Name: assessment of pulmonary capillary blood volume, membrane diffusing capacity, and intrapulmonary arteriovenous anastomoses during exercise
Uploaded: 2017-02-20T12:30:00.000+00:00
Duration: 7 min 9 s
Description: Watch this Scientific Journal Video about Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise at JoVE.com

Funding was provided by the Natural Sciences and Engineering Research Council of Canada and The Heart and Stroke Foundation of Canada.

该协议遵循人类研究伦理委员会在阿尔伯塔大学的指导方针，并符合赫尔辛基宣言的最新版本规定的标准。 1.分级运动试验（VO 2peak） <ol><li>获得书面知情从主体的同意。有阅读的主体和回答关于身体活动能力问卷+（PAR-Q +）上市，以确定运动24他们准备的问题。 </li><li>调整功率自行车的座椅高度，根据拍摄对象的偏好。广场上按照标准3导联ECG安置病人的四名后卫心电图（ECG）电极，以修改肢体导致测量心脏速率（HR）25。 </li><li>插入吸嘴插入被检者的口以测量整个使用代谢的测量系统25在测试的呼出气体和通风。 注:代谢系统将测量实时氧消耗（VO 2），二氧化碳的生产（VCO 2），通风（V E）中 ，心脏心率（HR）和呼气末二氧化碳 （P ET CO 2）。 </li><li>以下收集基线数据的2分钟，指示须用50瓦的初始工作量开始骑自行车，保持≥60RPM一贯的节奏。增加25瓦的步骤每2分钟，直到对象到达意志用尽或要求停止测试25的工作量。 </li></ol> 2.吸入氧分数多（F I O 2）弥散量（DL CO）方法7 <ol><li>计算对应于30％，50％，70％，和90％的VO 2peak使用在分级运动试验中得到的峰值VO 2的工作负荷。至少48小时的分级运动试验后，让主体重新转向实验室DLCO演习。 </li><li>不要超过每天12弥散测试，碳氧血红蛋白（碳氧血红蛋白）积聚可反复测试5出现。因此，执行基于要进行的锻炼的工作负载的数量和弥散数据的质量多天的测试。 </li><li>通过将100％ 的 O 2气体的罐和医用级空气（21％O 2和79％N 2）的空气搅拌器系统的罐制备呼吸预气体。填充两个60升非扩散道格拉斯袋，含40％ 的 O 2之一，并且含有一个60％ 的 O 2，使用空气搅拌器系统。 </li><li>设置了两个大口径，三路活塞阀，将允许吸入气体混合物的调制。这些将被称为"呼吸预阀"。 </li><li>道格拉斯袋连接到使用灵活，无压缩的管阀系统。所述阀系统连接到一个双向，T形非再呼吸阀康恩部对代谢测量系统的质量流量传感器的测试气体入口组件。 </li><li>对于休息的测量，让主体直立坐姿，双脚平放在地板上。对于运动试验，确保主体处于稳定状态，通过使用心电图（HR±3 BPM稳态）监测人力资源。 注意:稳态可能不会在VO 2peak的90％到达;因此，开始测量，一旦受试者已经达到HR相当于VO 2peak 90％的分级运动试验。 </li><li>通过手指刺收集的毛细管一滴血，并分析其对血红蛋白浓度。然后，调整使用下列公式26 [血红蛋白]所有后续DL CO: <img alt="式（1）" src="/files/ftp_upload/54949/54949equation1.jpg" /></li><li>通过切换预呼吸阀到所需方向选择一个F I O 2在随机（21％，40％，或60％）。周仰杰本身在相应的F I O 2 -DL CO转动DL CO气体阀选择器的气体（ 见图1C）。 </li><li>指示受试者对贴上鼻夹和正常呼吸对着话筒用于从对应于各F I O 2的道格拉斯袋5次呼吸。 </li><li>指示受到期残留量。当肺容积在高原残气量，让主体吸入DL CO气体混合物肺总量和呼气残留量前屏住呼吸6秒钟。 </li><li>在呼气期间监控甲烷跟踪以确保该斜率是水平的，因为这表明CO测试气体在肺良好平衡。 注:肺泡体积（V A）和屏气时间会自动计算和代谢测量系统的报道。 </li><li>确保每个弥散回旋V A在5％以内ØF上试验。同样，屏气时间应为6.0±0.3秒。如果没有，重复动作。 </li><li>等待4分钟，使残留的一氧化碳洗出来，然后重复步骤2.8 - 2.11其余每个F I O 2在休息。 </li><li>在每个运动强度为每个F I O 2稳态（30％，50％，70％和90％的VO 2peak的）期间2.15 -至少48小时后，重复步骤2.9。减少工作量之间的呼吸保持在VO 2peak工作量的90％恢复的主题。 </li><li>等待在运动中弥散测试之间的2分钟运动过程中清除肺泡CO。不要超过每天12弥散测试，以避免碳氧血红蛋白（碳氧血红蛋白）集结5。 </li></ol> 3.计算肺毛细血管血量和膜弥散能力<ol><li>计算出O 2（P A O 2）使用跟随着的肺泡氧分压摹方程 <img alt="公式（2）" src="/files/ftp_upload/54949/54949equation2.jpg" /> 注:F I O 2是吸入O 2的分数P BAR是大气压力，P H 2 O是水蒸汽压力P 在 CO 2是动脉的 CO 2的压力，和RER是呼吸交换率。 </li><li>使用测得的30秒平均P 等 的 CO 2和RER用于从在前面的分级运动试验中获得的数据中的各自的运动强度估计RER和P 在 CO 2。 </li><li>计算使用下面的等式7θCO。 <img alt="公式3" src="/files/ftp_upload/54949/54949equation3.jpg" /></li><li>图表为每个F I O 2 1 /弥散形容词和1 /θCO间的关系，并计算回归方程。 注:最小可接受R 2值是0.95，并且当r 2的值是在该范围21以外的DL CO演习应该重复。 </li></ol><img alt="图2" src="/files/ftp_upload/54949/54949fig2.jpg" /> 图2: 对峰值练习1 /θCO 1 / DL CO代表图。 1 / DL CO和1 /θCO之间的关系作图三个呼吸保持在各个F I O 2（21％，40％和60％）。 Vc和Dm的计算是从回归方程为上述的关系的。的直线的斜率（1 / 0.00796）的倒数给出Vc的（125.5毫升）中的值，和y截距的倒数（1 / 0.00869）给出了DM 115.0毫升·分-1·毫米汞柱的值（ -1）。 <a href="https://ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/54949/54949fig2large.jpg" target="_blank">请点击这里查看LAR</a>GER版本这个数字。 <ol start="5"><li>通过取1 / DL CO和1 /θCO之间的回归方程的斜率的倒数计算Vc的。通过取方程的y截距的倒数计算DM。 </li></ol> 4.肺内动静脉吻合招聘<ol><li>上从DL CO数据收集一个单独的一天，将一个20号静脉（IV）导管插入肘前静脉，它通过一个6第四延伸管连接到一个三路活塞用于对比度搅拌盐水的注射超声心动图11，17。 </li></ol><img alt="图3" src="/files/ftp_upload/54949/54949fig3.jpg" /> 图3:搅动盐水对比度设置。静脉导管被放置在所述肘空间，并通过一个6中延伸连接到三通阀。两个10毫升注射器在tached到活塞以创建对比度溶液，其中含有10毫升盐水和0.5mL室温的空气。 <a href="https://ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/54949/54949fig3large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <ol start="2"><li>两个10毫升的注射器连接到三路活塞。结合10毫升0.9％的无菌盐水中，用0.5ml的空气，并有力地搅拌它通过三路活塞，来回两个注射器之间，以形成精细，悬浮气泡，直到声谱仪准备对比。 </li><li>拥有一支经验丰富的超声医师或心脏病专家获得心脏的标准心尖四腔心切。休息时，有超声心动图检查评估内部房间隔和室间隔对于心内分流与标准的超声心动图和彩色多普勒成像。 <ol><li>如果没有发现心内分流，指导课题的对比度注射期间执行Valsalva动作离子以评估卵圆孔未闭（PFO）11，17。非主动脉期间重复测量。 </li></ol></li><li>注入对比度，超声医师保持四腔心切。记录在检测中的右心室造影15个心动周期。 </li><li>重复稳态运动时的对比度增强成像在30％，50％，和VO 2peak的70％。由于稳态不能在VO 2peak的90％达成，开始分级运动试验在成像曾经的目标HR，在VO 2peak的90％由HR鉴定，达到。 注意:运动强度之间的时间取决于对比从两个心室间隙，≥2分钟。 </li><li>有谁是盲法的实验条件的的echocardiographer解释根据先前描述的积分系统17 &lt;搅拌的盐水对比度超声心动图/ SUP&gt; 27。 注:评分是基于对比度的最大数量的气泡在一个单一的超声心动图帧左心室（LV）中可见，如下:没有对比度在LV = 0气泡，≤3气泡= 1，4 - 12气泡= 2 ，&gt; 12气泡= 3。 注:对比于左心室的外观五心循环之后显示一个IPAVA。一个内分流通过对比在不到五心动周期27的外观分级。 </li></ol><img alt="图4" src="/files/ftp_upload/54949/54949fig4.jpg" /> 图4:IPAVA评分代表图像。规模为5厘米（白色实线）。 （A）预注射造影剂。 （B）IPAVA得分= 0（C）IPAVA得分= 1（D）IPAVA分数= 3 <a href="https://ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/54949/54949fig4large.jpg" target="_blank">P</a>租赁点击此处查看该图的放大版本。

