Respiratory Physiology & Neurobiology最新文献_第7页

Neural gating of respiratory sensations as a potential mechanism of dyspnea perception: State-of-the-art and future directions 呼吸感觉的神经门控作为呼吸困难感知的潜在机制：现状和未来方向。

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-03-24 DOI: 10.1016/j.resp.2025.104418

Valentina Jelinčić , Pei-Ying S. Chan , Paul W. Davenport , Andreas von Leupoldt

Context

Dyspnea – the subjective experience of breathing discomfort – is a prevalent and debilitating symptom in various chronic conditions, featuring a complex interplay of sensory, cognitive, and emotional factors contributing to its perception. In recent years, growing evidence emerged for the importance of neural processing in shaping symptom experiences such as dyspnea.

Objective

This frontiers review focuses on the neural gating of respiratory sensations (NGRS), as a potential neural mechanism underlying dyspnea perception. NGRS is measured by the repetition suppression of respiratory-related evoked potentials (RREP) elicited by paired inspiratory occlusions. NGRS may reflect the brain’s capacity to filter redundant respiratory input, and reduced NGRS may constitute a biomarker for aversive dyspnea experience.

Review

We summarize the current state-of-the-art on the relationships between NGRS and dyspnea, noting the inconsistent findings in healthy individuals along with promising evidence from clinical populations, such as chronic obstructive pulmonary disease (COPD). The inconsistent findings may be attributed to methodological limitations, including the significant variability in experimental designs and analytical choices hampering NGRS reliability, and the influence of top-down attention and expectations. In the final part of the review, we suggest future directions for the investigation of the NGRS-dyspnea relationship, including mechanistic research using advanced EEG analysis, mobile neuroimaging, and brain stimulation techniques to delineate the contributions of top-down and bottom-up mechanisms to NGRS.

Conclusions

By addressing the current knowledge gaps, this review forms a part of the concentrated effort to promote brain-based interventions for alleviating the distressing experience of chronic dyspnea.

背景：呼吸困难-呼吸不适的主观体验-是各种慢性疾病中普遍存在的衰弱症状，具有感觉，认知和情绪因素的复杂相互作用，有助于其感知。近年来，越来越多的证据表明神经处理在形成呼吸困难等症状体验中的重要性。目的：本文综述了呼吸感觉的神经门控（NGRS）作为呼吸困难感知的潜在神经机制。NGRS是通过对呼吸相关诱发电位（RREP）的重复抑制来测量的。NGRS可能反映了大脑过滤多余呼吸输入的能力，减少的NGRS可能构成厌恶性呼吸困难经历的生物标志物。回顾：我们总结了NGRS与呼吸困难之间关系的最新进展，注意到健康个体的不一致发现以及来自临床人群（如慢性阻塞性肺疾病（COPD））的有希望的证据。不一致的结果可能归因于方法上的局限性，包括实验设计和分析选择的显著可变性阻碍了NGRS的可靠性，以及自上而下的关注和期望的影响。在综述的最后部分，我们提出了NGRS-呼吸困难关系的未来研究方向，包括利用先进的脑电图分析、移动神经成像和脑刺激技术进行机制研究，以描述自上而下和自下而上的机制对NGRS的贡献。结论：通过解决目前的知识差距，本综述是促进以脑为基础的干预措施减轻慢性呼吸困难痛苦经历的集中努力的一部分。

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引用次数: 0

Pathophysiological mechanisms of exertional dyspnea in people with cardiopulmonary disease: Recent advances 心肺疾病患者运动性呼吸困难的病理生理机制：最新进展

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-03-29 DOI: 10.1016/j.resp.2025.104423

