Inspiratory Occluded Airway Pressure

  • R. Fernandez
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 13)

Abstract

Respiration, as a physiological phenomenon, consists of a series of interconnected organs related in a bi-directional form. Centering our attention on the regulation of ventilation, the primary role of the bulbar respiratory center is noteworthy. This center is constituted by a neuronal clump situated in the medulla oblongata, the axons of which stimulate motor neurons of the anterior spinal horn through long descending pathways. The motor neurons control the contraction of the respiratory muscles producing the entrance of air into the lungs. In this elemental scheme, impulses originating from the cerebral cortex, protuberance and chemoreceptors act as regulatory elements in response to changes in arterial temperature, pH, PO2 and PCO2 [1, 2].

Keywords

Fatigue Obesity Depression Helium Respiration 

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References

  1. 1.
    Cotes JE (1975) Lung function, 4th edn. Blackwell, OxfordGoogle Scholar
  2. 2.
    Younes M, Memmers J (1981) Control of tidal volume and respiratory frequency. In: Hornbein Th (ed) Regulation of breathing. Dekker, New York, pp 621–671Google Scholar
  3. 3.
    Tobin M (1988) Respiratory monitoring in the intensive care unit. State of the art. Am Rev Respir Dis 138: 1625–1642PubMedGoogle Scholar
  4. 4.
    Freedman S, Campbell EJM (1970) The ability of normal subjects to tolerate added inspiratory loads. Respir Physiol 10: 213–235PubMedCrossRefGoogle Scholar
  5. 5.
    Milic-Emili J, Whitelaw W, Grassino A (1981) Measurement and testing of respiratory drive. In: Hornbein Th (ed) Regulation of breathing. Dekker, New York, pp 675–743Google Scholar
  6. 6.
    Rochester DF, Arora NS (1983) Respiratory muscle failure. Med Clin North Am 67: 573–597PubMedGoogle Scholar
  7. 7.
    Dantzker D, Tobin M (1985) Monitoring respiratory muscle function. Respir Care 30: 422–431Google Scholar
  8. 8.
    Black LF, Hyatt RE (1968) Maximal respiratory pressures: normal values and relationships to age and sex. Am Rev Respir Dis 99: 696–702Google Scholar
  9. 9.
    Marini J, Smith Th, Lamb V (1986) Estimation of inspiratory muscle strength in mechanically ventilated patients: the measurement of maximal inspiratory pressure. J CritCare 1: 32–38Google Scholar
  10. 10.
    Black LF, Hyatt RE (1971) Maximal static respiratory pressure in generalized neuromuscular disease. Am Rev Respir Dis 103: 641–650PubMedGoogle Scholar
  11. 11.
    Martin L, Chalmers I, Dhingra S, McCarthy D, Hunter Th (1985) Measurements of maximum respiratory pressures in polymyositis and dermatomyositis. J Rheumatol 12: 104–107PubMedGoogle Scholar
  12. 12.
    Laroche C, Hawkins P, Walport M, Turner-Warwick M, Green M (1988) Diaphragm weakness does not explain the shrinking lung syndrome of systemic lupus erythematosus. Am Rev Respir Dis 137: A69Google Scholar
  13. 13.
    Mier A, Green M (1988) Respiratory muscle weakness associated with cerebellar atrophy. Am Rev Respir Dis 137: 673–677Google Scholar
  14. 14.
    Siafakas N, Salesiotou B, Filaditaki B, Andreopoulos K, Tzavara J, Thalassinos N (1988) Respiratory muscle strength in hyperthyroidism before and after treatment. Am Rev Respir Dis 137: A71Google Scholar
  15. 15.
    Lisboa C, Pare P, Pertuze J, et al (1988) Inspiratory muscle function in unilateral diaphragmatic paralysis. Am Rev Respir Dis 134: 488–492Google Scholar
  16. 16.