<ol>
	<li>Naeije, R., Chesler, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+Circulation+at+Exercise.">Pulmonary Circulation at Exercise.</a> Comp Physiol. 2 (1), (2012).</li><li>Stickland, M. K., Lindinger, M. I., Olfert, I. M., Heigenhauser, G. J. F., Hopkins, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+gas+exchange+and+acid-base+balance+during+exercise.">Pulmonary gas exchange and acid-base balance during exercise.</a> Comp Physiol. 3 (2), 693-739 (2013).</li><li>Hsia, C. C., Herazo, L. F., Ramanathan, M., Johnson, R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+output+during+exercise+measured+by+acetylene+rebreathing,+thermodilution,+and+Fick+techniques.">Cardiac output during exercise measured by acetylene rebreathing, thermodilution, and Fick techniques.</a> J Appl Physiol. 78 (4), 1612-1616 (1995).</li><li>Hsia, C. C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recruitment+of+lung+diffusing+capacity:+update+of+concept+and+application.">Recruitment of lung diffusing capacity: update of concept and application.</a> Chest. 122 (5), 1774-1783 (2002).</li><li>Tedjasaputra, V., Bouwsema, M. M., Stickland, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+aerobic+fitness+on+capillary+blood+volume+and+diffusing+membrane+capacity+response+to+exercise.">Effect of aerobic fitness on capillary blood volume and diffusing membrane capacity response to exercise.</a> J Physiol. 594 (15), 4359-4370 (2016).</li><li>Johnson, R. L., Spicer, W. S., Bishop, J. M., Forster, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+capillary+blood+volume,+flow+and+diffusing+capacity+during+exercise.">Pulmonary capillary blood volume, flow and diffusing capacity during exercise.</a> J Appl Physiol. 15 (5), 893-902 (1960).</li><li>Roughton, F. J., Forster, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relative+importance+of+diffusion+and+chemical+reaction+rates+in+determining+rate+of+exchange+of+gases+in+the+human+lung,+with+special+reference+to+true+diffusing+capacity+of+pulmonary+membrane+and+volume+of+blood+in+the+lung+capillaries.">Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries.</a> J Appl Physiol. 11 (2), 290 (1957).</li><li>Forster, R. E., Roughton, F. J., Cander, L., Briscoe, W. A., Kreuzer, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Apparent+pulmonary+diffusing+capacity+for+CO+at+varying+alveolar+O2+tensions.">Apparent pulmonary diffusing capacity for CO at varying alveolar O2 tensions.</a> J Appl Physiol. 11 (2), 277-289 (1957).</li><li>Roughton, F. J., Forster, R. E., Cander, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rate+at+which+carbon+monoxide+replaces+oxygen+from+combination+with+human+hemoglobin+in+solution+and+in+the+red+cell.">Rate at which carbon monoxide replaces oxygen from combination with human hemoglobin in solution and in the red cell.</a> J Appl Physiol. 11 (2), 269-276 (1957).</li><li>Johnson, R. L., Hsia, C. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+recruitment+of+pulmonary+capillaries.">Functional recruitment of pulmonary capillaries.</a> J Appl Physiol. 76 (4), 1405-1407 (1994).</li><li>Tedjasaputra, V., Bryan, T. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dopamine+receptor+blockade+improves+pulmonary+gas+exchange+but+decreases+exercise+performance+in+healthy+humans.">Dopamine receptor blockade improves pulmonary gas exchange but decreases exercise performance in healthy humans.</a> J Physiol. 593 (14), 3147-3157 (2015).</li><li>Stickland, M. K., Welsh, R. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-pulmonary+shunt+and+pulmonary+gas+exchange+during+exercise+in+humans.">Intra-pulmonary shunt and pulmonary gas exchange during exercise in humans.</a> J Physiol. 561 (1), 321-329 (2004).</li><li>Stickland, M. K., Lovering, A. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exercise-induced+intrapulmonary+arteriovenous+shunting+and+pulmonary+gas+exchange.">Exercise-induced intrapulmonary arteriovenous shunting and pulmonary gas exchange.</a> Exerc Sport Sci Rev. 34 (3), 99-106 (2006).</li><li>Eldridge, M. W., Dempsey, J. A., Haverkamp, H. C., Lovering, A. T., Hokanson, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exercise-induced+intrapulmonary+arteriovenous+shunting+in+healthy+humans.">Exercise-induced intrapulmonary arteriovenous shunting in healthy humans.</a> J Appl Physiol. 97 (3), 797-805 (2004).</li><li>Hopkins, S. R., Olfert, I. M., Wagner, P. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point:Counterpoint:+Exercise-induced+intrapulmonary+shunting+is+imaginary.">Point:Counterpoint: Exercise-induced intrapulmonary shunting is imaginary.</a> J Appl Physiol. 107 (3), 993-994 (2009).</li><li>Lovering, A. T., Eldridge, M. W., Stickland, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Counterpoint:+Exercise-induced+intrapulmonary+shunting+is+real.">Counterpoint: Exercise-induced intrapulmonary shunting is real.</a> J Appl Physiol. 107 (3), 994-997 (2009).</li><li>Bryan, T. L., van Diepen, S., Bhutani, M., Shanks, M., Welsh, R. C., Stickland, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+dobutamine+and+dopamine+on+intrapulmonary+shunt+and+gas+exchange+in+healthy+humans.">The effects of dobutamine and dopamine on intrapulmonary shunt and gas exchange in healthy humans.</a> J Appl Physiol. 113 (4), 541-548 (2012).</li><li>Stickland, M. K., Welsh, R. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+acute+increases+in+pulmonary+vascular+pressures+on+exercise+pulmonary+gas+exchange.">Effect of acute increases in pulmonary vascular pressures on exercise pulmonary gas exchange.</a> J Appl Physiol. 100 (6), 1910-1917 (2006).