Matthew D. James , Devin B. Phillips , Nicolle J. Domnik , J.Alberto Neder

Physical activity is a leading trigger of dyspnea in chronic cardiopulmonary diseases. Recently, there has been a renewed interest in uncovering the mechanisms underlying this distressing symptom. We start by articulating a conceptual framework linking cardiorespiratory abnormalities with the central perception of undesirable respiratory sensations during exercise. We specifically emphasize that exertional dyspnea ultimately reflects an imbalance between (high) demand and (low) capacity. As such, the symptom arises in the presence of a heightened inspiratory neural drive – the will to breathe – secondary to a) increased ventilatory output relative to the instantaneous ventilatory capacity (excessive breathing) and/or b) its impeded translation into the act of breathing due to constraints on tidal volume expansion (constrained breathing). In patients with chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and interstitial lung disease (ILD), constrained breathing assumes a more dominant role as the disease progresses. Excessive breathing due to heightened wasted ventilation in the physiological dead space is particularly important in the initial stages of COPD, while alveolar hyperventilation has a major contributory role in hypoxemic patients with ILD. Hyperventilation is also a leading driver of dyspnea in heart failure (HF) with reduced ejection fraction (EF), while high physiological dead space is the main underlying mechanism in HF with preserved EF. Similarly, wasted ventilation in poorly perfused lung tissue dominates the scene in pulmonary vascular disease. New artificial intelligence-based approaches to expose the contribution of excessive and constrained breathing may enhance the yield of cardiopulmonary exercise testing in investigating exertional dyspnea in these patients.

体力活动是慢性心肺疾病呼吸困难的主要诱因。最近，人们对揭示这种令人痛苦的症状背后的机制重新产生了兴趣。我们首先阐明一个概念框架，将心肺异常与运动期间不良呼吸感觉的中枢知觉联系起来。我们特别强调，用力性呼吸困难最终反映了（高）需求和（低）容量之间的不平衡。因此，该症状出现在吸气神经驱动（呼吸意志）增强的情况下，继发于：a)相对于瞬时通气量增加的通气量输出（呼吸过度）和/或b)由于潮汐容积扩张受限（呼吸受限），其转化为呼吸行为受阻。在慢性阻塞性肺疾病（COPD）、哮喘、囊性纤维化和间质性肺疾病（ILD）患者中，随着疾病的进展，呼吸受限的作用越来越明显。在慢性阻塞性肺病的初始阶段，由于生理死腔中浪费的通气增加而导致的过度呼吸尤为重要，而肺泡过度通气在低氧血症的ILD患者中起主要作用。过度换气也是心力衰竭（HF）伴射血分数降低（EF）时呼吸困难的主要驱动因素，而高生理性死亡空间是心力衰竭伴射血分数保留的主要潜在机制。同样，在肺血管疾病中，肺组织灌注不良导致的通气浪费占主导地位。新的基于人工智能的方法来揭示过度和受限呼吸的贡献，可能会提高心肺运动试验在调查这些患者的用力性呼吸困难中的产量。

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引用次数: 0

Changes in cough motor output during repetitive mechanical stimulation of the tracheobronchial tree in cats 猫气管支气管树重复机械刺激时咳嗽运动输出的变化

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-06-06 DOI: 10.1016/j.resp.2025.104457

Ivan Poliacek , Lukas Martvon , Melanie J. Rose , M. Nicholas Musselwhite , Teresa Pitts , Donald C. Bolser

The lack of airway protective responses is highly predictive of pulmonary morbidity and mortality. We investigated changes in motor output of mechanically induced cough during a repeated stimulation protocol, as may occur during aspiration of food / liquid over a meal. The occurrence, magnitude, phase durations, and power spectra characteristics of diaphragm and abdominal muscle electromyograms, and esophageal pressures during coughing were recorded during repeated mechanical stimulation of the trachea in cats. After the initial increase in cough excitability, repeated tracheal stimulation resulted in reduced cough number, electromyograms and esophageal pressure magnitudes, which fit an exponential model. There was little change in cough phase durations. Additionally, a pause in sequential airway stimulation (lasting several minutes) resulted in a further cough reduction, associated with prolongation of cough phase durations, but was resolved after one additional stimulus trial, consistent with long-latency transient depression. Power spectral analysis suggested changes in recruitment of motor units for parasternal muscles and no signs of fatigue although hundreds of coughs were executed. Our results are consistent with the presence of central adaptive mechanisms that can regulate the excitability of repetitive coughing, likely overlapping with transient potentiation and depression. The results have mechanistic implications for predicting airway protective responses in respiratory diseases.

