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Section of Thoracic Surgery, Department of Surgery, and Section of Respiratory Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada R3E-0Z3
The effect of pulmonary resection on
the maximal emptying of the remaining lobes was examined in an
open-chest preparation in normal canine lungs and in a unilobar papain
emphysema model. The objectives were to determine whether, compared
with when both lungs were deflated (BL), maximal emptying of the normal
lower lobes or the emphysematous right lower lobe would be altered
1) when acute pneumonectomy of the contralateral lung was
performed (OL) and 2) when the lower lobe deflated alone
(LA). The alveolar capsule technique was used to measure alveolar
pressures (Palv) at 75, 50, and 30% lobar vital capacity (VC). During
forced deflation, the maximal rates of deflation (dPalv/dt)
and flows (lobar
max) of the lower lobes were
determined under the three different conditions. The Pitot-static tube
technique was used to measure intrabronchial pressures and to estimate
bronchial area and compliance in which values were obtained at the same
central airway during the conditions studied. The results showed that,
compared with BL and OL, dPalv/dt and lobar
max decreased during LA (P < 0.05).
These findings were due to a reduction in bronchial area during LA that
limited flow at a lower maximal value compared with BL. This decrease in area appeared to be due to a change in bronchial pressure area behavior that resulted in a smaller bronchial area during LA for similar transmural pressures between conditions. There were no differences in findings between normal and emphysematous lobes. This
study suggested that removal of lobes may alter the pressure area
behavior of central airways. Possible mechanisms considered were
differences in axial tension between conditions, negative effort
dependence, or parenchymal-bronchial interdependence that may be
relevant to understanding the dynamic collapsibility of central as well
as intraparenchymal airways.
maximal expiratory flow; regional emptying; choke point; emphysema; lung resection; parenchymal-bronchial interdependence
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