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Department of Anesthesia (Bio-Engineering), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; and Ruhrlandklinik Essen, Essen, Germany
Flow limitation during forced exhalation and gas
trapping during high-frequency ventilation are affected by upstream
viscous losses and by the relationship between transmural pressure
(Ptm) and cross-sectional area
(Atr) of the
airways, i.e., tube law (TL). Our objective was to test the validity of
a simple lumped-parameter model of expiratory flow limitation,
including the measured TL, static pressure recovery, and upstream
viscous losses. To accomplish this objective, we assessed the TLs of
various excised animal tracheae in controlled conditions of
quasi-static (no flow) and steady forced expiratory flow.
Atr was measured
from digitized images of inner tracheal walls delineated by
transillumination at an axial location defining the minimal area during
forced expiratory flow. Tracheal TLs followed closely the exponential
form proposed by Shapiro (A. H. Shapiro. J. Biomech.
Eng. 99: 126-147, 1977) for elastic tubes: Ptm = Kp
[(Atr/Atr0)
n
1], where Atr0 is
Atr at Ptm = 0 and
Kp is a
parametric factor related to the stiffness of the tube wall. Using
these TLs, we found that the simple model of expiratory flow limitation
described well the experimental data. Independent of upstream
resistance, all tracheae with an exponent
n < 2 experienced flow limitation, whereas a trachea with n > 2 did
not. Upstream viscous losses, as expected, reduced maximal expiratory
flow. The TL measured under steady-flow conditions was stiffer than
that measured under expiratory no-flow conditions, only if a
significant static pressure recovery from the choke point to atmosphere
was assumed in the measurement.
flow limitation; tracheal cross-sectional area and collapse; wave speed
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