缺乏气道保护反应是预测肺部发病率和死亡率的重要因素。我们研究了在重复刺激方案中机械引起的咳嗽运动输出的变化，这可能发生在吃饭时吸入食物/液体的过程中。记录猫在气管反复机械刺激时膈肌和腹肌肌电图的发生、幅度、相位持续时间、功率谱特征以及咳嗽时的食管压力。初始咳嗽兴奋性升高后，气管重复刺激导致咳嗽次数、肌电图和食管压力值降低，符合指数模型。咳嗽期持续时间变化不大。此外，连续气道刺激的暂停（持续几分钟）导致咳嗽进一步减少，与咳嗽期持续时间延长有关，但在一次额外的刺激试验后得到解决，与长潜伏期短暂性抑郁一致。功率谱分析表明胸骨旁肌肉运动单元的补充发生了变化，尽管咳嗽了数百次，但没有出现疲劳的迹象。我们的结果与中枢适应机制的存在是一致的，该机制可以调节重复性咳嗽的兴奋性，可能与短暂增强和抑郁重叠。该结果具有预测呼吸道疾病气道保护反应的机制意义。

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引用次数: 0

Corrigendum to “Ethanol abolishes ventilatory long-term facilitation and blunts the ventilatory response to hypoxia in female rats” [Respir. Physiol. Neurobiol. 332 (2024) 104373] “乙醇消除了雌性大鼠的通气长期促进作用并减弱了对缺氧的通气反应”的更正[呼吸]。杂志。中国生物医学工程学报，2016,32(4):387 - 387。

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-05-14 DOI: 10.1016/j.resp.2025.104450

Aaron L. Silverstein, Warren J. Alilain

引用次数: 0

Chrysin-loaded PLGA nanoparticle attenuates ferroptosis in lipopolysaccharide-induced indirect acute lung injury by upregulating Nrf2-dependent antioxidant responses 白玉载PLGA纳米颗粒通过上调nrf2依赖的抗氧化反应，减轻脂多糖诱导的间接急性肺损伤中的铁凋亡

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-05-14 DOI: 10.1016/j.resp.2025.104451

Islam Ahmed Abdelmawgood , Ayman Saber Mohamed , Noha A. Mahana , Abdel Hady A. Abdel Wahab , Abeer Mahmoud Badr , Asmaa Elsayed Abdelkader

Chrysin (CHR) is the principal active compound in honey, propolis and plants. Its pharmacological effects include anti-inflammatory, antiallergic, and antioxidant capabilities. However, its poor solubility and bioavailability constitute a limitation. In this study, Poly-lactic-co-glycolic acid (PLGA) was used as a nanocarrier to enhance the stability, bioavailability, and effectiveness of CHR to protect mice from indirect acute lung injury (ALI) caused by lipopolysaccharide (LPS). CHR-loaded PLGA nanoparticle (CHR-NP) was prepared and characterized using techniques such as FTIR, zeta potential analysis, DLS, in vitro drug release assessment, encapsulation efficiency measurement, and TEM. Prior to the intraperitoneal injection of LPS (10 mg/kg), C57BL/6 mice were orally administered CHR (50 mg/kg), PLGA (50 mg/kg), CHR-NP (50 mg/kg), and dexamethasone (Dexa) (5 mg/kg) for a duration of six days. Following 24 h of LPS or normal saline (control) injection, the mice were anesthetized. CHR-NP increased catalase, glutathione, and glutathione peroxidase while decreasing malondialdehyde, myeloperoxidase, nitric oxide, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-12, and interferon (IFN)-γ. Moreover, treatment with CHR-NP augmented the gene and protein expression of the Keap1/Nrf2/ARE signaling pathway utilizing quantitative real-time PCR (RT-PCR), western blotting, and immunohistochemistry. Additionally, CHR-NP reduced histological alterations, pulmonary edema, damage, and iron deposition. Our findings indicate that CHR-NP significantly mitigated indirect ALI, possibly through the suppression of inflammation, oxidative stress, and ferroptosis via the activation of the Keap1/Nrf2/ARE signaling pathways.

