2 Dept. of Anesthesia and Medicine, Massachusetts General

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Presentation transcript:

2 Dept. of Anesthesia and Medicine, Massachusetts General Correlation in Degradation of Lung Mechanics with Ventilation Distribution in Asthmatics N. T. Tgavalekos1,2 R. S. Harris2, M.F. Vidal Melo2, G. Musch2, T. Winkler2, K.R. Lutchen1 and J. G. Venegas2 1 Dept. of Biomedical Engineering, Boston University, Boston, MA 2 Dept. of Anesthesia and Medicine, Massachusetts General Hospital, Boston, MA October 2, 2003 BMES conference

Evidence of Mechanical Heterogeneity in Asthma Healthy Mild-Moderate Asthmatic Severe Asthmatic RL(cmH2O/l/s) EL(cmH2O/l) Airway closure/Heterogeneity Heterogeneity Heterogeneity Lutchen, K.R., D.W. Kaczka, E. Israel, B. Suki, E.P. Ingenito. Airway constriction pattern is a central component of asthma severity: the role of deep inspirations. Amer. J. of Resp. and Crit. Care Medicine 164: 207-215, 2001.

Evidence of Heterogeneity in Ventilation Baseline Post Challenge

Indices of Ventilation Dynamic Lung Mechanics Main Goal Are ventilation heterogeneity related to mechanical heterogeneity? l Indices of Mechanic Heterogeneity Relationship? Indices of Ventilation PET imaging Dynamic Lung Mechanics RL,EL vs. freq.

Lung Mechanics RL, EL estimated from lung impedance (ZL) via forced oscillations: ZL(jw) = Ptp (jw) Q (jw) RL = Re {ZL} EL =-2pf Im {ZL}

Quantifying Dynamic Lung Mechanics Rlow Rlow-Rhigh ~ heterogeneity Elow Ehigh Ehigh-Elow ~ heterogeneity/ airway shunting Rhigh Rhigh ~ Raw

Features of Lung Mechanics ** p<.001 * p<.001 * **

Relating Ventilation Heterogeneity to Mechanical Heterogeneity Post Challenge Baseline Tracer Retention Airway closure/ Heterogeneity Apnea Washout Time (secs)

Multi - Compartmental Washout Baseline Post Challenge R2=.99 R2=.99 Two Compartment Model C(t) = C1(0)e-t/t1 +C2(0)e-t/t2

Quantifying Ventilation Heterogeneity . . = fraction of blood flow . Heterogeneity Index (HI) .

Mechanics vs. Ventilation Heterogeneity Baseline Post Challenge

Conclusions Elevation and frequency dependence in lung mechanics is also indicative of ventilation heterogeneity Airway constriction in asthma is inherently heterogeneous causing a distribution of poorly ventilated regions throughout the lung simultaneously with degradation lung mechanics These data sets can be combined with airway tree models to identify what level of airways are actually closing or constricting during asthma

Acknowledgements Anesthesia & Critical Care José G. Venegas, Ph.D. R. Scott Harris, M.D. Marcos Vidal Melo, M.D. Ph.D. Guido Musch, M.D. Tilo Winkler, Ph.D. Dominick Layfield, Ph.D. BU Respiratory Lab K. R. Lutchen, Ph.D Cortney Henderson, Ph.D Carissa Bellardine, M.S. Derek Affonce, M.S

Quantifying Airway Closure

Rlow vs. HI

PET Imaging in Asthmatics End Washout : Gas Trapping PET functional imaging may provide useful insights into the role of gas trapping in asthma