WorldWideScience

Sample records for volume positive pressure

  1. Evaluation of low tidal volume with positive end-expiratory pressure application effects on arterial blood gases during laparoscopic surgery.

    Science.gov (United States)

    Baki, Elif Dogan; Kokulu, Serdar; Bal, Ahmet; Ela, Yüksel; Sivaci, Remziye Gül; Yoldas, Murat; Çelik, Fatih; Ozturk, Nilgun Kavrut

    2014-07-01

    Pneumoperitoneum (PNP) and patient positions required for laparoscopy can induce pathophysiological changes that complicate anesthetic management during laparoscopic procedures. This study investigated whether low tidal volume and positive end-expiratory pressure (PEEP) application can improve ventilatory and oxygenation parameters during laparoscopic surgery. A total of 60 patients undergoing laparoscopic surgery were randomized to either the conventional group (n = 30, tidal volume = 10 mL/kg, rate = 12/minute, PEEP = 0 cm H(2)O) or the low tidal group with PEEP group (n = 30, tidal volume = 6 mL/kg, rate = 18/minute, PEEP = 5 cm H(2)O) at maintenance of anesthesia. Hemodynamic parameters, peak plateau pressure (Pplat) and arterial blood gases results were recorded before and after PNP. There was a significant increase in the partial pressure of arterial carbon dioxide (PaCO(2)) values after PNP in the conventional group in the reverse Trendelenburg (41.28 mmHg) and Trendelenburg positions (44.80 mmHg;p = 0.001), but there was no difference in the low tidal group at any of the positions (36.46 and 38.56, respectively). We saw that PaO(2) values recorded before PNP were significantly higher than the values recorded 1 hour after PNP in the two groups at all positions. No significant difference was seen in peak inspiratory pressure (Ppeak) at the reverse Trendelenburg position before and after PNP between the groups, but there was a significant increase at the Trendelenburg position in both groups (conventional; 21.67 cm H(2)O, p = 0.041, low tidal; 23.67 cm H(2)O, p = 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions. The application of low tidal volume + PEEP + high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases. Copyright © 2014. Published by Elsevier B.V.

  2. A quasi-positive family of continuous Darcy-flux finite-volume schemes with full pressure support

    Science.gov (United States)

    Edwards, Michael G.; Zheng, Hongwen

    2008-11-01

    A new family of flux-continuous, locally conservative, finite-volume schemes is presented for solving the general tensor pressure equation of subsurface flow in porous media. The new schemes have full pressure continuity imposed across control-volume faces. Previous families of flux-continuous schemes are point-wise continuous in pressure and flux. When applying the earlier point-wise flux-continuous schemes to strongly anisotropic full-tensor fields their failure to satisfy a maximum principle (as with other FEM and finite-volume methods) can result in loss of local stability for high anisotropy ratios which can cause strong spurious oscillations in the numerical pressure solution. An M-matrix analysis reveals the upper limits for guaranteeing a maximum principle for general 9-point schemes and aids in the design of schemes that minimize the occurrence of spurious oscillations in the discrete pressure field. The full pressure continuity schemes are shown to possess a larger range of flux-continuous schemes, than the previous point-wise counter parts. For strongly anisotropic full-tensor cases it is shown that the full quadrature range possessed by the new schemes permits these schemes to exploit quadrature points (previously out of range) that are shown to minimize spurious oscillations in discrete pressure solutions. The new formulation leads to a more robust quasi-positive family of flux-continuous schemes applicable to general discontinuous full-tensor fields.

  3. Effects of Positive End-Expiratory Pressure on Oscillated Volume during High-Frequency Chest Compression in Children with Cystic Fibrosis

    Directory of Open Access Journals (Sweden)

    Cara F Dosman

    2003-01-01

    Full Text Available OBJECTIVE: To investigate the effects of positive end-expiratory pressure (PEEP on end-expiratory lung volume (EELV and mean oscillated volume (Vosc during high frequency chest compression (HFCC.

  4. Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial.

    Science.gov (United States)

    Komasawa, Nobuyasu; Mihara, Ryosuke; Imagawa, Kentaro; Hattori, Kazuo; Minami, Toshiaki

    2015-01-01

    The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP) and taper-shaped (taper) cuffs in a prospective randomized clinical trial. Methods. Forty patients were intubated using tracheal tubes with either HVLP (n = 20; HVLP group) or taper-shaped (n = 20; Taper group) cuffs. Initial cuff pressure was adjusted to 15, 20, or 25 cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation. Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure. Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered with UMIN000016119.

  5. Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Nobuyasu Komasawa

    2015-01-01

    Full Text Available The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP and taper-shaped (taper cuffs in a prospective randomized clinical trial. Methods. Forty patients were intubated using tracheal tubes with either HVLP (n=20; HVLP group or taper-shaped (n=20; Taper group cuffs. Initial cuff pressure was adjusted to 15, 20, or 25 cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation. Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure. Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered with UMIN000016119.

  6. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during prone position.

    Science.gov (United States)

    Sen, Oznur; Bakan, Mefkur; Umutoglu, Tarik; Aydın, Nurdan; Toptas, Mehmet; Akkoc, Ibrahim

    2016-01-01

    Prone position during general anesthesia for special surgical operations may be related with increased airway pressure, decreased pulmonary and thoracic compliance that may be explained by restriction of chest expansion and compression of abdomen. The optimum ventilation mode for anesthetized patients on prone position was not described and studies comparing volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) during prone position are limited. We hypothesized that PCV instead of VCV during prone position could achieve lower airway pressures and reduce the systemic stress response. In this study, we aimed to compare the effects of PCV and VCV modes during prone position on respiratory mechanics, oxygenation, and hemodynamics, as well as blood cortisol and insulin levels, which has not been investigated before. Fifty-four ASA I-II patients, 18-70 years of age, who underwent percutaneous nephrolithotomy on prone position, were randomly selected to receive either the PCV (Group PC, n = 27) or VCV (Group VC, n = 27) under general anesthesia with sevoflurane and fentanyl. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O PEEP. Respiratory parameters were recorded during supine and prone position. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated during surgery and 60 min after extubation. P-peak and P-plateau levels during supine and prone positions were significantly higher and P-mean and compliance levels during prone position were significantly lower in Group VC when compared with Group PC. Postoperative PaO2 level was significantly higher in Group PC compared with Group

  7. The decrease of cardiac chamber volumes and output during positive-pressure ventilation

    DEFF Research Database (Denmark)

    Kristensen, Kasper Kyhl; Ahtarovski, Kiril Aleksov; Iversen, Kasper

    2013-01-01

    the effect of PPV on the central circulation by studying cardiac chamber volumes with cardiac magnetic resonance imaging (CMR). We hypothesized that PPV lowers cardiac output (CO) mainly via the Frank-Starling relationship. In 18 healthy volunteers, cardiac chamber volumes and flow in aorta and the pulmonary...

  8. Effects of hip joint position and intra-capsular volume on hip joint intra-capsular pressure: a human cadaveric model

    Directory of Open Access Journals (Sweden)

    Tse Paul

    2009-04-01

    Full Text Available Abstract Background Increase in hip intra-capsular pressure has been implicated in various hip pathologies, such as avascular necrosis complicating undisplaced femoral neck fracture. Our study aimed at documenting the relationship between intra-capsular volume and pressure in various hip positions. Methods Fifty-two cadaveric hips were studied. An electronic pressure-monitoring catheter recorded the intra-capsular hip pressure after each instillation of 2 ml of normal saline and in six hip positions. Results In neutral hip position, the control position for investigation, intra-capsular pressure remained unchanged when its content was below 10 ml. Thereafter, it increased exponentially. When the intra-capsular volume was 12 ml, full abduction produced a 2.1-fold increase (p = 0.028 of the intra-capsular hip joint pressure; full external rotation and full internal rotation increased the pressure by at least 4-fold (p Conclusion Intra-capsular pressure increases with its volume, but with a wide variation with different positions. It would be appropriate to recommend that hips with haemarthrosis or effusion should be positioned in 45-degree flexion.

  9. The Effect of Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Prone Position on Pulmonary Mechanics and Inflammatory Markers.

    Science.gov (United States)

    Şenay, Hasan; Sıvacı, Remziye; Kokulu, Serdar; Koca, Buğra; Bakı, Elif Doğan; Ela, Yüksel

    2016-08-01

    The aim of this present study is to compare the effect of pressure-controlled ventilation and volume-controlled ventilation on pulmonary mechanics and inflammatory markers in prone position. The study included 41 patients undergoing to vertebrae surgery. The patients were randomized into two groups: Group 1 received volume-controlled ventilation, while group 2 received pressure-controlled ventilation. The demographic data, pulmonary mechanics, the inflammatory marker levels just after the induction of anesthetics, at the 6th and 12th hours, and gas analysis from arterial blood samples taken at the beginning and the 30th minute were recorded. The inflammatory marker levels increased in both groups, without any significant difference among groups. Peak inspiratory pressure level was higher in the volume-controlled ventilation group. This study revealed that there is no difference regarding inflammatory marker levels between volume- and pressure-controlled ventilation.

  10. Nasal continuous positive airway pressure

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Lamwers, Stephanie; Tepel, Martin

    2012-01-01

    Obstructive sleep apnoea (OSA) is linked to increased cardiovascular risk. This risk can be reduced by nasal continuous positive airway pressure (nCPAP) treatment. As OSA is associated with an increase of several vasoconstrictive factors, we investigated whether nCPAP influences the digital volume...

  11. Effects of Positive End-Expiratory Pressure on Oscillated Volume during High-Frequency Chest Compression in Children with Cystic Fibrosis

    OpenAIRE

    Dosman, Cara F; Peter C Zuberbuhler; Tabk, Joan I; Jones, Richard L

    2003-01-01

    OBJECTIVE: To investigate the effects of positive end-expiratory pressure (PEEP) on end-expiratory lung volume (EELV) and mean oscillated volume (Vosc) during high frequency chest compression (HFCC).DESIGN: A clinic-based prospective intervention study.SETTING: Pulmonary function laboratory, University of Alberta, Edmonton, Alberta.POPULATION: Nine children with cystic fibrosis with little or no obstructive airway disease who were selected from the outpatient Cystic Fibrosis and Pediatric Pul...

  12. Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study.

    Science.gov (United States)

    Cabral, Elis E A; Resqueti, Vanessa R; Lima, Illia N D F; Gualdi, Lucien P; Aliverti, Andrea; Fregonezi, Guilherme A F

    2017-07-08

    Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls. 16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20cmH2O) were administered in a random order with a 30 minutes rest interval between intensities. During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32L, 0.56 vs. 1.54L, 0.52 vs. 1.8L, at 10, 15, 20cmH2O positive expiratory pressure, for stroke and control groups; pFisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Positive outcome of average volume-assured pressure support mode of a Respironics V60 Ventilator in acute exacerbation of chronic obstructive pulmonary disease: a case report

    Directory of Open Access Journals (Sweden)

    Okuda Miyuki

    2012-09-01

    Full Text Available Abstract Introduction We were able to treat a patient with acute exacerbation of chronic obstructive pulmonary disease who also suffered from sleep-disordered breathing by using the average volume-assured pressure support mode of a Respironics V60 Ventilator (Philips Respironics: United States. This allows a target tidal volume to be set based on automatic changes in inspiratory positive airway pressure. This removed the need to change the noninvasive positive pressure ventilation settings during the day and during sleep. The Respironics V60 Ventilator, in the average volume-assured pressure support mode, was attached to our patient and improved and stabilized his sleep-related hypoventilation by automatically adjusting force to within an acceptable range. Case presentation Our patient was a 74-year-old Japanese man who was hospitalized for treatment due to worsening of dyspnea and hypoxemia. He was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and full-time biphasic positive airway pressure support ventilation was initiated. Our patient was temporarily provided with portable noninvasive positive pressure ventilation at night-time following an improvement in his condition, but his chronic obstructive pulmonary disease again worsened due to the recurrence of a respiratory infection. During the initial exacerbation, his tidal volume was significantly lower during sleep (378.9 ± 72.9mL than while awake (446.5 ± 63.3mL. A ventilator that allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range was attached in average volume-assured pressure support mode, improving his sleep-related hypoventilation, which is often associated with the use of the Respironics V60 Ventilator. Polysomnography performed while our patient was on noninvasive positive pressure ventilation revealed obstructive sleep apnea syndrome (apnea-hypopnea index = 14, suggesting that his chronic

  14. FCT (functional computed tomography) evaluation of the lung volumes at different PEEP (positive-end expiratory pressure) ventilation pattern, in mechanical ventilated patients

    Energy Technology Data Exchange (ETDEWEB)

    Papi, M.G.; Di Segni, R.; Mazzetti, G.; Staffa, F. [Dept. of Radiology, S. Giovanni HS, Rome (Italy); Conforto, F.; Calimici, R.; Salvi, A. [Dept. of Anesthesiology, S. Giovanni HS, Rome (Italy); Matteucci, G. [Dept. of Pneumology, S. Giovanni HS, Rome (Italy)

    2007-06-15

    Purpose To evaluate with FCT (functional computed tomography) total lung volume and fractional lung volumes at different PEEP (positive end expiratory pressure) values in acute mechanically ventilated patients. Methods Nine ICU (intensive care unity) patients (1 lung pneumonia, 2 polytrauma, 2 sepsis, 3 brain surgery, 1 pulmonary embolism); mean age 48 {+-} 15 years, 6 male, 3 female; GE 16 MDCT scan was performed with acquisition from apex to diaphragma in seven seca at different PEEP values. Raw CT data were analysed by an advantage workstation to obtain volume density masks and histograms of both lungs and each lung and these density ranges were applied: - 1000 - 950 = hyper-ventilated lung, -900 - 650 well aerated lung, -950 - 500 all aerated lung, -500 + 200 lung tissue. Total and fractional lung volumes, Hounsfield unit (HU) were calculated and compared at different PEEP values (0, 5, 10, 15 cm H{sub 2}O). In four patients lung volumes were compared between the more and the less involved lung at increased PEEP. Statistic analysis: comparison means-medians tests. Results Data calculated at five PEEP showed unexpected decrease of total lung volume and increase of lung density (HU); proportionally no significant improvement of oxigenation. (orig.)

  15. Intraoperative and postoperative evaluation of low tidal volume combined with low-level positive end-expiratory pressure ventilation in laparoscopic surgery in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Ye-Qiu Li; Zheng-Lan Zhao; Qin-Fang Li

    2016-01-01

    Objective:To evaluate intraoperative and postoperative condition of low tidal volume combined with low-level positive end-expiratory pressure ventilation in laparoscopic surgery in elderly patients.Methods: A total of 176 cases of elderly patients (more than 60 years old) receiving laparoscopic surgery in our hospital from July 2013 to July 2015 were selected as research subjects and randomly divided into observation group and control group, each group included 88 cases, control group received conventional ventilation strategy, observation group received low tidal volume combined with low-level positive end-expiratory pressure ventilation strategy, and then levels of hemodynamic indexes, respiratory mechanical indexes, serology indexes and cerebral vessel related indexes, etc of two groups were compared.Results:Intraoperative and postoperative heart rate and mean arterial pressure levels of observation group were lower than those of control group, arterial partial pressure of oxygen and oxygenation index levels were higher than those of control group and differences had statistical significance (P<0.05); intraoperative APIP and Pplat values of observation group were lower than those of control group, Cs value was higher than that of control group and differences had statistical significance (P<0.05); intraoperative and postoperative serum IL-8 and TNF-αlevels of observation group were lower than those of control group, IL-10 level was higher than that of control group and differences had statistical significance (P<0.05); intraoperative and postoperative PjvO2, SjvO2 and CjvO2 levels of observation group were higher than those of control group, Da-jvO2 level was lower than that of control group and differences had statistical significance (P<0.05).Conclusions:When elderly patients receive laparoscopic surgery, the use of low tidal volume combined with low-level positive end-expiratory pressure ventilation strategy can stabilize hemodynamic level and respiratory

  16. Positive expiratory pressure and oscillatory positive expiratory pressure therapies.

    Science.gov (United States)

    Myers, Timothy R

    2007-10-01

    Airway clearance techniques, historically referred to as chest physical therapy, have traditionally consisted of a variety of breathing maneuvers or exercises and manual percussion and postural drainage. The methods and types of airway clearance techniques and devices have rapidly increased in an effort to find a more efficacious strategy that allows for self-therapy, better patient adherence and compliance, and more efficient durations of care. Mechanically applied pressure devices have migrated from European countries over the last several decades to clinical practice in the United States. I conducted a comprehensive MEDLINE search of two such devices: positive expiratory pressure (PEP) and oscillatory positive expiratory pressure (OPEP) and their role in airway clearance strategies. This was followed by a comprehensive search for cross-references in an attempt to identify additional studies. The results of that search are contained and reported in this review. From a methods standpoint, most of the studies of PEP and OPEP for airway clearance are limited by crossover designs and small sample sizes. While PEP and OPEP do not definitively prove superiority to other methods of airway clearance strategies, there is no clear evidence that they are inferior. Ultimately, the correct choice may be an airway clearance strategy that is clinically and cost effective, and is preferred by the patient so that adherence and compliance can be at the very least supported.

  17. Human gallbladder pressure and volume

    DEFF Research Database (Denmark)

    Borly, L; Højgaard, L; Grønvall, S;

    1996-01-01

    Increased gallbladder (GB) pressure is probably a part of the pathogenesis of acute cholecystitis, and measurements of GB pressure might therefore be of interest. The aim of this study was to validate a microtip pressure transducer for intraluminal GB pressure measurements. In vitro precision...... and accuracy was within 0.2 mmHg, (SD) and 0.6 +/- 0.1 mmHg (mean +/- SD), respectively. Pressure rise rate was 24.8 +/- 5.5 mmHg s-1. Zero drift was in the range 0.3 +/- 0.4 to 0.8 +/- 0.9 mmHg (mean +/- SD). GB pressure was investigated in 16 patients with acute cholecystitis treated with percutaneous...

  18. On pressure: volume relations in hemodialysis

    NARCIS (Netherlands)

    E.H.Y. Ie (Eric)

    2005-01-01

    textabstractChapter 1 is a brief introduction to several aspects of cardiovascular pressure-volume relations in dialysis patients. The aims of the thesis are presented. In Chapter 2, an overview is presented of circulatory physiology in hemodialysis (HD) patients. Volume withdrawal by ultrafiltrati

  19. Osmosis at constant volume. Negative pressure

    CERN Document Server

    Zupanovic, Pasko; Brumen, Milan; Fajmut, Ales; Juretic, Davor

    2009-01-01

    A thermodynamic state of solvent and solution separated with an elastic semipermeable membrane, in the box with a fixed volume, is considered. It is shown that the minimum of the free energy is accompanied by the compression of the solution and tension of the solvent caused by the transfer of solvent molecules into compartment with solution. The tensile state of the solvent is described in terms of negative pressure. It is found that the negative pressure as well as compression pressure is of the order of osmotic pressure given by van't Hoff equation. It is proposed that this mechanism could be responsible for the water uptake in tall trees.

  20. Relative effects of negative versus positive pressure ventilation depend on applied conditions.

    Science.gov (United States)

    Engelberts, Doreen; Malhotra, Atul; Butler, James P; Topulos, George P; Loring, Stephen H; Kavanagh, Brian P

    2012-05-01

    Comparisons of negative versus positive pressure ventilation have imperfectly matched the pressure-time profile or the lung volume history, or have incompletely applied in vivo negative pressure to include the complete thoracic wall and abdomen. Negative pressure exerts the same pattern of lung distension as positive pressure when the pressure-time and volume history profiles are identical and the application of negative pressure is over the whole lung. (1) In isolated (ex vivo) and (2) intact (in vivo) mouse lungs (n = 4/group) (sealed chamber enclosing either the whole lung or whole mouse except for external airway opening), identical and inverse-tidal, square-wave pressure-time profiles were obtained with positive and negative pressure ventilation. (3) Following an identical volume history, surfactant-depleted rabbits (n = 7) were randomly assigned to sustained, static equivalent positive versus negative pressures. (4) Surfactant-depleted anesthetized rabbits (n = 10) with identical volume histories were randomized to positive versus negative ventilation with identical pressure-time characteristics. Matched positive and negative pressure time profiles in ex vivo and in vivo mice resulted in identical tidal volumes. Identical (negative vs. positive) sustained static pressures resulted in similar PaO(2) and end expiratory lung volumes. Positive and negative ventilation with identical volume histories and pressure time characteristics showed no difference in oxygenation or lung volumes. Historical comparisons suggested better oxygenation with negative pressure when the volume history was not identical. These data do not support major biological differences between negative and positive pressure ventilation when waveforms and lung volume history are matched.

  1. Respiratory Variations in Pulse Pressure Reflect Central Hypovolemia during Noninvasive Positive Pressure Ventilation

    Directory of Open Access Journals (Sweden)

    Ingrid Elise Hoff

    2014-01-01

    Full Text Available Background. Correct volume management is essential in patients with respiratory failure. We investigated the ability of respiratory variations in noninvasive pulse pressure (ΔPP, photoplethysmographic waveform amplitude (ΔPOP, and pleth variability index (PVI to reflect hypovolemia during noninvasive positive pressure ventilation by inducing hypovolemia with progressive lower body negative pressure (LBNP. Methods. Fourteen volunteers underwent LBNP of 0, −20, −40, −60, and −80 mmHg for 4.5 min at each level or until presyncope. The procedure was repeated with noninvasive positive pressure ventilation. We measured stroke volume (suprasternal Doppler, ΔPP (Finapres, ΔPOP, and PVI and assessed their association with LBNP-level using linear mixed model regression analyses. Results. Stroke volume decreased with each pressure level (−11.2 mL, 95% CI −11.8, −9.6, P<0.001, with an additional effect of noninvasive positive pressure ventilation (−3.0 mL, 95% CI −8.5, −1.3, P=0.009. ΔPP increased for each LBNP-level (1.2%, 95% CI 0.5, 1.8, P<0.001 and almost doubled during noninvasive positive pressure ventilation (additional increase 1.0%, 95% CI 0.1, 1.9, P=0.003. Neither ΔPOP nor PVI was significantly associated with LBNP-level. Conclusions. During noninvasive positive pressure ventilation, preload changes were reflected by ΔPP but not by ΔPOP or PVI. This implies that ΔPP may be used to assess volume status during noninvasive positive pressure ventilation.

  2. Cardiovascular simulator improvement: pressure versus volume loop assessment.

    Science.gov (United States)

    Fonseca, Jeison; Andrade, Aron; Nicolosi, Denys E C; Biscegli, José F; Leme, Juliana; Legendre, Daniel; Bock, Eduardo; Lucchi, Julio Cesar

    2011-05-01

    This article presents improvement on a physical cardiovascular simulator (PCS) system. Intraventricular pressure versus intraventricular volume (PxV) loop was obtained to evaluate performance of a pulsatile chamber mimicking the human left ventricle. PxV loop shows heart contractility and is normally used to evaluate heart performance. In many heart diseases, the stroke volume decreases because of low heart contractility. This pathological situation must be simulated by the PCS in order to evaluate the assistance provided by a ventricular assist device (VAD). The PCS system is automatically controlled by a computer and is an auxiliary tool for VAD control strategies development. This PCS system is according to a Windkessel model where lumped parameters are used for cardiovascular system analysis. Peripheral resistance, arteries compliance, and fluid inertance are simulated. The simulator has an actuator with a roller screw and brushless direct current motor, and the stroke volume is regulated by the actuator displacement. Internal pressure and volume measurements are monitored to obtain the PxV loop. Left chamber internal pressure is directly obtained by pressure transducer; however, internal volume has been obtained indirectly by using a linear variable differential transformer, which senses the diaphragm displacement. Correlations between the internal volume and diaphragm position are made. LabVIEW integrates these signals and shows the pressure versus internal volume loop. The results that have been obtained from the PCS system show PxV loops at different ventricle elastances, making possible the simulation of pathological situations. A preliminary test with a pulsatile VAD attached to PCS system was made.

  3. Interaction between intra-abdominal pressure and positive-end expiratory pressure

    Directory of Open Access Journals (Sweden)

    Jamili Anbar Torquato

    2009-02-01

    Full Text Available OBJECTIVE: The aim of this study was to quantify the interaction between increased intra-abdominal pressure and Positive-End Expiratory Pressure. METHODS: In 30 mechanically ventilated ICU patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a Positive-End Expiratory Pressure level of zero and 10 cm H2O. The measurements were repeated after placing a 5 kg weight on the patients' belly. RESULTS: After the addition of 5 kg to the patients' belly at zero Positive-End Expiratory Pressure, both intra-abdominal pressure (p<0.001 and plateau pressures (p=0.005 increased significantly. Increasing the Positive-End Expiratory Pressure levels from zero to 10 cm H2O without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165. However, plateau pressures increased significantly (p< 0.001. Increasing Positive-End Expiratory Pressure from zero to 10 cm H2O and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001 and plateau pressure from 18.26 to 27.2 (p<0.001. Maintaining Positive-End Expiratory Pressure at 10 cm H2O and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001 but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83. CONCLUSIONS: The addition of a 5kg weight onto the abdomen significantly increased both IAP and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. However, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using PEEP. In these patients, the intra-abdominal pressure must also be measured.