</li><li>Berk, J. L., Hagen, J. F., Tong, R. K., Maly, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+dopamine+to+correct+the+reduced+cardiac+output+resulting+from+positive+end-expiratory+pressure.+A+two-edged+sword.">The use of dopamine to correct the reduced cardiac output resulting from positive end-expiratory pressure. A two-edged sword.</a> Crit Care Med. 5 (6), 269 (1977).</li><li>Lalande, S., Yerly, P., Faoro, V., Naeije, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+vascular+distensibility+predicts+aerobic+capacity+in+healthy+individuals.">Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals.</a> J Physiol. 590 (17), 4279-4288 (2012).</li><li>Tedjasaputra, V., Collins, S. &. #. 2. 0. 1. ;., Bryan, T. L., van Diepen, S., Bouwsema, M. M., Stickland, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+there+a+relationship+between+pulmonary+capillary+blood+volume+and+intrapulmonary+arteriovenous+anastomosis+recruitment+during+exercise?.">Is there a relationship between pulmonary capillary blood volume and intrapulmonary arteriovenous anastomosis recruitment during exercise?.</a> FASEB J. 30 (1), (2016).</li><li>Reeves, J. T., Linehan, J. H., Stenmark, K. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Distensibility+of+the+normal+human+lung+circulation+during+exercise.">Distensibility of the normal human lung circulation during exercise.</a> Am J Physiol. Lung cellular and molecular physiology. 288 (3), 419-425 (2005).</li><li>Thadani, U., Parker, J. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemodynamics+at+rest+and+during+supine+and+sitting+bicycle+exercise+in+normal+subjects.">Hemodynamics at rest and during supine and sitting bicycle exercise in normal subjects.</a> Am J Card. 41 (1), 52-59 (1978).</li><li>Warburton, D. E. R., Jamnik, V. K., Bredin, S. S. D., Gledhill, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Physical+Activity+Readiness+Questionnaire+for+Everyone+(PAR-Q)+and+Electronic+Physical+Activity+Readiness+Medical+Examination+(ePARmed-X+).">The Physical Activity Readiness Questionnaire for Everyone (PAR-Q) and Electronic Physical Activity Readiness Medical Examination (ePARmed-X+).</a> The Health &amp; Fitness Journal of Canada. 4 (2), (2011).</li><li>Wasserman, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Principles of Exercise Testing and Interpretation. , (2012).</li><li>Wasserman, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determinants+and+detection+of+anaerobic+threshold+and+consequences+of+exercise+above+it.">Determinants and detection of anaerobic threshold and consequences of exercise above it.</a> Circulation. 76 (6), (1987).</li><li>Marrades, R. M., Diaz, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adjustment+of+DLCO+for+hemoglobin+concentration.">Adjustment of DLCO for hemoglobin concentration.</a> Am J Resp Crit Care Med. 155 (1), 236-241 (2011).</li><li>Lovering, A. T., Romer, L. M., Haverkamp, H. C., Pegelow, D. F., Hokanson, J. S., Eldridge, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intrapulmonary+shunting+and+pulmonary+gas+exchange+during+normoxic+and+hypoxic+exercise+in+healthy+humans.">Intrapulmonary shunting and pulmonary gas exchange during normoxic and hypoxic exercise in healthy humans.</a> J Appl Physiol. 104 (5), 1418-1425 (2008).</li><li>Weyman, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Principles and Practice of Echocardiography. , (1994).</li><li>Laurie, S. S., Elliott, J. E., Goodman, R. D., Lovering, A. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Catecholamine-induced+opening+of+intrapulmonary+arteriovenous+anastomoses+in+healthy+humans+at+rest.">Catecholamine-induced opening of intrapulmonary arteriovenous anastomoses in healthy humans at rest.</a> J Appl Physiol. 113 (8), 1213-1222 (2012).</li><li>Hopkins, S. R., Bogaard, H. J., Niizeki, K., Yamaya, Y., Ziegler, M. G., Wagner, P. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=&#946;-Adrenergic+or+parasympathetic+inhibition,+heart+rate+and+cardiac+output+during+normoxic+and+acute+hypoxic+exercise+in+humans.">&#946;-Adrenergic or parasympathetic inhibition, heart rate and cardiac output during normoxic and acute hypoxic exercise in humans.</a> J Physiol. 550 (2), 605-616 (2009).</li><li>Zavorsky, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+rise+in+carboxyhemoglobin+from+repeated+pulmonary+diffusing+capacity+tests.">The rise in carboxyhemoglobin from repeated pulmonary diffusing capacity tests.</a> Respir Physiol Neurobiol. 186 (1), 103-108 (2013).</li><li>Coffman, K. E., Taylor, B. J., Carlson, A. R., Wentz, R. J., Johnson, B. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimizing+the+calculation+of+DM,CO+and+VC+via+the+single+breath+single+oxygen+tension+DLCO/NO+method.">Optimizing the calculation of DM,CO and VC via the single breath single oxygen tension DLCO/NO method.</a> Respir Physiol Neurobiol. 221, 19-29 (2015).</li><li>Guazzi, M., Pontone, G., Brambilla, R., Agostoni, P., R&#232;ina, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alveolar-capillary+membrane+gas+conductance:+a+novel+prognostic+indicator+in+chronic+heart+failure.">Alveolar-capillary membrane gas conductance: a novel prognostic indicator in chronic heart failure.</a> Eur Heart J. 23 (6), 467-476 (2002).</li><li>Ofir, D., Laveneziana, P., Webb, K. A., Lam, Y. -. M., O'Donnell, D. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+Dyspnea+during+Cycle+Exercise+in+Symptomatic+Patients+with+GOLD+Stage+I+Chronic+Obstructive+Pulmonary+Disease.">Mechanisms of Dyspnea during Cycle Exercise in Symptomatic Patients with GOLD Stage I Chronic Obstructive Pulmonary Disease.</a> Am J Resp Crit Care Med. 177 (6), 622-629 (2008).</li></ol>

