Mechanics of Breathing: New Insights from New Technologies

407 Pages·2014·13.186 MB·English

by  Andrea Aliverti, Antonio Pedotti (eds.)

Andrea Aliverti
Antonio Pedotti Editors
Mechanics
of Breathing
New Insights from
New Technologies
Second Edition
Mechanics of Breathing

Andrea Aliverti (cid:129) Antonio P edotti
Editors
Mechanics of Breathing
New Insights from New Technologies
Second Edition
Editors
Andrea Aliverti Antonio Pedotti
Politecnico di Milano Politecnico di Milano
Milano Milano
Italy Italy
Videos to this book can be accessed at h ttp://www.springerimages.com/videos/978-88-470-5646-6
ISBN 978-88-470-5646-6 ISBN 978-88-470-5647-3 (eBook)
DOI 10.1007/978-88-470-5647-3
Springer Milan Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014938110
© Springer-Verlag Italia 2014
T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection
with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and
executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this
publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's
location, in its current version, and permission for use must always be obtained from Springer.
Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations
are liable to prosecution under the respective Copyright Law.
T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for
any errors or omissions that may be made. The publisher makes no warranty, express or implied, with
respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Foreword
Although in the last two decades most of the funds and efforts in respiratory research
have been focused on cellular and molecular mechanisms, there are no doubts that
a full understanding of the more “classical” respiratory mechanics at organ and
system levels is far to be completely reached.
And understanding the mechanics of breathing is important.
As described by Peter Macklem in “A Century of the Mechanics of Breathing”
(American Journal of Respiratory and Critical Care Medicine 170:10–15, 2004), the
progresses in the knowledge of mechanics of breathing gained in the last century
had an enormous impact in the clinical practice and allowed great benefi ts in terms
of prevention, diagnosis and treatment of respiratory diseases.
For instance, the discovery of surfactant role, achieved by studies on alveolar
mechanics, resulted in an extraordinary reduction in infant mortality from neonatal
respiratory distress syndrome by suggesting treatments based on mechanical venti-
lation, corticosteroids and replacement of surfactant itself. In respiratory intensive
care, the technological progress and intelligent use of mechanical ventilators during
anaesthesia, that improved substantially the rate of survival in surgical interven-
tions, would have not been possible without a detailed knowledge of lung and chest
wall mechanics. In lung volume reduction surgery for emphysema, suitable mechan-
ical models are of crucial importance for predicting the functional outcome during
surgical planning and patient selection. Research in respiratory mechanics has
allowed to highlight the abnormalities in obstructive sleep apnea and to propose the
successful treatment by nasal continuous positive airway pressure.
We strongly believe that given the complexity of the respiratory system, further
insights and improvements in clinical practice can only be obtained by an integra-
tive, multi-scale and multidisciplinary approach based on innovative technologies
for measuring and investigating structure and function combined with computa-
tional models to process and interpret the available amount of data.
S olving the problem of asthma, the most prevalent respiratory disease in devel-
oped countries, will certainly require integration of knowledge from molecular and
cellular biology on airway infl ammation and from biomechanics on how altera-
tion of airway geometry, load and structure and function of smooth muscles lead
to excessive airway narrowing to identify the proper cure. A similar approach is
v
vi Foreword
required for better understanding the mechanisms of loss of lung elastic recoil and
peripheral airway obstruction in chronic obstructive pulmonary disease (COPD)
and identifying proper means to prevent or arrest these processes.
T his book was envisioned as a state-of-the-art description of the complexity in
normal and pathological respiratory system, mainly observed from the point of view
of the mechanics of the airways, lung and chest wall. It is intended as an occasion
to spread new insights into the mechanics of breathing obtained by innovative meth-
ods of functional imaging of the respiratory system, together with new emerging
concepts in physiology and pathophysiology. It is explained how these advances
permit the assessment of emerging treatment approaches, including new drugs,
innovative surgical techniques and modes of mechanical ventilation and new forms
of rehabilitation. In order to ensure a comprehensive coverage of the subject, a mul-
tidisciplinary team of authors, comprising basic scientists in respiratory medicine,
chest and intensive care physicians and bioengineers involved in both modelling
and innovative technologies, was assembled.
T he book is structured into four parts. In the fi rst part, eight chapters report last
fi ndings on airway, lung and chest wall mechanics during spontaneous breathing at
rest and during exercise, and how physiological aspects of mechanics of breathing
are altered in presence of diseases, namely asthma, COPD, and acute lung injury
(ALI). In the second part, established and emerging methods for assessing respira-
tory mechanics and, more generally, lung function are illustrated including: spirom-
etry, forced oscillations, optoelectronic plethysmography, gas washout, assessment
of respiratory muscle perfusion, and dyspnea.
The third part offers an update on how thoracic functional imaging can provide
