Effect of high negative inspiratory pressure on single breath CO diffusing capacity

doi:10.1016/0034-5687(83)90110-X

Respiration Physiology

Volume 54, Issue 1, October 1983, Pages 19-29

Respiration Physiolo...

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Abstract

We measured the single breath diffusing capacity for carbon monoxide (DlcoSB) using a three-equation method to describe CO uptake in 10 normal seated subjects who eiter voluntarily inhaled slowly (0.5 L/sec) to total capacity (TLC), or inhaled slowly to TLC maximal effort through a high inspiratory which created high negative inspirator pressure. Subjects then performed in duplicate both with and without high negative inspiratory pressure while subjects were seated upright at reast and during steaty-state bicycle exercise. We found high negative inspiratory pressure increased DLcoSB by 10.5% ± 4.9% (mean ± SD) at rest P < 0.0001). In 7 sujects low level exercise alone increased DLcoSB by a similar 12.1 ± 7.3%; P = 0.0005). In six of the subjects there was a significanlt correlation between the increase in DLcoSB during high negative inspiratory pressure at rest and the increase in DLcoSB during steady-state exercise (r = 0.89; P < 0.01). During steady-state exercise, high negative inspiratory pressure further increased DLcoSB 6.4 ± 6.3% compared to exercise alone (P = 0.05). We conclude that the increase in DLcoSB with high negative inspiratory pressure at rest is a simple reproducible method of assessing recruitment of the pulmonary capillary bed in man.

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Cited by (16)