The authors declare that they have no competing financial interests.

该方法，能够在运动中肺扩散容量和肺内动静脉吻合招募的评估。 该协议中的关键步骤虽然在DL CO屏气在其余的是比较简单的，呼吸运动时保持呈现给受试者一个独特的挑战，因为它是反直觉的，并且受试者具有高的驱动运动时呼吸。因此，VC和DM的优质决心依靠测试仪和拍摄对象之间的关系和清晰的沟通。测试仪的技术能力可与肺泡体积（先前试验的±5％）和6.0±0.3秒的屏气时间甲苯（BHT）的变异性进行定量。 修改和故障排除在VC / DM测试结束，测试人员应迅速绘制三个DL CO演习脱termine数据点的最佳拟合线;所述DL CO 21％F I O 2测得应该总是比与40％，这应该比用60％的更大的大。如果不是，则建议以检查阀开关对应于正确的测试气体。类似地，检查呼吸预袋填充有对应于该检测气体（ 图1B-1D）正确的F I O 2气体。应谨慎测试的参与者谁是吸烟者，如碳氧血红蛋白升高水平可能低估弥散时服用。 对于IPAVA招聘评估，主体的位置是至关重要的，以确保高品质的图像采集。有可能用一个横卧功率自行车来代替直立功率自行车以减少受试者的运动。然而，横卧周期运动将引起对于给定的工作速度不同的代谢反应，因此，分级运动试验应重复上横卧功率自行车。胸上部的扫描可能会不舒服一些妇女;在这种情况下，建议使用雌性声谱仪。最后，推荐的运动方案是专为年轻，健康的人;因此，该锻炼协议可以被修改为不同的目标群。 该技术的局限性多个F I O 2 DL CO技术的主要限制是测试人员的技能和被摄体的跟踪命令和屏气时要保持冷静，因为主动脉或苗勒演习将影响测量的能力。其次，在一个会话中保持呼吸的数目应限制在12，由于增加的CO背压，这可能会影响到Vc和DM测量5，30和对健康造成风险受试者。根据不同的研究设计，它中号AY必须完成在多个会话测试，以便二氧化碳的清除和限制参与者的疲劳。有了良好的参与者教练和良好的技术能力，我们已经确定了试验间变异系数满意为弥散，VC和DM为7％，8％和15％，分别为。 多个F I O 2的DL CO技术假定肺泡的 O 2是相同的毛细管的 O 2，因此，与已知的气体交换障碍个人解释数据时应小心。 搅拌盐水对比度超声成像是由声谱仪的技术能力和受试者在运动时，尽量减少胸廓运动的能力的限制。同样重要的是，图像的解释熟悉刻度按既定程序进球IPAVA招募（ 图4 </str翁&gt;）27。运动过程中的积极生理盐水造影超声心动图的意义仍然是辩论15，16的话题，有一些讨论，在左心室积极的生理盐水搅动对比度可继发于毛细血管扩张，而不是IPAVA招聘。正在进行的工作是试图解决这一问题。 相对于现有的/替代方法的技术意义通过利用这些生理技术，能够在各种条件下运动时，以评估肺血管，包括在健康，疾病和药物干预。虽然质量测试仪的能力取决于这些技能是方便，快捷地与适当的指导和培训获得的。多重F I O 2 DL CO方法被认为是在MEA的"金标准"DM和Vc 31 surement。而临床上不计算这些措施，这些值可以被用来确定用于低氧血症和运动耐受的机制，来预测患者结果，并进一步表征诊断31,32。同样，搅拌盐水超声心动图的技术是在确定IPAVAs招募的最广泛使用的方法。 掌握这一技术后，未来的应用或指示这些技术适用于在一系列的实验条件和干预使用。我们运动时表明这些技术，但他们可以很容易地进行修改，以测量药物输注期间肺血管反应，例如多巴酚丁胺或多巴胺，已知增加心输出17强心剂。此外，有可能在临床人群中使用这些技术，例如如在患有心脏衰竭34或慢性阻塞性肺疾病（COPD）中，其中在DL CO相比年龄匹配的对照受试者35是低级。

在运动过程中，心输出量可提高到六倍以上的休息值1。鉴于肺部的唯一机构接收心输出量的100％，运动呈现相当大的压力，以肺系统。对于增量运动，肺弥散量（DL CO）必须增加，以满足增加的需氧量2。从静止到峰值运动，DL CO可增加到静止值高达150％，没有达到相对于一个上限心输出3，4，5。在弥散量增加的发生是由于在膜弥散量（DM）和毛细血管血量（VC），继发于肺毛细血管6的招聘和扩张增加的结果。 Roughton和福斯特（1957）开发出一种技术，分区D米和VC 7里由一氧化碳测试（DL CO）标准的扩散能力时调节吸入氧浓度（F I O 2）的比例。氧气和一氧化碳（CO）的竞争性结合对血红蛋白血红素网站，例如，增加F I O 2会降低DL CO 8,9。通过标准DL CO动作时调制F I O 2，这种关系可以被利用来衡量Vc和DM 7。我们最近适于这种技术锻炼5期间使用。到以前的工作类似，我们已经发现，DL CO连续增加高达二次峰值运动在两个Vc和DM 5增加。有趣的是，我们已经发现，在谁具有更大的氧消耗，从而对弥散能力更需要耐力训练的运动员，有在运动高峰的增加在DL CO。，继发于增加Dm和不Vc的，这表明在运动员5的肺膜的电位的适应。 运动过程中Vc和DM的增加是通过增加肺动脉压力，这将导致在休息4，10以前低灌注肺毛细血管的招聘和扩张来实现的。这导致增加了肺毛细血管网的横截面面积，由此降低肺血管阻力和衰减在肺动脉压力的增加。 用生理盐水激动超声造影研究运动11，12，13时已经显示肺内动静脉吻合（IPAVA）招募的证据14。 IPAVA招聘的意义尚不清楚，虽然一些研究表明，它们可能有助于气体交换障碍12,14和可用于卸载右心室11，12，话题仍存在争议15,16。此外，虽然IPAVA招募的确切机制是未知的，我们已经发现，增加心输出量，以及外源性多巴胺，使IPAVA招募在休息17。一个敏锐地增加肺动脉压力18或多巴胺阻断不会出现运动11时显著影响IPAVA招聘。有人猜测，这些大直径IPAVA血管可能有助于保护肺毛细血管从肺动脉大幅增加通过降低肺血管阻力12，17，19，20，21的压力。 当与Vc和DM的评价相结合，激动生理盐水造影是肺循环的适应性研究锻炼22,23的压力的重要工具。

