Removal of observer variability from the determination of the volume of isoflow.

The initial attractiveness of the volume of isoflow (VisoV) as an index of early small airways dysfunction has faded, perhaps because of VisoV's high variability, a significant part of which is contributed by the observer. We suggest here that the observer variability can be removed by filtering the flow data in the reciprocal volume domain, by using a modified foreign gas mixture in which some of the helium is replaced by neon, and by reading VisoV from a plot of density dependence vs. lung inflation. Support for these suggestions is drawn from both model simulations and experiments. Model simulations suggested that VisoV would be increased by the substitution of neon for some of the helium in the usual helium-oxygen (Helox) mixture. This was confirmed in tests on matched groups of normal and asymptomatic asthmatic children. The inclusion of 20% neon (Heneox20) was found to reduce the coefficient of variation in the mean value of VisoV in both groups of subjects. An interesting result of this test was that VisoV using Heneox20 was significantly higher in the asthmatic group than in the normal group, whereas VisoV using Helox was not. The results for density dependence (DD) between the 2 groups were not significantly different using Heneox20 but were using Helox. Plots of DD (derived from heavily filtered flow curves) vs. lung inflation showed an unambiguous value for VisoV.

Ventilatory pattern and chest wall mechanics during ketamine anesthesia in humans.

The effects of anesthetic doses of ketamine (iv bolus of 3 mg X kg-1 followed by a continuous infusion of 20 micrograms X kg-1 X min-1) on functional residual capacity (FRC) measured by the helium dilution method and on the breathing pattern recorded by a noninvasive method (NIM) based on chest wall circumference changes were studied in 14 ASA P.S. I patients. Ketamine anesthesia was associated with: 1) the maintenance of FRC, minute ventilation, and tidal volume; 2) an increase in rib cage contribution to tidal breathing; and 3) an alteration of volume-motion relationships of the chest wall compartments. It is concluded that: 1) in contrast to volatile anesthetic agents, ketamine anesthesia has a sparing effect on intercostal muscle activity, which may explain the maintenance of FRC; and 2) changes in chest wall geometry and compliance induced by anesthetic agents must be taken into account for NIM to be valid.

Reference values for pulmonary tissue volume, membrane diffusing capacity, and pulmonary capillary blood volume.

Pulmonary tissue volume (Vti), carbon monoxide diffusing capacity, membrane diffusing capacity, pulmonary capillary blood flow and pulmonary capillary blood volume were measured in ninety (54 men and 36 women) healthy lifetime nonsmokers using an inert gas rebreathing technique. Prediction equations were generated using multiple linear regressions with height and age as the independent variables. Normalizing the data by dividing by functional residual capacity eliminated all sex differences. In contrast to the other variables, normalized pulmonary tissue volume did not correlate with any of the independent variables tested. Therefore, an average normalized Vti value can be recommended as a reference value

Lung-function reference values from Victorian power-industry workmen.

Reference values for a number of lung function tests performed on a group of apparently healthy Victorian power industry workmen are described. Most workers in this industry have had at least incidental exposure to a range of respiratory hazards, including asbestos dust, at some time in their working lives, but men who recalled handling asbestos materials were excluded from the study. Comparison with other published Australian data shows considerable variation. Differences such as measurement technique, equipment calibration, occupational factors, and selection bias must be considered when reference values from published reports are used for clinical or epidemiological purposes.

Reference values for functional residual capacity and maximal expiratory flow in young children.

To determine the relation of functional residual capacity and maximal expiratory flow at functional residual capacity to sex, age, height, and weight in healthy young children living in Portland, Oregon, we tested 37 boys and 36 girls using a modified helium-dilution technique and partial expiratory flow-volume curves. Within the age, height, and weight ranges studied, exponential or multiple regression techniques offered no substantial advantage over simple linear regression using height, weight, or age. There were no sex differences for the relationship between either variable and age, height, or weight. These techniques can readily be used in children as young as 3 years of age and may provide a method for studying lung growth and development in early childhood and a way to observe the progression of disease or the effect of treatment in the young child.

Variability of the closing volume measurement in normal subjects.

The repeatablilty of the measurement of closing volume (nitrogen method) in healthy, normal subjects was investigated. At least 7 consecutive measurements at 5-min intervals were made in each of 22 subjects. The mean coefficient of variation for the absolute volume of phase IV was 36.1 per cent and for the percentage ratio of phase IV to vital capacity, 36.1 per cent. Repeated measurements by the same observer of the same records on various days did not differ significantly (P greater than 0.5). There was a significant difference (P less than 0.05) between 2 observers measuring the same records, but there was no significant difference between the two observers in the variance of the closing variability in the same subject, it may be necessary to perform several closing volume maneuvers in each subject to establish his or her range before changes in the closing volume can be interpreted.

Factors influencing the measurement of closing volume.

The various factors influencing closing volume were studied by performing the single-breath N2 test on 9 healthy nonsmokers. Time of day, day of the week, and preceding volume history had no effect on either closing volume or alveolar plateau. Slow inspiratory flow resulted in larger ratio of closing volume to vital capacity, ratio of closing capacity to total lung capacity, and change in N2 concentration than fast inspiratory flow. Voluntary regulation of the expiratory flow resulted in smaller ratios of closing volume to vital capacity and closing capacity to total lung capacity than when flow was regulated by a resistance. Prolonged breath holding of the inspired O2 led to larger ratio of closing volume to vital capacity and ratio of closing capacity to total lung capacity. To obtain uniform, comparable closing volumes, it is suggested that the subject inspire slowly, control expiratory flow (preferably voluntarily), and not pause between inspiration and expiration.