  4. Kidney volume and ambulatory blood pressure in children.

    Science.gov (United States)

    Gurusinghe, Shari; Palvanov, Arkadiy; Bittman, Mark E; Singer, Pamela; Frank, Rachel; Chorny, Nataliya; Infante, Lulette; Sethna, Christine B

    2016-12-16

    Low nephron number has been shown to be a risk factor for hypertension (HTN) in adulthood. Kidney volume may serve as a surrogate marker for nephron mass. The relationship between kidney volume and ambulatory blood pressure (BP) in the pediatric population is not known. A retrospective chart review of children younger than 21 years who were evaluated for HTN was performed. Twenty-four-hour BP and ultrasonography data were obtained. Multiple regression was used to examine associations between BP and kidney volume. Of 84 children (mean age 13.87 years, 72.6% males), 54 had HTN. Systolic BP index during the awake, sleep, and 24-hour periods (all P≤.05) was found to be positively correlated with total kidney volume. Greater total kidney volume was found to be a positive predictor of 24-hour and sleep systolic index (P≤.05). It failed to serve as a predictor of HTN, pre-HTN, or white-coat HTN. Contrary to expectation, total kidney volume was positively associated with systolic BP indices.

  5. Positive pressure breathing during rest and exercise

    NARCIS (Netherlands)

    Hartog, E.A. den; Heus, R.

    2003-01-01

    The requirements to maintain a positive pressure with respiratory protection during heavy exercise and the effects on ventilation and feelings of discomfort were investigated. Eight male subjects participated, using the respirator system during rest and exercise at about 80% of their individual

  6. Positive pressure breathing during rest and exercise

    NARCIS (Netherlands)

    Hartog, E.A. den; Heus, R.

    2003-01-01

    The requirements to maintain a positive pressure with respiratory protection during heavy exercise and the effects on ventilation and feelings of discomfort were investigated. Eight male subjects participated, using the respirator system during rest and exercise at about 80% of their individual maxi

  7. Computing the partial volume of pressure vessels

    Energy Technology Data Exchange (ETDEWEB)

    Wiencke, Bent [Nestle USA, Corporate Engineering, 800 N. Brand Blvd, Glendale, CA 91203 (United States)

    2010-06-15

    The computation of the partial and total volume of pressure vessels with various type of head profiles requires detailed knowledge of the head profile geometry. Depending on the type of head profile the derivation of the equations can become very complex and the calculation process cumbersome. Certain head profiles require numerical methods to obtain the partial volume, which for most application is beyond the scope of practicability. This paper suggests a unique method that simplifies the calculation procedure for the various types of head profiles by using one common set of equations without the need for numerical or complex computation methods. For ease of use, all equations presented in this paper are summarized in a single table format for horizontal and vertical vessels. (author)

  8. Left ventricular pressure-volume diagrams and end-systolic pressure-volume relations in human beings.

    Science.gov (United States)

    McKay, R G; Aroesty, J M; Heller, G V; Royal, H; Parker, J A; Silverman, K J; Kolodny, G M; Grossman, W

    1984-02-01

    Assessment of left ventricular pressure-volume relations serially in response to altered loading conditions and heart rate has been difficult to achieve with contrast ventriculography. Accordingly, to study changing pressure-volume relations during altered loading and heart rate, left ventricular pressure and radionuclide absolute volume curves (obtained using a counts-based method with attenuation factor corrections) were recorded in 20 patients. Ventricular pressure and radionuclide volume curves were digitized and synchronized to end-diastole, and pressure-volume plots were subsequently constructed from 32 pressure-volume coordinates throughout the cardiac cycle. In all patients, the correlation between radionuclide absolute volumes and angiographic ventricular volumes was r = 0.92. In 10 patients in whom both radionuclide and angiographic pressure-volume diagrams were constructed, the agreement between the two methods was excellent. With this method, end-systolic pressure-volume relations were examined during altered left ventricular loading conditions, pacing-induced incremental increases in heart rate and pacing-induced ischemia. Using pharmacologically induced changes in left ventricular loading conditions, the slope and volume intercept of the end-systolic pressure-volume line could be calculated as a means of assessing basal contractility. During pacing-induced tachycardia, the slope and volume intercept of the end-systolic pressure-volume line could be calculated to quantify the Treppe effect and assess negative inotropic changes secondary to ischemia. This study supports the validity of using serial recordings of left ventricular pressure and radionuclide volumes to assess left ventricular pressure-volume relations, and indicates that this approach may be useful in the analysis of end-systolic pressure-volume relations in patients.

  9. Left ventricular pressure-volume diagrams and end-systolic pressure-volume relations in human beings

    Energy Technology Data Exchange (ETDEWEB)

    McKay, R.G.; Aroesty, J.M.; Heller, G.V.; Royal, H.; Parker, J.A.; Silverman, K.J.; Kolodny, G.M.; Grossman, W.

    1984-02-01

    Assessment of left ventricular pressure-volume relations serially in response to altered loading conditions and heart rate has been difficult to achieve with contrast ventriculography. Accordingly, to study changing pressure-volume relations during altered loading and heart rate, left ventricular pressure and radionuclide absolute volume curves (obtained using a counts-based method with attenuation factor corrections) were recorded in 20 patients. Ventricular pressure and radionuclide volume curves were digitized and synchronized to end-diastole, and pressure-volume plots were subsequently constructed from 32 pressure-volume coordinates throughout the cardiac cycle. In all patients, the correlation between radionuclide absolute volumes and angiographic ventricular volumes was r . 0.92. In 10 patients in whom both radionuclide and angiographic pressure-volume diagrams were constructed, the agreement between the two methods was excellent. With this method, end-systolic pressure-volume relations were examined during altered left ventricular loading conditions, pacing-induced incremental increases in heart rate and pacing-induced ischemia. Using pharmacologically induced changes in left ventricular loading conditions, the slope and volume intercept of the end-systolic pressure-volume line could be calculated as a means of assessing basal contractility. During pacing-induced tachycardia, the slope and volume intercept of the end-systolic pressure-volume line could be calculated to quantify the Treppe effect and assess negative inotropic changes secondary to ischemia. This study supports the validity of using serial recordings of left ventricular pressure and radionuclide volumes to assess left ventricular pressure-volume relations, and indicates that this approach may be useful in the analysis of end-systolic pressure-volume relations in patients.

  10. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2012-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  11. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2010-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  12. Relationship between stroke volume and pulse pressure during blood volume perturbation: a mathematical analysis.

    Science.gov (United States)

    Bighamian, Ramin; Hahn, Jin-Oh

    2014-01-01

    Arterial pulse pressure has been widely used as surrogate of stroke volume, for example, in the guidance of fluid therapy. However, recent experimental investigations suggest that arterial pulse pressure is not linearly proportional to stroke volume. However, mechanisms underlying the relation between the two have not been clearly understood. The goal of this study was to elucidate how arterial pulse pressure and stroke volume respond to a perturbation in the left ventricular blood volume based on a systematic mathematical analysis. Both our mathematical analysis and experimental data showed that the relative change in arterial pulse pressure due to a left ventricular blood volume perturbation was consistently smaller than the corresponding relative change in stroke volume, due to the nonlinear left ventricular pressure-volume relation during diastole that reduces the sensitivity of arterial pulse pressure to perturbations in the left ventricular blood volume. Therefore, arterial pulse pressure must be used with care when used as surrogate of stroke volume in guiding fluid therapy.

  13. Effect of raised thoracic pressure and volume on 99mTc-DTPA clearance in humans

    Energy Technology Data Exchange (ETDEWEB)

    Nolop, K.B.; Maxwell, D.L.; Royston, D.; Hughes, J.M.

    1986-05-01

    Although positive airway pressure is often used to treat acute pulmonary edema, the effects on epithelial solute flux are not well known. We measured independently the effect of 1) positive pressure and 2) voluntary hyperinflation on the clearance of inhaled technetium-99m-labeled diethylenetriaminepentaacetic acid (/sup 99m/Tc-DTPA) in six nonsmokers and six smokers. Lung volumes were monitored by inductance plethysmography. Each subject was studied in four situations: 1) low end-expiratory volume (LO-), 2) low volume plus 9 cmH2O continuous positive airway pressure (LO+), 3) high end-expiratory volume (HI-), and 4) high volume plus continuous positive airway pressure (HI+). The clearance half time of 99mTc-DTPA for the nonsmokers decreased from 64.8 +/- 7.0 min (mean +/- SE) at LO- to 23.2 +/- 5.3 min at HI- (P less than 0.05). Positive pressure had no synergistic effect. The mean clearance half time for the smokers was faster than nonsmokers at base line but unaffected by similar changes in thoracic volume and pressure. We conclude that, in nonsmokers, positive airway pressure increases /sup 99m/Tc-DTPA clearance primarily through an increase in lung volume and that smokers are immune to these effects.

  14. Efeitos de diferentes volumes correntes e da pressão expiratória final positiva sobre a troca gasosa na fístula broncopleural experimental Effects of different tidal volumes and positive end expiratory pressure on gas exchange in experimental bronchopleural fistula

    Directory of Open Access Journals (Sweden)

    Maria Gabriela Cavicchia Toneloto

    2008-09-01

    melhora e o débito da fístula é reduzido quando comparado ao volume corrente de 10ml/Kg. Um baixo volume resulta em hipercapnia e grave dessaturação. Finalmente, em qualquer volume corrente, PEEP aumenta o débito da fístula e diminui a ventilação alveolar.OBJECTIVES: The present study was designed to identify the effect of positive end expiratory pressure (PEEP and the ideal pulmonary tidal volume to ventilate animals with a surgically produced bronchopleural fistula, aiming to reduce fistula output without affecting gas exchange. METHODS: Hemodynamic and respiratory assessment of gas exchange was obtained in five, healthy, young, mechanically ventilated Large White pigs under volume controlled ventilation with FiO2 of 0.4 and an inspiration:expiration ratio of 1:2, keeping respiratory rate at 22 cpm. A bronchopleural fistula was produced by resection of the lingula. Underwater seal drainage was installed and the thorax was hermetically closed. Gas exchange and fistula output were measured with the animals ventilated sequentially with tidal volumes of 4 ml/kg, 7 ml/kg and 10 ml/Kg alternating zero of positive end expiratory pressure (ZEEP and PEEP of 10 cmH2O, always in the same order. RESULTS: These findings are attributed to reduced alveolar ventilation and ventilation/perfusion abnormalities and were attenuated with larger tidal volumes. PEEP increases air leak, even with low volume (of 2.0 ± 2.8mL to 31 ± 20.7mL; p= 0.006 and decreases alveolar ventilation in all tidal volumes. Alveolar ventilation improved with larger tidal volumes, but increased fistula output (10 mL/kg - 25.8 ± 18.3mL to 80.2 ± 43.9mL; p=0.0010. Low tidal volumes result in hypercapnia (ZEEP - Toneloto MGC, Terzi RGG, Silva WA, Moraes AC, Moreira MM 83.7± 6.9 mmHg and with PEEP 10 - 93 ± 10.1mmHg and severely decreased arterial oxygen saturation, about of 84%. CONCLUSIONS: The tidal volume of 7 ml/Kg with ZEEP was considered the best tidal volume because, despite moderate hypercapnia

  15. Variable pattern contamination control under positive pressure

    Energy Technology Data Exchange (ETDEWEB)

    Philippi, H.M. [Chalk River Labs., Ontario (Canada)

    1997-08-01

    Airborne contamination control in nuclear and biological laboratories is traditionally achieved by directing the space ventilation air at subatmospheric pressures in one fixed flow pattern. However, biological and nuclear contamination flow control in the new Biological Research Facility, to be commissioned at the Chalk River Laboratories in 1996, will have the flexibility to institute a number of contamination control patterns, all achieved at positive (above atmospheric) pressures. This flexibility feature, made possible by means of a digitally controlled ventilation system, changes the facility ventilation system from being a relatively rigid building service operated by plant personnel into a flexible building service which can be operated by the facility research personnel. This paper focuses on and describes the application of these unique contamination control features in the design of the new Biological Research Facility. 3 refs., 7 figs.

  16. Capital Cost: Pressurized Water Reactor Plant Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    1977-06-01

    The investment cost study for the 1139-MW(e) pressurized water reactor (PWR) central station power plant consists of two volumes. This volume includes in addition to the foreword and summary, the plant description and the detailed cost estimate.

  17. The Intracranial Volume Pressure Response in Increased Intracranial Pressure Patients: Clinical Significance of the Volume Pressure Indicator

    Science.gov (United States)

    2016-01-01

    Background For patients suffering from primary brain injury, monitoring intracranial pressure alone is not enough to reflect the dynamic intracranial condition. In our previous study, a segment of the pressure-volume curve can be expressed by the parabolic regression model with single indicator “a”. The aim of this study is to evaluate if the indicator “a” can reflect intracranial conditions. Methods Patients with traumatic brain injury, spontaneous intracranial hemorrhage, and/or hydrocephalus who had external ventricular drainage from January 2009 to February 2010 were included. The successive volume pressure response values were obtained by successive drainage of cerebral spinal fluid from intracranial pressure 20–25 mm Hg to 10 mm Hg. The relationship between withdrawn cerebral spinal fluid volume and intracranial pressure was analyzed by the parabolic regression model with single parameter “a”. Results The overall mean for indicator “a” was 0.422 ± 0.046. The mean of “a” in hydrocephalus was 0.173 ± 0.024 and in severe intracranial mass with slender ventricle, it was 0.663 ± 0.062. The two extreme intracranial conditions had a statistical significant difference (phydrocephalus. Brain computed tomography should be performed early if a rapid elevation of indicator “a” is detected, as it can reveal some ongoing intracranial pathology prior to clinical deterioration. Increased intracranial pressure was frequently observed in patients with intracranial pathology. The progression can be differentiated using the pattern of the volume pressure indicator. PMID:27723794

  18. Low Positive Airway Pressure without Positive End-Expiratory Pressure Decreases Blood Loss during Hepatectomy in Living Liver Donors.

    Science.gov (United States)

    Iguchi, Tomohiro; Ikegami, Toru; Fujiyoshi, Tetsuhiro; Yoshizumi, Tomoharu; Shirabe, Ken; Maehara, Yoshihiko

    2017-01-01

    Despite the development of strategies to minimize blood loss during hepatectomy challenges remain. Our aim was to determine whether low positive airway pressure (PAP) without positive end-expiratory pressure (PEEP) could minimize blood loss during hepatectomy. Forty-one living liver donors who underwent extended left lobectomy or right lobectomy between December 2012 and November 2013 were retrospectively analyzed. In the standard PAP group (n = 18), tidal volume was 8-10 ml/kg, respiratory rate was 10-12/min and PEEP was maintained at 5 cm H2O. In the low PAP group (n = 23), tidal volume was reduced to 5 ml/kg, respiratory rate was increased to 15/min and PEEP maintained at 0 cm H2O. Low central venous pressure (CVP) was maintained during surgery in all cases. The low PAP group had significantly less blood loss (p = 0.0075) and shorter operation time (p = 0.0303) than the standard PAP group. In multiple regression analysis, ventilation mode and median CVP were found to be determining factors for blood loss. In no case did the ventilation mode affect perioperative management. Low PAP without PEEP is a safe mechanical ventilation mode that might help minimize blood loss along with CVP monitoring during hepatectomy. © 2016 S. Karger AG, Basel.

  19. Influence of different positive end expiratory pressure on volume responsiveness of patients with septic shock%不同呼气末正压对感染性休克患者容量反应性的影响

    Institute of Scientific and Technical Information of China (English)

    顾怀金; 方杰; 王建斌

    2015-01-01

    Objective To evaluate the influence of different positive end expiratory pressure(PEEP)levels on volume responsive-ness of mechanical ventilation patients with septic shock. Methods Twenty-eight patients with septic shock ever treated in our hospital from Jan 2012 to Aug 2014 were enrolled in the study. The patients were all mechanically ventilated with volume controlled mode till hemodynamic stability,then the PEEP levels were increased every one hour gradually from 0 cmH2 O to 15 cmH2 O(if tolerated). Depending on the tolera-ted PEEP level,all patients were divided into four groups:PEEP 0 cmH2 O group,PEEP 5 cmH2 O group,PEEP 10 cmH2 O group and PEEP 15 cmH2 O group,and the volume responsiveness of all patients were assessed by passive leg raising test(PLRT). The influence of different PEEP levels on volume responsiveness of all patients with septic shock was evaluated. Results Of the 28 patients with septic shock,the basal PEEP level was(8. 3 ± 2. 8)cmH2 O. With increased PEEP,CVP around PLRT was gradually increased,but the ΔCVP differences between different PEEP groups were not statistically significant(P ﹥ 0. 05);the cardiac index(CI)was gradually decreased with increased PEEP,but ΔCI between different PEEP groups were gradually increased,with significant difference(P ﹤ 0. 05). Conclusion For patients with septic shock using exogenous PEEP in mechanical ventilation,CVP is not a reliable indicator to assess the volume responsiveness,but CI is relatively reliable as a indicator,and the volume responsiveness would increase with the increasing PEEP.%目的:探讨不同水平的呼气末正压(PEEP)对进行机械通气感染性休克患者容量反应性的影响。方法选择2012年1月至2014年8月淮北市人民医院重症医学科收治的28例进行机械通气的感染性休克患者为研究对象,所有患者采用容量控制通气,血流动力学稳定后每隔1 h 递增 PEEP,PEEP 从0 cmH2 O 增加到15 cmH2 O(能

  20. Noninvasive positive pressure ventilation in unplanned extubation

    Directory of Open Access Journals (Sweden)

    Eryuksel Emel

    2009-01-01

    Full Text Available Background:Unplanned extubation is quite common in intensive care unit (ICU patients receiving mechanical ventilatory support. The present study aimed to investigate the effectiveness of noninvasive positive pressure ventilation (NPPV in patients with unplanned extubation. Materials and Methods: A total of 15 patients (12 male, age: 57 ± 24 years, APACHE II score: 19 ± 7 monitored at the medical ICU during the year 2004 who developed unplanned extubation were included in the study. NPPV was tried in all of them following unplanned extubation. Indications for admission to the ICU were as follows: nine patients with pneumonia, three with status epilepticus, one with gastrointestinal bleeding, one with cardiogenic pulmonary edema and one with diffuse alveolar bleeding. Results:Eleven of the patients (74% were at the weaning period at the time of unplanned extubation. Among these 11 patients, NPPV was successful in 10 (91% and only one (9% was reintubated due to the failure of NPPV. The remaining four patients (26% had pneumonia and none of them were at the weaning period at the time of extubation, but their requirement for mechanical ventilation was gradually decreasing. Unfortunately, an NPPV attempt for 6-8 h failed and these patients were reintubated. Conclusions:Patients with unplanned extubation before the weaning criteria are met should be intubated immediately. On the other hand, when extubation develops during the weaning period, NPPV may be an alternative. The present study was conducted with a small number of patients, and larger studies on the effectiveness of NPPV in unplanned extubation are warranted for firm conclusions.

  1. Influence of upper body position on middle cerebral artery blood velocity during continuous positive airway pressure breathing

    DEFF Research Database (Denmark)

    Højlund Rasmussen, J; Mantoni, T; Belhage, B

    2007-01-01

    Continuous positive airway pressure (CPAP) is a treatment modality for pulmonary oxygenation difficulties. CPAP impairs venous return to the heart and, in turn, affects cerebral blood flow (CBF) and augments cerebral blood volume (CBV). We considered that during CPAP, elevation of the upper body ...

  2. Pulse volume discharges in high pressure gases

    Science.gov (United States)

    Yamshchikov, V. A.

    2015-11-01

    New approach for suppression of plasma inhomogeneities and instabilities in the volume self-sustained discharge is offered. The physical model is offered and conditions of obtaining extremely homogeneous self-sustained discharge are defined (with full suppression of plasma inhomogeneity and instability). Results of calculations agree with experiments.

  3. [Positive end-expiratory pressure : adjustment in acute lung injury].

    Science.gov (United States)

    Bruells, C S; Dembinski, R

    2012-04-01

    Treatment of patients suffering from acute lung injury is a challenge for the treating physician. In recent years ventilation of patients with acute hypoxic lung injury has changed fundamentally. Besides the use of low tidal volumes, the most beneficial setting of positive end-expiratory pressure (PEEP) has been in the focus of researchers. The findings allow adaption of treatment to milder forms of acute lung injury and severe forms. Additionally computed tomography techniques to assess the pulmonary situation and recruitment potential as well as bed-side techniques to adjust PEEP on the ward have been modified and improved. This review gives an outline of recent developments in PEEP adjustment for patients suffering from acute hypoxic and hypercapnic lung injury and explains the fundamental pathophysiology necessary as a basis for correct treatment.

  4. Utilization of pressure-volume curves in the pediatric patient.

    Science.gov (United States)

    Bone, R C; Jantzen, D; Heithold, R

    1978-04-01

    Seven patients treated with continuous mechanical ventialtion were monitored with static and dynamic pressure-volume curves. Three patients developed no pulmonary complications, and mechanical ventilation was discontinued within 96 hr. In four patients, pressure-volume curves were used as a diagnostic aid in the detection of the physiologic defect resulting from bronchoconstriction, atelectasis, loculated pleural fluid, pulmonary edema, and mucous plugging. These measurements were also utilized to evaluate the effectivess of therapeutic modalities such as treatment of bronchoconstriction with bronchodilators, mucous plugging with adequate suctioning, and drainage of loculated pleural effusion. Pressure-v-lume measurements are simple, noninvasive, and require the smae equipment used in continuous mechanical ventilation. Pressure-volume monitoring of pediatric patients with curves warrants further investigation to evaluate its value.

  5. Gravitational Tension, Spacetime Pressure and Black Hole Volume

    CERN Document Server

    Armas, Jay; Sanchioni, Marco

    2015-01-01

    We study the first law of black hole thermodynamics in the presence of surrounding gravitational fields and argue that variations of these fields are naturally incorporated in the first law by defining gravitational tension or gravitational binding energy. We demonstrate that this notion can also be applied in Anti-de Sitter spacetime, in which the surrounding gravitational field is sourced by a cosmological fluid, therefore showing that spacetime volume and gravitational tension encode the same physics as spacetime pressure and black hole volume. We furthermore show that it is possible to introduce a definition of spacetime pressure and black hole volume for any spacetime with characteristic length scales which does not necessarily require a cosmological constant sourcing Einstein equations. However, we show that black hole volume is non-universal in the flat spacetime limit, questioning its significance. We illustrate these ideas by studying the resulting black hole volume of Kaluza-Klein black holes and of...

  6. Walking with continuous positive airway pressure

    NARCIS (Netherlands)

    Dieperink, W.; Goorhuis, JF; de Weerd, W; Hazenberg, A; Zijistra, JG; Nijsten, MWN

    2006-01-01

    A ventilator-dependent child had been in the paediatric intensive care unit (PICU) ever since birth. As a result, she had fallen behind considerably in her development. After 18 months, continuous positive airway tracheostomy tube with a novel lightweight device device, the child was discharged home

  7. Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

    Directory of Open Access Journals (Sweden)

    Park Marcelo

    2001-01-01

    Full Text Available OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2, continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05. Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05. CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

  8. Large volume high-pressure cell for inelastic neutron scattering

    Energy Technology Data Exchange (ETDEWEB)

    Wang, W.; Kamenev, K. V. [Centre for Science at Extreme Conditions and School of Engineering, University of Edinburgh, Edinburgh EH9 3JZ (United Kingdom); Sokolov, D. A.; Huxley, A. D. [SUPA, Centre for Science at Extreme Conditions and School of Physics and Astronomy, University of Edinburgh, Edinburgh EH9 3JZ (United Kingdom)

    2011-07-15

    Inelastic neutron scattering measurements typically require two orders of magnitude longer data collection times and larger sample sizes than neutron diffraction studies. Inelastic neutron scattering measurements on pressurised samples are particularly challenging since standard high-pressure apparatus restricts sample volume, attenuates the incident and scattered beams, and contributes background scattering. Here, we present the design of a large volume two-layered piston-cylinder pressure cell with optimised transmission for inelastic neutron scattering experiments. The design and the materials selected for the construction of the cell enable its safe use to a pressure of 1.8 GPa with a sample volume in excess of 400 mm{sup 3}. The design of the piston seal eliminates the need for a sample container, thus providing a larger sample volume and reduced absorption. The integrated electrical plug with a manganin pressure gauge offers an accurate measurement of pressure over the whole range of operational temperatures. The performance of the cell is demonstrated by an inelastic neutron scattering study of UGe{sub 2}.

  9. Large volume high-pressure cell for inelastic neutron scattering

    Science.gov (United States)

    Wang, W.; Sokolov, D. A.; Huxley, A. D.; Kamenev, K. V.

    2011-07-01

    Inelastic neutron scattering measurements typically require two orders of magnitude longer data collection times and larger sample sizes than neutron diffraction studies. Inelastic neutron scattering measurements on pressurised samples are particularly challenging since standard high-pressure apparatus restricts sample volume, attenuates the incident and scattered beams, and contributes background scattering. Here, we present the design of a large volume two-layered piston-cylinder pressure cell with optimised transmission for inelastic neutron scattering experiments. The design and the materials selected for the construction of the cell enable its safe use to a pressure of 1.8 GPa with a sample volume in excess of 400 mm3. The design of the piston seal eliminates the need for a sample container, thus providing a larger sample volume and reduced absorption. The integrated electrical plug with a manganin pressure gauge offers an accurate measurement of pressure over the whole range of operational temperatures. The performance of the cell is demonstrated by an inelastic neutron scattering study of UGe2.

