Resuscitation and auto resuscitation by airway reflexes in animals

Cough

Sona Gresova¹  Jan Jakus³  Roman Benacka²  Viliam Donic¹  Zoltan Tomori¹ 

[1] Department of Human Physiology Faculty of Medicine, University of PJ Safarik,Kosice, Slovakia;Department of Pathophysiology, Faculty of Medicine, University of PJ Safarik,Kosice, Slovakia;Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava,Slovakia

关键词: Resuscitation;    Expiration reflex;    Cough;    Autoresuscitation;    Aspiration reflex;    Asphyxia;    Animals;   

Others  :  809232
DOI  :  10.1186/1745-9974-9-21

 received in 2012-09-06, accepted in 2013-08-19,  发布年份 2013

【 摘 要 】

Various diseases often result in decompensation requiring resuscitation. In infants moderate hypoxia evokes a compensatory augmented breath – sigh and more severe hypoxia results in a solitary gasp. Progressive asphyxia provokes gasping respiration saving the healthy infant – autoresuscitation by gasping. A neonate with sudden infant death syndrome, however, usually will not survive. Our systematic research in animals indicated that airway reflexes have similar resuscitation potential as gasping respiration. Nasopharyngeal stimulation in cats and most mammals evokes the aspiration reflex, characterized by spasmodic inspiration followed by passive expiration. On the contrary, expiration reflex from the larynx, or cough reflex from the pharynx and lower airways manifest by a forced expiration, which in cough is preceded by deep inspiration. These reflexes of distinct character activate the brainstem rhythm generators for inspiration and expiration strongly, but differently. They secondarily modulate the control mechanisms of various vital functions of the organism. During severe asphyxia the progressive respiratory insufficiency may induce a life-threatening cardio-respiratory failure. The sniff- and gasp-like aspiration reflex and similar spasmodic inspirations, accompanied by strong sympatho-adrenergic activation, can interrupt a severe asphyxia and reverse the developing dangerous cardiovascular and vasomotor dysfunctions, threatening with imminent loss of consciousness and death. During progressive asphyxia the reversal of gradually developing bradycardia and excessive hypotension by airway reflexes starts with reflex tachycardia and vasoconstriction, resulting in prompt hypertensive reaction, followed by renewal of cortical activity and gradual normalization of breathing. A combination of the aspiration reflex supporting venous return and the expiration or cough reflex increasing the cerebral perfusion by strong expirations, provides a powerful resuscitation and autoresuscitation potential, proved in animal experiments. They represent a simple but unique model tested in animal experiments.

