Relationship of phase IV to closing volume in lateral body positions.

We studied the effect of body position in humans on the relationship between exhaled vital capacity (VC) and both helium (He) and nitrogen (N2) concentrations after delivery of an He bolus at residual volume (RV) followed by 100% oxygen to total lung capacity. Phase IV, defined as the % VC at the first sharp and permanent increase in N2 and He, occurred at a mean of 15.7% VC while seated, 60.0% VC in right lateral and 59.6% VC in left lateral positions. He bolus delivery above RV but well below 60% VC resulted in the disappearance of phase IV. Lung pressure-volume (PV) curves had inflections at the volume of phase IV in the seated position: but the inflections were well below phase IV in lateral positions. Phase IV increased to higher volumes at higher mouth pressures. The relationship between phase IV and mouth pressure fell near the respiratory system relaxation PV curves. The findings suggest the higher phase IV in lateral positions is due to sequence of emptying without airway closure and is influenced by active expiration.