Blood flow in "red" and "'white" calf muscles in cats during isometric and isotonic exercise.

Muscle blood flow was measured with the radioactive microspheres technique in plantar flexors of seven cats. Right leg performed rhythmic isotonic and left leg sustained isometric contractions. Flows were determined at rest, during stimulation periods, and immediately after 90 sec of high frequency stimulation. During isotonic contraction, flow to m. soleus (a "red muscle") increased progressively as stimulation increased: 0.06 +/- 0.02, 0.21 +/- 0.05, 0.42 +/- 0.12, and 0.26+/- 0.06 ml/min/g during rest, 10 Hz, 50 Hz, and after 50 Hz stimulation frequencies, respectively. Corresponding values for gastrocnemius medialis were 0.06 +/- 0.01, 0.38 +/- 0.05, 0.27 +/- 0.03, and 0.28 +/- 0.06 (x +/- S.E.). These last values were characteristic also for the other "'white" muscles investigated: gastrocnemius lateralis, and plantaris. During sustained isometric exercise at 5 and 25 Hz stimulation frequency the patterns were similar, except that higher flows were observed, and during recovery flows actually increased again in the "white" muscles. Blood pressure did not change. Resting flows were similar in innervated and denervated muscles. These data demonstrate that during isotonic as well as isometric exercise there is an increased resistance to flow with increasing muscle tension in "white" but not in "red" muscles. This supports the notion that a condition of relative ischaemia exists in "white" muscles during both isometric and isotonic contractions which is more pronounced during isometric exercise. The results corroborate previous studies on isometric exercise and suggest that the pattern during isotonic exercise is similar.

Comparison of two- and four-magnetometer methods of measuring ventilation.

Two computerized methods of measuring ventilation from four pairs magnetometers placed anteroposteriorly (AP) and laterally on the rib cage and abdomen were compared with a method that employs two pairs of magnetometers placed AP on the rib cage and abdomen. This comparison showed that the most accurate method of measuring ventilation employed four-magnetometer pairs and a model that assumes that the rib cage and abdomen may be approximated by elliptical cylinders. In 10 subjects of widely varying body habitus, this method predicted lung volume change accurately during quiet breathing (R greater than 0.98) and during vital capacity maneuvers (R greater than 0.97). With this technique, we have confirmed that the rib cage contributes the majority (74%) of the volume change in the upright position. Additionally, we have shown that this method is sufficiently accurate to be used as a method of monitoring ventilation under a wide variety of tidal volumes, postures, and exercise states.

Cardiovascular effects of positive-pressure ventilation in normal subjects.

In normal subjects during 15-min positive-pressure ventilation with 10 cmH2O end-expiratory pressure (PEEP), cardiac output fell 19% due to a fall in stroke volume. Transmural mean right atrial pressure rose 3.1 cmH2O and right ventricular end-diastolic diameter increased 15%. Simultaneously, left ventricular end-diastolic diameter decreased 21%, ejection time increased 11%, and velocity of circumferential fiber shortening fell 30%. Thus, right ventricular filling increased and left ventricular filling decreased. The function of the right ventricle was impaired and the function of the left ventricle may have been impaired. Cardiac output gradually increased due to a 7% increase in heart rate as PEEP was continued for 1 h and transmural mean right atrial pressure also increased further by 2.4 cmH2O. Compensation for the reduced stroke volume occurred as filling pressures and heart rate rose, but ventricular function remained impaired for the entire duration of PEEP. On resuming spontaneous breathing, cardiac output and ventricular function returned to base-line levels. We conclude that the reduced cardiac output during PEEP is not due to a direct mechanical reduction in right ventricular filling.

Lung volumes in man immersed to the neck: dilution and plethysmographic techniques.

Previous studies of lung volumes during immersion have utilized dilution techniques for residual volume. We have compared lung volumes obtained by the use of a dual inert gas dilution technique with those determined by the Boyle's law technique in a plethysmograph designed to allow measurements in air and submersed to the neck in water. Both techniques gave similar results dry, but during immersion the dilution residual volume (RV) was 0.200 liter (16%) lower than the plethysmographic value (P greater than 0.001), which suggests that there is a significant amount of gas trapping during immersion due to breathing at low lung volumes and the central shift of blood. The unchanged RV due to hydrostatic force on the chest wall is balanced by the tendency to increase RV due to vascular congestion, which increases closing volume and stiffens the lung to compression.

Cardiovascular effects of positive end-expiratory pressure in dogs.

Our purpose was to reexamine the relationship of the fall in cardiac output and blood pressure which occurs during positive end-expiratory pressure (PEEP) to changes in transmural right atrial and left atrial filling pressures. Closed-chest dogs, half with pulmonary edema, were studied during spontaneous breathing and inspiratory positive-pressure breathing (IPPB) with 0-15 cmH2O PEEP. Mean esophageal pressure accurately reflected changes in pericardial pressure and was used to estimate extracardiac pressure. We found that cardiac output fell approximately 50% and blood pressure fell 20% during 15 cmH2OPEEP in spite of well maintained transmural right atrial and left atrial (or pulmonary artery wedge) pressures suggesting a primary or reflex depression of atrial or ventricular function.