菊花素（CHR）是蜂蜜、蜂胶和植物中的主要活性化合物。其药理作用包括抗炎、抗过敏和抗氧化能力。然而，其溶解度和生物利用度差构成了限制。本研究以聚乳酸-羟基乙酸（PLGA）为纳米载体，提高CHR的稳定性、生物利用度和保护小鼠免受脂多糖（LPS）引起的间接急性肺损伤（ALI）的有效性。采用FTIR、zeta电位分析、DLS、体外释药评估、包封效率测定、TEM等技术对其进行表征。在腹腔注射LPS（10 mg/kg）之前，C57BL/6小鼠口服CHR（50 mg/kg）、PLGA（50 mg/kg）、hr - np（50 mg/kg）和地塞米松（5 mg/kg），持续6天。LPS或生理盐水（对照组）注射24 h后，对小鼠进行麻醉。hr - np增加过氧化氢酶、谷胱甘肽和谷胱甘肽过氧化物酶，同时降低丙二醛、髓过氧化物酶、一氧化氮、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-12和干扰素(IFN)-γ。此外，通过实时荧光定量PCR （RT-PCR）、western blotting和免疫组织化学，cr - np治疗增强了Keap1/Nrf2/ARE信号通路的基因和蛋白表达。此外，cr - np可减少组织学改变、肺水肿、损伤和铁沉积。我们的研究结果表明，chrp - np可能通过激活Keap1/Nrf2/ARE信号通路来抑制炎症、氧化应激和铁死亡，从而显著减轻间接ALI。

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引用次数: 0

Pulmonary stretch receptor modulation of synaptic inhibition shapes the discharge pattern of respiratory premotor neurons 肺牵张受体对突触抑制的调节影响呼吸前运动神经元的放电模式。

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-03-25 DOI: 10.1016/j.resp.2025.104420

Edward J. Zuperku , Francis A. Hopp , Astrid G. Stucke

Many studies focus on the mechanisms of respiratory rhythm generation through neuronal interactions in the preBötzinger and Bötzinger complex area. There is limited insight into how the varied discharge patterns of propriobulbar, rhythm generating neurons are integrated to generate the slowly augmenting and decrementing discharge patterns observed in respiratory premotor neurons. Neuronal discharge patterns were obtained, in vivo, from inspiratory (I) and expiratory (E) premotor neurons in the ventral respiratory group of adult, anesthetized and vagotomized canines. Electrical activation of vagal afferents was used to produce pulmonary stretch receptor (PSR), step-input patterns, throughout or within either the I- or E-phase. PSR inputs decreased the discharge pattern slopes of augmenting and decrementing E-neurons and increased the slopes of augmenting and decrementing I-neurons. PSR inputs that were applied only for part of the phase acutely changed the discharge pattern to the trajectory associated with those PSR throughout-phase inputs, but the pattern returned immediately to the original trajectory after the PSR input terminated. These types of responses can be reproduced with high fidelity by a mathematical model based on reciprocal inhibition between augmenting and decrementing neurons of the same respiratory phase. Best fit is achieved when PSR inputs solely modulate the strength of the synaptic inhibition of decrementing neurons by augmenting neurons at the presynaptic level. Leaky integrator functions are not necessary to generate the gradually augmenting and decrementing patterns. This model offers a novel and different mechanistic way to conceptualize the generation and PSR control of respiratory discharge patterns.

许多研究集中在通过preBötzinger和Bötzinger复杂区神经元相互作用产生呼吸节律的机制上。关于本体球、产生节律的神经元的各种放电模式如何整合以产生呼吸前运动神经元中观察到的缓慢增加和减少的放电模式的见解有限。对麻醉和迷走神经切除的成年犬腹侧呼吸组的吸气(I)和呼气(E)前运动神经元进行体内放电模式分析。迷走神经传入的电激活被用来产生肺伸展受体（PSR），在整个或在I期或e期内的阶跃输入模式。PSR输入降低了递增和递减e神经元的放电模式斜率，增加了递增和递减i神经元的放电模式斜率。仅用于部分相位的PSR输入急剧改变了与这些PSR全相位输入相关的放电模式轨迹，但在PSR输入终止后，该模式立即返回到原始轨迹。这些类型的反应可以通过基于相同呼吸相的增加和减少神经元之间的相互抑制的数学模型以高保真度再现。当PSR输入仅通过在突触前水平增加神经元来调节突触抑制减弱神经元的强度时，达到了最佳拟合。漏积函数对于生成渐增和渐减模式是不必要的。该模型提供了一种新颖而不同的机制方式来概念化呼吸放电模式的产生和PSR控制。

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引用次数: 0

Spirometric and exercise ventilatory predictors of expiratory flow-limitation in adults with normal and mildly-obstructed airways 正常和轻度气道阻塞成人呼气流量受限的肺活量测定和运动通气预测指标。

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-06-09 DOI: 10.1016/j.resp.2025.104460

Hans Christian Haverkamp , Peter Luu , Yannick Molgat-Seon , Gregory Petrics , Sterling McPherson

Purpose

We determined the resting spirometric and exercise ventilatory variables that are predictive of exercise expiratory flow limitation (EFL) in a group of adults in whom airway function varied from mildly obstructed to above predicted values.