Measurement of CO diffusion capacity (II): Standardization and quality criteria
2015, Anales de Pediatria
La capacidad de difusión es la técnica que mide la capacidad del aparato respiratorio para realizar el intercambio gaseoso y así diagnosticar la disfunción de la unidad alvéolo-capilar.
El parámetro más importante a evaluar es la capacidad de difusión del CO (DLCO). Actualmente hay nuevos métodos para medir la capacidad de difusión utilizando óxido nítrico (NO). Existen diferentes métodos de medida, aunque en este artículo nos referiremos sobre todo a la técnica de la respiración única, la más utilizada y mejor estandarizada.
Su complejidad, sus ecuaciones de referencia, las diferencias en equipamiento, la variabilidad interpacientes y las condiciones en las que se realiza hacen que exista una gran variabilidad interlaboratorio, habiéndose realizado estandarizaciones para hacer este método más fiable y reproducible.
Se analizan los aspectos prácticos de la técnica, especificando las recomendaciones para la realización de un procedimiento adecuado, sistemática de calibración y cálculos y ajustes necesarios. También se exponen sus aplicaciones clínicas.
Se produce un aumento de la transferencia de CO en las enfermedades en las que existe un aumento del volumen sanguíneo en los capilares pulmonares, en la policitemia y en la hemorragia pulmonar. Existe una disminución de la DLCO en los pacientes con reducción del volumen alveolar o en los defectos de difusión, ya sea por alteración de la membrana alvéolo-capilar (enfermedad intersticial) o por disminución del volumen de sangre en los capilares pulmonares (embolia pulmonar o hipertensión pulmonar primaria). También se exponen otras causas de disminución o aumento de la DLCO.
The diffusion capacity is the technique that measures the ability of the respiratory system for gas exchange, thus allowing a diagnosis of the malfunction of the alveolar-capillary unit. The most important parameter to assess is the CO diffusion capacity (DLCO). New methods are currently being used to measure the diffusion using nitric oxide (NO). There are other methods for measuring diffusion, although in this article the single breath technique is mainly referred to, as it is the most widely used and best standardized.
Its complexity, its reference equations, differences in equipment, inter-patient variability and conditions in which the DLCO is performed, lead to a wide inter-laboratory variability, although its standardization makes this a more reliable and reproductive method.
The practical aspects of the technique are analyzed, by specifying the recommendations to carry out a suitable procedure, the calibration routine, calculations and adjustments. Clinical applications are also discussed. An increase in the transfer of CO occurs in diseases in which there is an increased volume of blood in the pulmonary capillaries, such as in the polycythemia and pulmonary hemorrhage. There is a decrease in DLCO in patients with alveolar volume reduction or diffusion defects, either by altered alveolar-capillary membrane (interstitial diseases) or decreased volume of blood in the pulmonary capillaries (pulmonary embolism or primary pulmonary hypertension). Other causes of decreased or increased DLCO are also highlighted.
Performing the apnea of the single-breath carbon monoxide diffusing capacity: Relaxation on the shutter or full inspiration with near atmospheric intrapulmonary pressure?
2006, Chest
Citation Excerpt :
The Dlcosb measured in healthy subjects instructed to relax on the shutter is 3.4% lower than that when subjects are encouraged to maintain full inspiration with near-atmospheric intrapulmonary pressure. An increase in Dlcosb with negative inspiratory pressure has been shown on several occasions,910 but studies of the effect of an increase in alveolar pressure on Dlcosb are scarce. Ogilvie et al11 reported a decrease in Dlcosb in two of three subjects during a Valsalva maneuver.
The aim of the study was to measure the single-breath diffusing capacity of the lung for carbon monoxide (Dlcosb) in healthy subjects in the following two conditions originally proposed by the American Thoracic Society (ATS) guidelines: relaxation against the shutter; and full inspiration without straining.
Dlcosb was measured in 76 young adults in duplicate, in the two conditions. Mouth pressure was recorded during all of the trials.
The mean (± SD) value of the duplicate Dlcosb measurements was higher when measured with the patient in the nonrelaxed condition than in the relaxed condition (32.65 ± 7.65 vs 31.54 ± 7.11 mL/min/mm Hg, respectively; p < 0.001). The mean effective alveolar volume measured during the single-breath maneuver (VAeff) was also higher in the nonrelaxed condition (VAeff: nonrelaxed condition, 5,779 ± 1,093 mL; relaxed condition, 5,596 ± 1,097 mL; p < 0.001), at least as a consequence of a higher inspiratory volume (Vin) in the nonrelaxed condition (nonrelaxed condition, 4,378 ± 900 mL; relaxed condition, 4,232 ± 902 mL; p < 0.001). Asking the subject performing a Dlcosb maneuver to relax on the shutter during apnea lowers the Dlcosb value by approximately 3.4% in comparison to full inspiration without straining, at least in part because it results in a reduced Vin.
These data lend further support to the new European Respiratory Society/ATS Task Force recommendations (full inspiration maintained with near atmospheric intrapulmonary pressure).
Diffusing capacity in the clinical assessment of chronic airflow limitation
1996, Medical Clinics of North America
Effect of alveolar pressure on single-breath CO diffusing capacity at mid-lung volume
1990, Respiration Physiology
The present study examines whether changes in the alveolar pressure (Pa) affect the single breath diffusing capacity for carbon monoxide (Dl_CO) more strongly at mid-lung volume than at total lung capacity (TLC) in normal subjects. Dl_CO was measured at 60%, 80% and 100% of TLC, while Pa was kept at +30, 0, or −30 cm H₂O by the subject's effort during the measurement of Dl_CO at each lung volume. The capillary blood volume (Vc) and the membrane diffusing capacity (Dm) were also determined. Dl_CO at zero Pa was found to be higher at 100% TLC than at lower lung volumes. At $P a = +30 cm H_{2} O$ Dl_CO at 100%, 80%, and 60% TLC decreased by 8%, 13%, and 13%, respectively, and the decreases in Vc were 2%, 10%, and 21%, respectively. However, negative Pa did not cause any significant changes in Dl_CO or Vc at any lung volume. Also, Dm di not change at any Pa. We conclude that Dl_CO is more affected by a positive Pa at mid-lung volume than at a high lung volume, probably due to a greater decrease in Vc.
Reduction of the single breath CO diffusing capacity in cystic fibrosis
1985, Chest
The single breath diffusing capacity of the lung for carbon monoxide (Dsb) was measured using three equations to describe CO uptake separately during inhalation, breath holding, and exhalation in 24 patients with cystic fibrosis and 30 control subjects with similar age and height distributions. Using the control group, we developed two prediction equations for Dsb: one based on height, age, and sex; and another based on alveolar lung volume (V_A) to the 2/3 power. We also developed a prediction for Dsb/VA (K_co) based on height. The Dsb as percent predicted (% pred) using either prediction equation decreased with increasing age and height as well as with decreasing % pred maximal midexpiratory flow rate (FEF25-75) in cystic fibrosis patients but not in controls. The (% pred) also decreased in cystic fibrosis with increasing age and decreasing percent pred FEF25-75. We conclude that in patients with cystic fibrosis, Dsb decreases with variables that relate to increasing disease severity (age, height, and increasing airflow obstruction).
Influence of mouth pressure on measurement of diffusing capacity in the clinical pulmonary function laboratory
2019, Respiratory Care

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Effect of high negative inspiratory pressure on single breath CO diffusing capacity

Abstract

Respir. Physiol.

Respir. Physiol.

Chest

Am. J. Med.

J. Pediatr.

Distribution of pulmonary perfusion in erect man

J. Appl. Physiol.

Factors affecting regional distribution of ventilation and perfusion in the lung

J. Appl. Physiol.

Effect of negative intra-alveolar pressure on pulmonary diffusing capacity

J. Appl. Physiol.

The pressure-volume relationship of the normal pulmonary caplllary bed

J. Clin. Invest.

Measurements of capillary dimensions and blood volume in rapidly frozen lungs

J. Appl. Physiol.

A theoretical analysis of the single breath diffusing capacity for carbon monoxide

IEE Trans. Biomed. Eng. BME

Improved accuracy and precision of single-breath CO diffusing capacity measurements

J. Appl. Physiol.

Dynamic measurements of CO diffusing capacity using discrete samples of alveolar gas

J. Appl. Physiol.

Interrelationships of factors affecting pulmonary diffusing capacity

J. Appl. Physiol.