Airway Closure: Fluid-elastic instabilities of liquid-lined elastic tubes

Matthias Heil & Joseph P. White

Department of Mathematics

University of Manchester



[Background] [Aims of the project] [The model] [Results] [Physiological implications] [Acknowledgement/Funding]


Background

The physiological problem

The airways of the lung are lined with a thin liquid film which can undergo a surface-tension-driven fluid-elastic instability, leading to the formation of liquid bridges across the airway lumen. Evidence for the resulting `airway closure' has been observed directly in experiments on excised animal lungs. The experiments show that the formation of occluding liquid bridges is frequently accompanied by the non-axisymmetric collapse of the airway walls. Airway closure tends to occur in the smaller airways in the region of the terminal and respiratory bronchioli and towards the end of expiration when the airway diameters are smallest. In many pulmonary diseases the susceptibility to airway closure is enhanced and can lead to life-threatening conditions such as the respiratory distress syndrome (RDS) often experienced by premature neonates.

Previous theoretical work

Following early work on the Rayleigh instability in liquid-lined rigid tubes, Halpern & Grotberg [Fluid-Elastic Instabilities of Liquid-Lined Flexible Tubes. Journal of Fluid Mechanics 244, 615-632, (1992)] studied the liquid bridge formation in an elastic airway: Starting from an initial state in which a uniform liquid film lines a uniform axisymmetric airway, they computed the coupled time-dependent axisymmetric wall and air-liquid interface deformation which follows the initial Rayleigh instability of the liquid lining (see Fig. 1). They showed that wall elasticity significantly reduces the volume of fluid required to form an occluding liquid bridge. The two possible equilibrium configurations are depicted in Figs. 1c' and 1d: At small fluid volumes, the fluid redistributes so that the air-liquid interface has an unduloidal shape; in this case the airway remains open. At larger fluid-volumes the airway becomes occluded by a liquid bridge which is enclosed between two spherical air-liquid interfaces.

Figure 1: Sketch of axisymmetric airway closure.

The pressure jump over the highly curved air-liquid interfaces leads to a strong compression of the wetted part of the airway wall. Heil [
Minimal Liquid Bridges in Non-Axisymmetrically Buckled Elastic Tubes. Journal of Fluid Mechanics 380, 309-337 (1999)] showed that this compression can be strong enough to cause the axisymmetric airway to become unstable to non-axisymmetric perturbations. He determined the system's non-axisymmetric equilibrium configurations and showed that a non-axisymmetrically buckled airway can be occluded by liquid bridges of relatively small volume. However, his steady state analysis cannot determine which of these buckled equilibrium configurations can be realized via a time-dependent evolution from the initial axisymmetric state. Such configurations can only occur if The second case is particularly significant because in the physiological context it would imply that airway closure is possible at smaller fluid volumes than suggested by Halpern & Grotberg's axisymmetric analysis.

Aims of this project

The aim of the project was to investigate non-axisymmetric instabilities of liquid-lined elastic tubes and to assess their significance in the context of the physiological problem of airway closure. From a mathematical point of view, the key questions were as follows:

The Model

Throughout the project, geometrically non-linear shell theory was used to describe the deformation of the airway wall. The fluid flow in the liquid lining was modelled by lubrication theory; for one sub-problem the results obtained from this model were compared against an unsteady Navier-Stokes computation.

The key non-dimensional parameters in the model were: (i) The non-dimensional wall thickness hw/R0 where R0 is the undeformed radius of the airway and hw its wall thickness. (ii) The non-dimensional initial film thickness H0 = H0*/R0 where H0* is the uniform thickness of the liquid lining in the undeformed airway. (iii) The non-dimensional surface tension sigma=sigma*/(R0 K) where K is the bending stiffness of the airway wall. (iv) The non-dimensional external pressure pext=pext*/K. (v) The axial wavelength, L, of the deformation.

Results

Non-axisymmetric instabilities of liquid-lined elastic rings

The first problem we considered was the development of non-axisymmetric instabilities of liquid-lined elastic rings. (This analysis also applies to the case in which a finite length airway collapses axially uniformly). We performed a linear stability analysis to establish the value of the external pressure pext for which an axisymmetric, liquid-lined ring becomes unstable to non-axisymmetric perturbations. This analysis showed that the ring will buckle non-axisymmetrically (with a circumferential wavenumber of N=2) if pext + sigma 1/(1-H0) > 3. This result has the simple physical interpretation that buckling occurs when the compressive load created by the combination of the external pressure and the surface tension exceeds the classical buckling pressure, pext(buckl) = 3, of a dry ring. Numerical simulations (based on a fully coupled finite element discretisation of the governing equations) were then used to study the system's evolution following the onset of the non-axisymmetric instability. These simulations showed that for sufficiently large surface tension, the strong coupling between fluid and solid mechanics can induce a catastrophic collapse of the liquid-lined airway which leads to its complete occlusion. Fig. 2 illustrates the mechanism responsible for the collapse: Following the onset of the instability, the ring buckles non-axisymmetrically and surface tension forces drive fluid into the buckling lobe. (Surface tension attempts to return the air-liquid interface to an axisymmetric shape.) During this process, the curvature of the air-liquid interface (and hence the compression of the airway wall) increases continuously. At sufficiently large surface tension, the increase in compression can become so large that it cannot be balanced by the elastic restoring forces created by the ring's deformation. This leads to a rapid reduction of the luminal area and ultimately the complete occlusion of the airway.