【 授权许可】

   
2013 Tomori et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]Wulbrand H, Von Zezschwitz G, Bentele KH: Submental and diaphragmatic muscle activity during and at resolution of mixed and obstructive apnoeas and cardiorespiratory arousal in preterm infants. Pediatr Res 1995, 38:298-305.
• [2]Wulbrand H, Mc Namara F, Thach BT: The role of arousal related brainstem reflexes in causing recovery from upper airway occlusion in infants. Sleep 2008, 31:833-840.
• [3]Sanchez I, Vega-Briceño L, Muñoz C, Mobarec S, Brockman P, Mesa T, Harris P: Polysomnographic findings in 320 infants evaluated for apneic events. Pediatr Pulmonol 2006, 41:215-221.
• [4]Jacobi MS, Thach BT: Effect of maturation on spontaneous recovery from hypoxic apnea by gasping. J Appl Physiol 1989, 66:2384-2390.
• [5]Thach BT, Gershan WR, Jacobi MS: Control of breathing during asphyxia and autoresuscitation. In Developmental neurobiology of breathing. Edited by Haddad GG, Farber JP. Basel: Marcel Dekker, New York; 1991:681-699.
• [6]Sanocka UM, Donnelly DF, Haddad GG: Autoresuscitation: a survival mechanism in piglets. J Appl Physiol 1992, 73:749-753.
• [7]Sridhar R, Thach BT, Kelly DH, Henslee JA: Characterization of successful and failed autoresuscitation in human infants, including those dying of SIDS. Pediatr Pulmon 2003, 36:113-122.
• [8]Thach BT: The role of respiratory control disorders in SIDS. Respir Physiol Neurobiol 2005, 149:343-353.
• [9]McNamara F, Lijovska AS, Thach BT: Spontaneous arousal activity in infants during NREM and REM sleep. J Physiol 2002, 538:263-269.
• [10]Xie J, Weil MH, Sun S, Yu T, Tang W: Spontaneous gasping generates cardiac output during cardiac arrest. Crit Care Med 2004, 32:238-240.
• [11]St-John WM, Li A, Leiter JC: Genesis of gasping is independent of levels of serotonin in the Pet-1 knockout mouse. J Appl Physiol 2009, 107:679-685.
• [12]Onimaru H, Homma I: Two modes of respiratory rhythm generation in the newborn rat brainstem-spinal cord preparation. Adv Exp Med Biol 2008, 605:104-108.
• [13]St John WM: Medullary regions for neurogenesis of gasping: noeud vital or noeuds vitals? J Appl Physiol 1996, 81:1865-1877.
• [14]Mathew OP, Thach BT, Abu-Osba YK, Brouillette RT, Roberts JL: Regulation of upper airway maintaining muscles during progressive asphyxia. Pediatr Res 1984, 18:819-822.
• [15]Peña F: Neuronal network properties underlying the generation of gasping. Clin Exp Pharmacol Physiol 2009, 36:1218-1228.
• [16]Fong AY: Postnatal changes in the cardiorespiratory response and ability to autoresuscitate from hypoxic and hypothermic exposure in mammals. Respir Physiol Neurobiol 2010, 174:146-155.
• [17]Tomori Z: Pleural, tracheal and abdominal pressure variations in defensive and pathologic reflexes of the respiratory tract. Physiol Bohemoslov 1965, 14:84-95.
• [18]Tomori Z, Widdicombe JG: Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol 1969, 200:25-49.
• [19]Tomori Z: The sniff-like aspiration reflex. In Korpas J, Tomori Z: Cough and other respiratory reflexes. Edited by Karger company Basel. München, Paris, London, New York, Sydney: Karger Basel; 1979:234-250. [Progress in Respiratory Research Vol. 12]
• [20]Benacka R, Tomori Z: The sniff-like aspiration reflex evoked by electrical stimulation of the nasopharynx. Respir Physiol 1995, 102:163-174.
• [21]Jakus J, Tomori Z, Stransky A: Neuronal determinants of breathing, coughing and other motor behaviours. Wist: Martin; 2004.
• [22]Korpas J, Tomori Z: Cough and other respiratory reflexes. Basel: Karger company; 1979.
• [23]Marek W, Muckenhoff K, Prabhakar NR: Significance of pulmonary vagal afferents for respiratory muscle activity in the cat. J Physiol Pharmacol 2008, 59(Suppl. 6):407-420.
• [24]Tomori Z, Donic V, Kurpas J, Palenikova R: Sniff-like aspiration reflex evoked by pressure pulses from the upper airways in cats. Respir Physiol 1994, 96:163-175.
• [25]Nail BS, Sterling GM, Widdicombe JG: Epipharyngeal receptors responding to mechanical stimulation. J Physiol 1969, 204:91-98.
• [26]Janczewski WA, Feldman JL: Distinct rhythm generators for inspiration and expiration in the juvenile rat. J Physiol 2006, 570:407-420.
• [27]Bolser DC, Poliacek I, Jakus J, Fuller DD, Davenport PW: Neurogenesis of cough, other airway defensive behaviors and breathing: a holarchical system? Respir Physiol Neurobiol 2006, 152:255-265.
• [28]Rubin JE, Shevtsova NA, Ermentrout GB, Smith JC, Rybak IA: Multiple rhythmic states in a model of the respiratory central pattern generator. J Neurophysiol 2009, 101:2146-2165.