Respiratory muscle blood flow distribution during expiratory resistance.

When work load on the respiratory system is increased the relative increase in blood flow to each of the muscles of breathing provides an index of how the augmented effort of breathing is partitioned among the different muscles. We have used a radio-active microsphere technique to measure blood flow to each of the muscles of respiration in supine dogs during unobstructed respiration and breathing against graded expiratory threshold loads. 79% of the augmented flow went to expiratory muscles; of this increased flow to expiratory muscles 74% went to abdominal wall muscles and 26% to internal intercostals. In our earlier studies of hyperventilation induced by CO(2) rebreathing where expiratory work loads were low, 44% of the increase in flow went to expiratory muscles; of this, only 39% went to abdominal wall muscles and 61% to internal intercostals. During inspiratory resistance which produced small increases in expiratory work, 27% of the increase in blood flow went to expiratory muscles; of this, only 37% went to abdominal wall muscles and 63% to internal intercostals. These results suggest that the internal intercostals are predominantly used for expiration when expiratory work loads are low, whereas the abdominal wall muscles are predominantly used when loads are high. For similar rates of pressure-volume work done on the lung, the total respiratory muscle blood flow is significantly greater during expiratory loads than during unobstructed hyperventilation or inspiratory loads. Thus, the abdominal wall muscles that are utilized for overcoming high pressure expiratory loads are relatively inefficient in converting metabolic energy into pressure-volume work.

The relationship of respiratory failure to the oxygen consumption of, lactate production by, and distribution of blood flow among respiratory muscles during increasing inspiratory resistance.

An animal model was developed to determine if blood flow to the respiratory muscles limits oxygen delivery and thus work output during inspiratory resistance. With incremental increases in the rate of work of breathing to 15 times the resting level, blood flow to the diaphragm rose exponentially 26-fold. Blood flow to other inspiratory and a few expiratory muscles increased to a much smaller extent, often only at the greater work loads. Cardiac output and blood pressure did not change. Arterial-venous oxygen content difference across the diaphragm became maximal at low work rates and thereafter all increases in oxygen delivery during higher work rates were accomplished by increments in blood flow. Oxygen consumption of the respiratory musculature calculated by blood flow times oxygen extraction increased exponentially with increasing work of breathing and was less than the increase in total body oxygen consumption at each work load. Hypoxemia and respiratory acidosis occurred when the animals inspired through the highest resistance; blood flow and oxygen consumption were even higher than that observed during previous resistances and there was no evidence of a shift to anaerobic metabolsim in blood lactate and pyruvate levels. Respiratory failure did not appear to be a consequence of insufficient blood flow in this model.

The distribution of blood flow, oxygen consumption, and work output among the respiratory muscles during unobstructed hyperventilation.

An animal model was developed to describe respiratory muscle work output, blood flow, and oxygen consumption during mechanical ventilation, resting spontaneous ventilation, and the increased unobstructed ventilatory efforts induced by CO2 rebreathing. Almost all of the work of breathing was inspiratory work at all ventilatory levels; thus, only blood flows to the diaphragm and external intercostals increased in the transition from mechanical to spontaneous ventilation, and they further increased linearly as ventilatory work was incrementally augmented ninefold by CO2 rebreathing. No other muscles of inspiration manifest increased blood flows. A small amount of expiratory work was measured at high ventilatory volumes during which two expiratory muscles (transverse abdominal and intercostals) had moderate increases in blood flow. Blood pressure did not change, but cardiac output doubled. Arterial-venous oxygen content difference across the diaphragm increased progressively, so oxygen delivery was augmented by both increased blood flow and increased oxygen extraction at all work loads. Oxygen consumption increased linearly as work of breathing increased, so efficiency did not change significantly. The mean efficiency of the respiratory muscles was 15.5%. These results differ significantly from the patterns previously observed by us during increased work of breathing induced by inspiratory resistance, suggesting a different distribution of work load among the various muscles of respiration, a different fractionation of oxygen delivery between blood flow and oxygen extraction, and a higher efficiency when shortening, not tension development, of the muscle is increased.

Pulmonary hypertension and foreign body granulomas in intravenous drug abusers. Documentation by cardiac catheterization and lung biopsy.

In this report we confirm the presence of pulmonary hypertension by cardiac catheterization in four intravenous drug abusers with biopsy-documented foreign body granulomas in the pulmonary vessels and interstitium. Each patient had a history of intravenous injections of alpha-sympathomimetic agents obtained from nasal inhalers. There agents may have contributed to the disease by constricting small vessels when simultaneously injected foreign bodies were passing through the vasculature of the lung. The severity of the pulmonary hypertension correlated well with the decrease in single breath diffusing capacity in each case. Pulmonary hypertension may contribute significantly to the increased morbidity and mortality observed in intravenous drug users.