Figure 2: Illustration of the non-axisymmetric collapse of a liquid-lined ring: As the ring buckles, the curvature of the air-liquid interface increases and the fluid pressure becomes increasingly negative (see pressure contours). The increase in the wall compression accelerates the collapse and ultimately the lumen becomes completely occluded. Note the rapid evolution during the final stages of the collapse: The transition between (c) and (d) occurs in less than 10-3 dimensionless time-units.

In the simulation presented in Fig. 2 the fluid flow was computed by (numerically) solving the full 2D Navier-Stokes equations. The simulation shows that during the final stages of the airway collapse, the liquid lining becomes very thick. In this regime lubrication theory can not be expected to (and, in fact, does not) provide an adequate description of the fluid mechanics. We developed an improved lubrication theory model, which ensures exact mass conservation even in situations in which the film has become thick and the substrate and/or the air-liquid interface have become highly curved. A detailed comparison with the full Navier-Stokes simulations showed that, at least in the present application, this model provides an excellent description of the system's behaviour. Further details can be found in our paper:

Heil, M. & White, J.P. (2002) Airway Closure: Surface-tension-driven non-axisymmetric instabilities of liquid-lined elastic rings. Journal of Fluid Mechanics 462, 79-109. (ps preprint)(abstract)

The linear (in-)stability of the evolving axisymmetric configuration

The analysis discussed in the previous section showed that an airway can become occluded via an axially uniform, non-axisymmetric collapse if the external (pleural) pressure exceeds a critical value. Next we considered the behaviour of an airway that is initially lined with a uniform layer of liquid and loaded by an external (pleural) pressure below this buckling pressure. If the airway is sufficiently long, the liquid lining is unstable to the axisymmetric Rayleigh instability. We wished to investigate if the additional wall compression that is generated when the liquid lining undergoes the Rayleigh instability can be sufficient to cause the wall to buckle non-axisymmetrically.

For this purpose, we first developed a numerical scheme to simulate the axisymmetric evolution of the airway wall and the air-liquid interface during the Rayleigh instability; typical results are shown in Fig. 3(a). The stability of this evolving configuration with respect to non-axisymmetric perturbations was then determined by a frozen-coefficient linear stability analysis.

Figure 3: (a) The axisymmetric wall and air-liquid interface shapes at t=0 (top), t= 300 (middle), t=980 (bottom). (b) The maximum growth rate lambda of the non-axisymmetric perturbations with wavenumbers N=2,3,4 against non-dimensional time t. (c) The parameter values pinit, sigma for which the system becomes unstable to buckling instabilities with wavenumber N during the evolution of the axisymmetric Rayleigh lobe.

A representative result is shown in Fig. 3(b) which plots the growth rates of modes N=2,3,4 (N is the circumferential wavenumber of the perturbation) as a function of (non-dimensional) time. At t=0, the growth of the Rayleigh instability is initiated. During the early stages of the system's evolution, the growth rates of the non-axisymmetric perturbations are all negative, indicating that the axisymmetric state is stable. At t = 480, the growth of the Rayleigh instability has increased the wall compression so much that the system becomes unstable to non-axisymmetric perturbations with a circumferential wavenumber of N=3.

We performed a large number of such simulations to map out the regions in parameter space in which the axisymmetric system becomes unstable to non-axisymmetric perturbations at some point during its axisymmetric evolution. An illustrative result is shown in Fig. 3(c), where a marker indicates a combination of the initial wall compression, pinit = pext + sigma/(1-H0), and the surface tension sigma for which a non-axisymmetric instability is predicted to occur. For pinit > 3 the system is always unstable to the axially uniform instability with wavenumber N=2, as shown in the previous section. For sufficiently large surface tension the system can also become unstable at pinit < 3. In these cases the non-axisymmetric instability is initiated by the Rayleigh instability.

