous Subjects

Studies of total pulmonary capacity and its subdivisions. III. Changes with body posture

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