<table><tbody><tr><td>Metabolic Measurement System</td><td>SensorMedics Inc.</td><td>Encore 299 Vmax</td><td></td></tr><tr><td>Cycle Ergometer</td><td>Ergoline</td><td>Ergoselect II 1200</td><td></td></tr><tr><td>60 L Douglas Bags</td><td>Hans Rudolph</td><td>6100 Series</td><td></td></tr><tr><td>Two-way T Valve</td><td>Hans Rudolph</td><td>2700 Series</td><td></td></tr><tr><td>Hemoglobin Measurement System</td><td>HemoCue</td><td>Hb 201+</td><td></td></tr><tr><td>22-gauge Intravenous Catheter</td><td>BD</td><td>Insyte-W</td><td></td></tr><tr><td>Ultrasound&amp;nbsp;</td><td>Vivid Q</td><td>ECHOpac</td><td></td></tr><tr><td>Compressed gas 21% O&lt;sub&gt;2&lt;/sub&gt;, 0.3% CO, 0.3% CH&lt;sub&gt;4&lt;/sub&gt;, balance nitrogen</td><td>Praxair</td><td></td><td></td></tr><tr><td>Compressed gas 40% O&lt;sub&gt;2&lt;/sub&gt;, 0.3% CO, 0.3% CH&lt;sub&gt;4&lt;/sub&gt;, balance nitrogen</td><td>Praxair</td><td></td><td></td></tr><tr><td>Compressed gas 60% O&lt;sub&gt;2&lt;/sub&gt;, 0.3% CO, 0.3% CH&lt;sub&gt;4&lt;/sub&gt;, balance nitrogen</td><td>Praxair</td><td></td><td></td></tr><tr><td>Nose-clip</td><td>Vacu-Med</td><td>snuffer #1008</td><td></td></tr></tbody></table>

assessment of pulmonary capillary blood volume, membrane diffusing capacity, and intrapulmonary arteriovenous anastomoses during exercise

运动是一个偏重于肺血管。随着增量运动，肺弥散功能（DL CO）必须增加以应付增加的需氧量;否则，可能会发生扩散限制。与运动中的DL CO的增加是由于增加的毛细血管血液体积（Vc）的和膜弥散能力（DM）。 Vc和DM增加继发招募和肺毛细血管扩张，增加了气体交换的表面积和降低肺血管阻力，由此衰减肺动脉压力的增加。与此同时，肺内动静脉吻合（IPAVA）运动过程中招募可有助于气体交换障碍和/或预防肺动脉压力的大幅增加。 我们描述两种技术在休息和运动过程中，评估肺部扩散和流通。第一种技术使用多离吸入氧ction（F I O 2）DL 有限公司持有的气息，以确定Vc和DM在休息和运动过程中。此外，超声心动图静脉注射生理盐水激动的对比来评估IPAVAs招聘。 代表性的数据表明，在DL CO。，Vc的和Dm与运动强度增加。超声心动图的数据显示，没有IPAVA招聘在休息，而相比之下泡沫是与运动左心室看出，这表明运动诱发IPAVA招聘。 肺毛细血管血体积，膜弥散能力，并利用超声心动图的方法IPAVA招募的评估是有用的表征肺脉管系统的适应锻炼在健康的应力的能力，以及在患病群体，如那些与肺动脉高血压和慢性阻塞性肺疾病。

示于表1氧消耗量增加运动强度，弥散能力，肺毛细血管血液体积，膜扩散能力，并IPAVA得分的效果。 VO 2，DL CO。，Vc的和Dm增加响应于增加输出功率。 图2显示了在运动中使用多个F I O 2 -DL CO技术Vc和DM的代表计算。 DL CO随着F I O 2减少，这种关系被利用来划分Vc和DM。计算1 / DL CO的与在VC 1 /θCO结果的斜率的倒数，和y截距的逆产生用于DM的值。正如预期的那样，无论是运动过程中Vc和DM相比增加休息值。 I O 2 DL CO和激动盐水超声造影方法提供调查人员更深入地了解肺毛细血管和膜招聘整体扩散能力的贡献，并可以补充在临床上传统的肺功能检测。未能扩大Vc的或Dm运动时会导致一个扩散限制和低氧血症。例如，一个低的DL CO继发低Vc的将指示改变到肺毛细血管;同样地，降低的DM将指示变更至肺膜。 图4示出的四腔对比度echocardiographs代表描。随着运动强度的IPAVA得分从0增加（ <eM&gt;即，在剩下的3在最高运动强度（ 表1）IPAVAs没有证据）。先前的研究表明，运动增加IPAVA得分11，12，14，但没有达成共识，以这些IPAVAs是如何招募的。有证据表明，IPAVAs可以药理学上在休息与多巴胺17,28通过增加多巴酚丁胺17,28和肾上腺素28心输出招募，以及。强心剂如多巴胺和肾上腺素是特别感兴趣的，因为它们的运动29期间内源性增加。此外，还有一些证据表明，行使血流动力学，在该缺席IPAVAs的出现造成更大的肺动脉压力IPAVA招募可能是重要的，降低Çardiac输出，降低峰值功率输出12。因此，该技术可以在研究探讨与肺动脉高压的个体使用。 <img alt="图1" src="/files/ftp_upload/54949/54949fig1.jpg" /> 图1:多个F I O 2 DL CO设置。 （ 一 ）设置概述。 （B）含21％，40％，和60％ 的 O 2 0.3％CO，0.3％的甲烷，和其余为氮的压缩气体钢瓶，以及一个补充氧气压缩气瓶。 （C），三通阀切换三个F I O 2 DL CO坦克。 （D）的阀系列中与F I O 2的选择用于预呼吸切换为三通阀。 <a href="https://ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/54949/54949fig1large.jpg" target="_blank">请点击这里查看LAR</a>GER版本这个数字。 <img alt="表格1" src="/files/ftp_upload/54949/54949table1.jpg" /> 表1:在休息一个主题，并在运动过程中，在30，50，70代表性的数据，90％的VO 2peak的。 VO 2，相对于体重的氧消耗量的容积; DL CO，一氧化碳弥散能力; VC，肺毛细血管血液量; DM，膜弥散能力; IPAVA得分，五心循环后对比外观在左心室的得分。从Tedjasaputra 等人修改的数据。 2016年。