  10. Volume analysis of supercooled water under high pressure

    OpenAIRE

    Duki, Solomon F.; Tsige, Mesfin

    2016-01-01

    Motivated by recent experimental findings on the volume of supercooled water at high pressure [O. Mishima, J. Chem. Phys. 133, 144503 (2010)] we performed atomistic molecular dynamics simulations study of bulk water in the isothermal-isobaric ensemble. Cooling and heating cycles at different isobars and isothermal compression at different temperatures are performed on the water sample with pressures that range from 0 to 1.0 GPa. The cooling simulations are done at temperatures that range from...

  11. The Impact of Economic Pressure on Parent Positivity, Parenting, and Adolescent Positivity into Emerging Adulthood.

    Science.gov (United States)

    Neppl, Tricia K; Jeon, Shinyoung; Schofield, Thomas J; Donnellan, M Brent

    2015-02-01

    The current study describes how positivity can be incorporated into the Family Stress Model to explain resilience to disrupted family processes in the face of economic distress. Prospective, longitudinal data came from 451 mothers, fathers, and youth participating from their adolescence through early adulthood. Assessments included observational and self-report measures. Information regarding economic pressure, parental positivity, and parenting were collected during early adolescence, positivity was collected in late adolescence and emerging adulthood. Results indicated that economic pressure was indirectly associated with adolescent positivity through parental positivity. Economic pressure was negatively associated with parent positivity, whereas parental positivity was positively associated with parenting. Moreover, parental positivity and parenting were both related to positivity in adolescence. Results suggest that personal resources linked to a positive outlook can foster nurturant parenting, even in times of economic strain. Such parenting seems to positively influence adolescent development into emerging adulthood.

  12. The effect of intermittent positive-pressure hyperinflation in restrictive chest wall disease.

    Science.gov (United States)

    Simonds, A K; Parker, R A; Branthwaite, M A

    1989-01-01

    The effects of intermittent positive-pressure hyperinflation on lung volumes, arterial blood gas tensions and respiratory muscle performance have been assessed in 10 patients with severe scoliosis (vital capacity 22-43% predicted). Hyperinflation was carried out 2-3 times a day for 5 min aiming to double the spontaneous tidal volume with each delivered breath. A volume-preset, time-cycled device was used in 6 patients and a pressure-cycled, patient-triggered machine in 4 cases. Progressive reduction in lung volume was reversed by the volume-preset device which increased the mean vital capacity from 29 to 33% predicted after 3 months (p less than 0.05) with improvement maintained after 9 months. This machine offered a significant advantage over the pressure-cycled device which at maximum or near maximum inflation pressures produced less hyperinflation and had no beneficial effect on lung volumes. The improvement in vital capacity was correlated with the degree of hyperinflation (r = 0.65; p less than 0.05). The effect of hyperinflation on arterial blood gas tensions was transient and not accompanied by an increase in accessible alveolar volume.

  13. Volume loading of the heart by "leg up" position and head down tilting (-6°) (HDT)

    Science.gov (United States)

    Dirschedl, P.; Gregull, A.; Löllgen, H.

    Head down tilting is widely used to increase preload and to induce intrathoracic blood pooling similar to microgravity. During daily routine, this venous pooling is performed by rising the legs up. In this study, both these approaches have been compared by invasive measurement using a right heart catheter. In patients with moderate coronary artery disease, diagnostic right heart catheterization was performed by the Swan-Ganz-techniques. All measurements were performed with head down tilting (-6°) and with "leg up" position. Patients then received Nitrogycerin to countermeasure the preload changes. Pressures in the pulmonary artery as well as in the wedge position increased significantly during leg up and HDT. However, changes were significantly more pronouced in the "leg up" position than during HDT. No changes were observed for arterial blood pressure, cardiac output, stroke volume and resistances. Nitroglycerin during HDT lowered blood pressure and pressures in the pulmonary artery and in PCW-position and reduced cardiac output significantly. Both approaches of volume loading of the heart induced significant changes and increases of preload. However, changes were more pronounced during the "leg up" position than during HDT. It is questioned whether HDT with -6° is appropriate to truly reflect hemodynamic alterations during simulated weightlessness.

  14. Changes in extracellular muscle volume affect heart rate and blood pressure responses to static exercise

    Science.gov (United States)

    Baum, K.; Essfeld, D.; Stegemann, J.

    To investigate the effect of μg-induced peripheral extracellular fluid reductions on heart rate and blood pressure during isometric exercise, six healthy male subjects performed three calf ergometer test with different extracellular volumes of working muscles. In all tests, body positions during exercise were identical (supine with the knee joint flexed to 900). After a pre-exercise period of 25 min, during which calf volumes were manipulated, subjects had to counteract an external force of 180 N for 5 min. During the pre-exercise period three different protocols were applied. Test A: Subjects rested in the exercise position; test B: Body position was the same as in A but calf volume was increased by venous congestion (cuffs inflated to 80 mm Hg); test C: Calf volumes were decreased by a negative hydrostatic pressure (calves about 40 cm above heart level with the subjects supine). To clamp the changed calf volumes in tests B and C, cuffs were inflated to 300 mm Hg 5 min before the onset of exercise. This occlusion was maintained until termination of exercise. Compared to tests A and B, the reduced volume of test C led to significant increases in heart rate and blood pressure during exercise. Oxygen uptake did not exceed resting levels in B and C until cuffs were deflated, indicating that exclusively calf muscles contributed to the neurogenic peripheral drive. It is concluded that changes in extracellular muscle volume have to be taken into account when comparing heart rate and blood pressure during lg- and μg- exercise.

  15. Programmed-pressure air supply for positive-pressure breathing system

    Science.gov (United States)

    Troutman, S. J., Jr.; Annis, J. F.

    1974-01-01

    Motor-driven cam varies height of mercury column connected to loading diaphragm of pressure-regulating valve. Air supplied to open-loop, positive pressure breathing system is controlled so repetitive pressure--time profiles can be obtained during every insufflation--exhaust cycle.

  16. Gravitational tension, spacetime pressure and black hole volume

    Science.gov (United States)

    Armas, Jay; Obers, Niels A.; Sanchioni, Marco

    2016-09-01

    We study the first law of black hole thermodynamics in the presence of surrounding gravitational fields and argue that variations of these fields are naturally incorporated in the first law by defining gravitational tension or gravitational binding energy. We demonstrate that this notion can also be applied in Anti-de Sitter spacetime, in which the surrounding gravitational field is sourced by a cosmological fluid, therefore showing that spacetime volume and gravitational tension encode the same physics as spacetime pressure and black hole volume. We furthermore show that it is possible to introduce a definition of spacetime pressure and black hole volume for any spacetime with characteristic length scales which does not necessarily require a cosmological constant sourcing Einstein equations. However, we show that black hole volume is non-universal in the flat spacetime limit, questioning its significance. We illustrate these ideas by studying the resulting black hole volume of Kaluza-Klein black holes and of a toy model for a black hole binary system in five spacetime dimensions (the black saturn solution) as well as of several novel perturbative black hole solutions. These include the higher-dimensional Kerr-Newman solution in Anti-de Sitter spacetime as well as other black holes in plane wave and Lifshitz spacetimes.

  17. Comparison of Noninvasive Positive Pressure Ventilation and Invasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    Jian Li; De-hou Zhang; Xian-feng Huang; Ming Ding; Guo-rong Shu

    2005-01-01

    @@ The use of noninvasive positive pressure ventilation (NPPV)in the treatment of acute respiratory failure (ARF) has been supported by a number of randomised controlled trials. We conducted a controlled prospective randomised study to compare the efficacy of NPPV with the efficacy of invasive positive pressure ventilation (IPPV) in ARF patients whose conditions had not improved under aggressive medical therapy thus requiring mechanical ventilation (MV).

  18. Plasma volume and electrolyte shifts with heavy exercise in sitting and supine positions

    Science.gov (United States)

    Greenleaf, J. E.; Van Beaumont, W.; Brock, P. J.; Morse, J. T.; Mangseth, G. R.

    1979-01-01

    An experimental study was carried out to compare fluid and electrolyte shifts after heavy exercise performed by four voluntary male subjects (26-45 yr) in sitting and supine positions. Plasma volume and electrolyte shifts were measured during the 6-min control period and for 60 min after a continuous peak oxygen uptake test. The results indicate that the most likely driving force for the restitution of plasma volume after peak exercise is provided by a change in hydrostatic and/or systemic blood pressures when exercise ceases.

  19. Recommended reference materials for realization of physicochemical properties pressure-volume-temperature relationships

    CERN Document Server

    Herington, E F G

    1977-01-01

    Recommended Reference Materials for Realization of Physicochemical Properties presents recommendations of reference materials for use in measurements involving physicochemical properties, namely, vapor pressure; liquid-vapor critical temperature and critical pressure; orthobaric volumes of liquid and vapor; pressure-volume-temperature properties of the unsaturated vapor or gas; and pressure-volume-temperature properties of the compressed liquid. This monograph focuses on reference materials for vapor pressures at temperatures up to 770 K, as well as critical temperatures and critical pressures

  20. Pressure and volume controlled mechanical ventilation in anaesthetized pregnant sheep.

    Science.gov (United States)

    Davis, J; Musk, G C

    2014-10-01

    Optimal mechanical ventilation of the pregnant ewe during anaesthesia is of vital importance for maintaining fetal viability. This study aimed to compare peak inspiratory pressure (PIP), oxygenation and cardiovascular parameters with pressure-control (PCV) or volume-control (VCV) mechanical ventilation of anaesthetized pregnant sheep. Twenty ewes at 110 days gestation underwent general anaesthesia in dorsal recumbency for fetal surgery in a research setting. All the sheep were mechanically ventilated; one group with PCV (n = 10) and another with VCV (n = 10) to maintain normocapnia. PIP, direct arterial blood pressure, heart rate, arterial pH and arterial oxygen tension were recorded. PIP was lower in the PCV group (P sheep anaesthetized in dorsal recumbency, though PCV may provide superior oxygenation at a lower PIP.

  1. Atmospheric pressure loading effects on Global Positioning System coordinate determinations

    Science.gov (United States)

    Vandam, Tonie M.; Blewitt, Geoffrey; Heflin, Michael B.

    1994-01-01

    Earth deformation signals caused by atmospheric pressure loading are detected in vertical position estimates at Global Positioning System (GPS) stations. Surface displacements due to changes in atmospheric pressure account for up to 24% of the total variance in the GPS height estimates. The detected loading signals are larger at higher latitudes where pressure variations are greatest; the largest effect is observed at Fairbanks, Alaska (latitude 65 deg), with a signal root mean square (RMS) of 5 mm. Out of 19 continuously operating GPS sites (with a mean of 281 daily solutions per site), 18 show a positive correlation between the GPS vertical estimates and the modeled loading displacements. Accounting for loading reduces the variance of the vertical station positions on 12 of the 19 sites investigated. Removing the modeled pressure loading from GPS determinations of baseline length for baselines longer than 6000 km reduces the variance on 73 of the 117 baselines investigated. The slight increase in variance for some of the sites and baselines is consistent with expected statistical fluctuations. The results from most stations are consistent with approximately 65% of the modeled pressure load being found in the GPS vertical position measurements. Removing an annual signal from both the measured heights and the modeled load time series leaves this value unchanged. The source of the remaining discrepancy between the modeled and observed loading signal may be the result of (1) anisotropic effects in the Earth's loading response, (2) errors in GPS estimates of tropospheric delay, (3) errors in the surface pressure data, or (4) annual signals in the time series of loading and station heights. In addition, we find that using site dependent coefficients, determined by fitting local pressure to the modeled radial displacements, reduces the variance of the measured station heights as well as or better than using the global convolution sum.

  2. Comparison of Efficacy and Tolerance of Automatic Continuous Positive Airway Pressure Devices With the Optimum Continuous Positive Airway Pressure.

    Science.gov (United States)

    Tommi, George; Aronow, Wilbert S; Sheehan, John C; McCleay, Matthew T; Meyers, Patrick G

    Patients diagnosed with obstructive sleep apnea syndrome were randomly placed on automatic continuous positive airway pressure (ACPAP) for 2 hours followed by manual titration for the rest of the night. One hundred sixty-one patients entered the study, with at least 50 patients titrated with each of 3 ACPAP devices. The optimum continuous positive airway pressure (CPAP) was defined as the lowest pressure with an apnea-hypoxia index of ≤5/hr, which ranged from 4 cm to 18 cm. Success with ACPAP was approximately 60%-80% when the optimum CPAP was 4-6 cm but fell to below 30% if the optimum CPAP was ≥8 cm (P = 0.001). Average ACPAP ranged from 2 to 10 cm below the optimum level if the optimum CPAP was ≥8 cm. Patients who responded to a low CPAP but deteriorated on higher pressures failed to respond to any of the automatic devices. We recommend that CPAP titration be performed manually before initiation of ACPAP in patients with obstructive sleep apnea. The basal pressure for ACPAP should be the optimum pressure obtained by manual titration. Limits on the upper level of ACPAP may be necessary for patients who deteriorate on higher positive pressures.

  3. Running on a lower-body positive pressure treadmill

    DEFF Research Database (Denmark)

    Raffalt, Peter C; Hovgaard-Hansen, Line; Jensen, Bente Rona

    2013-01-01

    This study investigated maximal oxygen consumption (VO2max) and time to exhaustion while running on a lower-body positive pressure treadmill (LBPPT) at normal body weight (BW) as well as how BW support affects respiratory responses, ground reaction forces, and stride characteristics....

  4. Multiple applications of the Boussignac continuous positive airway pressure system

    NARCIS (Netherlands)

    Dieperink, Willem

    2008-01-01

    Continuous positive airway pressure, (CPAP) is a form of treatment to support patients with dyspnea. For the application of CPAP a mechanical ventilator or complex CPAP apparatus is mostly used. The Boussignac CPAP (BCPAP) system developed by George Boussignac does not need such apparatus. The BCPAP

  5. Continuous Positive Airway Pressure Strategies with Bubble Nasal Continuous Positive Airway Pressure: Not All Bubbling Is the Same: The Seattle Positive Airway Pressure System.

    Science.gov (United States)

    Welty, Stephen E

    2016-12-01

    Premature neonates are predisposed to complications, including bronchopulmonary dysplasia (BPD). BPD is associated with long-term pulmonary and neurodevelopmental consequences. Noninvasive respiratory support with nasal continuous positive airway pressure (CPAP) has been recommended strongly by the American Academy of Pediatrics. However, CPAP implementation has shown at least a 50% failure rate. Enhancing nasal CPAP effectiveness may decrease the need for mechanical ventilation and reduce the incidence of BPD. Bubble nasal CPAP is better than nasal CPAP using mechanical devices and the bubbling provides air exchange in distal respiratory units. The Seattle PAP system reduces parameters that assess work of breathing. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Drought resistance of four grasses using pressure-volume curve

    Institute of Scientific and Technical Information of China (English)

    HE Xingdong; CONG Peifang; GAO Yubao; LU Jianguo; WANG Haitao; XUE Pingping; ZHANG Xu

    2007-01-01

    Pressure-volume curve (PV curve) technique is a major method for studying critical plant water potential and critical tissue water content when plasmolysis takes place.In the present study,a mathematical solution method is put forward to obtain parameters based on the PV curve.The calculated results for the parameters ofLolium perenne,Festuca arundinacea,Leymus chinensis and Stipa krylovii indicated that the mathematical solution method is convenient for actual research compared with the graphical method.Further analysis of the calculations suggested that drought resistance decreased in the following order:S.krylovii > F.arundinacea and L.chinensis > L.perenne.

  7. Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Svenningsen, Sarah; Paulin, Gregory A; Sheikh, Khadija; Guo, Fumin; Hasany, Aasim; Kirby, Miranda; Rezai, Roya Etemad; McCormack, David G; Parraga, Grace

    2016-01-01

    Evidence-based guidance for the use of airway clearance techniques (ACT) in chronic obstructive pulmonary disease (COPD) is lacking in-part because well-established measurements of pulmonary function such as the forced expiratory volume in 1s (FEV1) are relatively insensitive to ACT. The objective of this crossover study was to evaluate daily use of an oscillatory positive expiratory pressure (oPEP) device for 21-28 days in COPD patients who were self-identified as sputum-producers or non-sputum-producers. COPD volunteers provided written informed consent to daily oPEP use in a randomized crossover fashion. Participants completed baseline, crossover and study-end pulmonary function tests, St. George's Respiratory Questionnaire (SGRQ), Patient Evaluation Questionnaire (PEQ), Six-Minute Walk Test and (3)He magnetic resonance imaging (MRI) for the measurement of ventilation abnormalities using the ventilation defect percent (VDP). Fourteen COPD patients, self-identified as sputum-producers and 13 COPD-non-sputum-producers completed the study. Post-oPEP, the PEQ-ease-bringing-up-sputum was improved for sputum-producers (p = 0.005) and non-sputum-producers (p = 0.04), the magnitude of which was greater for sputum-producers (p = 0.03). There were significant post-oPEP improvements for sputum-producers only for FVC (p = 0.01), 6MWD (p = 0.04), SGRQ total score (p = 0.01) as well as PEQ-patient-global-assessment (p = 0.02). Clinically relevant post-oPEP improvements for PEQ-ease-bringing-up-sputum/PEQ-patient-global-assessment/SGRQ/VDP were observed in 8/7/9/6 of 14 sputum-producers and 2/0/3/3 of 13 non-sputum-producers. The post-oPEP change in (3)He MRI VDP was related to the change in PEQ-ease-bringing-up-sputum (r = 0.65, p = 0.0004) and FEV1 (r = -0.50, p = 0.009). In COPD patients with chronic sputum production, PEQ and SGRQ scores, FVC and 6MWD improved post-oPEP. FEV1 and PEQ-ease-bringing-up-sputum improvements were related to improved ventilation providing

  8. Leakage Characteristics of Dual-Cannula Fenestrated Tracheostomy Tubes during Positive Pressure Ventilation: A Bench Study

    Directory of Open Access Journals (Sweden)

    Thomas Berlet

    2016-01-01

    Full Text Available This study compared the leakage characteristics of different types of dual-cannula fenestrated tracheostomy tubes during positive pressure ventilation. Fenestrated Portex® Blue Line Ultra®, TRACOE® twist, or Rüsch® Traceofix® tracheostomy tubes equipped with nonfenestrated inner cannulas were tested in a tracheostomy-lung simulator. Transfenestration pressures and transfenestration leakage rates were measured during positive pressure ventilation. The impact of different ventilation modes, airway pressures, temperatures, and simulated static lung compliance settings on leakage characteristics was assessed. We observed substantial differences in transfenestration pressures and transfenestration leakage rates. The leakage rates of the best performing tubes were <3.5% of the delivered minute volume. At body temperature, the leakage rates of these tracheostomy tubes were <1%. The tracheal tube design was the main factor that determined the leakage characteristics. Careful tracheostomy tube selection permits the use of fenestrated tracheostomy tubes in patients receiving positive pressure ventilation immediately after stoma formation and minimises the risk of complications caused by transfenestration gas leakage, for example, subcutaneous emphysema.

  9. Leakage Characteristics of Dual-Cannula Fenestrated Tracheostomy Tubes during Positive Pressure Ventilation: A Bench Study.

    Science.gov (United States)

    Berlet, Thomas; Marchon, Mathias

    2016-01-01

    This study compared the leakage characteristics of different types of dual-cannula fenestrated tracheostomy tubes during positive pressure ventilation. Fenestrated Portex® Blue Line Ultra®, TRACOE® twist, or Rüsch® Traceofix® tracheostomy tubes equipped with nonfenestrated inner cannulas were tested in a tracheostomy-lung simulator. Transfenestration pressures and transfenestration leakage rates were measured during positive pressure ventilation. The impact of different ventilation modes, airway pressures, temperatures, and simulated static lung compliance settings on leakage characteristics was assessed. We observed substantial differences in transfenestration pressures and transfenestration leakage rates. The leakage rates of the best performing tubes were <3.5% of the delivered minute volume. At body temperature, the leakage rates of these tracheostomy tubes were <1%. The tracheal tube design was the main factor that determined the leakage characteristics. Careful tracheostomy tube selection permits the use of fenestrated tracheostomy tubes in patients receiving positive pressure ventilation immediately after stoma formation and minimises the risk of complications caused by transfenestration gas leakage, for example, subcutaneous emphysema.

  10. Non-invasive quantification of peripheral arterial volume distensibility and its non-linear relationship with arterial pressure.

    Science.gov (United States)

    Zheng, Dingchang; Murray, Alan

    2009-05-29

    Arterial wall function is associated with different physiological and clinical factors. Changes in arterial pressure cause major changes in the arterial wall. This study presents a simple non-invasive method to quantify arterial volume distensibility changes with different arterial pressures. The electrocardiogram, finger and ear photoplethysmogram were recorded from 15 subjects with the right arm at five different positions (90 degrees , 45 degrees , 0 degrees , -45 degrees and -90 degrees referred to the horizontal level). Arm pulse propagation time was determined by subtracting ear pulse transit time from finger pulse transit time, and was used to obtain arterial volume distensibility. The mean arterial blood pressure with the arm at the horizontal level was acquired, and changes with position were calculated using the hydrostatic principle that blood pressure in the arm is linearly related to its vertical distance from the horizontal level. The mean arm pulse propagation times for the five different positions were 88, 72, 57, 54 and 52ms, with the corresponding mean arterial volume distensibility of 0.234%, 0.158%, 0.099%, 0.088% and 0.083% per mmHg. For all consecutive changes in arm position, arm pulse propagation time and arterial volume distensibility, were significantly different (all probability Ppressure decreased significantly between each consecutive arm position from 90 degrees to -45 degrees (all Ppressure changes from 101 to 58mmHg. In conclusion, the inverse and non-linear relationship between arterial volume distensibility and arterial pressure has been quantified using a simple arm positioning procedure, with the greatest effect at low pressures. This work is an important step in developing a simple non-invasive technique for assessing peripheral arterial volume distensibility.

  11. Mandibular Advancing Positive Pressure Apnea Remediation Device (MAPPARD)

    Science.gov (United States)

    2014-06-01

    amount of opening for the air inlet. Orthodontic molds of the teeth will be used to 24 make custom indentations for the patient to properly seat and...Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. Journal of Clinical Sleep... Journal  : Official Journal of the European Society for Clinical Respiratory Physiology, 34(4), 914–20. doi:10.1183/09031936.00148208. George, P. T

  12. Electrical power free, low dead volume, pressure-driven pumping for microfluidic applications.

    Science.gov (United States)

    Moscovici, Mario; Chien, Wei-Yin; Abdelgawad, Mohamed; Sun, Yu

    2010-10-13

    This paper presents a simple-to-construct, low dead volume pump capable of generating a wide range of positive and negative pressures for microfluidic applications. The pump generates pressure or vacuum by changing the volume of air confined inside a syringe and is able to generate pressures between -95 and +300 kPa with a resolution as high as 1 Pa. Different from syringe pumps and electrokinetic pumping, which are capable of controlling flow rates only, our pump can be used to generate constant flow rates or constant pressures, which are required for certain applications such as the aspiration of biological cells for biophysical characterization. Compared to syringe pumps, the new pump has almost zero dead volume and does not exhibit pulsatile flows. Additionally, the system does not require electrical power and is cost effective (∼$100). To demonstrate the capabilities of the pump, we used it to aspirate osteoblasts (MC3T3-E1 cells) and to determine Young's modulus of the cells, to generate a concentration gradient, and to produce variable-sized droplets in microchannels using hydrodynamic focusing.

  13. Trait positive affect is associated with hippocampal volume and change in caudate volume across adolescence.

    Science.gov (United States)

    Dennison, Meg; Whittle, Sarah; Yücel, Murat; Byrne, Michelle L; Schwartz, Orli; Simmons, Julian G; Allen, Nicholas B

    2015-03-01

    Trait positive affect (PA) in childhood confers both risk and resilience to psychological and behavioral difficulties in adolescence, although explanations for this association are lacking. Neurodevelopment in key areas associated with positive affect is ongoing throughout adolescence, and is likely to be related to the increased incidence of disorders of positive affect during this period of development. The aim of this study was to prospectively explore the relationship between trait indices of PA and brain development in subcortical reward regions during early to mid-adolescence in a community sample of adolescents. A total of 89 (46 male, 43 female) adolescents participated in magnetic resonance imaging assessments during both early and mid-adolescence (mean age at baseline = 12.6 years, SD = 0.45; mean follow-up period = 3.78 years, SD = 0.21) and also completed self-report measures of trait positive and negative affect (at baseline). To examine the specificity of these effects, the relation between negative affect and brain development was also examined. The degree of volume reduction in the right caudate over time was predicted by PA. Independent of time, larger hippocampal volumes were associated with higher PA, and negative affect was associated with smaller left amygdala volume. The moderating effect of negative affect on the development of the left caudate varied as a function of lifetime psychiatric history. These findings suggest that early to mid-adolescence is an important period whereby neurodevelopmental processes may underlie key phenotypes conferring both risk and resilience for emotional and behavioral difficulties later in life.