new insights to the assessment of mechanics of breathing, particularly to study air-
way distensibility, regional ventilation, diaphragm displacement, and regional per-
fusion. The fourth part includes six chapters and reports an updated review on how
different kinds of intervention (pharmacological treatment, rehabilitation, and inva-
sive and non-invasive mechanical ventilation) affect the mechanics of breathing in
selected diseases.
This volume constitutes an updated and signifi cantly revised second edition of
the book Mechanics of Breathing: P athophysiology, D iagnosis and Treatment,
which was based on a series of lectures delivered during the post-graduate course
“What is new in mechanics of breathing: implications for diagnosis and treatment”,
held in Como, Italy, on April 2001. The present edition contains, in addition, a
selection of lectures provided at the ERS Research Seminar “The Limits to Exercise
in COPD: New Insights from New Methods”, held in Como, Italy, on September
2007. The two chapters authored by Peter Macklem and Solbert Permutt, eminent
scientists who have enormously contributed to a better understanding of different
aspects of the mechanics of breathing and recently passed away, are reported inte-
grally as in the fi rst edition. This book is dedicated to them.
Milano, Italy Andrea Aliverti
Milano, Italy Antonio Pedotti
Contents
Part I Physiological and Pathophysiological
Aspects of Mechanics of Breathing
1 The Act of Breathing............................................................................ 3
Peter T. Macklem
2 Work of Breathing During Exercise:
Implications for Performance ............................................................. 11
Lee M. Romer and Jerome A. Dempsey
3 Pathology of COPD and Asthma ........................................................ 25
Simonetta Baraldo, Riccardo Cazzuffi , Erica Bazzan, Fabrizio Luppi,
Graziella Turato, and Marina Saetta
4 Pathophysiology of Airfl ow Obstruction ............................................ 37
Vito Brusasco
5 Role of Airway Smooth Muscle Mechanical Properties
in the Regulation of Airway Caliber .................................................. 53
Susan J. Gunst
6 Nitric Oxide in Asthma Is Like Insulin in Type II Diabetes ............ 65
Solbert Permutt
7 Static and Dynamic Hyperinfl ation in Chronic Obstructive
Pulmonary Disease ............................................................................... 73
Pierantonio Laveneziana, Katherine A. Webb,
and Denis E. O’Donnell
8 Lung Recruitment and De-recruitment ............................................. 99
Göran Hedenstierna and João B. Borges
vii
viii Contents
Part II Assessment of Mechanics of Breathing
9 Lung Function Testing, Spirometry, Diffusion Capacity
and Interpretation ................................................................................ 123
Flemming Madsen, Jann Mortensen, Birgitte Hanel,
and Ole F. Pedersen
10 Forced Oscillation Technique .............................................................. 139
Daniel Navajas, Raffaele L. Dellacà,
and Ramon Farré
11 Optoelectronic Plethysmography: Principles of Measurements
and Recent Use in Respiratory Medicine ........................................... 151
Andrea Aliverti and Antonio Pedotti
12 Respiratory Muscle Blood Flow Measured by Near-Infrared
Spectroscopy (NIRS) and Indocyanine Green Dye (ICG) ................ 171
Zafeiris Louvaris, Spyros Zakynthinos,
and Ioannis Vogiatzis
13 Assessment of Dyspnoea ...................................................................... 185
Giorgio Scano, Giulia Innocenti-Bruni,
Loredana Stendardi, and Francesco Gigliotti
14 Noninvasive Measures of Lung Structure
and Ventilation Heterogeneity ............................................................ 197
Sylvia Verbanck and Manuel Paiva
Part III Assessment of Mechanics of Breathing: Functional Imaging
15 Computed Tomography (CT)–Based Analysis
of Regional Lung Ventilation .............................................................. 217
Andrea Aliverti, Francesca Pennati,
and Caterina Salito
16 Functional Imaging of Airway Distensibility .................................... 233
Nicola Scichilone and Robert H. Brown
17 Function and Microstructure by Hyperpolarized Gas MRI ............ 249
Jason C. Woods, Dmitriy A. Yablonskiy,
and Mark S. Conradi
18 Dynamic MRI – Clinical Signifi cance in Treatment
for Patients with COPD ....................................................................... 271
Koji Chihara and Akinari Hidaka
19 Pulmonary Functional Imaging with Positron
Emission Tomography ......................................................................... 285
Jose G. Venegas, Dominic Layfi eld, and Scott Harris
Contents ix
Part IV Different Treatment and Mechanics of Breathing
20 Pharmacological Treatment: an Update ............................................ 313
Peter Calverley
21 Respiratory and Non-respiratory Muscle
Dysfunction in COPD .......................................................................... 325
Didier Saey, Marc-André Caron, Richard Debigaré,
and François Maltais
22 Pathophysiology of Chronic Obstructive Pulmonary
Disease ................................................................................................... 341
Bartolome R. Celli
23 Old and New Trends in Invasive Mechanical Ventilation ................ 355
Maria Vargas, Iole Brunetti, and Paolo Pelosi
24 Use of Respiratory Mechanics for Monitoring and Setting
of Noninvasive Mechanical Ventilation .............................................. 367
Luca Fasano, Lara Pisani, and Stefano Nava
25 Use of FOT for Optimising Mechanical Ventilation ......................... 383
Raffaele L. Dellacà, Pasquale P. Pompilio, Ramon Farré,
Daniel Navajas, and Emanuela Zannin
Index .............................................................................................................. 397