Watch this Scientific Journal Video about Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise at JoVE.com

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

为了评估锻炼肺扩散和血管的反应，我们描述了多吸入氧扩散能力的技术来确定毛细血管血量和膜弥散能力，以及搅动盐水超声造影评估肺内动静脉吻合的招聘。

肺毛细血管血量，膜弥散能力，及肺内动静脉吻合的评估期间行使

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

assessment-pulmonary-capillary-blood-volume-membrane-diffusing

Universidad San Sebastian

Research

Education

JoVE Core

JoVE Journal

Medical-Surgical Nursing

Medicine

Unit 1

An Overview of the Respiratory System: Anatomy, Physiology, Assessment, and Abnormalities

SCIENTISTS IN ACTION

13.0K 次观看.  University of Alberta. 为了评估锻炼肺扩散和血管的反应，我们描述了多吸入氧扩散能力的技术来确定毛细血管血量和膜弥散能力，以及搅动盐水超声造影评估肺内动静脉吻合的招聘。 

视频: Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling

This demonstrates a MR imaging method to measure the spatial distribution of pulmonary blood flow in healthy subjects 
during normoxia (inspired O2, fraction (FIO2) = 0.21) hypoxia (FIO2 = 0.125), and hyperoxia 
(FIO2 = 1.00). In addition, the physiological responses of the subject are monitored in the MR scan environment. MR images 
were obtained on a 1.5 T GE MRI scanner during a breath hold from a sagittal slice in the right lung at functional residual capacity. An arterial 
spin labeling sequence (ASL-FAIRER) was used to measure the spatial distribution of pulmonary blood flow 1,2 and a multi-echo fast 
gradient echo (mGRE) sequence 3 was used to quantify the regional proton (i.e. H2O) density, allowing the quantification 
of density-normalized perfusion for each voxel (milliliters blood per minute per gram lung tissue). 
With a pneumatic switching valve and facemask equipped with a 2-way non-rebreathing valve, different oxygen concentrations 
were introduced to the subject in the MR scanner through the inspired gas tubing. A metabolic cart collected expiratory gas via expiratory tubing. Mixed expiratory O2 and CO2 concentrations, oxygen consumption, carbon dioxide production, respiratory exchange ratio, 
respiratory frequency and tidal volume were measured. Heart rate and oxygen saturation were monitored using pulse-oximetry. 
Data obtained from a normal subject showed that, as expected, heart rate was higher in hypoxia (60 bpm) than during normoxia (51) or hyperoxia (50) and the arterial oxygen saturation (SpO2) was reduced during hypoxia to 86%. Mean ventilation was 8.31 L/min BTPS during hypoxia, 7.04 L/min during normoxia, and 6.64 L/min during hyperoxia. Tidal volume was 0.76 L during hypoxia, 0.69 L during normoxia, and 0.67 L during hyperoxia. 
Representative quantified ASL data showed that the mean density normalized perfusion was 8.86 ml/min/g during hypoxia, 8.26 ml/min/g during normoxia and 8.46 ml/min/g during hyperoxia, respectively. In this subject, the relative dispersion4, an index of global heterogeneity, was increased in hypoxia (1.07 during hypoxia, 0.85 during normoxia, and 0.87 during hyperoxia) while the fractal dimension (Ds), another index of heterogeneity reflecting vascular branching structure, was unchanged (1.24 during hypoxia, 1.26 during normoxia, and 1.26 during hyperoxia). 
Overview. This protocol will demonstrate the acquisition of data to measure the distribution of pulmonary perfusion noninvasively under conditions of normoxia, hypoxia, and hyperoxia using a magnetic resonance imaging technique known as arterial spin labeling (ASL). 
Rationale: Measurement of pulmonary blood flow and lung proton density using MR technique offers high spatial resolution images which can be quantified and the ability to perform repeated measurements under several different physiological conditions. In human studies, PET, SPECT, and CT are commonly used as the alternative techniques. However, these techniques involve exposure to ionizing radiation, and thus are not suitable for repeated measurements in human subjects.

A MR imaging method to study the distribution of pulmonary blood flow under a variety of physiological conditions, in this case exposure to three different inspired oxygen concentrations: hypoxia, normoxia, and hyperoxia, is described. This technique utilizes human pulmonary physiology research techniques in an MR scanning environment.

使用校准动脉自旋标记磁共振肺灌注显像定量

This demonstrates a MR imaging method to measure the spatial distribution of pulmonary blood flow in healthy subjects 
during normoxia (inspired O2, ...

科研

医学

Non-invasive Assessment of Microvascular and Endothelial Function

The authors have utilized capillaroscopy and forearm blood flow techniques to investigate the role of microvascular dysfunction in pathogenesis of cardiovascular disease. Capillaroscopy is a non-invasive, relatively inexpensive methodology for directly visualizing the microcirculation. Percent capillary recruitment is assessed by dividing the increase in capillary density induced by postocclusive reactive hyperemia (postocclusive reactive hyperemia capillary density minus baseline capillary density), by the maximal capillary density (observed during passive venous occlusion). Percent perfused capillaries represents the proportion of all capillaries present that are perfused (functionally active), and is calculated by dividing postocclusive reactive hyperemia capillary density by the maximal capillary density. Both percent capillary recruitment and percent perfused capillaries reflect the number of functional capillaries. The forearm blood flow (FBF) technique provides accepted non-invasive measures of endothelial function: The ratio FBFmax/FBFbase is computed as an estimate of vasodilation, by dividing the mean of the four FBFmax values by the mean of the four FBFbase values. Forearm vascular resistance at maximal vasodilation (FVRmax) is calculated as the mean arterial pressure (MAP) divided by FBFmax. Both the capillaroscopy and forearm techniques are readily acceptable to patients and can be learned quickly.
The microvascular and endothelial function measures obtained using the methodologies described in this paper may have future utility in clinical patient cardiovascular risk-reduction strategies. As we have published reports demonstrating that microvascular and endothelial dysfunction are found in initial stages of hypertension including prehypertension, microvascular and endothelial function measures may eventually aid in early identification, risk-stratification and prevention of end-stage vascular pathology, with its potentially fatal consequences.