  14. The Impact of Economic Pressure on Parent Positivity, Parenting, and Adolescent Positivity into Emerging Adulthood

    OpenAIRE

    Neppl, Tricia K.; Jeon, Shinyoung; Schofield, Thomas J.; Donnellan, M. Brent

    2015-01-01

    The current study describes how positivity can be incorporated into the Family Stress Model to explain resilience to disrupted family processes in the face of economic distress. Prospective, longitudinal data came from 451 mothers, fathers, and youth participating from their adolescence through early adulthood. Assessments included observational and self-report measures. Information regarding economic pressure, parental positivity, and parenting were collected during early adolescence, positi...

  15. Effect of low tidal volume one lung ventilation plus positive end-expiratory pressure on inflammatory responses of pulmonary in patients with lung cancer operation%低潮气量单肺通气复合呼气末正压对肺癌手术患者肺部炎症反应的影响

    Institute of Scientific and Technical Information of China (English)

    孔岚

    2014-01-01

    Objective To compare the effect of low tidal volume and normal tidal volume one lung ventilation plus positive end-expiratory pressure(PEEP) on inflammatory responses of pulmonary in patients with lung cancer operation.Methods Divided 40 patients with lung cancer operation into PEEP group(group L) and normal tidal volume one lung ventilation group(goup N), 20 cases in each group, tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6), Interleukin-8(IL-8) and Interleukin-10(IL-10) were assessed with ELISA on the following time①two lung ventilation after anesthesia induction(T1); ②60 min after one lung ventilation (T2); ③90 min after one lung ventilation (T3); ④60 min after two lung ventilation(T4); ⑤1d after operation (T5). Results Compared to T1, TNF-α、IL-6、IL-8 and IL-10 were increased in other time point in both groups. The TNF-α、IL-6、IL -8 in group L were significant decreased than group N in T2, T3, T4, T5 time point(P<0.05). The IL-10 in group L were significant increased than group N in T2, T3, T4, T5 time point(P<0.05).Conclusion Low tidal volume one lung ventilation plus positive end-expiratory pressure can lessen pulmonary inflammatory response obviously than normal tidal volume and relieve the lung injury.%目的:对比低潮气量单肺通气复合呼气末正压(PEEP)与正常潮气量单肺通气对肺癌手术患者肺部炎症反应的影响。方法40例择期肺癌手术患者随机分为低潮气量单肺通气复合PEEP组(L组)和正常潮气量单肺通气组(N组),每组20例。两组患者分别在麻醉诱导后双肺通气时(T1)、单肺通气60 min时(T2)、单肺通气90 min时(T3)、术毕双肺通气60 min时(T4)、术后1 d(T5)采取外周静脉血,采用放射酶联免疫吸附法(ELISA)测量肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及白细胞介素-10(IL-10)水平。结果与T1比较,两组各时点血浆TNF-α, IL-6, IL-8及IL-10水平均持续升高(P<0.05)

  16. Noninvasive Intracranial Volume and Pressure Measurements Using Ultrasound

    Science.gov (United States)

    Hargens, A. R.

    1998-01-01

    Prevention of secondary brain injuries following head can be accomplished most easily when intracranial pressure (ICP) is monitored. However, current measurement techniques are invasive and thus not practical in the combat environment. The Pulsed Phase Lock Loop (PPLL) devise, which was developed and patented, uses a unique, noninvasive ultrasonic phase comparison method to measure slight changes in cranial volume which occur with changes in ICP. Year one studies involved instrument improvements and measurement of altered intracranial distance with altered ICP in fresh cadavera. Our software was improved to facilitate future studies of normal subjects and trauma patients. Our bench studies proved that PPLL output correlated highly with changes in path length across a model cranium. Cadaveric studies demonstrated excellent compact, noninvasive devise for monitoring changes in intracranial distance may aid in the early detection of elevated ICP, decreasing risk of secondary brain injury and infection, and returning head-injured patients to duty.

  17. Clinical observation of low tidal volume with low positive end-expiratory pressure in one-lung ventilation patients undergoing esophageal cancer resection%低潮气量联合低呼气末正压通气用于食管癌根治术患者单肺通气的临床观察

    Institute of Scientific and Technical Information of China (English)

    周荣胜; 刘齐宁; 关正; 毕阳

    2012-01-01

    目的 观察低潮气量联合低呼气末正压通气用于食管癌根治术患者单肺通气的临床效果.方法 32例ASA Ⅰ或Ⅱ级择期行食管癌(中段)根治术患者随机均分为 A、B两组.A组为低潮气量联合低呼气末正压通气组:VT=6ml*kg-1,f=16次/min-1,加5cm H2O PEEP;B组为传统单肺通气组:VT=10ml*kg-1,f=12次/min.观察气管插管后切皮前(T1)、单肺通气后60min(T2)、恢复双肺通气后15min(T3)、拔管后30min(T4)的动脉氧分压(PaO2)、动脉二氧化碳分压( PaCO2)、呼气末二氧化碳分压(PETCO2)、氧合指数(PaO2/FiO2)、平均动脉压(MAP)及术中的气道峰压(Ppeak)、气道平台压力(Pplat)、气道压力(Paw).结果 T2时A组的Ppeak、Pplat及Paw明显低于B组(P0.05).结论 食管癌根治术中应用低潮气量联合低呼气末正压通气能有效改善患者术中低氧血症,减少肺部并发症,有利于患者呼吸功能的恢复,对血流动力学无明显影响,是食管癌根治手术全麻安全、有效的通气方法.%Objective: To investigate the effects of low tidal volume with low positive end - expiratory pressure in one - lung ventilation patients undergoing esophageal cancer resection. Methods: Thirty - two ASA class I or II patients scheduled to undergo esophagectomy for esophageal cancer were randomly assigned into 2 groups ( n = 16 each ). Low VT and low positive end - expiratory pressure( PEEP )mechanical ventilation were applied to the patients in group A( VT = 6ml"kg~ ,f=16, PEEP = 5 cm H2 0 ), while traditional ventilation was used in group B( VT = 10 ml ? Kg"1 ,f = 12, PEEP = 0 ). Arterial blood samples were taken and PaO2 ,PaCO2 ,PETCO2 , PaO2/FiO2 and MAP were recorded at the time points of before operation( Tj ) ,60 min after one - lung ventilation( T2 ), 15 min after double lung ventilation and 30 min after tracheal extubation( T4 ). Peak airway pressure( Ppeak ), Pplat and Paw were recorded during operation. Results: At T2 ,Ppeak,Pplat and Paw in

  18. Pressure-Volume-Temperature (PVT) Gauging of an Isothermal Cryogenic Propellant Tank Pressurized with Gaseous Helium

    Science.gov (United States)

    VanDresar, Neil T.; Zimmerli, Gregory A.

    2014-01-01

    Results are presented for pressure-volume-temperature (PVT) gauging of a liquid oxygen/liquid nitrogen tank pressurized with gaseous helium that was supplied by a high-pressure cryogenic tank simulating a cold helium supply bottle on a spacecraft. The fluid inside the test tank was kept isothermal by frequent operation of a liquid circulation pump and spray system, and the propellant tank was suspended from load cells to obtain a high-accuracy reference standard for the gauging measurements. Liquid quantity gauging errors of less than 2 percent of the tank volume were obtained when quasi-steady-state conditions existed in the propellant and helium supply tanks. Accurate gauging required careful attention to, and corrections for, second-order effects of helium solubility in the liquid propellant plus differences in the propellant/helium composition and temperature in the various plumbing lines attached to the tanks. On the basis of results from a helium solubility test, a model was developed to predict the amount of helium dissolved in the liquid as a function of cumulative pump operation time. Use of this model allowed correction of the basic PVT gauging calculations and attainment of the reported gauging accuracy. This helium solubility model is system specific, but it may be adaptable to other hardware systems.

  19. Low positive end-expiratory pressure does not exacerbate nebulized-acid lung injury in dogs.

    Science.gov (United States)

    Pellett, Andrew A; Welsh, David A; deBoisblanc, Bennett P; Lipscomb, Gary; Johnson, Royce W; Lord, Kevin C; Levitzky, Michael G

    2005-03-01

    It is not clear if low end-expiratory pressures contribute to ventilator-induced lung injury in large animals. We sought to determine whether ventilation with a low level of positive end-expiratory pressure (PEEP) worsens preexisting permeability lung injury in dogs. Lung injury was initiated in 20 mongrel dogs by ventilating with nebulized 3N hydrochloric acid until a lower inflection point (LIP) appeared on the respiratory system pressure-volume loop. One group of 10 dogs was then ventilated for 4 hours with PEEP set below the LIP (low PEEP), whereas the remaining group of dogs was ventilated for the same time period with similar tidal volumes but with PEEP set above the LIP (high PEEP). We found histologic evidence of reduced alveolar volumes in the low-PEEP animals. However, there were no differences in neutrophil infiltration, lung lobe weights, pulmonary capillary hemorrhage or congestion, or arterial endothelin-1 concentration between the 2 protocol groups. In conclusion, we were unable to demonstrate that ventilation with PEEP set below the LIP exacerbates hydrochloric acid-induced lung injury in dogs.

  20. Blood pressure monitor with a position sensor for wrist placement to eliminate hydrostatic pressure effect on blood pressure measurement.

    Science.gov (United States)

    Sato, Hironori; Koshimizu, Hiroshi; Yamashita, Shingo; Ogura, Toshihiko

    2013-01-01

    Accurate measurement of blood pressure at wrist requires the heart and wrist to be kept at the same level to avoid the effects of hydrostatic pressure. Although a blood pressure monitor with a position sensor that guides appropriate forearm angle without use of a chair and desk has already been proposed, a similar functioning device for measuring upper arm blood pressure with a chair and desk is needed. In this study, a calculation model was first used to explore design of such a system. The findings were then implemented into design of a new blood pressure monitor. Results of various methods were compared. The calculation model of the wrist level from arthrosis angles and interarticulars lengths was developed and considered using published anthropometric dimensions. It is compared with 33 volunteer persons' experimental results. The calculated difference of level was -4.1 to 7.9 (cm) with a fixed chair and desk. The experimental result was -3.0 to 5.5 (cm) at left wrist and -2.1 to 6.3(cm) at right wrist. The absolute difference level equals ±4.8 (mmHg) of blood pressure readings according to the calculated result. This meets the AAMI requirements for a blood pressure monitor. In the conclusion, the calculation model is able to effectively evaluate the difference between the heart and wrist level. Improving the method for maintaining wrist to heart level will improve wrist blood pressure measurement accuracy when also sitting in the chair at a desk. The leading angle of user's forearm using a position sensor is shown to work for this purpose.

  1. A Randomized Trial of Low-Flow Oxygen versus Nasal Continuous Positive Airway Pressure in Preterm Infants

    DEFF Research Database (Denmark)

    Heiring, Christian; Steensberg, Jesper; Bjerager, Mia

    2015-01-01

    BACKGROUND: Nasal continuous positive airway pressure (nCPAP) stabilizes the residual volume and may decrease the risk of 'atelectotrauma', potentially promoting lung development in neonates. OBJECTIVES: To assess whether replacing nCPAP by low-flow O2 by nasal cannula affects lung function expre...

  2. Estimation of lung volume and pressure from electrocardiogram

    KAUST Repository

    Elsayed, Gamal Eldin Fathy Amin

    2011-05-01

    The Electrocardiography (ECG) is a tool measuring the electrical excitation of the heart that is extensively used for diagnosis and monitoring of heart diseases. The ECG signal reflects not only the heart activity but also many other physiological processes. The respiratory activity is a prominent process that affects the ECG signal due to the close proximity of the heart and the lungs and, on the other hand, due to neural regulatory processes. In this paper, several means for the estimation of the respiratory process from the ECG signal are presented. The results show a strong correlation of the voltage difference between the R and S peak of the ECG and the lung\\'s volume and pressure. Correlation was also found for some features of the vector ECG, which is a two dimensional graph of two different ECG signals. The potential benefit of the multiparametric evaluation of the ECG signal is a reduction of the number of sensors connected to patients, which will increase the patients\\' comfort and reduce the costs associated with healthcare. In particular, it is relevant for sleep monitoring, where a reduction of the number of different sensors would facilitate a more natural sleeping environment and hence a higher sensitivity of the diagnosis. © 2011 IEEE.

  3. Personality correlates of adherence with continuous positive airway pressure (CPAP).

    Science.gov (United States)

    Moran, Alicia M; Everhart, Daniel Erik; Davis, Claude Ervin; Wuensch, Karl L; Lee, Daniel O; Demaree, Heath A

    2011-12-01

    Adherence with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) has been problematic. Understanding the factors associated with nonadherence may assist with psychosocial interventions. The objective of this study was to examine the relationship between adherence and three measures of personality and coping strategies. Ratings on the behavioral inhibition system/behavioral activation system (BIS/BAS) scales, the ways of coping inventory, and a broad personality measure (mini-IPIP) were analyzed with a binary logistic regression among 63 subjects, adult men (31) and women (32), diagnosed with OSA. Data from the CPAP device was obtained following initial 30 days at minimum, with adherence defined as >4 h/night on 70% of nights. Elevated BIS was the strongest predictor of nonadherence (r = -.452, p scale may be a useful tool for predicting nonadherence and assist with the development of intervention strategies that will increase adherence.

  4. Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects

    Directory of Open Access Journals (Sweden)

    Peter Juhl-Olsen

    2012-01-01

    Full Text Available Background. The use of echocardiography in intensive care settings impacts decision making. A prerequisite for the use of echocardiography is relative resistance to changes in volume status and levels of positive pressure ventilation (PPV. Studies on indices of diastolic function report conflicting results with regard to dependence on volume status. Evidence is scarce on PPV. Methods. Ten healthy subjects were exposed to 6 levels of positive end-expiratory pressure (PEEP and pressure support (PS following a baseline reading. All ventilator settings were performed at three positions: horizontal, reverse-Trendelenburg, and Trendelenburg. Echocardiography was performed throughout. Results. During spontaneous breathing, early diastolic transmitral velocity ( changed with positioning (, whereas early diastolic velocity of the mitral annulus ( was independent (. With PPV, and proved preload dependent (. Increases in PEEP, PS, or a combination influenced and in reverse-Trendelenburg- and horizontal positions, but not in the Trendelenburg position. Discussion. The change towards preload dependency of with PPV suggests that PPV increases myocardial preload sensitivity. The susceptibility of and to preload changes during PPV discourages their use in settings of volume shifts or during changes in ventilator settings. Conclusion. Positioning and PPV affect and .

  5. [Noninvasive positive pressure ventilation in postoperative period of tracheal surgery].

    Science.gov (United States)

    De La Torre, C A; Hernández, F; Sanabria, P; Vázquez, J; Miguel, M; Luis, A L; Barrena, S; Aguilar, R; Ramírez, M; Hernández, S; Borches, D; Lassaletta, L; Tovar, J A

    2011-04-01

    Reconstructive surgery of the airway often means prolonged periods of intubation during the post-operatory period, increasing the needs for drugs and favoring the appearance of infectious complications. We present an original system of ventilatory support with non-invasive positive pressure ventilation (NIPPV) using in patients subjected to reconstructive surgery of the airway. A retrospective study in patients undergoing reconstructive procedures of the airway in the year 2009 was carried out. We exclude those treated endoscopically and those who had vascular rings. The positive pressure mechanism used in the Surgery Critical Care Unit was a design made by the unit based on the circuit devised by Mapleson that provides optimum levels of ventilation without need for connection to a respiratory. We analyze the results, postoperatory intubation time, time dependent on NIPPV and medical treatment received. A total of 7 patients (1 Female and 6 Males) with median age of 1.6 (0.1-7.5) years were included. The diagnoses were: 4 subglottic stenosis, 2 had tracheal stenosis and 1 subcarinal stenosis with involvement of both principal bronchioles. The techniques used were: laryngotracheoplasty with costal cartilage graft (4), tracheoplasty with costal cartilage (1) and sliding tracheoplasty (2) with bilateral bronchoplasty in one of them. The mean time of nasotracheal intubation was 3 days, and mean time of NIPPV was 2.3. No patient required reintubation and none had infectious complications. Ventilatory support by VPPNI allows effective extubation in these patients, it being possible to maintain a safe airway. Infectious complications, frequent in prolonged intubations, were not observed in any of the cases.

  6. Effect of Head Position on Cerebrospinal Fluid Pressure in Cats: Comparison with Artificial Model

    Science.gov (United States)

    Klarica, Marijan; Radoš, Milan; Draganić, Pero; Erceg, Gorislav; Orešković, Darko; Maraković, Jurica; Bulat, Marin

    2006-01-01

    Aim To demonstrate that changes in the cerebrospinal fluid (CSF) pressure in the cranial cavity and spinal canal after head elevation from the horizontal level occur primarily due to the biophysical characteristics of the CSF system, ie, distensibility of the spinal dura. Methods Experiments in vivo were performed on cats and a new artificial model of the CSF system with dimensions similar to the CSF system in cats, consisting of non-distensible cranial and distensible spinal part. Measurements of the CSF pressure in the cranial and spinal spaces were performed in chloralose-anesthetized cats (n = 10) in the horizontal position on the base of a stereotaxic apparatus (reference zero point) and in the position in which the head was elevated to 5 cm and 10 cm above that horizontal position. Changes in the CSF pressure in the cranial and spinal part of the model were measured in the cranial part positioned in the same way as the head in cats (n = 5). Results When the cat was in the horizontal position, the values of the CSF pressure in the cranial (11.9 ± 1.1 cm H2O) and spinal (11.8 ± 0.6 cm H2O) space were not significantly different. When the head was elevated 5 cm or 10 cm above the reference zero point, the CSF pressure in the cranium significantly decreased to 7.7 ± 0.6 cm H2O and 4.7 ± 0.7 cm H2O, respectively, while the CSF pressure in the spinal space significantly increased to 13.8 ± 0.7 cm H2O and 18.5 ± 1.6 cm H2O, respectively (P<0.001 for both). When the artificial CSF model was positioned in the horizontal level and its cranial part elevated by 5 cm and 10 cm, the changes in the pressure were the same as those in the cats when in the same hydrostatic position. Conclusions The new model of the CSF system used in our study faithfully mimicked the changes in the CSF pressure in cats during head elevation in relation to the body. Changes in the pressure in the model were not accompanied by the changes in fluid volume in

  7. A Rotational Crofton Formula for Flagged Intrinsic Volumes of Sets of Positive Reach

    DEFF Research Database (Denmark)

    Auneau, Jeremy Michel

    A rotational Crofton formula is derived relating the flagged intrinsic volumes of a compact set of positive reach with the flagged intrinsic volumes measured on sections passing through a fixed point. In particular cases, the flagged intrinsic volumes defined in the present paper are identical...... to the classical intrinsic volumes. The tight connection between our main result and other recent rotational integral formulae involving intrinsic volumes is pointed out....

  8. A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Dursunoglu Nese

    2007-01-01

    Full Text Available The natural history of chronic obstructive pulmonary disease (COPD is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH. Noninvasive positive pressure ventilation (NPPV treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO2 and decrease PaCO2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment.

  9. Otilonium bromide enhances sensory thresholds of volume and pressure in patients with irritable bowel syndrome.

    Science.gov (United States)

    Czimmer, J; Süto, G; Király, A; Mózsik, G

    2001-01-01

    Visceral hyperalgesia has been suggested to play a role in the development of symptoms presented by irritable bowel syndrome patients. Otilonium bromide was developed to block smooth muscle Ca release to control cramping pain of these patients. to determine whether otilonium bromide can influence sensory thresholds of patients suffering from irritable bowel syndrome. 15 patients with Rome-II positive IBS were tested by Synectics Visceral Stimulator Barostat using rapid phasic distension (870 ml/min). The sensory threshold for first sensation, stool, pain and maximum tolerable volume and pressure were measured. All of the parameters were tested before and 1 week after the initiation of otilonium bromide (Spasmomen, Berlin Chemie, 3x40 mg) therapy. The perceptual thresholds for first sensation, stool, pain and maximum tolerable distention were, 8.8+/-1.7 Hgmm, 19.2+/-2.1 Hgmm, 26.3+/-2.8 Hgmm, 28.7+/-2.8 Hgmm for pressure, 90+/-21 ml, 145+/-28 ml, 208+/-25 ml, 213+/-28 ml for volume, before treatment, respectively. Otilonium bromide treatment did not influence the thresholds for first sensation and stool, 7.4+/-1.4 Hgmm, 20.7+/-4.6 Hgmm and 83+/-21 ml, 178+/-35.8 ml, respectively. The pressure threshold of pain was significantly higher 1 week after treatment (26.3+/-2.8 Hgmm vs. 29.1+/-5.5 Hgmm, Potilonium bromide treatment. These data suggest that otilonium bromide enhances sensory thresholds to recto-sigmoideal distention.

  10. Adapting the Bird Mark 7 to deliver noninvasive continuous positive airway pressure: a bench study.

    Science.gov (United States)

    Kikuti, Beatriz Mayumi; Utsunomia, Karen; Colaneri, Renata Potonyacz; Carvalho, Carlos Roberto Ribeiro de; Caruso, Pedro

    2008-03-01

    To test the efficiency of the Bird Mark 7 ventilator adapted to deliver continuous positive airway pressure (CPAP) in noninvasive positive pressure ventilation. This was an experimental study using a mechanical model of the respiratory system. A Bird Mark 7 ventilator was supplied with 400 and 500 kPa and tested at CPAP of 5, 10 and 15 cmH2O. The following variables were analyzed: difference between the preset CPAP and the CPAP actually attained CPAP (trueCPAP); area of airway pressure at the CPAP level employed (AREA CPAP); and tidal volume generated. Adapting the Bird Mark 7 to offer CPAP achieved the expected tidal volume in all situations of inspiratory effort (normal or high), ventilator pressure supply (400 or 500 kPa) and CPAP value (5, 10 or 15 cmH2O). At a CPAP of 5 or 10 cmH2O, the trueCPAP was near the preset level, and the AREA CPAP was near zero. However, at a CPAP of 15 cmH2O, the value remained below the preset, and the AREA CPAP was high. The efficiency of Bird Mark 7 adaptation in offering CPAP was satisfactory at 5 and 10 cmH2O but insufficient at 15 cmH2O. If adapted as described in our study, the Bird Mark 7 might be an option for offering CPAP up to 10 cmH2O in areas where little or no equipment is available.

  11. Partial molar volume of L-Valine in water under high pressure

    Science.gov (United States)

    Sawamura, Seiji

    2013-06-01

    Partial molar volume of L-valine in water was estimated up to 400 MPa from pressure coefficient of the solubility of the solute and molar volume of solid valine. The former was measured in a previous paper and the latter was measured in this article using a piston-cylinder typed cell. The partial molar volume increased with pressure and a maximum was observed around 250 MPa. It was compared with other amino acids.

  12. The current science of gastric banding: an overview of pressure-volume theory in band adjustments.

    Science.gov (United States)

    Fried, Martin

    2008-01-01

    Laparoscopic adjustable gastric banding (LAGB) is a safe and effective bariatric operation for the treatment of morbid obesity. Optimized long-term weight loss and reduced complications may be facilitated by development of a standardized, accurate, band-fill measurement methodology for use in postoperative LAGB adjustments. A summary of the primary in vitro, theoretical, and in vivo studies of pressure-volume theory relative to gastric banding was undertaken. LAGBs range in mechanisms of action from low-pressure/high-volume to high-pressure/low-volume. Use of both basic and dynamic pressure data obtained experimentally and clinically with a low-pressure/high-volume (LP/HV) band as a research tool revealed that intra-band pressures remained very low even when the band balloon was filled to its maximum fill volume; in contrast, when a high-pressure/low-volume (HP/LV) band was filled, it exhibited a pressure curve markedly steeper and of greater amplitude than that of the LP/HV band. Theoretical calculations of the differences between the bands in terms of the pressures they exerted on a bolus of food passing through a stoma found that the pressure created by the HP/LV band against the gastric wall was >100% higher than that applied by the LP/HV band; these mathematical results were verified by using invasive manometry in 35 patients undergoing band adjustment. In clinical testing, basic band pressure, band volume, and dynamic pressure data (that demonstrated esophageal motility patterns at the stoma during bolus passage) were gathered and correlated. As identified by intra-band pressure readings, a zone of disruptive peristaltic activity that obstructed bolus passage through the stoma was observed; slightly beneath this zone, it was hypothesized that successful patient adjustments might be carried out. The manometrically delineated measure of mean band pressure sufficient to exert a significant yet not disruptive restriction (i.e., 20 mm Hg; mean volume of 5.4 m

  13. Volume and Nutritional Status Evaluated by Bioimpedance Affected by Body Positions

    Directory of Open Access Journals (Sweden)

    Ender HÜR

    2014-01-01

    Full Text Available OBJECTIVE: Body composition analysis is useful technique for assessing hydration, nutritional status and predicting clinical outcomes. Bioimpedance analysis (BIA is a cheap and noninvasive tool for monitoring body composition but needs some improvements regarding measurement methods. We aimed to fi nd out if body position has an effect on the BIA results. MATERIAL and METHODS: Personal characteristics including age, gender, height, weight and blood pressure were recorded. Hydration and nutritional status measured by body composition monitor in supine and standing positions consequently for each individual. RESULTS: Two hundred and one populations from various region in Turkey, 61% (n: 123 male, mean age was 46.3±12 years (18-76 of age, participated in this crossectional study. From supine to standing positions overhydration and extracellular water (ECW were increased from 0.04±1.08 and 17.69±2.92 to 0.46±1.05 L and 17.84±2.90 L while intracellular water (ICW decreased from 22.55±4.35 to 22.04±4.28 L signifi cantly. Systolic and diastolic blood pressures were 131.3±18.1 and 75.1±12 decreased to 127.0±16.0 and 72.2±9.0 mmHg in supine to standing positions (p> 0.05. CONCLUSION: Supine and standing positions could affect the volume parameters of BIA due to shift of ECW and ICW by gravity but nutritional parameters also changes signifi cantly. Protocols should be re evaluated in order to get more accurate results in bioimpedance measurements.

