Nonhomogeneous alveolar pressure swings in the presence of airway closure.

When thoracic gas volume (TGV) is determined plethysmographically, it is assumed that the alveolar pressure swings are homogeneous and are appropriately represented by pressure swings at the mouth. However, recent studies have demonstrated differences in total lung capacities derived from TGV measurements made at different levels in the vital capacity. These differences suggested that, in the presence of airway closure, alveolar pressure swings may be nonhomogeneous during a TGV determination. This possibility was tested in six dogs. Pressure at the airway opening (ao) was measured from an endotracheal catheter. A balloon-tipped catheter was passed into the right lower lobe (RLL) bronchus for measurement of RLL pressure. delta PRLL -- delta Pao was monitored during inspiratory efforts with the airway opening occluded. With the RLL balloon inflated, delta PRLL always exceeded delta Pao by an amount averaging 8.2%. Induction of a pneumothorax eliminated all differences between delta PRLL and delta Pao. Thus, during a TGV measurement, the chest wall may apply to the lungs nonhomogeneous forces that, in the presence of airway closure (e.g., chronic obstructive pulmonary disease and asthma) would result in nonhomogeneous alveolar pressure swings and potentially significant errors in the plethysmographic determination of TGV.