Capillaroscopy is a non-invasive, relatively inexpensive methodology for directly visualizing the microcirculation. The forearm blood flow technique provides accepted non-invasive measures of endothelial function.

非侵入性的评估微血管和内皮功能

The authors have utilized capillaroscopy and forearm blood flow techniques to investigate the role of microvascular dysfunction in pathogenesis of ...

Characterization of the Isolated, Ventilated, and Instrumented Mouse Lung Perfused with Pulsatile Flow

The isolated, ventilated and instrumented mouse lung preparation allows steady and pulsatile pulmonary vascular pressure-flow relationships to be measured with independent control over pulmonary arterial flow rate, flow rate waveform, airway pressure and left atrial pressure. Pulmonary vascular resistance is calculated based on multi-point, steady pressure-flow curves; pulmonary vascular impedance is calculated from pulsatile pressure-flow curves obtained at a range of frequencies. As now recognized clinically, impedance is a superior measure of right ventricular afterload than resistance because it includes the effects of vascular compliance, which are not negligible, especially in the pulmonary circulation. Three important metrics of impedance - the zero hertz impedance Z0, the characteristic impedance ZC, and the index of wave reflection RW - provide insight into distal arterial cross-sectional area available for flow, proximal arterial stiffness and the upstream-downstream impedance mismatch, respectively. All results obtained in isolated, ventilated and perfused lungs are independent of sympathetic nervous system tone, volume status and the effects of anesthesia. We have used this technique to quantify the impact of pulmonary emboli and chronic hypoxia on resistance and impedance, and to differentiate between sites of action (i.e., proximal vs. distal) of vasoactive agents and disease using the pressure dependency of ZC. Furthermore, when these techniques are used with the lungs of genetically engineered strains of mice, the effects of molecular-level defects on pulmonary vascular structure and function can be determined.

The following protocol outlines the process of isolating, ventilating and instrumenting mouse lungs to measure steady or pulsatile pulmonary vascular pressure-flow relationships in order to quantify the effects of blood flow, airflow, airway changes and vascular changes on right ventricular afterload.

表征隔离，通风，和仪表小鼠肺灌注与脉动流

The isolated, ventilated and instrumented mouse lung preparation allows steady and pulsatile pulmonary vascular pressure-flow relationships to be measured ...

生物学

Surgical Placement of Catheters for Long-term Cardiovascular Exercise Testing in Swine

This protocol describes the surgical procedure to chronically instrument swine and the procedure to exercise swine on a motor-driven treadmill. Early cardiopulmonary dysfunction is difficult to diagnose, particularly in animal models, as cardiopulmonary function is often measured invasively, requiring anesthesia. As many anesthetic agents are cardiodepressive, subtle changes in cardiovascular function may be masked. In contrast, chronic instrumentation allows for measurement of cardiopulmonary function in the awake state, so that measurements can be obtained under quiet resting conditions, without the effects of anesthesia and acute surgical trauma. Furthermore, when animals are properly trained, measurements can also be obtained during graded treadmill exercise.
Flow probes are placed around the aorta or pulmonary artery for measurement of cardiac output and around the left anterior descending coronary artery for measurement of coronary blood flow. Fluid-filled catheters are implanted in the aorta, pulmonary artery, left atrium, left ventricle and right ventricle for pressure measurement and blood sampling. In addition, a 20 G&#160;catheter is positioned in the anterior interventricular vein to allow coronary venous blood sampling.
After a week of recovery, swine are placed on a motor-driven treadmill, the catheters are connected to pressure and flow meters, and swine are subjected to a five-stage progressive exercise protocol, with each stage lasting 3 min. Hemodynamic signals are continuously recorded and blood samples are taken during the last 30 sec of each exercise stage.
The major advantage of studying chronically instrumented animals is that it allows serial assessment of cardiopulmonary function, not only at rest but also during physical stress such as exercise. Moreover, cardiopulmonary function can be assessed repeatedly during disease development and during chronic treatment, thereby increasing statistical power and hence limiting the number of animals required for a study.

Here we present a protocol to assess cardiopulmonary function in awake swine, at rest and during graded treadmill exercise. Chronic instrumentation allows for repeated hemodynamic measurements uninfluenced by cardiodepressive anesthetic agents.

导管手术放置了长期的心血管运动试验猪

This protocol describes the surgical procedure to chronically instrument swine and the procedure to exercise swine on a motor-driven treadmill. Early ...

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic pressure through echocardiography, as well as to obtain measurements of the Aorta and PA diameter in mice.
Mice older than 10 d of age can be analyzed using the present technique. The technique is composed of 3 main steps: set-up, image acquisition, and image analysis. The set-up step consists of getting the mouse anesthetized with 1% isoflurane, shaving it, and taping it in a supine position to a heated EKG board where the image acquisition will take place. The image acquisition step consists of learning to identify the cardiac structures and obtaining all the required images with its correspondent probe and axis in order to be able to calculate volumes and diameters. The image analysis step consists of measuring the previously acquired images with the aid of computer software.
Advantages of the proposed technique include a fast (15 min) procedure that would allow the researcher to evaluate interventions in a non-invasive, non-terminal approach and therefore follow the same mouse over time; each mouse can be used as its own control. This fact plus having the same operator perform all the acquisition and analysis for the entire experiment minimizes the limitation of operator-dependency. The present methodology is useful for mouse researchers in cardiovascular and pulmonary medicine.

The following protocol describes the methodology for the acquisition and analysis of echocardiographic images used to obtain the Left Atrial Volume (LAV), Aorta (Ao) diameter, and Pulmonary Artery (PA) diameter in mice. This technique is a non-invasive, non-terminal procedure that allows assessment of the cardiopulmonary function.

左心房，主动脉和肺动脉的超声心动图小鼠

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic ...

Combining Volumetric Capnography And Barometric Plethysmography To Measure The Lung Structure-function Relationship

Tools to measure lung and airways volume are critical for pulmonary researchers interested in evaluating the impact of disease or novel therapies on the lung. Barometric plethysmography is a classic technique to evaluate the lung volume with a long history of clinical use. Volumetric capnography utilizes the profile of exhaled carbon dioxide to determine the volume of the conducting airways, or dead space, and provides an index of airways homogeneity. These techniques may be used independently, or in combination to evaluate the dependence of airways volume and homogeneity on lung volume. This paper provides detailed technical instructions to replicate these techniques and our representative data demonstrates that the airways volume and homogeneity are highly correlated to lung volume. We also provide a macro for the analysis of capnographic data, which can be modified or adapted to fit different experimental designs. The advantage of these measures is that their advantages and limitations are supported by decades of experimental data, and they can be made repeatedly in the same subject without expensive imaging equipment or technically advanced analysis algorithms. These methods may be particularly useful for investigators interested in perturbations that change both the functional residual capacity of the lung and airways volume.