  14. The relationships between foot arch volumes and dynamic plantar pressure during midstance of walking in preschool children.

    Directory of Open Access Journals (Sweden)

    Hsun-Wen Chang

    Full Text Available OBJECTIVES: The purpose of this study was to examine the correlation between the foot arch volume measured from static positions and the plantar pressure distribution during walking. METHODS: A total of 27 children, two to six years of age, were included in this study. Measurements of static foot posture were obtained, including navicular height and foot arch volume in sitting and standing positions. Plantar pressure, force and contact areas under ten different regions of the foot were obtained during walking. RESULTS: The foot arch index was correlated (r = 0.32 with the pressure difference under the midfoot during the foot flat phase. The navicular heights and foot arch volumes in sitting and standing positions were correlated with the mean forces and pressures under the first (r = -0.296∼-0.355 and second metatarsals (r = -0.335∼-0.504 and midfoot (r = -0.331∼-0.496 during the stance phase of walking. The contact areas under the foot were correlated with the foot arch parameters, except for the area under the midfoot. CONCLUSIONS: The foot arch index measured in a static position could be a functional index to predict the dynamic foot functions when walking. The foot arch is a factor which will influence the pressure distribution under the foot. Children with a lower foot arch demonstrated higher mean pressure and force under the medial forefoot and midfoot, and lower contact areas under the foot, except for the midfoot region. Therefore, children with flatfoot may shift their body weight to a more medial foot position when walking, and could be at a higher risk of soft tissue injury in this area.

  15. High-inflation pressure and positive end-expiratory pressure. Injurious to the lung? No.

    Science.gov (United States)

    Nelson, L D

    1996-07-01

    Survival rates in ARDS with conventional ventilation using high oxygen fractions and low PEEP levels have been reported to be less than 10%. In three prospective evaluations of ARDS in the 1980s, mortality rates remained greater than 60%. Early studies using high-level PEEP therapy in severe ARDS by Douglas, Downs, Kirby, and Civetta showed improved survival rates with ranges between 60% and 80%. In 1979 Gallagher reviewed 59 patients with ARDS who were treated with PEEP greater than 15 cm H2O titrated to improve FRC by achieving an intrapulmonary shunt fraction of 15%. The overall survival was 65%, with only 5% of the patients dying secondary to respiratory failure. In the more recent study by Miller in trauma patients and later by DiRusso in a variety of surgical patients, the overall mortality rate for those patients receiving PEEP greater than 15 cm H2O was 20% to 30%. Of the 14 patients who died, only seven (10% of the total) succumbed to respiratory failure. The remaining patients died from the primary underlying disease with normal oxygenation or after significant weaning from high PEEP levels. By using a goal-oriented approach to the management of patients with severe ARDS, we have found that high-level PEEP therapy was effective in lowering the intrapulmonary shunt and improving the SaO2 at acceptable levels of inspired oxygen. All of these patients were ventilated with traditional high tidal volumes (10 to 15 mL/kg) and therefore exhibited high peak inspiratory airway pressures. This support method did not seem to cause lung injury or an excessive amount of barotrauma in these patients, but in fact, was associated with a lower mortality rate (30%) than reported in other studies of patients with lesser degrees of lung oxygenation dysfunction and extrapulmonary organ system dysfunction. Currently available information indicates that increases in mean airway pressure (induced with PEEP or other modes of ventilatory support to restore losses in FRC that occur

  16. Noninvasive positive pressure ventilation in acute asthmatic attack

    Directory of Open Access Journals (Sweden)

    A. Soroksky

    2010-03-01

    Full Text Available Asthma is characterised by reversible airway obstruction. In most patients, control of disease activity is easily achieved. However, in a small minority, asthma may be fatal. Between the two extremes lie patients with severe asthmatic attacks, refractory to standard treatment. These patients are at an increased risk of recurrent severe attacks, with respiratory failure, and mechanical ventilation. Invasive mechanical ventilation of the asthmatic patient is associated with a higher risk of complications and, therefore, is a measure of last resort. Noninvasive positive pressure ventilation (NPPV is another treatment modality that may be beneficial in patients with severe asthmatic attack who are at an increased risk of developing respiratory failure. These patients have the potential to benefit from early respiratory support in the form of NPPV. However, reports of NPPV in asthmatic patients are scarce, and its usage in asthmatic attacks is, therefore, still controversial. Only a few reports of NPPV in asthma have been published over the last decade. These studies mostly involve small numbers of patients and those who have problematic methodology. In this article we review the available evidence for NPPV in asthma and try to formulate our recommendations for NPPV application in asthma based on the available evidence and reports.

  17. Conversion table for running on lower body positive pressure treadmills.

    Science.gov (United States)

    Kline, John R; Raab, Scot; Coast, J Richard; Bounds, Roger G; McNeill, David K P; de Heer, Hendrik D

    2015-03-01

    Lower body positive pressure (LBPP) or antigravity treadmills are becoming increasingly popular in sports and rehabilitation settings. Running at a decreased body weight (BW) reduces metabolic cost, which can be offset by running at faster speeds. To date, however, little is known about how much faster someone must run to offset the reduced metabolic cost. This study aimed to develop a user-friendly conversion table showing the speeds required on an LBPP treadmill to match the equivalent metabolic output on a regular, non-LBPP, treadmill across a range of body weight supports. A total of 20 recreational runners (11 males, 9 females) ran multiple 3-minute intervals on a regular treadmill and then on an LBPP treadmill at 6 different BWs (50-100%, 10% increments). Metabolic outputs were recorded and matched between the regular and LBPP treadmill sessions. Using regression analyses, a conversion table was successfully created for the speeds from 6.4 to 16.1 km·h (4 to 10 mph) in 0.8 km·h (0.5 mph) increments on the regular treadmill and BW proportions of 50, 60, 70, 80, 90, and 100% on an LBPP treadmill. The table showed that a greater increase in speed on the LBPP treadmill was needed with more support (p < 0.001) but that the proportion increase was smaller at higher speeds (p < 0.001). This research has implications for coaches or practitioners using or prescribing training on an LBPP treadmill.

  18. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children.

    Science.gov (United States)

    Jat, Kana R; Mathew, Joseph L

    2015-01-07

    Acute bronchiolitis is one of the most frequent causes of emergency department visits and hospitalisation in infants. There is no specific treatment for bronchiolitis except for supportive therapy. Continuous positive airway pressure (CPAP) is supposed to widen the peripheral airways of the lung, allowing deflation of over-distended lungs in bronchiolitis. The increase in airway pressure also prevents the collapse of poorly supported peripheral small airways during expiration. In observational studies, CPAP is found to be beneficial in acute bronchiolitis. To assess the efficacy and safety of CPAP compared to no CPAP or sham CPAP in infants and children up to three years of age with acute bronchiolitis. We searched CENTRAL (2014, Issue 3), MEDLINE (1946 to April week 2, 2014), EMBASE (1974 to April 2014), CINAHL (1981 to April 2014) and LILACS (1982 to April 2014). We considered randomised controlled trials (RCTs), quasi-RCTS, cross-over RCTs and cluster-RCTs evaluating the effect of CPAP in children with acute bronchiolitis. Two review authors independently assessed study eligibility, extracted data using a structured proforma, analysed the data and performed meta-analyses. We included two studies with a total of 50 participants under 12 months of age. In one study there was a high risk of bias for incomplete outcome data and selective reporting, and both studies had an unclear risk of bias for several domains including random sequence generation. The effect of CPAP on the need for mechanical ventilation in children with acute bronchiolitis was uncertain due to imprecision around the effect estimate (two RCTs, 50 participants; risk ratio (RR) 0.19, 95% CI 0.01 to 3.63; low quality evidence). Neither trial measured our other primary outcome of time to recovery. One trial found that CPAP significantly improved respiratory rate compared with no CPAP (one RCT, 19 participants; mean difference (MD) -5.70 breaths per minute, 95% CI -9.30 to -2.10), although the other

  19. Understanding Subcutaneous Tissue Pressure for Engineering Injection Devices for Large-Volume Protein Delivery.

    Science.gov (United States)

    Doughty, Diane V; Clawson, Corbin Z; Lambert, William; Subramony, J Anand

    2016-07-01

    Subcutaneous injection allows for self-administration of monoclonal antibodies using prefilled syringes, autoinjectors, and on-body injector devices. However, subcutaneous injections are typically limited to 1 mL due to concerns of injection pain from volume, viscosity, and formulation characteristics. Back pressure can serve as an indicator for changes in subcutaneous mechanical properties leading to pain during injection. The purpose of this study was to investigate subcutaneous pressures and injection site reactions as a function of injection volume and flow rate. A pressure sensor in the fluid path recorded subcutaneous pressures in the abdomen of Yorkshire swine. The subcutaneous tissue accommodates large-volume injections and with little back pressure as long as low flow rates are used. A 1 mL injection in 10 seconds (360 mL/h flow rate) generated a pressure of 24.0 ± 3.4 kPa, whereas 10 mL delivered in 10 minutes (60 mL/h flow rate) generated a pressure of 7.4 ± 7.8 kPa. After the injection, the pressure decays to 0 over several seconds. The subcutaneous pressures and mechanical strain increased with increasing flow rate but not increasing dose volume. These data are useful for the design of injection devices to mitigate back pressure and pain during subcutaneous large-volume injection. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  20. Effect of intermittent positive pressure ventilation on cardiac systolic time intervals.

    Science.gov (United States)

    Brundin, T; Hedenstierna, G; McCarthy, G

    1976-01-01

    The measurement of systolic time intervals (STI) has been widely used as a non-invasive method of assessing the inotropic state of the heart, and normal values are available for healthy individuals breathing spontaneously. The present study was performed in order to evaluate how intermittent positive pressure ventilation (IPPV) affects STI. Ten subjects were investigated before and during halothane anaesthesia for routine surgery. Oesophageal pressure, respiratory minute volume and frequency, arterial blood-gas tensions, cardiac output and heart rate were also measured simultaneously. As expected, the institution of IPPV was associated with a reduction in cardiac output and an increase in oesophageal pressure. Paco2 was reduced. These changes were associated with a considerable lengthening of electro-mechanical systole. This was due to a lengthened pre-ejection period (PEP), whereas the left ventricular ejection time (LVET) was slightly shortened. These changes were even more marked during artifical hyperventilation. The changes in STI are attributed mainly to the reduction of venous return to the heart, subsidiary factors being intrathoracic pressure, myocardial inotropy and vascular resistance.

  1. Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    SHI Jia-xin; XU Jin; SUN Wen-kui; SU Xin; ZHANG Yan; SHI Yi

    2013-01-01

    Background This meta-analysis evaluated the effect of noninvasive,positive pressure ventilation on severe,stable chronic obstructive pulmonary disease (COPD).Methods PUBMED,CNKI,Wanfang,EMBASE and the Cochrane trials databases were searched.Randomized controlled trials of patients with severe,stable COPD and receiving noninvasive positive pressure ventilation,compared with sham ventilation or no ventilation,were reviewed.The mortality,physiological and health related parameters were pooled to yield odds ratio (OR),weighted mean differences or standardized mean differences (SMD),with 95% confidence interval (C/).Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria.Pooled analysis for parallel,randomized controlled trials showed noninvasive positive pressure ventilation:(1) Did not affect the 12-or 24-month mortality (OR 0.82,95% C/:0.48 to 1.41); (2) Improved the arterial carbon dioxide tension (SMD-0.88,95%C/:-1.43 to-0.34); (3) Did not improve forced expiratory volume in one second (SMD 0.20,95% C/:-0.06 to 0.46),maximal inspiratory pressure (SMD 0.01,95% C/:-0.28 to 0.29) or 6-minute walk distance (SMD 0.17,95% C/:-0.16 to 0.50); (4) Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients.Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation.Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality,pulmonary function,or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.

  2. Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly

    Science.gov (United States)

    Brito, Aline de Freitas; de Oliveira, Caio Victor Coutinho; Brasileiro-Santos, Maria do Socorro; Santos, Amilton da Cruz

    2014-01-01

    Background The purpose of this study was to evaluate the effect of two sessions of resistance exercise with different volumes on post-exercise hypotension, forearm blood flow, and forearm vascular resistance in hypertensive elderly subjects. Methods The study was conducted with ten hypertensive elderly (65±3 years, 28.7±3 kg/m2) subjected to three experimental sessions, ie, a control session, exercise with a set (S1), and exercise with three sets (S3). For each session, the subjects were evaluated before and after intervention. In the pre-intervention period, blood pressure, forearm blood flow, and forearm vascular resistance were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same time period. Both S1 and S3 comprised a set of ten repetitions of ten exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (post-intervention) in the supine position. Results Post-exercise hypotension was greater in S3 than in S1 (systolic blood pressure, −26.5±4.2 mmHg versus −17.9±4.7 mmHg; diastolic blood pressure, −13.8±4.9 mmHg versus −7.7±5 mmHg, P<0.05). Similarly, forearm blood flow and forearm vascular resistance changed significantly in both sessions with an increase and decrease, respectively, that was more evident in S3 than in S1 (P<0.05). Conclusion Resistance exercises with higher volume were more effective in causing post-exercise hypotension, being accompanied by an increase in forearm blood flow and a reduction of forearm vascular resistance. PMID:25540580

  3. Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly.

    Science.gov (United States)

    Brito, Aline de Freitas; de Oliveira, Caio Victor Coutinho; Brasileiro-Santos, Maria do Socorro; Santos, Amilton da Cruz

    2014-01-01

    The purpose of this study was to evaluate the effect of two sessions of resistance exercise with different volumes on post-exercise hypotension, forearm blood flow, and forearm vascular resistance in hypertensive elderly subjects. The study was conducted with ten hypertensive elderly (65±3 years, 28.7±3 kg/m(2)) subjected to three experimental sessions, ie, a control session, exercise with a set (S1), and exercise with three sets (S3). For each session, the subjects were evaluated before and after intervention. In the pre-intervention period, blood pressure, forearm blood flow, and forearm vascular resistance were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same time period. Both S1 and S3 comprised a set of ten repetitions of ten exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (post-intervention) in the supine position. Post-exercise hypotension was greater in S3 than in S1 (systolic blood pressure, -26.5±4.2 mmHg versus -17.9±4.7 mmHg; diastolic blood pressure, -13.8±4.9 mmHg versus -7.7±5 mmHg, Pexercises with higher volume were more effective in causing post-exercise hypotension, being accompanied by an increase in forearm blood flow and a reduction of forearm vascular resistance.

  4. [Domiciliary noninvasive positive pressure ventilation in chronic alveolar hypoventilation].

    Science.gov (United States)

    Casas, J P; Robles, A M; Pereyra, M A; Abbona, H L; López, A M

    2000-01-01

    Effectiveness of treatment with domiciliary nocturnal noninvasive positive pressure ventilation is analyzed in a group of patients with chronic alveolar hypoventilation of different etiologies. It was applied with two levels of pressure (BiPAP) via nasal mask. Criteria for evaluation were symptomatology and improvement in gas exchange. Data were analyzed by Student t tests. A total of 13 patients were included, mean age 55.7 range 20 to 76 years (5 male 8 female). Main diagnosis was tuberculosis in 6, four of them having had surgical procedure (thoracoplasty 2, frenicectomy 1 and neumonectomy 1), myopathy 3 (myasthenia gravis 1, muscular dystrophy 1 and diaphragmatic paralysis 1), obesity-hypoventilation syndrome 1, escoliosis 1, bronchiectasis 1 and cystic fibrosis 1. These last two patients were on waiting list for lung transplantation. At the moment of consultation, the symptoms were: dysnea 13/13 (100%), astenia 13/13 (100%), hypersomnolency 10/13 (77%), cephalea 9/13 (69%), leg edema 6/13 (46%), loss of memory 6/13 (46%). Regarding gas exchange, they showed hypoxemia and hypercapnia. Mean follow up was of 2.2 years (range 6 months to 4 years). Within the year, all 13 patients became less dyspneic. Astenia, hypersomnolency, cephalea, leg edema and memory loss disappeared. Improvement in gas exchange was: PaO2/FiO2 from 269 +/- 65.4 (basal) to 336.7 +/- 75.3 post-treatment (p = 0.0018). PaCO2 from 70.77 +/- 25.48 mmHg (basal) to 46.77 +/- 8.14 mmHg (p = 0.0013). Ventilatory support was discontinued en 5 patients: three because of pneumonia requiring intubation and conventional mechanical ventilation, two of them died and one is still with tracheostomy; One patient with bronchiectasis and one with cystic fibrosis were transplanted. The remaining eight patients are stable. In conclusion, chronic alveolar hypoventilation can be effectively treated with domiciliary nocturnal noninvasive ventilation. Long term improvement in symptomatology and arterial blood gases

  5. Left ventricular pressure and volume data acquisition and analysis using LabVIEW.

    Science.gov (United States)

    Cassidy, S C; Teitel, D F

    1997-03-01

    To automate analysis of left ventricular pressure-volume data, we used LabVIEW to create applications that digitize and display data recorded from conductance and manometric catheters. Applications separate data into cardiac cycles, calculate parallel conductance, and calculate indices of left ventricular function, including end-systolic elastance, preload-recruitable stroke work, stroke volume, ejection fraction, stroke work, maximum and minimum derivative of ventricular pressure, heart rate, indices of relaxation, peak filling rate, and ventricular chamber stiffness. Pressure-volume loops can be graphically displayed. These analyses are exported to a text-file. These applications have simplified and automated the process of evaluating ventricular function.

  6. Planetary geometry handbook: Jupiter positional data, 1985 - 2020, volume 4

    Science.gov (United States)

    Sergeyevsky, A. B.; Snyder, G. C.; Paulson, B. L.; Cunniff, R. A.

    1983-01-01

    Graphical data necessary for the analysis of planetary exploration missions to Jupiter are presented. Positional and geometric information spanning the time period from 1985 through 2020 is provided. The data and their usage are explained.

  7. Pressure Dependence of Molar Volume near the Melting Point in Benzene

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The pressure dependence of the molar volume was at constant temperatures close to the melting point in benzene. The molar volume of benzene was calculated using experimental data for the thermal expansivity for constant temperatures of 25℃, 28.5℃, 40℃, and 51℃ at various pressures for both the solid and liquid phases. The predictions are in good agreement with the observed volumes in both the solid and liquid phases of benzene. The predicted values of the molar volume for a constant temperature of 28.5℃ in the liquid phase of benzene agree well with experimental data in the literature.

  8. Effects of mechanical ventilation with lower tidal volume and positive end-expiratory pressure on pulmonary function during laparoscopic surgery in patients with chronic obstructive pulmonary disease%低潮气量联合呼气末正压通气对慢性阻塞性肺疾病患者腹腔镜手术时肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    陈志远; 吴健华; 王玉珍; 李岩; 许小婷

    2013-01-01

    Objective To investigate the effects of mechanicl ventilation with lower tidal volume and positive end-expiratory pressure (PEEP) on pulmonary function during laparoscopic surgery in patients with chronic obstructive pulmonary disease (COPD).Methods Forty patients with COPD,aged 60-82 yr,with body mass index of 16-29 kg/m2,undergoing elective laparoscopic surgery,were randomly divided into 2 groups (n =20 each) using a random number table:conventional ventilation group (group Ⅰ) and mechanical ventilation with lower tidal volume and PEEP group (group Ⅱ).Anesthesia was induced with midazolam,sufentanil,cisatracurium and propofol and maintained with iv infusion of propofol,cisawacurium and remifentanil.The patients were endotracheally ventilated and mechanically ventilated.In group Ⅰ,fresh gas flow was set at 2 L/min,VT at 10 ml/kg,and I∶E at 1∶2 during ventilation.In group Ⅱ,fresh gas flow was set at 2 L/min,VT at 6 ml/kg,I∶E at 1∶2 and PEEP at 6 cm H2O during ventilation.PErCO2 was maintained at 35-45 mm Hg in both groups.Airway peak pressure (Pp~),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were measured at 5 min after intubation (T1),45 min of pneumoperitoneum (T2),and 15 min after the end of pneumoperitoneum (T3).Arterial blood samples were obtained at T1,T2 and T3 for blood gas analysis.Alveolar-arterial oxygen gradiant (A-aDO2),oxygenation index (PaO2/FiO2),respiratory index (RI) and physiologic dead space fraction (VD/VT) were calculated.The extubation time and development of complications were recorded within 48 h after operation.Results Compared with group Ⅰ,Ppeak and Plat at T2 and Raw at T1,2 were significantly decreased,Cdyn at T2 and PaO2/FiO2 at T1-3 were significantly increased,RI,VD/VT and A-aDO2 were significantly decreased at T1-3,and the incidence of hyoxemia,atelectasis and rales was decreased within 48 h after operation in group Ⅱ (P < 0.05).There was no significant difference

  9. Peripheral arterial volume distensibility: significant differences with age and blood pressure measured using an applied external pressure.

    Science.gov (United States)

    Zheng, Dingchang; Murray, Alan

    2011-05-01

    A new arterial distensibility measurement technique was assessed in 100 healthy normotensive subjects. Arterial transmural pressures on the whole right arm were reduced with a 50 cm long cuff inflated to 10, 20, 30 and 40 mmHg. The electrocardiogram, and finger and ear photoplethysmograms were recorded simultaneously. Arm pulse propagation time, pulse wave velocity (PWV) and arterial volume distensibility were determined. With a 40 mmHg reduction in transmural pressure, arm pulse propagation time increased from 61 to 83 ms, PWV decreased from 12 to 8 m s(-1) and arterial distensibility increased from 0.102% to 0.232% per mmHg (all P pressures, arterial distensibility was significantly related to resting mean arterial pressure (MAP), diastolic blood pressure (DBP) and age, and for systolic blood pressure at 30 and 40 mmHg (all P pressure, arterial distensibility fell by 54% for a MAP increase from 75 to 105 mmHg, 57% for a DBP increase from 60 to 90 mmHg and 47% for an age increase from 20 to 70 years. These changes were more than double than those without cuff pressure. Our technique showed that systemic volume distensibility of the peripheral arm artery reduced with age, with a greater effect at higher external and lower transmural pressures.

  10. Pressures and Oscillation Frequencies Generated by Bubble-Positive Expiratory Pressure Devices.

    Science.gov (United States)

    Santos, Mary D; Milross, Maree A; Eisenhuth, John P; Alison, Jennifer A

    2017-04-01

    Positive expiratory pressure (PEP) devices are used to assist with airway clearance. Little is known about the therapist-made or commercially available bubble-PEP devices. The aim of this study was to determine the end-expiratory pressures (cm H2O) and oscillation frequencies (Hz) generated when a range of flows were applied to the therapist-made bubble-PEP devices (Bubble-PEP-3cm and Bubble-PEP-0cm) and commercial bubble-PEP devices (AguaPEP, Hydrapep, and Therabubble). This was a bench-top experimental study using a compressed air source, flow rotameter (flows of 5, 10, 15, 20, and 25 L/min), and pressure transducer. Data were collected using a data acquisition device with PhysioDAQxs software and analyzed with Breathalyser software to determine the pressures and oscillation frequencies generated by 5 bubble-PEP devices. Each flow was constant for a 30-s measurement period, and measurements were repeated in triplicate. The 5 devices were: a therapist-made Bubble-PEP-3cm device (filled with 13 cm of water, tubing resting 3 cm from the base of the container); the therapist-made Bubble-PEP-0cm (filled with 10 cm of water, tubing resting at the base of the container); and the AguaPEP, Hydrapep, and Therabubble devices with water to the 10 cm mark on the containers. Flows of 5-25 L/min produced the following mean ± SD PEP and oscillation frequencies (Hz): the Bubble-PEP-3cm produced PEP of 10.4 ± 0.14 to 10.8 ± 0.24 cm H2O, oscillations between 13 and 17 Hz; the Bubble-PEP-0cm produced PEP of 10.9 ± 0.01 to 12.9 ± 0.08 cm H2O, oscillations between 12 and 14 Hz; the AguaPEP produced PEP from 9.7 ± 0.02 to 11.5 ± 0.02 cm H2O, oscillations between 11 and 17 Hz; the Hydrapep produced PEP of 9.6 ± 0.35 to 10.7 ± 0.39 cm H2O, oscillations between 14 and 17 Hz; and the Therabubble produced PEP from 8.6 ± 0.01 to 12.8 ± 0.03 cm H2O, oscillations between 14 and 17 Hz. Bubble-PEP-3cm maintained the most stable pressure throughout the range of flows tested. All

  11. The pressure-volume relationship of the heart: past, present and future.

    Science.gov (United States)

    Sunagawa, Kenji

    2010-01-01

    The pressure-volume relationship of the heart was first reported more than a century ago. It was not widely accepted, however, until the mid-1970s. The pressure-volume diagram became a central theme of cardiac mechanics once it was shown to be a good representation of ventricular mechanics. Early in 1980s, the introduction of the ventricular interaction with afterload using effective arterial elastance made it possible to translate ventricular mechanical properties represented by the pressure-volume relationship to the pumping ability of the heart. Furthermore incorporating the framework of ventricular arterial interaction into the classic Guyton's circulatory equilibrium early in 2000s enabled us to express quantitatively how mechanical properties of the ventricles and vascular systems determine the circulatory equilibrium. Successful quantitative descriptions of circulatory equilibrium using the pressure-volume concept would promote basic cardiovascular physiology and accelerate its clinical applications.