    Mier A, Brophy C, Moxham J, Green M (1988) Assessment of diaphragm weakness. Am Rev Respir Dis 137: 877–883Google Scholar
  17. 17.
    Wilson D, Rogers R, Hoffman R (1985) Nutrition and chronic lung disease: state of the art. Am Rev Respir Dis 132: 1347–1365PubMedGoogle Scholar
  18. 18.
    Sahn SA, Lakshminarayan S (1973) Bedside criteria for discontinuation of mechanical ventilation. Chest 63: 1002–1005PubMedCrossRefGoogle Scholar
  19. 19.
    Tahvanainen J, Salenpera M, Nikki P (1983) Extubation criteria after weaning from intermittent mandatory ventilation and continuous positive airway pressure. Crit Care Med 11: 702–707PubMedCrossRefGoogle Scholar
  20. 20.
    Maeda H, Nakahara K, Ohno K, Kido T, Ikeda M, Kawashima Y (1988) Diaphragm function after pulmonary resection. Am Rev Respir Dis 137: 678–681PubMedGoogle Scholar
  21. 21.
    Smith Th, Marini J (1988) Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction. J Appl Physiol 65: 1488–1499Google Scholar
  22. 22.
    Howell S, Fitzgerald R, Roussos Ch (1985) Effects of aminophylline, isoproterenol, and neostigmine on hypercapnic depression of diaphragmatic contractility. Am Rev Respir Dis 132: 241–247PubMedGoogle Scholar
  23. 23.
    Mucciardi N, Muspratt J, Miller M (1988) Propranolol and inspiratory muscle performance in normal subjects. J Clin Pharmacol 28: 625–633PubMedGoogle Scholar
  24. 24.
    Supinski G, Levin S, Kelsen K (1986) Caffeine effect on respiratory muscle endurance and sense of effort during loaded breathing. J Appl Physiol 60: 2040–2047PubMedGoogle Scholar
  25. 25.
    Lewis M, Belman M, Dorr-Uyemura L (1987) Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135: 1062–1068PubMedGoogle Scholar
  26. 26.
    Efthimiou J, Gomes F, Spiro S (1988) The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 137: 1075–1082PubMedGoogle Scholar
  27. 27.
    Capps J, Hicks G (1987) Monitoring non-gas respiratory variables during mechanical ventilation. Respir Care 32: 558–571Google Scholar
  28. 28.
    Martyn J, Moreno R, Pare P, Pardy R (1987) Measurement of inspiratory muscle performance with incremental threshold loading. Am Rev Respir Dis 135: 919–923PubMedGoogle Scholar
  29. 29.
    Supinski G, Clary S, Bark H, Kelsen S (1987) Effect of inspiratory muscle fatigue on perception of effort during loaded breathing. J Appl Physiol 62: 300–307PubMedGoogle Scholar
  30. 30.
    Aldrich Th, Arora N, Rochester D (1982) The influence of airway obstruction and respiratory muscle strength on maximal voluntary ventilation in lung disease. Am Rev Respir Dis 126: 195–199PubMedGoogle Scholar
  31. 31.
    Arora N, Rochester D (1982) Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir 126: 5–8Google Scholar
  32. 32.
    Leblanc P, Bowie D, Summers E, Jones N, Killian K (1986) Breathlessness and exercise in patients with cardiorespiratory disease. Am Rev Respir Dis 133: 21–25PubMedGoogle Scholar
  33. 33.
    Whitelaw W, Derenne JP, Milic-Emili J (1975) Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol 23: 181–199PubMedCrossRefGoogle Scholar
  34. 34.
    Milic-Emili J (1982) Recent advances in clinical assessment of control of breathing. Lung 160: 1–17CrossRefGoogle Scholar
  35. 35.
    Baydur A, Behrakis P, Zin W, Jaeger M, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126: 788–791PubMedGoogle Scholar
  36. 36.
    Roussos Ch (1985) Energetics. In: Roussos Ch, Macklem P (eds) The thorax. Dekker, New York, pp 437–492Google Scholar
  37. 37.