Methods

We studied n = 25 adults (16/9 M/F; age, 31 years) in whom forced expiratory volume in 1 s (FEV₁) ranged from 63 % to 149 %-predicted. Subjects completed an incremental exercise test. Tidal expiratory flow-volume (TEFV) curves were placed within the maximal expiratory flow-volume (MEFV) curve and %-EFL was determined based on the overlap between the TEFV and MEFV curves. Multivariate linear (MR_lin) and logistic regression (MR_log) were performed using spirometric and exercise measurements as predictor variables and the presence and magnitude of EFL as the outcome variable.

Results

A set of spirometric variables explained 75 % and 73 % of the variance in %-EFL and the presence of EFL using MR_lin and MR_log, respectively. A set of inputs consisting of both spirometric and exercise ventilatory variables improved the predictive ability of the models. Backward stepwise modeling, using both MR_lin and MR_log, resulted in a total of seven final variables in both analyses. The final variables represented a combination of spirometric and exercise ventilatory inputs, and R² values of 0.93 and 1.00 for MR_lin and MR_log.

Conclusions

Given the difficulty of measuring EFL during exercise, our findings suggest that integrating additional measurements reflecting ventilatory capacity (i.e., spirometry) and demand (exercise measurements), including dynamic operating lung volumes, in clinical exercise testing will improve assessment of exercise ventilatory constraint.

目的：在一组气道功能从轻度阻塞到高于预测值的成人中，我们确定了预测运动性呼气流量限制（EFL）的静息肺活量和运动通气变量。方法：我们研究了n=25名成人(16/9M/F；年龄，31岁)，其中15秒用力呼气量（FEV1）范围为63%至149%-预测。受试者完成了一项增量运动测试。将潮汐呼气流量-容积（TEFV）曲线置于最大呼气流量-容积（MEFV）曲线内，根据TEFV曲线与MEFV曲线的重叠度确定%-EFL。多变量线性回归（MRlin）和逻辑回归（MRlog）使用肺活量和运动测量作为预测变量，EFL的存在和程度作为结果变量。结果：一组肺活量测量变量分别用MRlin和MRlog解释了%-EFL和EFL存在的75%和73%的方差。一组由肺活量测定和运动通气变量组成的输入提高了模型的预测能力。使用MRlin和MRlog的后向逐步建模在两种分析中总共产生了7个最终变量。最终变量代表肺活量测定和运动通气输入的组合，MRlin和MRlog的R2值分别为0.93和1.00。结论：考虑到在运动过程中测量EFL的难度，我们的研究结果表明，在临床运动测试中整合反映通气量（即肺活量测定法）和需求（运动测量法）的额外测量，包括动态操作肺容量，将改善对运动通气约束的评估。

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引用次数: 0

Progressive changes of oxygenation, diving response, and involuntary breathing movements during repeated apneas 反复呼吸暂停时氧合、潜水反应和不自主呼吸运动的渐进式变化。

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-06-05 DOI: 10.1016/j.resp.2025.104455

Eric R. Mulder , Janne Bouten , Pontus K. Holmström , Erika K. Schagatay

Purpose

This study investigated whether trained freedivers can sustain a 1:1 apnea-to-recovery ratio without progressive arterial or cerebral oxygen desaturation.

Methods

21 trained freedivers (6 females) performed 7 static apneas of fixed 2-min duration, each followed by 2-min of rest, in a supine laboratory setting. Arterial oxygen saturation (SpO₂) and heart rate (HR) were measured continuously. Near-infrared spectroscopy (NIRS) assessed cerebral and peripheral muscle oxygenation. A chest force sensor recorded involuntary breathing movements (IBM). End-tidal CO₂ (EtCO₂) was measured pre- and post apnea.