  12. The Effect of Equal Ratio Ventilation on Oxygenation, Respiratory Mechanics, and Cerebral Perfusion Pressure During Laparoscopy in the Trendelenburg Position.

    Science.gov (United States)

    Jo, Youn Yi; Kim, Ji Young; Chang, Young Jin; Lee, Sehwan; Kwak, Hyun Jeong

    2016-06-01

    The aim of this study was to investigate the effects of equal ratio ventilation (ERV) on oxygenation, respiratory mechanics, and the cerebral perfusion pressure during pneumoperitoneum in the Trendelenburg position. Thirty patients undergoing laparoscopic low anterior resection (25 to 65 y) were enrolled. Mechanical ventilator was set to volume-controlled mode at an inspiratory to expiratory (I:E) ratio of 1:2 with a tidal volume of 8 mL/kg of ideal body weight with a 5 cm H2O positive end-expiratory pressure. Twenty minutes after pneumoperitoneum in the Trendelenburg position, the I:E ratio was changed to 1:1 for 20 minutes and then restored to 1:2. No significant changes in arterial oxygen tension and respiratory compliance after adopting ERV. Mean arterial pressure and cerebral perfusion pressure decreased significantly over time after adopting the Trendelenburg position during pneumoperitoneum (P=0.014 and 0.005, respectively). In conclusion, there was no improvement in oxygenation or respiratory mechanics with ERV.

  13. Variability in the cardiac EIT image as a function of electrode position, lung volume and body position.

    Science.gov (United States)

    Patterson, R P; Zhang, J; Mason, L I; Jerosch-Herold, M

    2001-02-01

    A study was conducted using the Sheffield electrical impedance tomography (EIT) portable system DAS-01 P to determine the change in the cardiac image with electrode position, lung volume and body position. Sixteen electrodes were positioned in three transverse planes around the thorax at the level of the second intercostal space, at the level of the xiphisternal joint, and midway between upper and lower locations. Data were collected at each electrode level with the breath held at end expiration and after inspiring 0.5, 1 and 1.5 l of air with the subject in both the supine and sitting position. These data were analysed using a Matlab developed program that calculates the average resistivity change in the cardiac region from automatically determined borders. Results show significant individual variability with electrode position and air volume. The middle electrode most consistently shows an increase in impedance in the region of the heart during systole. In some subjects the change in the ventricular-volume-like curve showed a greater than 50% change as a function of lung volume. The pattern of variability with electrode position was not consistent among subjects. In one subject MRI images were obtained to compare actual structures with those seen in the EIT image. The results suggest that using these electrode locations reliable and consistent data, which could be used in clinical applications, cannot be obtained.

  14. Pediatric Positive Airway Pressure Adherence in Obstructive Sleep Apnea Enhanced by Family Member Positive Airway Pressure Usage.

    Science.gov (United States)

    Puri, Pooja; Ross, Kristie R; Mehra, Reena; Spilsbury, James C; Li, Hong; Levers-Landis, Carolyn E; Rosen, Carol L

    2016-07-15

    Adherence to positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) remains a challenge in children. We hypothesized that the presence of another family member on PAP therapy (parent, sibling, other family member) would be associated with better adherence in the child. We conducted a retrospective chart review to identify children family member on PAP therapy, patient demographics, and clinical characteristics. Group differences between children with and without a family member on PAP therapy were determined using χ(2) test and Wilcoxon two-sample test. PAP adherence measures at each time point and patterns of change across time between the two groups were examined using mixed-effects models. The final analytic sample included 56 children: age 13.2 ± 3.7 years, 60% male, 67% African American, 65% obese, and 32% with developmental disabilities. The mean obstructive apnea-hypopnea index was 25.2 ± 28.7, and 19 (33%) had a family member on PAP therapy. Overall PAP adherence was 2.8 ± 2.4 h/night at 3 months. At month 3, the group with a family member on PAP therapy had significantly greater average nightly PAP use on all nights (3.6 ± 0.6 vs. 2.3 ± 0.39) and on nights used (4.8 ± 0.6 vs. 3.8 ± 0.40); (p value = 0.04). Overall PAP adherence was low, but having a family member on PAP therapy as a "role model" was associated with better adherence. A commentary on this article appears in this issue on page 941. © 2016 American Academy of Sleep Medicine.

  15. Arterial Pulse Pressure and Its Association With Reduced Stroke Volume During Progressive Central Hypovolemia

    Science.gov (United States)

    2006-09-01

    Measurement of Stroke Volume Stroke volume (SV) was measured noninvasively using thoracic electrical bioimpedance (TEB). TEB was measured using four...tients who did not die. For the current study, we measured mean arterial blood pressure (MAP), pulse pressure (PP), SV, and muscle sympathetic nerve...hemorrhagic shock. The vital sign monitors placed in emergency transport vehicles provide the medic with routine measures of arterial systolic, diastolic and

  16. Lower body positive and negative pressure alter thermal and hemodynamic responses after exercise.

    Science.gov (United States)

    Journeay, W Shane; Reardon, Francis D; Jean-Gilles, Sartre; Martin, C Ryan; Kenny, Glen P

    2004-10-01

    The purpose of this study was to determine the effect of upright lower body positive and negative pressure (LBPP/LBNP) application on the post-exercise thermal response. It was hypothesized that the application of LBPP would decrease core temperature secondary to increases in skin blood flow (SkBF) and sweating, whereas the application of LBNP would maintain core temperature secondary to attenuated SkBF and sweating responses. There were six subjects who randomly underwent each of the following treatments in the upright posture, separated by a minimum of 48 h: 1) +45 mmHg LBPP; 2) -20 mmHg LBNP; or 3) no pressure for 45 min after performing 15 min of cycle ergometry exercise at 70% of their VO2peak. Measurements included mean arterial pressure (MAP), heart rate (HR), cardiac output (Q), stroke volume (SV), total peripheral resistance (TPR), mean skin temperature (Tsk), mean heat flux, esophageal temperature (Tes), SkBF, and sweat rate. After the application of LBPP, we observed a significantly greater decrease in core temperature relative to the LBNP and control conditions (p restoration of hemodynamics while LBNP and control prolonged the post-exercise hemodynamic state. We conclude that during recovery from exercise in the upright seated posture, core temperature recovery is affected by compromised SkBF and sweating secondary to nonthermal cardiovascular influences.

  17. Image analysis based quantification of bacterial volume change with high hydrostatic pressure.

    Science.gov (United States)

    Pilavtepe-Celik, M; Balaban, M O; Alpas, H; Yousef, A E

    2008-11-01

    Scanning electron microscopy (SEM) images of Staphylococcus aureus 485 and Escherichia coli O157:H7 933 were taken after pressure treatments at 200 to 400 MPa. Software developed for this purpose was used to analyze SEM images and to calculate the change in view area and volume of cells. Significant increase in average cell view area and volume for S. aureus 485 was observed in response to pressure treatment at 400 MPa. Cell view area for E. coli O157:H7 933 significantly increased at 325 MPa, the maximum pressure treatment tested against this pathogen. In contrast to S. aureus, cells of E. coli O157:H7 exhibited significant increase in average view area and volume at 200 MPa. The pressure-induced increase in these parameters may be attributed to modifications in membrane properties, for example, denaturation of membrane-bound proteins and pressure-induced phase transition of membrane lipid bilayer.

  18. Combination of constant-flow and continuous positive-pressure ventilation in canine pulmonary edema.

    Science.gov (United States)

    Sznajder, J I; Becker, C J; Crawford, G P; Wood, L D

    1989-08-01

    Constant-flow ventilation (CFV) maintains alveolar ventilation without tidal excursion in dogs with normal lungs, but this ventilatory mode requires high CFV and bronchoscopic guidance for effective subcarinal placement of two inflow catheters. We designed a circuit that combines CFV with continuous positive-pressure ventilation (CPPV; CFV-CPPV), which negates the need for bronchoscopic positioning of CFV cannula, and tested this system in seven dogs having oleic acid-induced pulmonary edema. Addition of positive end-expiratory pressure (PEEP, 10 cmH2O) reduced venous admixture from 44 +/- 17 to 10.4 +/- 5.4% and kept arterial CO2 tension (PaCO2) normal. With the innovative CFV-CPPV circuit at the same PEEP and respiratory rate (RR), we were able to reduce tidal volume (VT) from 437 +/- 28 to 184 +/- 18 ml (P less than 0.001) and elastic end-inspiratory pressures (PEI) from 25.6 +/- 4.6 to 17.7 +/- 2.8 cmH2O (P less than 0.001) without adverse effects on cardiac output or pulmonary exchange of O2 or CO2; indeed, PaCO2 remained at 35 +/- 4 Torr even though CFV was delivered above the carina and at lower (1.6 l.kg-1.min-1) flows than usually required to maintain eucapnia during CFV alone. At the same PEEP and RR, reduction of VT in the CPPV mode without CFV resulted in CO2 retention (PaCO2 59 +/- 8 Torr). We conclude that CFV-CPPV allows CFV to effectively mix alveolar and dead spaces by a small bulk flow bypassing the zone of increased resistance to gas mixing, thereby allowing reduction of the CFV rate, VT, and PEI for adequate gas exchange.

  19. Positive End-expiratory Pressure Titration after Alveolar Recruitment Directed by Electrical Impedance Tomography

    Institute of Scientific and Technical Information of China (English)

    Yun Long; Da-Wei Liu; Huai-Wu He; Zhan-Qi Zhao

    2015-01-01

    Background:Electrical impedance tomography (EIT) is a real-time bedside monitoring tool,which can reflect dynamic regional lung ventilation.The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome (ARDS) during positive-end-expiratory pressure (PEEP) titration using EIT.Methods:Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study.After recruitment maneuvers (RMs),decremental PEEP titration was performed from 20 cmH2O to 5 cmH2O in steps of 3 cmH2O every 5-10 min.Regional over-distension and recruitment were monitored with EIT.Results:After RMs,patient with arterial blood oxygen partial pressure (PaO2) + carbon dioxide partial pressure (PaCO2) >400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders.Thirteen ARDS patients was diagnosed as responders whose PaO2 + PaCO2 were higher than nonresponders (419 ± 44 mmHg vs.170 ± 73 mmHg,P < 0.0001).In responders,PEEP mainly increased recruited pixels in dependent regions and over-distended pixels in nondependent regions.PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume.PEEP levels without significant alveolar derecruitment and over-distension were identified individually.Conclusions:After RMs,PEEP titration significantly affected regional gas distribution in lung,which could be monitored with EIT.EIT has the potential to optimize PEEP titration.

  20. Intracranial pressure pulse waveform correlates with aqueductal cerebrospinal fluid stroke volume.

    Science.gov (United States)

    Hamilton, Robert; Baldwin, Kevin; Fuller, Jennifer; Vespa, Paul; Hu, Xiao; Bergsneider, Marvin

    2012-11-01

    This study identifies a novel relationship between cerebrospinal fluid (CSF) stroke volume through the cerebral aqueduct and the characteristic peaks of the intracranial pulse (ICP) waveform. ICP waveform analysis has become much more advanced in recent years; however, clinical practice remains restricted to mean ICP, mainly due to the lack of physiological understanding of the ICP waveform. Therefore, the present study set out to shed some light on the physiological meaning of ICP morphological metrics derived by the morphological clustering and analysis of continuous intracranial pulse (MOCAIP) algorithm by investigating their relationships with a well defined physiological variable, i.e., the stroke volume of CSF through the cerebral aqueduct. Seven patients received both overnight ICP monitoring along with a phase-contrast MRI (PC-MRI) of the cerebral aqueduct to quantify aqueductal stroke volume (ASV). Waveform morphological analysis of the ICP signal was performed by the MOCAIP algorithm. Following extraction of morphological metrics from the ICP signal, nine temporal ICP metrics and two amplitude-based metrics were compared with the ASV via Spearman's rank correlation. Of the nine temporal metrics correlated with the ASV, only the width of the P2 region (ICP-Wi2) reached significance. Furthermore, both ICP pulse pressure amplitude and mean ICP did not reach significance. In this study, we showed the width of the second peak (ICP-Wi2) of an ICP pulse wave is positively related to the volume of CSF movement through the cerebral aqueduct. This finding is an initial step in bridging the gap between ICP waveform morphology research and clinical practice.

  1. Assessment of positive end-expiratory pressure induced lung volume change by ultrasound in mechanically ventilated patients%床旁超声对机械通气患者呼气末正压诱导肺容积改变的评估价值

    Institute of Scientific and Technical Information of China (English)

    沈鹏; 罗汝斌; 高玉芝; 王吉文; 张茂

    2014-01-01

    Objective To investigate the value of lung ultrasound for assessing positive endexpiratory pressure (PEEP)-induced lung volume change in mechanically ventilated patients with acute lung injury(ALI) or acute respiratory distress syndrome (ARDS).Methods Eighteen patients with ALI or ARDS were prospectively studied.P-V curves and lung ultrasound were performed at PEEP 12,8,4 and 0 cmH2O(1 cmH2O =0.098 kPa).PEEP-induced lung volume change was measured using the P-V curve method and lung ultrasound.Results Four lung ultrasound entities were defined:consolidation,multiple irregularly spaced B lines,multiple abutting B lines and normal aeration.For each of the 12 lung regions examined,PEEP-induced ultrasound changes were measured and an lung ultrasound score (LUS)was calculated.A highly significant correlation was found between PEEP-induced lung volume change measured by P-V curves and LUS change (r =0.82,P < 0.01).A statistically significant correlation was found between LUS change and PEEP-induced increase in PaO2 (r =0.66,P < 0.01).Conclusion PEEP-induced lung volume change can be adequately estimated with bedside lung ultrasound.Since lung ultrasound cannot assess PEEP-induced lung hyperinflation,it should not be the sole method for PEEP titration.%目的 探讨床旁超声在机械通气患者呼气末正压(PEEP)诱导肺容积改变的评估价值.方法 选取2011年6月至2012年12月浙江大学医学院附属第二医院急诊监护室(EICU)内符合急性肺损伤(ALI)或ARDS并接受机械通气的患者,采用Taema XTEND系列呼吸机专利的压力容积曲线测定程序自动测定PEEP为12、8、4、0 cmH2O(1 cmH2O =0.098 kPa)时的压力容积曲线,得到不同PEEP水平下的呼气末肺容积(EELV)并计算呼气末肺容积变化(△EELV),根据△EELV变化确定合适PEEP,在呼吸机测定压力容积曲线的同时使用床旁超声评估肺容积变化,计算肺部超声评分(LUS)及肺部超声评分变化(△LUS),相关计量数据进

  2. Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly

    Directory of Open Access Journals (Sweden)

    Brito AF

    2014-12-01

    Full Text Available Aline de Freitas Brito,1 Caio Victor Coutinho de Oliveira,2 Maria do Socorro Brasileiro-Santos,1 Amilton da Cruz Santos1 1Physical Education Department, 2Research Laboratory for Physical Training Applied to Performance and Health, Federal University of Paraíba, João Pessoa, Brazil Background: The purpose of this study was to evaluate the effect of two sessions of resistance exercise with different volumes on post-exercise hypotension, forearm blood flow, and forearm vascular resistance in hypertensive elderly subjects.Methods: The study was conducted with ten hypertensive elderly (65±3 years, 28.7±3 kg/m2 subjected to three experimental sessions, ie, a control session, exercise with a set (S1, and exercise with three sets (S3. For each session, the subjects were evaluated before and after intervention. In the pre-intervention period, blood pressure, forearm blood flow, and forearm vascular resistance were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same time period. Both S1 and S3 comprised a set of ten repetitions of ten exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (post-intervention in the supine position.Results: Post-exercise hypotension was greater in S3 than in S1 (systolic blood pressure, −26.5±4.2 mmHg versus −17.9±4.7 mmHg; diastolic blood pressure, −13.8±4.9 mmHg versus −7.7±5 mmHg, P<0.05. Similarly, forearm blood flow and forearm vascular resistance changed significantly in both sessions with an increase and decrease, respectively, that was more evident in S3 than in S1 (P<0.05.Conclusion: Resistance exercises with higher volume were more effective in causing post-exercise hypotension, being accompanied by an increase in forearm blood flow and a reduction of forearm vascular

  3. Magnetic resonance velocity imaging derived pressure differential using control volume analysis

    Directory of Open Access Journals (Sweden)

    Cohen Benjamin

    2011-03-01

    Full Text Available Abstract Background Diagnosis and treatment of hydrocephalus is hindered by a lack of systemic understanding of the interrelationships between pressures and flow of cerebrospinal fluid in the brain. Control volume analysis provides a fluid physics approach to quantify and relate pressure and flow information. The objective of this study was to use control volume analysis and magnetic resonance velocity imaging to non-invasively estimate pressure differentials in vitro. Method A flow phantom was constructed and water was the experimental fluid. The phantom was connected to a high-resolution differential pressure sensor and a computer controlled pump producing sinusoidal flow. Magnetic resonance velocity measurements were taken and subsequently analyzed to derive pressure differential waveforms using momentum conservation principles. Independent sensor measurements were obtained for comparison. Results Using magnetic resonance data the momentum balance in the phantom was computed. The measured differential pressure force had amplitude of 14.4 dynes (pressure gradient amplitude 0.30 Pa/cm. A 12.5% normalized root mean square deviation between derived and directly measured pressure differential was obtained. These experiments demonstrate one example of the potential utility of control volume analysis and the concepts involved in its application. Conclusions This study validates a non-invasive measurement technique for relating velocity measurements to pressure differential. These methods may be applied to clinical measurements to estimate pressure differentials in vivo which could not be obtained with current clinical sensors.

  4. Relative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery.

    Science.gov (United States)

    Breukers, Rose-Marieke B G E; Trof, Ronald J; de Wilde, Rob B P; van den Berg, Paul C M; Twisk, Jos W R; Jansen, Jos R C; Groeneveld, Johan

    2009-01-01

    Cardiac function may differ after valvular (VS) and coronary artery (CAS) surgery and this may affect assessment of fluid responsiveness. The aim of the study was to compare VS and CAS in the value of cardiac filling pressures and volumes herein. There were eight consecutive patients after VS and eight after CAS, with femoral and pulmonary artery catheters in place. In each patient, five sequential fluid loading steps of 250 ml of colloid each were done. We measured central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP) and, by transpulmonary thermodilution, cardiac index (CI) and global end-diastolic (GEDVI) and intrathoracic blood volume (ITBVI) indices. Fluid responsiveness was defined by a CI increase >5% or >10% per step. Global ejection fraction was lower and PAOP was higher after VS than CAS. In responding steps after VS (n=9-14) PAOP and volumes increased, while CVP and volumes increased in responding steps (n=12-19) after CAS. Baseline PAOP was lower in responding steps after VS only. Hence, baseline PAOP as well as changes in PAOP and volumes were of predictive value after VS and changes in CVP and volumes after CAS, in receiver operating characteristic curves. After VS, PAOP and volume changes equally correlated to CI changes. After CAS, only changes in CVP and volumes correlated to those in CI. While volumes are equally useful in monitoring fluid responsiveness, the predictive and monitoring value of PAOP is greater after VS than after CAS. In contrast, the CVP is of similar value as volume measurements in monitoring fluid responsiveness after CAS. The different value of pressures rather than of volumes between surgery types is likely caused by systolic left ventricular dysfunction in VS. The study suggests an effect of systolic cardiac function on optimal parameters of fluid responsiveness and superiority of the pulmonary artery catheter over transpulmonary dilution, for haemodynamic monitoring of VS patients.

  5. Cardiac output assessment using oxygen consumption estimated from the left ventricular pressure-volume area.

    Science.gov (United States)

    Negroni, Jorge A; Lascano, Elena C; Bertolotti, Alejandro M; Gómez, Carmen B; Rodríguez Correa, Carlos A; Favaloro, Roberto R

    2010-01-01

    Use of a majority of structural variables (age, sex, height) to estimate oxygen consumption in the calculation of cardiac output (CO) by the Fick principle does not account for changes in physiological conditions. To improve this limitation, oxygen consumption was estimated based on the left ventricular pressure-volume area. A pilot study with 10 patients undergoing right cardiac catheterization showed that this approach was successful to estimate CO (r=0,73, vs. thermodilution measured CO). Further essays changing end-diastolic-volume in the pressure-volume area formula by body weight or body surface area showed that this last yielded the best correlation with the thermodilution measured CO (slope=1, ordinate =0.01 and r=0.93). These preliminary results indicate that use of a formula originated from the pressure-volume-area concept is a good alternative to estimate oxygen consumption for CO calculation.

  6. Cardiovascular regulatory response to lower body negative pressure following blood volume loss

    Science.gov (United States)

    Shimizu, M.; Ghista, D. N.; Sandler, H.

    1979-01-01

    An attempt is made to explain the cardiovascular regulatory responses to lower body negative pressure (LBNP) stress, both in the absence of and following blood or plasma volume loss, the latter being factors regularly observed with short- or long-term recumbency or weightlessness and associated with resulting cardiovascular deconditioning. Analytical expressions are derived for the responses of mean venous pressure and blood volume pooled in the lower body due to LBNP. An analysis is presented for determining the HR change due to LBNP stress following blood volume loss. It is concluded that the reduced orthostatic tolerance following long-term space flight or recumbency can be mainly attributed to blood volume loss, and that the associated cardiovascular responses characterizing this orthostatic intolerance is elicited by the associated central venous pressure response.

  7. Noninvasive respiratory support of juvenile rabbits by high-amplitude bubble continuous positive airway pressure.

    Science.gov (United States)

    Diblasi, Robert M; Zignego, Jay C; Tang, Dennis M; Hildebrandt, Jack; Smith, Charles V; Hansen, Thomas N; Richardson, C Peter

    2010-06-01

    Bubble continuous positive airway pressure (B-CPAP) applies small-amplitude, high-frequency oscillations in airway pressure (DeltaPaw) that may improve gas exchange in infants with respiratory disease. We developed a device, high-amplitude B-CPAP (HAB-CPAP), which provides greater DeltaPaw than B-CPAP provides. We studied the effects of different operational parameters on DeltaPaw and volumes of gas delivered to a mechanical infant lung model. In vivo studies tested the hypothesis that HAB-CPAP provides noninvasive respiratory support greater than that provided by B-CPAP. Lavaged juvenile rabbits were stabilized on ventilator nasal CPAP. The animals were then supported at the same mean airway pressure, bias flow, and fraction of inspired oxygen (FiO2) required for stabilization, whereas the bubbler angle was varied in a randomized crossover design at exit angles, relative to vertical, of 0 (HAB-CPAP0; equivalent to conventional B-CPAP), 90 (HAB-CPAP90), and 135 degrees (HAB-CPAP135). Arterial blood gases and pressure-rate product (PRP) were measured after 15 min at each bubbler angle. Pao2 levels were higher (p<0.007) with HAB-CPAP135 than with conventional B-CPAP. PaCO2 levels did not differ (p=0.073) among the three bubbler configurations. PRP with HAB-CPAP135 were half of the PRP with HAB-CPAP0 or HAB-CPAP90 (p=0.001). These results indicate that HAB-CPAP135 provides greater respiratory support than conventional B-CPAP does.

  8. Pressure-volume characteristics of aortas of harbor and Weddell seals.

    Science.gov (United States)

    Rhode, E A; Elsner, R; Peterson, T M; Campbell, K B; Spangler, W

    1986-07-01

    The mechanical properties of the radially enlarged proximal segment of the aorta of diving marine mammals was studied on 15 excised aortas of harbor seals and five aortas of Weddell seals. This was done by recording static pressure-volume relationships for the whole thoracic aorta, the aortic bulb, and the descending thoracic aorta and passive length-tension measurements of aortic strips. Aortic bulb volume distensibility was found to be much greater than that of the descending thoracic aorta or of an equivalent aortic segment of terrestrial mammals. The consequences were that the total potential energy and volume that may be stored within the aortic bulb is very large, with a capacity for storage of the stroke work of more than two normal heart beats and a volume of more than three times normal stroke volume. The aortic bulb has an average radius and wall thickness twice that of the descending aorta, but at any level of distension the wall stress (g/cm2) is the same throughout. The static mechanical properties of aortic strips from the bulb and descending thoracic aortas were not markedly different, so that the differences in the pressure-volume relationships are explained by differences in geometry of the two sections. The expanded aortic bulb functions through energy and volume storage actions and through uncoupling actions to maintain arterial pressures and stroke volume at near predive levels during a dive.

