Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation

Mayy Chahla; Christopher D Larson; Kalpaj R Parekh; Robert M Reed; Peter Terry; Gregory A Schmidt; Michael Eberlein

doi:10.1016/j.chest.2015.12.032

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Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation

Journal article

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Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation

Mayy Chahla, Christopher D Larson, Kalpaj R Parekh, Robert M Reed, Peter Terry, Gregory A Schmidt and Michael Eberlein

Chest, Vol.149(6), pp.e161-e167

06/2016

DOI: 10.1016/j.chest.2015.12.032

PMID: 27287591

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Abstract

In emphysema airway resistance can exceed collateral airflow resistance, causing air to flow preferentially through collateral pathways. In severe emphysema ventilation through openings directly through the chest wall into the parenchyma (spiracles) could bypass airway obstruction and increase alveolar ventilation via transpleural expiration. During lung transplant operations, spiracles occasionally can occur inadvertently. We observed transpleural expiration via spiracles in three subjects undergoing lung transplant for emphysema. During transpleural spiracle ventilation, inspiratory tidal volumes (TV) were unchanged; however, expiration was entirely transpleural in two patients whereas the expired TV to the ventilator circuit was reduced to 25% of the inspired TV in one. At baseline, mean PCO2 was 61 ± 5 mm Hg, which decreased to a mean PCO2 of 49 ± 5 mm Hg (P = .05) within minutes after transpleural spiracle ventilation and further decreased at 1 to 2 h (36 ± 4 mm Hg; P = .002 compared with baseline) on unchanged ventilator settings. This observation of increased alveolar ventilation supports further studies of spiracles as a possible therapy for advanced emphysema.

spiracle

mechanical ventilation

lung transplant

collateral ventilation

physiology

transpleural ventilation

chronic obstructive pulmonary disease

emphysema

Details

Title: Subtitle: Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation
Creators: Mayy Chahla - Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Christopher D Larson - Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA
Kalpaj R Parekh - Department of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
Robert M Reed - Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD
Peter Terry - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
Gregory A Schmidt - Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Michael Eberlein - Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Resource Type: Journal article
Publication Details: Chest, Vol.149(6), pp.e161-e167
DOI: 10.1016/j.chest.2015.12.032
PMID: 27287591
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Publisher: Elsevier Inc
Language: English
Date published: 06/2016
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Anatomy and Cell Biology; Surgery; General Internal Medicine; Cardiothoracic Surgery; Internal Medicine
Record Identifier: 9984025356702771

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