Results

SpO₂ declined most during the first apnea (94 ± 3 %) but stabilized thereafter (p < 0.005). Lowest HR increased from 61 ± 15 to 65 ±13 bpm across the series (p = 0.02), and the intial apnea tachycardia declined by 10 bpm (p = 0.012). Cerebral oxygenation increased above baseline only during the first apnea (1.0 ± 2.3 %); in subsequent apneas it remained stable, although slightly below baseline. Muscle oxygenation declined during all apneas but was more pronounced in the first (-6.7 ± 3.1 %). IBM onset was progressively delayed; 63 % of participants showed no IBM during the final apnea. EtCO₂ increased after each apnea by ≈ 1.0kPa (p < 0.001) but did not change progressively across the series.

Conclusion

A 1:1 apnea-to-recovery ratio was physiologically sustainable in trained freedivers at rest, without inducing progressive oxygen desaturation. The initial apnea elicited the strongest oxygen-conserving responses, which progressively attenuated across the series, suggesting that physiological regulation during repeated submaximal apneas is adaptable to meet situation-specific demands. The progressive IBM delay despite stable CO₂ levels suggests additional mechanisms beyond chemoreflex-driven stimulation of breathing may contribute to ventilatory drive.

目的：本研究调查了训练有素的自由潜水员是否可以在没有进行性动脉或脑氧饱和度下降的情况下维持1:1的呼吸恢复比。方法：21名训练有素的自由潜水员（6名女性）在仰卧的实验室环境中进行了7次固定持续2分钟的静态呼吸，每次静止呼吸后休息2分钟。连续测定血氧饱和度（SpO₂）和心率（HR）。近红外光谱（NIRS）评估大脑和周围肌肉氧合。胸力传感器记录了不自主呼吸运动（IBM）。呼吸暂停前后分别测量潮末CO₂（EtCO₂）。结果：SpO₂在第一次呼吸暂停期间下降最多（94±3%），但此后趋于稳定(p结论：1:1的呼吸恢复比在训练自由潜水员休息时是生理上可持续的，不会引起进行性氧饱和度降低。最初的呼吸暂停引起了最强的保氧反应，在整个系列中逐渐减弱，这表明在重复的亚最大呼吸暂停期间的生理调节是适应特定情况的需求的。尽管二氧化碳水平稳定，但渐进式IBM延迟表明，除了化学反射驱动的呼吸刺激之外，还有其他机制可能有助于通气驱动。

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引用次数: 0

Revisiting Acute Respiratory Distress Syndrome ventilation management: Time for a paradigm shift focusing on tidal volume 重新审视急性呼吸窘迫综合征的通气管理：是时候将重心转移到潮气量上了

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-05-30 DOI: 10.1016/j.resp.2025.104454

Raffaele Merola , Maria Vargas , Denise Battaglini

Acute Respiratory Distress Syndrome (ARDS) remains a critical challenge in intensive care medicine, with persistently high mortality despite decades of research and advancements in supportive therapies. Mechanical ventilation, particularly low tidal volume (VT) strategies, has become the cornerstone of ARDS management; however, emerging evidence suggests that a uniform application of these approaches may not be universally beneficial. This viewpoint critically examines the evolution of ARDS ventilation strategies, from high VT methods to protective ventilation protocols centered on reduced VT and plateau pressures. It explores the limitations of current guidelines, highlighting how global parameters such as VT and driving pressure (ΔP) may inadequately capture the complex and heterogeneous pathophysiology of ARDS. Concepts like mechanical power, compliance-based ventilation, and transpulmonary pressure offer promising avenues for more personalized care but remain underutilized in clinical practice. Additionally, this viewpoint underscores the significance of heart-lung interactions and the impact of ventilator settings on cardiovascular function, further complicating one-size-fits-all approaches. Ultimately, this work calls for a reassessment of existing paradigms, advocating for individualized, physiology-driven strategies that move beyond population-based protocols to better address the nuanced needs of ARDS patients.