  9. Little pump that could : hydraulic submersible pump tackles low pressure, low fluid volume gas wells

    Energy Technology Data Exchange (ETDEWEB)

    Ross, E.

    2008-03-15

    A new pump designed by Global Energy Services was described. The pump was designed to address problems associated with downhole pumps in coalbed methane (CBM) wells. The hydraulic submersible pump (HSP) was designed to address issues related to artificial lift gas lock and solids. The pump has been installed at 35 CBM wells in western Canada as well as at natural gas wells with low pressures and low rates of water. The HSP technology was designed for use with wells between 0.01 cubic metres and 24 cubic metres per day of water. A single joystick in the surface unit is used to determine the amount of hydraulic oil delivered to the bottomhole pump when then determines the amounts of fluid produced. A 10-slot self-flushing sand screen is used to filter out particles of sand, coal, and cement. The pump also includes a hydraulic flow control valve to control water volumes. The HSP's positive displacement design makes it suitable for use in horizontal and deviated wells. The pump technology is currently being re-designed to handle larger volumes at deeper depths. 2 figs.

  10. Is aerobic workload positively related to ambulatory blood pressure?

    DEFF Research Database (Denmark)

    Korshøj, Mette; Clays, Els; Lidegaard, Mark

    2016-01-01

    PURPOSE: Cardiovascular disease is prevalent among workers with high levels of occupational physical activity. The increased risk may be due to a high relative aerobic workload, possibly leading to increased blood pressure. However, studies investigating the relation between relative aerobic...... workload and ambulatory blood pressure (ABP) are lacking. The aim was to explore the relationship between objectively measured relative aerobic workload and ABP. METHODS: A total of 116 cleaners aged 18-65 years were included after informed consent was obtained. A portable device (Spacelabs 90217...... relative aerobic workload and ABP were significant. CONCLUSIONS: Because workers may have an elevated relative aerobic workload for several hours each working day, this relationship may elucidate a mechanism behind the increased risk for cardiovascular disease among workers exposed to high levels...

  11. Different characteristics of ventilator application between tracheostomy- and noninvasive positive pressure ventilation patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Park, Donghwi; Lee, Goo Joo; Kim, Ha Young; Ryu, Ju Seok

    2017-03-01

    The aim of the study was to investigate the appropriate home ventilator settings for patients with amyotrophic lateral sclerosis (ALS).In total, 71 patients with ALS, who had received either a noninvasive positive pressure ventilation (NIPPV) or tracheostomy positive pressure ventilation (TPPV), were included. Accordingly, patients were divided into 2 groups (the TPPV and NIPPV groups). We retrospectively evaluated the values used in home ventilators for patients with ALS, who had maintained a stable level of CO2 on both the arterial blood gas analysis (ABGA) and transcutaneous blood gas monitoring. To measure the main outcome, we also investigated the actual body weight (ABW) and predicted body weight (PBW) of patients, and the following setting values of ventilators were also recorded: the inspired tidal volume (VTi), minute ventilation (MV), peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), and inspiratory time (Tins).VTi and MV showed a significantly positive correlation with both PBW and ABW of patients in the TPPV group. However, both VTi and MV had greater significant correlation with PBW than ABW in the TPPV group. In addition, VTi and MV did not show a significantly positive correlation with either PBW or ABW in the NIPPV group.In patients with ALS, PBW was more useful for predicting VTi and MV than ABW. Moreover, it will be helpful to know the differences of setting values between TPPV and NIPPV, especially because ALS patients are usually treated with TPPV due to the initial difficulties associated with NIPPV.

  12. Beat-by-beat analysis of cardiac output and blood pressure responses to short-term barostimulation in different body positions

    Science.gov (United States)

    Hildebrandt, Wulf; Schütze, Harald; Stegemann, J.

    Rapid quantification of the human baro-reflex control of heart rate has been achieved on a beat-by-beat basis using a neck-chamber with quick ECG-triggered pressure changes. Referring to recent findings on heart rate and stroke volume, the present study uses this technique to compare cardiac output as well as blood pressure changes in supine and upright position to investigate feedback effects and to confirm postural reflex modifications not revealed by RR-interval changes. A suction profile starting at +40 mmHg and running 7 steps of pressure decrease down to -65 mmHg was examined in 0° and 90° tilting position while beat-by-beat recordings were done of heart rate, stroke volume (impedance-cardiography) and blood pressure (Finapres tm) (n=16). The percentual heart rate decrease failed to be significantly different between positions. A suction-induced stroke volume increase led to a cardiac output almost maintained when supine and significantly increased when upright. A decrease in all blood pressure values was found during suction, except for systolic values in upright position which increased. Conclusively, (a) it is confirmed that different inotropy accounts for the seen gravitational effect on the cardiac output not represented by heart rate; (b) identical suction levels in different positions lead to different stimuli at the carotid receptor. This interference has to be considered in microgravity studies by beat-by-beat measurement of cardiac output and blood pressure.

  13. Early nasal continuous positive airway pressure in a cohort of the smallest infants in Denmark

    DEFF Research Database (Denmark)

    Hansen, Bo M; Esbjørn, Barbara Hoff; Greisen, G

    2004-01-01

    To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period.......To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period....

  14. 21 CFR 868.5965 - Positive end expiratory pressure breathing attachment.

    Science.gov (United States)

    2010-04-01

    ... attachment. 868.5965 Section 868.5965 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... Positive end expiratory pressure breathing attachment. (a) Identification. A positive end expiratory pressure (PEEP) breathing attachment is a device attached to a ventilator that is used to elevate...

  15. Leakage Characteristics of Dual-Cannula Fenestrated Tracheostomy Tubes during Positive Pressure Ventilation: A Bench Study

    OpenAIRE

    Thomas Berlet; Mathias Marchon

    2016-01-01

    This study compared the leakage characteristics of different types of dual-cannula fenestrated tracheostomy tubes during positive pressure ventilation. Fenestrated Portex® Blue Line Ultra®, TRACOE® twist, or Rüsch® Traceofix® tracheostomy tubes equipped with nonfenestrated inner cannulas were tested in a tracheostomy-lung simulator. Transfenestration pressures and transfenestration leakage rates were measured during positive pressure ventilation. The impact of different ventilation modes, air...

  16. Simulation of pore pressure accumulation under cyclic loading using Finite Volume Method

    DEFF Research Database (Denmark)

    Tang, Tian; Hededal, Ole

    2014-01-01

    This paper presents a finite volume implementation of a porous, nonlinear soil model capable of simulating pore pressure accumulation under cyclic loading. The mathematical formulations are based on modified Biot’s coupled theory by substituting the original elastic constitutive model with an adv...... mapping algorithm is used to calculate the stress and strain relation in each control volume level. Test cases show very good performance of the model.......This paper presents a finite volume implementation of a porous, nonlinear soil model capable of simulating pore pressure accumulation under cyclic loading. The mathematical formulations are based on modified Biot’s coupled theory by substituting the original elastic constitutive model...... with an advanced elastoplastic model suitable for describing monotonic as well as cyclic loading conditions. The finite volume method is applied to discretize these formulations. The resulting set of coupled nonlinear algebraic equations are then solved by a ’segregated’ solution procedure. An efficient return...

  17. Experimental Investigation of Pressure-volume-Temperature Mass Gauging Method Under Microgravity Condition by Parabolic Flight

    Science.gov (United States)

    Seo, Mansu; Park, Hana; Yoo, DonGyu; Jung, Youngsuk; Jeong, Sangkwon

    Gauging the volume or mass of liquid propellant of a rocket vehicle in space is an important issue for its economic feasibility and optimized design of loading mass. Pressure-volume-temperature (PVT) gauging method is one of the most suitable measuring techniques in space due to its simplicity and reliability. This paper presents unique experimental results and analyses of PVT gauging method using liquid nitrogen under microgravity condition by parabolic flight. A vacuum-insulated and cylindrical-shaped liquid nitrogen storage tank with 9.2 L volume is manufactured by observing regulation of parabolic flight. PVT gauging experiments are conducted under low liquid fraction condition from 26% to 32%. Pressure, temperature, and the injected helium mass into the storage tank are measured to obtain the ullage volume by gas state equation. Liquid volume is finally derived by the measured ullage volume and the known total tank volume. Two sets of parabolic flights are conducted and each set is composed of approximately 10 parabolic flights. In the first set of flights, the short initial waiting time (3 ∼ 5 seconds) cannot achieve sufficient thermal equilibrium condition at the beginning. It causes inaccurate gauging results due to insufficient information of the initial helium partial pressure in the tank. The helium injection after 12 second waiting time at microgravity condition with high mass flow rate in the second set of flights achieves successful initial thermal equilibrium states and accurate measurement results of initial helium partial pressure. Liquid volume measurement errors in the second set are within 11%.

  18. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy.

    Science.gov (United States)

    Sen, Oznur; Umutoglu, Tarik; Aydın, Nurdan; Toptas, Mehmet; Tutuncu, Ayse Cigdem; Bakan, Mefkur

    2016-01-01

    Pressure-controlled ventilation (PCV) is less frequently employed in general anesthesia. With its high and decelerating inspiratory flow, PCV has faster tidal volume delivery and different gas distribution. The same tidal volume setting, delivered by PCV versus volume-controlled ventilation (VCV), will result in a lower peak airway pressure and reduced risk of barotrauma. We hypothesized that PCV instead of VCV during laparoscopic surgery could achieve lower airway pressures and reduce the systemic stress response. Forty ASA I-II patients were randomly selected to receive either the PCV (Group PC, n = 20) or VCV (Group VC, n = 20) during laparoscopic cholecystectomy. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. General anesthesia with sevoflurane and fentanyl was employed to all patients. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O positive-end expiratory pressure (PEEP). Respiratory parameters were recorded before and 30 min after pneumoperitonium. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated 30 min after pneumoperitonium and 60 min after extubation. The P-peak levels observed before (18.9 ± 3.8 versus 15 ± 2.2 cmH2O) and during (23.3 ± 3.8 versus 20.1 ± 2.9 cmH2O) pneumoperitoneum in Group VC were significantly higher. Postoperative partial arterial oxygen pressure (PaO2) values are higher (98 ± 12 versus 86 ± 11 mmHg) in Group PC. Arterial carbon dioxide pressure (PaCO2) values (41.8 ± 5.4 versus 36.7 ± 3.5 mmHg) during pneumoperitonium and post-operative mean cortisol and insulin levels were higher in Group VC. When compared to VCV mode, PCV mode may improve compliance during pneumoperitoneum

  19. Topical negative pressure in managing severe peritonitis: A positive contribution?

    Institute of Scientific and Technical Information of China (English)

    Amin Ibrahim Amin; Irshad A Shaikh

    2009-01-01

    AIM: To assess the use of topical negative pressure (TNP) in the management of severe peritonitis.METHODS: This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP following laparotomy for severe peritonitis.RESULTS: There were 11 males with an average age of (59.3 ± 3.95) years. Nine had a perforated viscus,five had anastomotic leaks, three had iatrogenicbowel injury, and a further three had severe pelvic inflammatory disease. TNP and the VAC. Abdominal Dressing System were initially used. These were changed every two to three days. Abdominal closurewas achieved in 15/20 patients within 4.53 ± 1.64 d. One patient required relaparotomy due to residual sepsis. Two patients with severe faecal peritonitis due to perforated diverticular disease received primary anastomosis at second look laparotomy, as sepsis and their general condition improved. In the remaining 5/20 cases, the abdomen was left open due to bowel oedema and or abdominal wall oedema. Dressing was switched to TNP and VAC. GranuFoam.. Three of the five patients returned a few months later for abdominal wall reconstruction and restoration of intestinal continuity. Two patients developed intestinal fistulae. All 20 patients survived. CONCLUSION: The use of TNP is safe. Further studies are needed to assess its value in managing these difficult cases.

  20. Volume of supercooled water under pressure and the liquid-liquid critical point.

    Science.gov (United States)

    Mishima, Osamu

    2010-10-14

    The volume of water (H(2)O) was obtained at about 200-275 K and 40-400 MPa by using emulsified water. The plot of volume against temperature showed slightly concave-downward curvature at pressures higher than ≈200 MPa. This is compatible with the liquid-liquid critical-point hypothesis, but hardly with the singularity-free scenario. When the critical point is assumed to exist at ≈50 MPa and ≈223 K, the experimental volume and the derived compressibility are qualitatively described by the modified Fuentevilla-Anisimov scaling equation.

  1. Entropy and volume change of dissociation in tobacco mosaic virus probed by high pressure.

    Science.gov (United States)

    Bispo, Jose A C; Bonafe, Carlos F S; Joekes, Ines; Martinez, Ernesto A; Carvalho, Giovani B M; Norberto, Douglas R

    2012-12-27

    Virus dissociation and inactivation by high pressure have been extensively studied in recent decades. Pressure-induced dissociation of viral particles involves a reduction in the Gibbs free energy of dissociation and a negative change in volume. In this work, we investigated the combined effect of high pressure and temperature on the dissociation of tobacco mosaic virus (TMV). We assumed the presence of two states of TMV with different tendencies to dissociate. Thus one form presents a low tendency (L) and the other a high tendency (H) to dissociate. Based on the model described here, the L-H transition was favored by an increase in pressure and a decrease in temperature. The volume change of dissociation was pressure- and temperature-dependent, with a highly negative value of -80 mL/mol being recorded at 0 °C and atmospheric pressure. The entropy and enthalpy of dissociation were very temperature- and pressure-dependent, with values of entropy of 450 to -1300 kJ/mol and values of enthalpy of 5.5 × 10(4) to 2.4 × 10(4) kJ/mol. The dissociation of TMV was enthalpy-driven at all temperatures and pressures investigated. Based on these findings, we conclude that the model presented allows accurate predictions of viral dissociation behavior in different experimental conditions.

  2. Effects of flow amplitudes on intraprong pressures during bubble versus ventilator-generated nasal continuous positive airway pressure in premature infants.

    Science.gov (United States)

    Kahn, Doron J; Habib, Robert H; Courtney, Sherry E

    2008-11-01

    The goal were to characterize the flow dependence of bubble nasal continuous positive airway pressure delivery in a cohort of preterm infants and to compare the actual (delivered) intraprong continuous positive airway pressure with the intended (set) nasal continuous positive airway pressure for both ventilator-generated nasal continuous positive airway pressure and bubble nasal continuous positive airway pressure delivery. A range of set values and constant flow rates were studied in the same preterm infants. For 12 premature infants of pressures were measured at 3 increasing flow settings, repeated for set nasal continuous positive airway pressures (or desired immersion depths) of 4 and 6 cm H(2)O. Next, intraprong pressures were measured at bubble nasal continuous positive airway pressure expiratory tubing submersion depths and ventilator-generated nasal continuous positive airway pressure set expiratory pressures of 2, 3, 4, 5, and 7 cm H(2)O while the flow rate was held constant. Actual (delivered) intraprong pressure during bubble nasal continuous positive airway pressure delivery was highly flow dependent and increased as the flow rate increased. During ventilator-generated nasal continuous positive airway pressure delivery, actual pressure at the nasal prongs closely approximated the pressure set at the ventilator. During bubble nasal continuous positive airway pressure delivery at constant flow rate, the average delivered prong pressure was 1.3 cm H(2)O (range: 0.5-2.2 cm H(2)O) higher than that set through submersion of the expiratory tubing, and the relative difference between the set and actual pressures increased at lesser immersion depths. Prong pressure during bubble nasal continuous positive airway pressure delivery is highly variable and depends on the interaction of submersion depth and flow amplitudes.

  3. Pressure ratio effects on self-similar scalar mixing of high-pressure turbulent jets in a pressurized volume

    Science.gov (United States)

    Ruggles, Adam; Pickett, Lyle; Frank, Jonathan

    2014-11-01

    Many real world combustion devices model fuel scalar mixing by assuming the self-similar argument established in atmospheric free jets. This allows simple prediction of the mean and rms fuel scalar fields to describe the mixing. This approach has been adopted in super critical liquid injections found in diesel engines where the liquid behaves as a dense fluid. The effect of pressure ratio (injection to ambient) when the ambient is greater than atmospheric pressure, upon the self-similar collapse has not been well characterized, particularly the effect upon mixing constants, jet spreading rates, and virtual origins. Changes in these self-similar parameters control the reproduction of the scalar mixing statistics. This experiment investigates the steady state mixing of high pressure ethylene jets in a pressurized pure nitrogen environment for various pressure ratios and jet orifice diameters. Quantitative laser Rayleigh scattering imaging was performed utilizing a calibration procedure to account for the pressure effects upon scattering interference within the high-pressure vessel.

  4. Thermodynamic analysis of energy density in pressure retarded osmosis: The impact of solution volumes and costs

    Energy Technology Data Exchange (ETDEWEB)

    Reimund, Kevin K. [Univ. of Connecticut, Storrs, CT (United States). Dept. of Chemical and Biomolecular Engineering; McCutcheon, Jeffrey R. [Univ. of Connecticut, Storrs, CT (United States). Dept. of Chemical and Biomolecular Engineering; Wilson, Aaron D. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-08-01

    A general method was developed for estimating the volumetric energy efficiency of pressure retarded osmosis via pressure-volume analysis of a membrane process. The resulting model requires only the osmotic pressure, π, and mass fraction, w, of water in the concentrated and dilute feed solutions to estimate the maximum achievable specific energy density, uu, as a function of operating pressure. The model is independent of any membrane or module properties. This method utilizes equilibrium analysis to specify the volumetric mixing fraction of concentrated and dilute solution as a function of operating pressure, and provides results for the total volumetric energy density of similar order to more complex models for the mixing of seawater and riverwater. Within the framework of this analysis, the total volumetric energy density is maximized, for an idealized case, when the operating pressure is π/(1+√w⁻¹), which is lower than the maximum power density operating pressure, Δπ/2, derived elsewhere, and is a function of the solute osmotic pressure at a given mass fraction. It was also found that a minimum 1.45 kmol of ideal solute is required to produce 1 kWh of energy while a system operating at “maximum power density operating pressure” requires at least 2.9 kmol. Utilizing this methodology, it is possible to examine the effects of volumetric solution cost, operation of a module at various pressure, and operation of a constant pressure module with various feed.

  5. Does Incremental Positioning (Weight Shifts) Reduce Pressure Injuries in Critical Care Patients?

    Science.gov (United States)

    Krapfl, Lee Ann; Langin, Julia; Pike, Caitlin A; Pezzella, Patricia

    Incremental positioning or weight shifts are often suggested as an alternative to standard repositioning/turning in critical care patients deemed clinically unstable. This evidence-based report card reviews whether incremental positioning and/or weight shifts reduce hospital-acquired sacral/buttocks pressure injuries in critical care patients deemed too unstable to turn. A scoping review of the literature was conducted for studies related to repositioning and hospital-acquired pressure injuries in high-risk, critical care patients. The databases searched were CINAHL, EMBASE, and PubMed. Key words used in the search were "intensive care," "critical care," "pressure ulcer(s)," "pressure injury(ies)," "pressure sore(s)," "turn(s)," "turning," "shift(s)," "shifting," "position(s)," OR "positioning, cardiopulmonary support." The search yielded 183 articles. The search was then narrowed to those published within the past 10 years, yielding 35 citations. Following title and abstract review, 5 studies were identified that met inclusion criteria; an additional 13 articles were found by ancestry and hand-searching. No evidence was identified that incremental positioning and/or weight shifts reduce hospital-acquired sacral/buttocks pressure injuries in critical care patients deemed too unstable to turn. In addition, no evidence was found that incremental positioning and/or weight shifts affect interface pressure on the sacrum/buttocks. However, there was evidence that incremental positioning and/or weight shifts do impact gravitational equilibrium. Despite the paucity of evidence, incremental positioning and/or weight shifts are recommended as an intervention in critical care patients deemed too unstable to turn. Further research is needed to examine whether incremental positioning and/or weight shifts are effective in reducing pressure injuries in critical care patients.

  6. [Initiation of therapy in the sleep apnea syndrome using continuous positive pressure respiration].

    Science.gov (United States)

    Sonka, K; Kucerová, O; Hoskovec, P; Nevsímalová, S

    1994-09-26

    Continuous positive airway pressure is the most important therapeutic method of sleep apnea syndrome (SAS). The prerequisite for its initiation is assessment of the optimal positive pressure and adaptation of the patient to this treatment. The basic criterium for assessment of positive pressure is elimination of apnoic intervals. The objective of the present work was to evaluate the optimal positive pressure CPAP according to the continuity of sleep and the appearance of an abnormally long (longer than 30 mins.) episode of REM sleep ("REM rebound"). CPAP was indicated in 13 patients with SAS (12 men, 1 woman), mean age 52.1 +/- 8.8 (SD) years, mean body mass index (BMI) 37.4 +/- 10.5. Severe cases of SAS were involved and/or SAS associated with other diseases (acromegaly-2, hypertension-8, IHD-4, chronic bronchopulmonary obstruction-3, and stroke-1). During one-night polysomnographic monitoring gradually the CPAP pressure was increased. Optimal positive pressure was signalized in addition to indicators of ventilation by uninterrupted sleep and "REM rebound". For treatment equipment of SEFAM Co. was used: 2x Pression+, 7x REM+, 4x REM+Control. Two patients refused CPAP treatment during the adaptation night. Eleven patients accepted CPAP treatment. The mean positive pressure value was 10.4 +/- 3.0 mbar. Assessment based on "REM rebound" was possible in six patients and based on continuity in 5 patients. Later pressure changes were called for in one patient (during adaptation he did not have "REM rebound"). Assessment of the optimal CPAP pressure as the lowest positive pressure compatible with regular breathing, as well as stabilized normal oxygen saturation of peripheral blood, continuous sleep and possibly "rebound" REM sleep proved useful.

  7. Non-pharmacological heart failure therapies : evaluation by ventricular pressure-volume loops

    NARCIS (Netherlands)

    Tulner, Sven Arjen Friso

    2006-01-01

    In this thesis, we evaluated the acute and chronic hemodynamic effects of non-pharmacological heart failure therapies. In particular, the effects of surgical treatment and biventricular pacing therapy were investigated by left ventricular pressure-volume loop analyses. We demonstrated that restrict

  8. Rapid die manufacturing - high pressure casting of low volume non ferrous metals components

    CSIR Research Space (South Africa)

    Pereira, MFV

    2006-11-01

    Full Text Available Pressure Casting of Low Volume Non Ferrous Metals Components Date: 2 November 2006 Slide 2 © CSIR 2006 www.csir.co.za Introduction to RPT • Rapid Prototyping Techniques (RPT) generally used for non functional prototypes • RPT...

  9. Assessment of respiratory system compliance with electrical impedance tomography using a positive end-expiratory pressure wave maneuver during pressure support ventilation: a pilot clinical study.

    Science.gov (United States)

    Becher, Tobias H; Bui, Simon; Zick, Günther; Bläser, Daniel; Schädler, Dirk; Weiler, Norbert; Frerichs, Inéz

    2014-12-10

    Assessment of respiratory system compliance (Crs) can be used for individual optimization of positive end-expiratory pressure (PEEP). However, in patients with spontaneous breathing activity, the conventional methods for Crs measurement are inaccurate because of the variable muscular pressure of the patient. We hypothesized that a PEEP wave maneuver, analyzed with electrical impedance tomography (EIT), might be suitable for global and regional assessment of Crs during assisted spontaneous breathing. After approval of the local ethics committee, we performed a pilot clinical study in 18 mechanically ventilated patients (61 ± 16 years (mean ± standard deviation)) who were suitable for weaning with pressure support ventilation (PSV). For the PEEP wave, PEEP was elevated by 1 cmH2O after every fifth breath during PSV. This was repeated five times, until a total PEEP increase of 5 cmH2O was reached. Subsequently, PEEP was reduced in steps of 1 cmH2O in the same manner until the original PEEP level was reached. Crs was calculated using EIT from the global, ventral and dorsal lung regions of interest. For reference measurements, all patients were also examined during controlled mechanical ventilation (CMV) with a low-flow pressure-volume maneuver. Global and regional Crs(low-flow) was calculated as the slope of the pressure-volume loop between the pressure that corresponded to the selected PEEP and PEEP +5 cmH2O. For additional reference, Crs during CMV (Crs(CMV)) was calculated as expired tidal volume divided by the difference between airway plateau pressure and PEEP. Respiratory system compliance calculated from the PEEP wave (Crs(PEEP wave)) correlated closely with both reference measurements (r = 0.79 for Crs(low-flow) and r = 0.71 for Crs(CMV)). No significant difference was observed between the mean Crs(PEEP wave) and the mean Crs(low-flow). However, a significant bias of +17.1 ml/cmH2O was observed between Crs(PEEP wave) and Crs(CMV). Analyzing a PEEP wave

  10. Positive end-expiratory pressure and variable ventilation in lung-healthy rats under general anesthesia.

    Directory of Open Access Journals (Sweden)

    Luciana M Camilo

    Full Text Available OBJECTIVES: Variable ventilation (VV seems to improve respiratory function in acute lung injury and may be combined with positive end-expiratory pressure (PEEP in order to protect the lungs even in healthy subjects. We hypothesized that VV in combination with moderate levels of PEEP reduce the deterioration of pulmonary function related to general anesthesia. Hence, we aimed at evaluating the alveolar stability and lung protection of the combination of VV at different PEEP levels. DESIGN: Randomized experimental study. SETTING: Animal research facility. SUBJECTS: Forty-nine male Wistar rats (200-270 g. INTERVENTIONS: Animals were ventilated during 2 hours with protective low tidal volume (VT in volume control ventilation (VCV or VV and PEEP adjusted at the level of minimum respiratory system elastance (Ers, obtained during a decremental PEEP trial subsequent to a recruitment maneuver, and 2 cmH2O above or below of this level. MEASUREMENTS AND MAIN RESULTS: Ers, gas exchange and hemodynamic variables were measured. Cytokines were determined in lung homogenate and plasma samples and left lung was used for histologic analysis and diffuse alveolar damage scoring. A progressive time-dependent increase in Ers was observed independent on ventilatory mode or PEEP level. Despite of that, the rate of increase of Ers and lung tissue IL-1 beta concentration were significantly lower in VV than in VCV at the level of the PEEP of minimum Ers. A significant increase in lung tissue cytokines (IL-6, IL-1 beta, CINC-1 and TNF-alpha as well as a ventral to dorsal and cranial to caudal reduction in aeration was observed in all ventilated rats with no significant differences among groups. CONCLUSIONS: VV combined with PEEP adjusted at the level of the PEEP of minimal Ers seemed to better prevent anesthesia-induced atelectasis and might improve lung protection throughout general anesthesia.