• [29]Jakus J, Halasova E, Poliacek I, Tomori Z, Stransky A: Brainstem areas involved in the aspiration reflex: c-Fos study in anaesthetized cats. Physiol Res 2004, 33:703-717.
• [30]Knociková J: Time-frequency energy distribution of phrenic nerve discharges during aspiration reflex, cough and quiet inspiration. Comput Programs, methods Biomed 2010, 102:81-90.
• [31]Tomori Z, Poliacek I, Jakus J, Widdicombe JG, Donic V, Benacka R, Gresova S: Distinct generators for aspiration and expiration reflexes: localization, mechanisms and effects. J Physiol Pharmacol 2010, 61:5-12.
• [32]Tang W, Pagliardiny S, Yang P, Janczewski WA, Feldman JL: Projections of preBötzinger complex neurons in adults rats. J Comp Neurol 2010, 518:1862-1878.
• [33]Fung ML, StJohn WM, Tomori Z: Reflex recruitment of medullary gasping mechanisms in eupnoea by pharyngeal stimulation in cats. J Physiol 1994, 475:519-529.
• [34]Tomori Z, Fung ML, Donic V, Donicova V, St.John WM: Power spectral analysis of respiratory reflexes to pharyngeal stimulation in cats: comparisons with eupnoea and gasping. J Physiol 1995, 485:551-559.
• [35]Jakus J, Tomori Z, Bosel’ova L, Nagyova B, Kubinec V: Respiration and airway reflexes after transversal brainstem lesions in cats. Physiol Bohemoslov 1987, 36:329-340.
• [36]Gresova S, Vrbenska A, Tomori Z, Donic V, Kurpas M: Provocation of aspiration reflex and confirmation of its antiarrhythmic effect in rats (in Slovak). Martin; 2007. [In proceedings of Slovak and Czech conference on sleep] Abstract p 13
• [37]Tomori Z, Lemáková S, Holecyová A: Defensive reflexes of the respiratory tract in dogs. Physiol Bohemoslov 1977, 26:49-54.
• [38]Javorka K, Tomori Z, Zavarská L: Protective and defensive airway reflexes in premature infants. Physiol Bohemoslov 1980, 29:29-35.
• [39]Cross K, Klaus M, Tooley WH, Weisser K: The response of the new-born baby to inflation of the lungs. J Physiol (Lond) 1960, 151:551-565.
• [40]Tomori Z, Donic V, Benacka R, Gresova S, Peregrim I, Kundrik M, Pallayova M, Jakus J: Reversal of functional disorders by aspiration, expiration, and cough reflexes and their voluntary counterparts. Front. Respir. Physio 2012, article 00467:1-14.
• [41]Widdicombe J: Historical perspective: reflexes from the lungs and airways. J Appl Physiol 2006, 101:628-634.
• [42]Canning BJ: Anatomy and neurophysiology of the cough reflex: ACCP evidence-based clinical practice guidelines. Chest 2006, 129(1):33S-47S.
• [43]Widdicombe JG, Tatar M, Fontana G, Hanacek J, Davenport P, Lavorini F, Bolser D, et al.: Workshop: tuning the ‘cough center’. Pulm Pharmacol Ther 2011, 24:344-352.
• [44]Shannon R, Baekey DM, Morris KF, Li Z, Lindsey BG: Functional connectivity among ventrolateral medullary respiratory neurones and responses during fictive cough in the cat. J Physiol 2000, 525(Pt 1):207-224.
• [45]Segers LS, Nuding SC, Vovk A, Pitts T, Baekey DM, O’Connor R, Morris KF, Lindsey BG, Shannon R, Bolser DC: Discharge identity of medullary inspiratory neurons is altered during repetitive fictive cough. Front Physiol 2012, 3:223.
• [46]Poliacek I, Jakus J, Simera M, Barani H, Visnovcova N, Halasova E, Tomori Z: Excitability and rhythmicity of tracheobronchial cough is altered by aspiration reflex in cats. J Physiol Pharmacol 2009, 60(Suppl 5):105-110.
• [47]Poliacek I, Morris KF, Lindsey BG, Segers LS, Rose MJ, Corrie LW, Wang C, Pitts TE, Davenport PW, Bolser DC: Blood pressure changes alter tracheobronchial cough: computational model of the respiratory-cough network and in vivo experiments in anesthetized cats. J Appl Physiol 2011, 111:861-873.
• [48]Teramoto S, Ishii T, Yamamoto Y, et al.: Significance of chronic cough as a defense mechanism or a symptom of elderly patients with aspiration and aspiration pneumonia. Eur Respir J 2005, 24:10-12.
• [49]Widdicombe JG, Addington WR, Fontana RA, Stephens RE: Voluntary and reflex cough and the expiration reflex, implications for aspiration. Pulm Pharmacol Ther 2011, 3:312-317.
• [50]Korpas J: Expiration reflex from the vocal folds. Physiol bohemoslov 1972, 21:671-675.
• [51]Korpas J: The expiration reflex. In Korpas J, Tomori Z: Cough and other respiratory reflexes. Edited by Karger company Basel. München, Paris, London, New York, Sydney: Karger Basel; 1979:189-217. [Progress in Respiratory Research Vol. 12]
• [52]Canning BJ: The cough reflex in animals: relevance to human cough research. Lung 2008, 186(Suppl 1):S23-S28.
• [53]Addington WR, Stephens RE, Widdicombe JG, Rekab K: Effect of stroke location on the laryngeal cough reflex and pneumonia risk. Cough 2005, 1:4. BioMed Central Full Text