Here, we describe two measures of pulmonary function &#8211; barometric plethysmography, which allows the measurement of lung volume, and volumetric capnography, a tool to measure the anatomic dead space and airways uniformity. These techniques may be used independently or combined to assess airways function at different lung volumes.

体积摄影与气压面学相结合测量肺结构-功能关系

Tools to measure lung and airways volume are critical for pulmonary researchers interested in evaluating the impact of disease or novel therapies on the ...

Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction (HF). However, in clinical cardiopulmonary exercise testing (CPET), cerebral hemodynamics is not assessed. NIRS is used to measure cerebral tissue oxygen saturation (SctO2) in the frontal lobe. This method is reliable and valid and has been utilized in several studies. SctO2 is lower during both rest and peak exercise in patients with HF than in healthy controls (66.3 &#177; 13.3% and 63.4 &#177; 13.8% vs. 73.1 &#177; 2.8% and 72 &#177; 3.2%). SctO2 at rest is significantly linearly correlated with peak VO2 (r = 0.602), oxygen uptake efficiency slope (r = 0.501), and brain natriuretic peptide (r = -0.492), all of which are recognized prognostic and disease severity markers, indicating its potential prognostic value. SctO2 is determined mainly by end-tidal CO2 pressure, mean arterial pressure, and hemoglobin in the HF population. This article demonstrates a protocol that integrates SctO2 using NIRS into incremental CPET on a calibrated bicycle ergometer.

This protocol integrated near-infrared spectroscopy into conventional cardiopulmonary exercise testing to identify the involvement of the cerebral hemodynamic response in exercise intolerance in patients with heart failure.

心力衰竭患者心肺运动测试中脑组织饱和监测的集成

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction ...

Quantifying Single Microvessel Permeability in Isolated Blood-perfused Rat Lung Preparation

The isolated blood-perfused lung preparation is widely used to visualize and define signaling in single microvessels. By coupling this preparation with real time imaging, it becomes feasible to determine permeability changes in individual pulmonary microvessels. Herein we describe steps to isolate rat lungs and perfuse them with autologous blood. Then, we outline steps to infuse fluorophores or agents via a microcatheter into a small lung region. Using these procedures described, we determined permeability increases in rat lung microvessels in response to infusions of bacterial lipopolysaccharide. The data revealed that lipopolysaccharide increased fluid leak across both venular and capillary microvessel segments. Thus, this method makes it possible to compare permeability responses among vascular segments and thus, define any heterogeneity in the response. While commonly used methods to define lung permeability require postprocessing of lung tissue samples, the use of real time imaging obviates this requirement as evident from the present method. Thus, the isolated lung preparation combined with real time imaging offers several advantages over traditional methods to determine lung microvascular permeability, yet is a straightforward method to develop and implement.

The isolated blood-perfused lung preparation makes it feasible to visualize microvessel networks on the lung surface. Here we describe an approach to quantify permeability of single microvessels in isolated lungs using real time fluorescence imaging.

在离体血液灌注大鼠肺备量化单微血管通透性

The isolated blood-perfused lung preparation is widely used to visualize and define signaling in single microvessels. By coupling this preparation with ...

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge

A preload challenge (PC) is a clinical maneuver that, first, increases the cardiac filling (i.e., preload) and, second, calculates the change in cardiac output. Fundamentally, a PC is a bedside approach for testing the Frank-Starling-Sarnoff (i.e., "cardiac function") curve. Normally, this curve has a steep slope such that a small change in the cardiac preload generates a large change in the stroke volume (SV) or cardiac output. However, in various disease states, the slope of this relationship flattens such that increasing the volume into the heart leads to little rise in the SV. In this pathological scenario, additional cardiac preload (e.g., intravenous fluid) is unlikely to be physiologically effective and could lead to harm if organ congestion evolves. Therefore, inferring both the cardiac preload and output is clinically useful as it may guide intravenous (IV) fluid resuscitation. Accordingly, the goal of this protocol is to describe a method for contemporaneously tracking the surrogates of cardiac preload and output using a novel, wireless, wearable ultrasound during a well-validated preload challenge.

The Frank-Starling-Sarnoff curve is clinically important and describes the relationship between cardiac preload and output. This report illustrates a novel method of simultaneous jugular venous and carotid arterial Doppler velocimetry as transient surrogates of cardiac preload and output, respectively; this approach is enabled by wireless, wearable Doppler ultrasound.

负荷前激发期间的连续静脉动脉多普勒超声检查

A preload challenge (PC) is a clinical maneuver that, first, increases the cardiac filling (i.e., preload) and, second, calculates the change in cardiac ...

评估运动期间肺泡毛细血管储备

Dual Test Gas Pulmonary Diffusing Capacity Measurement During Exercise in Humans Using the Single-Breath Method

The combined single-breath measurement of the diffusing capacity of carbon monoxide (DL,CO) and nitric oxide (DL,NO) is a useful technique to measure pulmonary alveolar-capillary reserve in both healthy and patient populations. The measurement provides an estimate of the participant&#39;s ability to recruit and distend pulmonary capillaries. The method has recently been reported to exhibit a high test-retest reliability in healthy volunteers during exercise of light to moderate intensity. Of note, this technique permits up to 12 repeated maneuvers and only requires a single breath with a relatively short breath-hold time of 5 s. Representative data are provided showing the gradual changes in DL,NO and DL,CO from rest to exercise at increasing intensities&#160;of up to 60% of maximal workload. The measurement of diffusing capacity and evaluation of alveolar-capillary reserve is a useful tool to evaluate the lung&#39;s ability to respond to exercise both in the healthy population as well as in patient populations such as those with chronic lung disease.

作者聚焦:将肺泡毛细血管储备测量整合到运动适应和治疗策略中

This protocol presents a method to assess pulmonary alveolar-capillary reserve measured by combined single-breath measurement of the diffusing capacity to carbon monoxide (DL,CO) and nitric oxide (DL,NO) during exercise. Assumptions and recommendations for using the technique during exercise form the foundation of this article.

使用单次呼吸法测量人体运动期间的双重测试气体肺弥散能力

The combined single-breath measurement of the diffusing capacity of carbon monoxide (DL,CO) and nitric oxide (DL,NO) is a useful technique to measure ...