The system's non-axisymmetric evolution in the large-displacement regime

Having established that the axisymmetric Rayleigh instability can initiate the non-axisymmetric buckling of the airway wall, we proceeded to determine if the nonlinear growth of the instability can result in the occurrence of airway closure. For this purpose we developed a numerical scheme for the coupled solution of the three-dimensional shell and lubrication theory equations. The simulations were started from an axially uniform configuration and small axial and circumferential perturbations were applied to initiate the Rayleigh and buckling instabilities, respectively. Fig. 4 illustrates the system's evolution for the case where the axial wavelength L corresponds to the fastest growing Rayleigh mode. Fig. 4(a) shows the initial configuration in which a thin liquid film lines the uniform axisymmetric tube. In Figs. 4(b-c) the redistribution of liquid by the axisymmetric Rayleigh instability is clearly visible: The film thickness has increased substantially at one end of the domain whereas the film has become very thin at the other end. The increased curvature of the air-liquid interface in the region where the film thickness has increased, leads to an additional compression of the airway wall. In Fig. 4(c) this compression has initiated the buckling of the airway wall. As the non-axisymmetric collapse proceeds, the air-liquid interface moves inwards very rapidly, see Fig. 4(d).

Figure 4: The shape of the tube and the air-liquid interface during the growth of primary axisymmetric axisymmetric (a-b) and secondary non-axisymmetric (c-d) instability. A segment of the air-liquid interface is not shown.

To reveal the time-scales required for the transitions between the four stages shown in Figs. 4(a-d), Fig. 5 illustrates the system's evolution by plotting the radii of eight characteristic points (four on the air-liquid interface; four on the tube wall).

At t=0, the air-liquid interface and the tube wall are axisymmetric and we have R1=...=R4=1 and Rh1=...=Rh4 = 0.9. During the initial stages of the Rayleigh instability, the air-liquid interface and the tube wall remain axisymmetric (Rh1 ~ Rh2 and Rh3 ~ Rh4) and the thickness of the liquid lining increases/decreases at the two ends of the domain: Rh1 and Rh2 grow while Rh3 and Rh4 decrease. In its axisymmetric state, the airway wall is very stiff and only deforms very little, R1 ~ ... ~ R4 ~ 1. In agreement with the predictions from the linear stability analysis, the tube wall begins to buckle at the compressed end when t ~ 480, causing R3 to decrease and R4 to increase. Buckling only occurs over a short axial length and the opposite end of the domain remains approximately axisymmetric, R1 ~ R2 ~ 1. Fig. 5 shows that the final collapse occurs extremely rapidly -- the lines representing the radii R3 and R4 become practically vertical. In this regime, the adaptive time-stepping scheme used in the computations chooses smaller and smaller time-steps to resolve the rapid collapse. Ultimately, the convergence of the numerical scheme deteriorates severely when roundoff errors begin to dominate the finite-difference approximations in the time-stepping scheme. This prohibits the continuation of the simulation beyond a certain degree of collapse. However, at this stage in the simulation it is clear that the system evolves rapidly towards a completely occluded configuration.

Figure 5: The evolution of various radii on the tube wall and the air-liquid interface (identified in the sketch on the right) as a function of non-dimensional time. Note the rapid evolution during the final stages of the collapse.

Again we performed a large number of such simulations to investigate the effect of various parameters on the system's behaviour. Most significantly, these parameter studies confirmed that non-axisymmetric airway closure can occur for physiologically realistic parameter values and that airway closure is possible even if the volume of fluid in the liquid lining is insufficient to occlude an axisymmetric airway.

Physiological implications

The main results of our mathematical/computational study are as follows Obviously, the mathematical model used in our analysis represents a strong simplification of the situation in vivo. We have deliberately excluded many effects that we regard as secondary to the primary instability mechanism. Neglected features include the presence of airway bifurcations, the viscoelastic behaviour of the airway wall, and the presence of parenchymal tethering.

We believe that inclusion of these effects would not change our main results. For instance the length of an individual airway between two successive bifurcations tends to be between 3-4 diameters. This is long enough for the initial Rayleigh instability to develop. Furthermore, our simulations predict airway collapse to occur in a strongly localised fashion -- the non-axisymmetric collapse tends to occur over a length of about two diameters. Hence, if the collapsing region is located in the central part of an airway, the presence of the bifurcations is unlikely to be of great importance.

Viscoelastic behaviour of the airway wall would affect the time-scales for the instability but would not be able to suppress the ultimate occlusion which is caused by the inability of the elastic restoring forces to balance the compression generated by surface tension.

Similarly, the presence of parenchymal tethering would stiffen the airway wall and thus require larger compressive forces to achieve the same degree of collapse. However, the surface-tension-driven compression depends linearly on the curvature of the air-liquid interface which increases rapidly with increasing collapse. Therefore, we expect that even in the presence of tethering, surface tension forces will ultimately be able to overcome the elastic restoring forces and cause the airway to become occluded.

Acknowledgements/Funding

This project was funded by EPSRC grant GR/M75464/01.


Page last modified: December 10, 2002

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