Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)e161-e167
JournalChest
Volume149
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Emphysema
Ventilation
Tidal Volume
Mechanical Ventilators
Transplants
Lung
Airway Resistance
Thoracic Wall
Airway Obstruction
Air

Keywords

  • chronic obstructive pulmonary disease
  • collateral ventilation
  • emphysema
  • lung transplant
  • mechanical ventilation
  • physiology
  • spiracle
  • transpleural ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Chahla, M., Larson, C. D., Parekh, K. R., Reed, R. M., Terry, P. B., Schmidt, G. A., & Eberlein, M. (2016). Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation. Chest, 149(6), e161-e167. https://doi.org/10.1016/j.chest.2015.12.032

Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation. / Chahla, Mayy; Larson, Christopher D.; Parekh, Kalpaj R.; Reed, Robert M.; Terry, Peter Browne; Schmidt, Gregory A.; Eberlein, Michael.

In: Chest, Vol. 149, No. 6, 01.06.2016, p. e161-e167.

Research output: Contribution to journalArticle

Chahla, M, Larson, CD, Parekh, KR, Reed, RM, Terry, PB, Schmidt, GA & Eberlein, M 2016, 'Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation', Chest, vol. 149, no. 6, pp. e161-e167. https://doi.org/10.1016/j.chest.2015.12.032
Chahla, Mayy ; Larson, Christopher D. ; Parekh, Kalpaj R. ; Reed, Robert M. ; Terry, Peter Browne ; Schmidt, Gregory A. ; Eberlein, Michael. / Transpleural Ventilation via Spiracles in Severe Emphysema Increases Alveolar Ventilation. In: Chest. 2016 ; Vol. 149, No. 6. pp. e161-e167.
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