    Aubier M, Murciano D, Fournier M, Milic-Emili J, Pariente R, Derenne JP (1980) Central respiratory drive in acute respiratory failure of patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 122: 191–199PubMedGoogle Scholar
  38. 38.
    Kryger M, McCullaugh E, Weils A (1976) Aspects of technique which affect precision in mouth occlusion pressure measurement. Am Rev Respir Dis 113: 246–247Google Scholar
  39. 39.
    Montserrat JM, Picado C, Canet J, Casan P, Sanchis J (1987) Presión de oclusión. Formas de medición. Arch Bronconeumol 23: 285–288Google Scholar
  40. 40.
    Fernández R, Benito S, Sanchis J, Milic-Emili J, Net A (1988) Inspiratory effort and occlusion pressure in triggered mechanical ventilation. Intensive Care Med 14: 650–653PubMedGoogle Scholar
  41. 41.
    Dimarco A, Kelsen S, Cherniack N, Gothe B (1983) Occlusion pressure and breathing pattern in patients with interstitial lung disease. Am Rev Respir Dis 127: 425–430PubMedGoogle Scholar
  42. 42.
    Sampson M, Grassino A (1983) Load compensation in obese patients during quiet tidal breathing. J Appl Physiol 55: 1269–1276PubMedGoogle Scholar
  43. 43.
    Tobin M, Perez W, Guenther S, et al (1986) The pattern of breathing during successful trials of weaning from mechanical ventilation. Am Rev Respir Dis 134: 1111–1118PubMedGoogle Scholar
  44. 44.
    Sassoon C, Te T, Mahutte C, Light R (1987) Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135: 107–113PubMedGoogle Scholar
  45. 45.
    Herrera M, Blasco J, Venegas J, Barba R, Doblas A, Marquez E (1985) Mouth occlusion pressure (PO.l) in acute respiratory failure. Intensive Care Med 11: 134–139PubMedCrossRefGoogle Scholar
  46. 46.
    Montgomery A, Holle R, Neagley S, Pierson D, Schoene R (1987) Prediction of successful ventilator weaning using airway occlusion pressure and hypercapnic challenge. Chest 91: 496–499PubMedCrossRefGoogle Scholar
  47. 47.
    Pugh R, Karetzky M, McDonough M, Pourre J, Schwamm E, Dunton A (1988) Effects of midazolam on ventilatory control in normal subjects. Am Rev Respir Dis 137: A269Google Scholar
  48. 48.
    Michiels Th, Light R, Mahutte K (1983) Effect of ethanol and naloxone on control of ventilation and load perception. J Appl Physiol 55: 929–934PubMedGoogle Scholar
  49. 49.
    Murciano D, Boczkowski J, Lecocguic Y, Milic-Emili J, Pariente R, Aubier M (1988) Tracheal occlusion pressure: a simple index to monitor respiratory muscle fatigue during acute respiratory failure in patients with chronic obstructive pulmonary disease. Ann Intern Med 108: 800–805PubMedGoogle Scholar
  50. 50.
    Hussain S, Pardy R, Dempsey J (1985) Mechanical impedance as determinant of inspiratory neural drive during exercise in humans. J Appl Physiol 59: 365–375PubMedGoogle Scholar
  51. 51.
    Sassoon C, Mahutte C, Te T, Simmons D, Light R (1988) Work of breathing and airway occlusion pressure during assist-mode mechanical ventilation. Chest 93: 571–576PubMedCrossRefGoogle Scholar
  52. 52.
    Marini J, Rodriguez M, Lamb V (1986) The inspiratory workload of patient-initiated mechanical ventilation. Am Rev Respir Dis 134: 902–909PubMedGoogle Scholar
  53. 53.
    Doyle D, Vanoye C, Flick G (1988) Does endotracheal tube cuff pressure alter respiratory drive? Am Rev Respir Dis 137: A67Google Scholar
  54. 54.
    D’Urzo A, Chapman K, Rebuck A (1987) Effect of inspiratory resistive loading on control of ventilation during progressive exercise. J Appl Physiol 62: 134–140PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

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  • R. Fernandez

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