Obesity and diabetes: similar respiratory mechanical but different gas exchange defects

被引:9
作者
Sudy, Roberta [1 ,2 ]
Petak, Ferenc [2 ]
Kiss, Liliana [1 ,2 ]
Balogh, Adam L. [1 ,2 ]
Fodor, Gergely H. [2 ]
Korsos, Anita [1 ]
Schranc, Almos [2 ]
Babik, Barna [1 ]
机构
[1] Univ Szeged, Dept Anaesthesiol & Intens Therapy, Szeged, Hungary
[2] Univ Szeged, Dept Med Phys & Informat, Szeged, Hungary
关键词
body mass index; capnography; diabetes mellitus; gas exchange; respiratory mechanics; PULMONARY-FUNCTION; ATHEROSCLEROSIS RISK; LUNG RECRUITMENT; MELLITUS; COMPLICATIONS; AIRWAY; ABNORMALITIES; METHACHOLINE; INFLAMMATION; SURFACTANT;
D O I
10.1152/ajplung.00439.2020
中图分类号
Q4 [生理学];
学科分类号
071003 ;
摘要
Diabetes mellitus increases smooth muscle tone and causes tissue remodeling, affecting elastin and collagen. Although the lung is dominated by these elements, diabetes is expected to modify the airway function and respiratory tissue mechanics. Therefore, we characterized the respiratory function in patients with diabetes with and without associated obesity. Mechanically ventilated patients with normal body shapes were divided into the control nondiabetic (n = 73) and diabetic (n = 31) groups. The other two groups included obese patients without diabetes (n = 43) or with diabetes (n = 30). The mechanical properties of the respiratory system were determined by forced oscillation technique. Airway resistance (Raw), tissue damping (G), and tissue elastance (H) were assessed by forced oscillation. Capnography was applied to determine phase 3 slopes and dead space indices. The intrapulmonary shunt fraction (Qs/Qt) and the lung oxygenation index (Pa-O2 /FIO2) were estimated from arterial and central venous blood samples. Compared with the corresponding control groups, diabetes alone increased the Raw (7.6 +/- 6 cmH(2)O.s/l vs. 3.1 +/- 1.9 cmH(2)O.s/l), G (11.7 +/- 5.5 cmH(2)O/l vs. 6.5 +/- 2.8 cmH(2)O/l), and H (31.5 +/- 11.8 cmH(2)O/l vs. 24.2 +/- 7.2 cm H2O/l (P < 0.001 for all). Diabetes increased the capnographic phase 3 slope, whereas PaolFio, or Qs/Qt was not affected. Obesity alone caused similar detrimental changes in respiratory mechanics and alveolar heterogeneity, but these alterations also compromised gas exchange. We conclude that diabetes-induced intrinsic mechanical abnormalities are counterbalanced by hypoxic pulmonary vasoconstriction, which maintained intrapulmonary shunt fraction and oxygenation ability of the lungs.
引用
收藏
页码:L368 / L376
页数:9
相关论文
共 53 条
  • [1] Abnormal Rho-associated kinase activity contributes to the dysfunctional myogenic response of cerebral arteries in type 2 diabetes
    Abd-Elrahman, Khaled S.
    Walsh, Michael P.
    Cole, William C.
    [J]. CANADIAN JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY, 2015, 93 (03) : 177 - 184
  • [2] Changes in respiratory mechanics during cardiac surgery
    Babik, B
    Asztalos, T
    Peták, F
    Deák, ZI
    Hantos, Z
    [J]. ANESTHESIA AND ANALGESIA, 2003, 96 (05) : 1280 - 1287
  • [3] Diabetes mellitus: endothelial dysfunction and changes in hemostasis
    Babik Barna
    Petak Ferenc
    Agocs Szilvia
    Blaskovics Ivett
    Alacs Endre
    Bodo Kinga
    Sudy Roberta
    [J]. ORVOSI HETILAP, 2018, 159 (33) : 1335 - 1345
  • [4] Effects of respiratory mechanics on the capnogram phases: importance of dynamic compliance of the respiratory system
    Babik, Barna
    Csorba, Zsofia
    Czoevek, Dorottya
    Mayr, Patrick N.
    Bogats, Gabor
    Petak, Ferenc
    [J]. CRITICAL CARE, 2012, 16 (05):
  • [5] Capnogram slope and ventilation dead space parameters: comparison of mainstream and sidestream techniques
    Balogh, A. L.
    Petak, F.
    Fodor, G. H.
    Tolnai, J.
    Csorba, Z.
    Babik, B.
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 2016, 117 (01) : 109 - 117
  • [6] Methacholine and Ovalbumin Challenges Assessed by Forced Oscillations and Synchrotron Lung Imaging
    Bayat, Sam
    Strengell, Satu
    Porra, Liisa
    Janosi, Tibor Z.
    Petak, Ferenc
    Suhonen, Heikki
    Suortti, Pekka
    Hantos, Zoltan
    Sovijarvi, Anssi R. A.
    Habre, Walid
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2009, 180 (04) : 296 - 303
  • [7] DECREASED BRONCHIAL RESPONSE TO METHACHOLINE IN IDDM PATIENTS WITH AUTONOMIC NEUROPATHY
    BERTHERAT, J
    LUBETZKI, J
    LOCKHART, A
    REGNARD, J
    [J]. DIABETES, 1991, 40 (09) : 1100 - 1106
  • [8] The Effects of Lung Recruitment on the Phase III Slope of Volumetric Capnography in Morbidly Obese Patients
    Boehm, Stephan H.
    Maisch, Stefan
    von Sandersleben, Alexandra
    Thamm, Oliver
    Passoni, Isabel
    Martinez Arca, Jorge
    Tusman, Gerardo
    [J]. ANESTHESIA AND ANALGESIA, 2009, 109 (01) : 151 - 159
  • [9] Obesity modulates diaphragm curvature in subjects with and without COPD
    Boriek, Aladin M.
    Lopez, Michael A.
    Velasco, Cristina
    Bakir, Azam A.
    Frolov, Anna
    Wynd, Shari
    Babb, Tony G.
    Hanania, Nicola A.
    Hoffman, Eric A.
    Sharafkhaneh, Amir
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY, 2017, 313 (05) : R620 - R629
  • [10] Biochemistry and molecular cell biology of diabetic complications
    Brownlee, M
    [J]. NATURE, 2001, 414 (6865) : 813 - 820