• [54]Ebihara S, Ebihara T: Cough in the elderly: a novel strategy for preventing aspiration pneumonia. Pulm Pharmacol Ther 2011, 24:318-323.
• [55]Dziewas R, Ritter M, Schilling M, Konrad C, Oelenberg S, Nobavi DG, Stogbauer S, Ringestein EB, Ludemann P: Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry 2004, 75:852-856.
• [56]Chung KF: Assessment and measurement of cough: the value of new tools. Pulm Pharmacol Ther 2002, 15:267-272.
• [57]Poliacek I, Rose MJ, Corrie LW, Wang C, Jakus J, Barani H, Stransky A, Polacek H, Halasova E, Bolser DC: Short reflex expirations (expiration reflexes) induced by mechanical stimulation of the trachea in anesthetized cats. Cough 2008, 4:1. BioMed Central Full Text
• [58]Shiba K, Satoh I, Kobayashi N, Hayashi F: Multifunctional laryngeal motoneurons: an intracellular study in the cat. J Neurosci 1999, 19:2717-2727.
• [59]O’Connor R, Segers LS, Morris KF, Nuding SC, Pitts T, Bolser DC, Davenport PW, Lindsey BG: A joint computational respiratory neural network - biomechanical model for breathing and airway defensive behaviors. Front Physiol 2012, 3:264.
• [60]Smith JC, Abdala AP, Koizumi H, Rybak IA, Paton JFJ: Spatial and functional architecture of the mammalian brain stem respiratory network: a hierarchy of three oscillatory mechanisms. Neurophysiol 2007, 98(6):3370-3387.
• [61]Molkov YI, Bacak BJ, Dick TE, Rybak IA: Control of breathing by interacting pontine and pulmonary feedback loops. Front Neural Circuits 2013, 7:16.
• [62]Fung ML, St John WM: Expiratory neural activities in gasping induced by pharyngeal stimulation and hypoxia. Respir Physiol 1995, 100:119-127.
• [63]Gottlieb JD, Schwartz AR, Marshall J, Ouyang P, Kern L, Shetty V, Trois M, Punjabi NM, Brown C, Najjar SS, Gottlieb SS: Hypoxia, not the frequency of apnea, induces acute hemodynamic stress in patients with chronic heart failure. J Am Coll Cardiol 2009, 54:1706-1712.
• [64]Szaboova E, Holoubek D, Tomori Z, Szabo P, Donic V, Stancak B: Severity of nocturnal cardiac arrhythmias correlates with intensity of sleep apnea in men. Adv Exp Med Biol 2013, 755:155-168.
• [65]Hamilton J, Moody D, Levy J: The use of the diving reflex to terminate supraventricular tachycardia in a 2-week-old infant. Am Heart J 1979, 97:371-374.
• [66]Varon J, Acosta P: Therapeutic hypothermia: past, present, and future. Chest 2008, 133:1267-1274.
• [67]Gupta A, Lennmarken C, Lemming D, Lindqvist J: Termination of paroxysmal supraventricular tachycardia with a nasogastric tube–a case report. Acta Anaesthesiol Scand 1991, 35:786-787.
• [68]Bjelakovic B, Vukovic B, Vojinovic J, Saranac L, Savic D, Zivanovi S, Petrovic A, Velickovic A, Miljkovic M: Deep nasopharyngeal aspiration as a treatment option for conversion of supraventricular paroxysmal tachycardia in infants. Pediatr Crit Care Med 2010, 12:1-2.
• [69]Salem MR, Baraka A, Rattenborg CC, Holaday DA: Treatment of hiccups by pharyngeal stimulation in anaesthetized and conscious subjects. J Amer Med Ass 1967, 202:32-36.
• [70]Criley JM, Blaufuss AH, Kissel GL: Cough-induced cardiac compression. J Amer Med Ass 1976, 236:1246-1250.
• [71]Leiter JC, Böhm I: Mechanisms of pathogenesis in the sudden infant death syndrome. Respir Physiol Neurobiol 2007, 159:127-138.
• [72]Ristagno G, Tang W, Sun S, Weil MH: Spontaneous gasping produces carotid blood flow during untreated cardiac arrest. Resuscitation 2007, 75:366-371.
• [73]Simpson JA, Iscoe S: Cardiorespiratory failure in rat induced by severe inspiratory resistive loading. J Appl Physiol 2007, 102:1556-1564.
• [74]Ross EZ, Nowicky AV, McConnel AK: Influence of acute inspiratory loading upon diaphragm motor-evoked potentials in healthy humans. J Appl Physiol 2007, 102:1883-1890.
• [75]Mahamed S, Strey KA, Mitchell GS, Baker-Herman TL: Reduced respiratory neural activity elicits phrenic motor facilitation. Respir Physiol Neurobiol 2011, 175:303-309.
• [76]Goshgarian HG: The crossed phrenic phenomenon: a model for plasticity in the respiratory pathways following spinal cord injury. J Appl Physiol 2003, 94:795-810.
• [77]Haouzi P, Van De Louw A, Haouzi A: Breathing during cardiac arrest following exercise: a new function of the respiratory system? Respir Physiol Neurobiol 2012, 181:220-227.
• [78]Legath L, Perecinsky S, Varga M, Orolin M, Tomori Z, Legath J: Latent airway hyperresponsiveness: a phenomenon bordering bronchial asthma definition. Adv Exp Med Biol 2013, 755:97-101.
• [79]Pecova R, Michnova T, Fabry J, Zatko T, Neuschlova M, Klco P, Hanacek J, Tatar M, Tomori Z: Deep nasal inspirations increase the cough threshold in children with mild asthma. Adv Exp Med Biol 2013, 755:65-69.