急性呼吸窘迫综合征（ARDS）仍然是重症监护医学的一个重大挑战，尽管数十年的研究和支持治疗取得了进展，但其死亡率仍然很高。机械通气，特别是低潮气量（VT）策略，已成为ARDS管理的基石；然而，新出现的证据表明，这些方法的统一应用可能并不普遍有益。这一观点批判性地考察了ARDS通气策略的演变，从高VT方法到以降低VT和平台压力为中心的保护性通气方案。它探讨了当前指南的局限性，强调了诸如VT和驱动压力（ΔP）等全局参数可能无法充分捕捉ARDS复杂和异质性的病理生理。机械动力、顺应性通气和跨肺压力等概念为更个性化的护理提供了有希望的途径，但在临床实践中仍未得到充分利用。此外，这一观点强调了心肺相互作用的重要性以及呼吸机设置对心血管功能的影响，使一刀切的方法进一步复杂化。最后，这项工作呼吁重新评估现有的范例，倡导个性化的、生理驱动的策略，超越基于人群的方案，更好地解决ARDS患者的细微需求。

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引用次数: 0

Validity and reliability of anharmonic morphological ventilometry for the characterisation of human breathing 非调和形态呼吸测量法对人类呼吸特征的有效性和可靠性。

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology

Pub Date : 2025-08-01 Epub Date: 2025-05-27 DOI: 10.1016/j.resp.2025.104453

Patrick Hanusse , Pierantonio Laveneziana , Marie-Cécile Niérat , Marion Teulier , Patrick Berger , Fabien Beaufils , Christian Straus , Thomas Similowski

Diagnosing and monitoring respiratory disorders typically rely on pulmonary function testing, which requires full patient cooperation and trained personnel, limiting its applicability. Analysing natural breathing offers a valuable alternative but requires new methodological approaches. This study introduces anharmonic morphological analysis, a novel technique to characterise breathing cycles, and evaluates its reliability and ability to distinguish healthy individuals from patients with chronic obstructive pulmonary disease (COPD). Twenty healthy individuals (17 men; age 28 ± 5 years; body mass index 21 ± 2 kg/m²) and 119 COPD patients (covering all spirometric GOLD stages) were studied during natural breathing using a linear pneumotachograph. Ventilatory flow traces were analysed using anharmonic morphological analysis, enabling the reconstruction of an average ventilatory cycle for each individual (personal respiratory profile, PRP). Comparisons were performed by calculating Euclidean distances between PRPs. Anharmonic morphological analysis enabled precise and reproducible characterisation of ventilatory cycles. PRPs showed high temporal stability. Tessellation based on Euclidean distances distinguished healthy individuals from COPD patients with a sensitivity of 86 % and a specificity of 94 %. Exploratory analyses further suggested the potential of the method to identify COPD patients responsive to bronchodilator administration based on inspiratory capacity changes. Anharmonic morphological analysis offers a reproducible, physiologically meaningful description of natural breathing and shows promise for future development as a spontaneous-breathing-based tool to assist in diagnosing respiratory disorders without requiring patient cooperation.

诊断和监测呼吸系统疾病通常依赖于肺功能测试，这需要患者的充分合作和训练有素的人员，限制了其适用性。分析自然呼吸提供了一个有价值的选择，但需要新的方法方法。本研究引入了非调和形态学分析，这是一种表征呼吸周期的新技术，并评估了其可靠性和区分健康个体与慢性阻塞性肺疾病（COPD）患者的能力。健康个体20人(男性17人；年龄28岁 ± 5岁；身体质量指数21 ± 2kg/m²)和119例COPD患者（包括所有肺活量计GOLD期）在自然呼吸时使用线性肺记录仪进行研究。使用非调和形态学分析分析通气流量痕迹，从而能够重建每个个体的平均通气周期（个人呼吸谱，PRP）。通过计算prp之间的欧几里得距离进行比较。非调和形态分析使通气周期的精确和可重复的特征。PRPs具有较高的时间稳定性。基于欧几里得距离的细分区分健康个体和COPD患者的敏感性为86%，特异性为94%。探索性分析进一步表明，该方法可以根据吸气量的变化来识别COPD患者对支气管扩张剂的反应。非调和形态分析提供了一种可重复的，生理上有意义的自然呼吸描述，并显示了未来发展的希望，作为一种基于自发呼吸的工具，帮助诊断呼吸系统疾病，而不需要患者的合作。

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