  11. Positive coping styles and perigenual ACC volume: two related mechanisms for conferring resilience?

    Science.gov (United States)

    Holz, Nathalie E; Boecker, Regina; Jennen-Steinmetz, Christine; Buchmann, Arlette F; Blomeyer, Dorothea; Baumeister, Sarah; Plichta, Michael M; Esser, Günter; Schmidt, Martin; Meyer-Lindenberg, Andreas; Banaschewski, Tobias; Brandeis, Daniel; Laucht, Manfred

    2016-05-01

    Stress exposure has been linked to increased rates of depression and anxiety in adults, particularly in females, and has been associated with maladaptive changes in the anterior cingulate cortex (ACC), which is an important brain structure involved in internalizing disorders. Coping styles are important mediators of the stress reaction by establishing homeostasis, and may thus confer resilience to stress-related psychopathology. Anatomical scans were acquired in 181 healthy participants at age 25 years. Positive coping styles were determined using a self-report questionnaire (German Stress Coping Questionnaire, SVF78) at age 22 years. Adult anxiety and depression symptoms were assessed at ages 22, 23 and 25 years with the Young Adult Self-Report. Information on previous internalizing diagnoses was obtained by diagnostic interview (2-19 years). Positive coping styles were associated with increased ACC volume. ACC volume and positive coping styles predicted anxiety and depression in a sex-dependent manner with increased positive coping and ACC volume being related to lower levels of psychopathology in females, but not in males. These results remained significant when controlled for previous internalizing diagnoses. These findings indicate that positive coping styles and ACC volume are two linked mechanisms, which may serve as protective factors against internalizing disorders. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  12. Volume and structural analysis of super-cooled water under high pressure

    Science.gov (United States)

    Duki, Solomon F.; Tsige, Mesfin

    2012-02-01

    Motivated by recent experimental study of super-cooled water at high pressure [1], we performed atomistic molecular dynamic simulations study on bulk water molecules at isothermal-isobaric ensemble. These simulations are performed at temperatures that range from 40 K to 380 K using two different cooling rates, 10K/ns and 10K/5ns, and pressure that ranges from 1atm to 10000 atm. Our analysis for the variation of the volume of the bulk sample against temperature indicates a downward concave shape for pressures above certain values, as reported in [1]. The same downward concave behavior is observed at high pressure on the mean-squared-displacements (MSD) of the water molecules when the MSD is plotted against time. To get further insight on the effect of the pressure on the sample we have also performed a structural analysis of the sample.[4pt] [1] O. Mishima, J. Chem. Phys. 133, 144503 (2010);

  13. [Value of dynamic arterial elastance in the predication of arterial pressure response to volume loading in shock patients].

    Science.gov (United States)

    Gong, Mao-lei; Liu, Da-wei; Wang, Xiao-ting; Chen, Xiu-kai

    2013-05-07

    To explore the value of dynamic arterial elastance (Eadyn) in the predication of arterial pressure response to volume loading in shock patients. A total of 32 patients with pulse indicator continuous cardiac output (PICCO) monitoring at our intensive care unit from January 2011 to December 2012 were retrospectively studied. The decision of fluid replacement was based upon the presence of shock (mean arterial pressure (MAP) ≤ 65 mm Hg, systolic arterial pressure arterial pressure response to volume loading. Significantly different between MAP responders and MAP nonresponders, baseline Eadyn was an effective predictor of MAP increase after volume loading. The area under the ROC curve was 0.95 for the prediction of volume loading on MAP for Eadyn at baseline (P 0.85 predicted a MAP increase after volume administration with a sensitivity of 89.5% and a specificity of 92.3%. Baseline Eadyn may predict accurately arterial pressure response in MAP to volume loading in shock patients.

  14. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension

    Institute of Scientific and Technical Information of China (English)

    YANG Yi; LI Yang; LIU Song-qiao; LIU Ling; HUANG Ying-zi; GUO Feng-mei; QIU Hai-bo

    2013-01-01

    Background Intra-abdominal hypertension (IAH) is common in acute respiratory distress syndrome (ARDS) patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure (PEEP).We investigated the effect of PEEP titrated by transpulmonary pressure (Ptp) on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol.Methods ARDS patients admitted to the intensive care unit (ICU) of the Zhongda Hospital were enrolled.Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol.Respiratory mechanics,gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round.IAH was defined as intra-abdominal pressure of 12 mmHg or more.Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled.PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH ((17.3±2.6) cmH2O vs.(6.3±1.6)cmH2O and without IAH ((9.5±2.1) cmH2O vs.(7.8±1.9) cmH2O).Arterial pressure of O2/fraction of inspired oxygen (PaO2/FiO2)was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH ((27.2±4.0) cmHg vs.(20.9± 5.0) cmHg.But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH.In ARDS patients with IAH,static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol.In ARDS patients with IAH,central venous pressure (CVP) was higher during PEEP titrated by Ptp than byARDSnet protocol.Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.

  15. Effect of Positive End-Expiratory Pressure on the Sonographic Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure during Robot-Assisted Laparoscopic Prostatectomy: A Randomized Controlled Trial

    Science.gov (United States)

    Chin, Ji-Hyun; Kim, Wook-Jong; Lee, Joonho; Han, Yun A.; Lim, Jinwook; Hwang, Jai-Hyun; Cho, Seong-Sik

    2017-01-01

    Background Positive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy. Methods After anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19). The sonographic optic nerve sheath diameter was measured prior to skin incision, 5 min and 30 min after pneumoperitoneum and the Trendelenburg position, and at the end of surgery. The study endpoint was the difference in the sonographic optic nerve sheath diameter 5 min after pneumoperitoneum and the Trendelenburg position between the ZEEP and PEEP groups. Results Optic nerve sheath diameters 5 min after pneumoperitoneum and the Trendelenburg position did not significantly differ between the groups [least square mean (95% confidence interval); 4.8 (4.6–4.9) mm vs 4.8 (4.7–5.0) mm, P = 0.618]. Optic nerve sheath diameters 30 min after pneumoperitoneum and the Trendelenburg position also did not differ between the groups [least square mean (95% confidence interval); 4.5 (4.3–4.6) mm vs 4.5 (4.4–4.6) mm, P = 0.733]. Conclusions An 8 cmH2O PEEP application under low tidal volume ventilation does not induce an increase in the optic nerve sheath diameter during pneumoperitoneum combined with the steep Trendelenburg position, suggesting that there might be no detrimental effects of PEEP on the intracranial pressure during robot-assisted laparoscopic prostatectomy. Trial Registration ClinicalTrial.gov NCT02516566 PMID:28107408

  16. Randomized trial of prongs or mask for nasal continuous positive airway pressure in preterm infants.

    LENUS (Irish Health Repository)

    Kieran, Emily A

    2012-11-01

    To determine whether nasal continuous positive airway pressure (NCPAP) given with nasal prongs compared with nasal mask reduces the rate of intubation and mechanical ventilation in preterm infants within 72 hours of starting therapy.

  17. EFFECT OF POSITIVE EXPIRATORY PRESSURE ON BREATHING PATTERN IN HEALTHY-SUBJECTS

    NARCIS (Netherlands)

    VANDERSCHANS, CP; DEJONG, W; DEVRIES, G; POSTMA, DS; KOETER, GH; VANDERMARK, TW

    1993-01-01

    The purpose of this study was to register breathing patterns, in healthy subjects, during breathing with a positive expiratory pressure. Integrated electromyographic (IEMG) activity of the following muscles was assessed: scalene muscle, parasternal muscle and abdominal muscles, using surface electro

  18. Selective indication for positive airway pressure (PAP in sleep-related breathing disorders with obstruction

    Directory of Open Access Journals (Sweden)

    Stasche, Norbert

    2006-10-01

    Full Text Available Positive airway pressure (PAP is the therapy of choice for most sleep-related breathing disorders (SRBD. A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP, most commonly used for symptomatic obstructive sleep apnoea (OSA without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP. Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV, which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal

  19. A MEMS-based passive hydrocephalus shunt for body position controlled intracranial pressure regulation.

    Science.gov (United States)

    Johansson, Staffan B; Eklund, Anders; Malm, Jan; Stemme, Göran; Roxhed, Niclas

    2014-08-01

    This paper reports a novel micro electro mechanical system (MEMS) valve with posture controlled flow characteristics for improved treatment of hydrocephalus, a disease that is characterized by elevated pressure in the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. In contrast to conventional differential pressure CSF valves, the CSF valve presented here features a third port which utilizes hydrostatic pressure from a pressure compensating catheter to adapt CSF drainage to optimized levels irrespective of body position. Prototypes have been fabricated using standard MEMS manufacturing processes and the experimental evaluation successfully showed that the flow rate was adjustable with a varying hydrostatic pressure on the third port. Measured data showed that flow rate was at near ideal values at laying body position and that the flow rate can be adjusted to optimal values at standing body position by selecting an appropriate length of the pressure compensating catheter. This is the first pressure balanced CSF valve intended for body position controlled CSF pressure regulation.

  20. Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital

    Directory of Open Access Journals (Sweden)

    Liria Yuri Yamauchi

    2012-07-01

    Full Text Available OBJECTIVES: To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis. METHODS: A prospective cohort study. RESULTS: Medical disorders (59% and elective surgery (21% were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55% and a decreased level of consciousness (20%. The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5 versus four (3-7 days]; they had lower levels of pH, HCO3 and base excess, and the FiO2 level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26 days vs. 8 (5-14 days], as well as a higher mortality rate (9 vs. 51%. There was an association between failure and mortality, which had an odds ratio (95% CI of 10.6 (5.93 -19.07. The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II$34, an inspiratory positive airway pressure level > 15 cmH2O and pH 34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.

  1. Changes in intracuff pressure of cuffed endotracheal tubes while positioning for adenotonsillectomy in children.

    Science.gov (United States)

    Olsen, Griffin H; Krishna, Senthil G; Jatana, Kris R; Elmaraghy, Charles A; Ruda, James M; Tobias, Joseph D

    2016-05-01

    When using cuffed endotracheal tubes (cETTs), changes in head and neck position can lead to changes in intracuff pressure. The aim of this study was to assess the combined effect of neck extension, shoulder roll placement, and Crowe-Davis retractor use during adenotonsillectomy on the intracuff pressure of cETTs in children. Patients 30 cm H2O. The intracuff pressure decreased in 28 patients (33.3%), while no change was noted in 10 patients (11.9%). Overall, the general trend was an increase in intracuff pressure from 15.9 ± 7.8 cm H2O to 18.9 ± 11.6 cm H2O. Both increases and decreases in the intracuff pressure may occur following positioning of the pediatric patient for adenotonsillectomy. An increase in intracuff pressure may result in a higher risk of damage to the tracheal mucosa. A decrease in the intracuff pressure can result in an air leak resulting in inadequate ventilation, increased risk of aspiration, and even predispose to airway fire if oxygen-enriched gases are used. Continuous intracuff pressure monitoring or rechecking the intracuff pressure after positioning for adenotonsillectomy may be indicated. © 2016 John Wiley & Sons Ltd.

  2. Effects of tongue position and lung volume on voluntary maximal tongue protrusion force in humans.

    Science.gov (United States)

    Saboisky, Julian P; Luu, Billy L; Butler, Jane E; Gandevia, Simon C

    2015-01-15

    Maximal voluntary protrusion force of the human tongue has not been examined in positions beyond the incisors or at different lung volumes. Tongue force was recorded with the tongue tip at eight positions relative to the incisors (12 and 4mm protrusion, neutral and 4, 12, 16, 24 and 32mm retraction) at functional residual capacity (FRC), total lung capacity (TLC) and residual volume (RV) in 15 healthy subjects. Maximal force occurred between 12mm and 32mm retraction (median 16mm). Maximum force at FRC was reproducible at the optimal tongue position across sessions (P=0.68). Across all positions at FRC the average force was highest at 24mm retraction (28.3±5.3N, mean±95% CI) and lowest at 12mm protrusion (49.1±4.6% maximum; Ptongue positions, maximal force was on average 9.3% lower at FRC than TLC and RV (range: 4.5-12.7% maximum, P<0.05). Retracted positions produce higher-force protrusions with a small effect of lung volume.

  3. Comparison of the dose to lung volume between supine and prone position during treatment planning

    Institute of Scientific and Technical Information of China (English)

    Yu Li; Huijun Xu ; Sujing Zhang; Xiaoliang Liu

    2015-01-01

    Objective The aim of the study was to compare the dose to lung volume in the supine and prone posi-tion while designing CyberKnife treatment plans to treat metastatic tumors in the spinous processes of the thoracic vertebrae, and of er a reference for reducing damage to normal tissues. Methods Nine cases of metastatic tumors in the spinous processes of the thoracic vertebrae were se-lected, and then we designed treatment plans based on the supine and prone positions and compared the results. Results In contrast with the treatment plan based on the prone position, the one for the supine position required 14862–36337 MU more; the lung D5% was 5.20–7.90 Gy higher; and the lung D20% was 2.61–5.73 Gy higher. The dif erence of dose to spine volume between the two plans was –2.21–2.67 Gy; to the skin volume was –3.93–7.85 Gy; and to the esophagus was 0.28–6.39 Gy. Conclusion The treatment plan based on the prone position of patients can better protect lung tissues than the one based on the supine position, and can also improve the availability of beams.

  4. Audiovisual biofeedback guided breath-hold improves lung tumor position reproducibility and volume consistency

    Directory of Open Access Journals (Sweden)

    Danny Lee, PhD

    2017-07-01

    Conclusions: This study demonstrated that audiovisual biofeedback can be used to improve the reproducibility and consistency of breath-hold lung tumor position and volume, respectively. These results may provide a pathway to achieve more accurate lung cancer radiation treatment in addition to improving various medical imaging and treatments by using breath-hold procedures.

  5. Effects of hypoproteinemia on renal hemodynamics, arterial pressure, and fluid volume

    Energy Technology Data Exchange (ETDEWEB)

    Manning, R.D. Jr.

    1987-01-01

    The effects of long-term hypoproteinemia on renal hemodynamics, arterial pressure, and fluid volume were studied in eight conscious dogs over a 34-day period. Plasma protein concentration (PPC) was decreased by daily plasmapheresis, and the effects of decreasing and increasing sodium intake were measured. By the 12th day of plasmapheresis PPC had decreased to 2.5 g/dl from a control value of 7.2 g/dl, mean arterial pressure had decreased to 78% of control, glomerular filtration rate (GFR) was 75.2% of control, and urinary sodium excretion was decreased. By day 18 of plasmapheresis, estimated renal plasma flow (ERPF) was decreased to 60% of control due to the decreased arterial pressure and an increase in renal vascular resistance. GFR and ERPF were determined from the total clearance of (/sup 125/I)iothalamate and (/sup 131/I)iodohippurate. Also, plasma renin activity and plasma aldosterone concentration were both increased, and the relationship between mean arterial pressure and urinary sodium excretion was distinctly shifted to the left along the arterial pressure axis. In contradistinction to acute experiments, chronic hypoproteinemia results in decreases in GFR, ERPF, and urinary sodium excretion and has marked effects on both fluid volume and arterial pressure regulation.

  6. 不同潮气量及呼气末正压机械通气对复苏后综合征患者的影响研究%Effect of Different Tidal Volumes and Mechanical Ventilation with Positive End-expiratory Pressure on Patients with Post-resuscitation Syndrome

    Institute of Scientific and Technical Information of China (English)

    熊华威; 黄亮; 曹春水; 杨继斌; 刘勇

    2013-01-01

    ,差异均有统计学意义(P<0.05).结论 低潮气量(6 ml/kg)+中等PEEP(6 cm H2O)可能是心肺复苏后24 h内较为合理的机械通气策略.%Objective To compare the effect of different tidal volumes ( TV ) and mechanical ventilation ( MV ) with positive end - expiratory pressure ( PEEP ) on patients with post - resuscitation syndrome ( PRS ), and discuss the ventilation strategy in cardiopulmonary resuscitation ( CPR ). Methods Thirty - six patients with PRS after cardiac arrest admitted in our hospital between December 2008 and December 2011 were randomly and evenly divided into group A, , group A2 , group A3, group B, , group B2 and group B3. Low TV ( 6 ml/kg ) plus low PEEP (3 cm H2O ) was applied to patients of group A,, low TV ( 6 ml/kg ) plus medium PEEP ( 6 cm H2O ) to group A2 , low TV ( 6 ml/kg ) plus high PEEP ( 12 cm H2O ) to group A3, routine TV ( 10 ml/kg ) plus low PEEP (3 cm H2O ) to group B, , routine TV ( 10 ml/kg ) plus medium PEEP ( 6 cm H2O ) to group B2 , and routine TV ( 10 ml/kg ) plus high PEEP ( 12 cm H2O ) to group B3. Timing was started after restoration of spontaneous circulation ( ROSC ). Patients'oxygenation index ( 01), blood gas analysis ( pH, PO2 , PCO2 ), central venous pressure ( CVP ), dopamine dose for basal MAP maintenance, heart rate ( HR ), hepatic and renal function ( ALT, TBiL, Cr), and Glasgow coma score ( GCS ) were measured and recorded at 1 h, 6 h, 12 h and 24 h. Results PO2 and 01 at 24 h was significantly lower than that of 1 h, 6 h and 12 h in all groups ( P <0. 05 ). PO2 and 01 at all time points in group A, was significantly lower than that of group A2 and A3, and that of group B, was lower than that of group B2 and B3 ( P < 0. 05 ). Dopamine dose for basal MAP maintenance, HR and CVP reached the highest at 6 h and decreased gradually during 12 ~ 24 h in all groups. Dopamine dose for basal MAP maintenance, HR and CVP at 6 h in all groups was significantly different from that of 1 h and 24 h ( P <0. 05

  7. Pressure-volume characteristics of lungs of rats during pregnancy and postpartum.

    Science.gov (United States)

    Faridy, E E

    1981-01-01

    Measurements of lung volumes in pregnant women show that the functional residual capacity and residual volume are reduced by 17-25% at late pregnancy. The present study was conducted to test the hypothesis that a decrease in FRC at pregnancy may result from an increase in retractive forces of the lung. The air and saline pressure-volume characteristics of excised lungs were studied in rats daily during pregnancy and the postpartum period. In comparison to non-pregnancy rats, the air PV measurements indicated that: (1) the retractive forces of the lungs were increased late in pregnancy resulting in reduction in both MLV (lung air volume at 40 cm H2O Ptp) and in V%10 (volume at 10/volume at 40 cm H2O Ptp X 100); (2) MLV was greater in lactating than in non-lactating and in non-pregnant rats. Lung saline volume was also greater in lactating than in non-lactating rats at early postpartum period. Lung phospholipids content was increased at late pregnancy and in lactating rats; (3) there was an increase in MLV and in V% immediately after delivery and 2-3 days after an abrupt cessation of lactation ("dried" rats). The minimal surface tension of lung lavages also decreased in these rats. A shift to that left of the air PV curve in "dried" rats suggest that under normal circumstances lung surface forces are not at their lowest.

  8. A Simple Mercury-Free Laboratory Apparatus to Study the Relationship between Pressure, Volume, and Temperature in a Gas

    Science.gov (United States)

    McGregor, Donna; Sweeney, William V.; Mills, Pamela

    2012-01-01

    A simple and inexpensive mercury-free apparatus to measure the change in volume of a gas as a function of pressure at different temperatures is described. The apparatus is simpler than many found in the literature and can be used to study variations in pressure, volume, and temperature. (Contains 1 table and 7 figures.)

  9. PRESSURE-VOLUME ANALYSIS OF THE LUNG WITH AN EXPONENTIAL AND LINEAR-EXPONENTIAL MODEL IN ASTHMA AND COPD

    NARCIS (Netherlands)

    BOGAARD, JM; OVERBEEK, SE; VERBRAAK, AFM; VONS, C; FOLGERING, HTM; VANDERMARK, TW; ROOS, CM; STERK, PJ

    1995-01-01

    The prevalence of abnormalities in lung elasticity in patients with asthma or chronic obstructive pulmonary disease (COPD) is still unclear, This might be due to uncertainties concerning the method of analysis of quasistatic deflation long pressure-volume curves. Pressure-volume curves were obtained

  10. A Simple Mercury-Free Laboratory Apparatus to Study the Relationship between Pressure, Volume, and Temperature in a Gas

    Science.gov (United States)

    McGregor, Donna; Sweeney, William V.; Mills, Pamela

    2012-01-01

    A simple and inexpensive mercury-free apparatus to measure the change in volume of a gas as a function of pressure at different temperatures is described. The apparatus is simpler than many found in the literature and can be used to study variations in pressure, volume, and temperature. (Contains 1 table and 7 figures.)

  11. Use of dynamic CT in acute respiratory distress syndrome (ARDS) with comparison of positive and negative pressure ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Helm, Emma; Babyn, Paul [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Talakoub, Omid; Alirezaie, Javad [Ryerson University, Department of Electrical and Computer Engineering, Toronto, ON (Canada); Grasso, Francesco; Engelberts, Doreen; Kavanagh, Brian P. [Hospital for Sick Children and the University of Toronto, Departments of Anesthesia and Critical Care Medicine and the Program in Pulmonary and Experimental Medicine, Toronto (Canada)

    2009-01-15

    Negative pressure ventilation via an external device ('iron lung') has the potential to provide better oxygenation with reduced barotrauma in patients with ARDS. This study was designed to see if oxygenation differences between positive and negative ventilation could be explained by CT. Six anaesthetized rabbits had ARDS induced by repeated saline lavage. Rabbits were ventilated with positive pressure ventilation (PPV) and negative pressure ventilation (NPV) in turn. Dynamic CT images were acquired over the respiratory cycle. A computer-aided method was used to segment the lung and calculate the range of CT densities within each slice. Volumes of ventilated lung and atelectatic lung were measured over the respiratory cycle. NPV was associated with an increased percentage of ventilated lung and decreased percentage of atelectatic lung. The most significant differences in ventilation and atelectasis were seen at mid-inspiration and mid-expiration (ventilated lung NPV=61%, ventilated lung PPV=47%, p<0.001; atelectatic lung NPV=10%, atelectatic lung PPV 19%, p<0.001). Aeration differences were not significant at end-inspiration. Dynamic CT can show differences in lung aeration between positive and negative ventilation in ARDS. These differences would not be appreciated if only static breath-hold CT was used. (orig.)

  12. Tongue resting pressure of the tongue anchorage pad in different body positions: a pilot study.

    Science.gov (United States)

    Zeng, J; Xu, K; Gao, X; Xu, T

    2015-06-01

    We designed a modified transpalatal arch (tongue anchorage pad, TAP) to help control the vertical dimension. This study aimed to evaluate its efficiency by measuring the tongue resting pressure at different anteroposterior positions of the TAP in the upright and supine positions and to investigate the effect of changes in body position. Our study recruited 17 volunteers with individual normal occlusion (4 males, 13 females, age 22-33 years). An individualised TAP was designed for each subject. With a miniature sensor (FSS1500NS) installed in the device, we measured the pressure at the level of the distal second premolar (PM2), the first molar (M1) and the second molar (M2) in both the upright and supine positions. Nonparametric analysis was applied with the level of significance set at 0.05. In the upright position, tongue pressures obtained at PM2, M1 and M2 were 183.94, 130.81 and 113.07 Pa, respectively, with the maximum value detected at PM2 (P = 0.001). While in the supine position, pressures of 187.03, 156.87 and 201.69 Pa were detected at the same sites, with significantly higher values for M1 (P = 0.002) and M2 (P = 0.004). Tongue resting pressure decreases from the anterior aspect to the posterior aspect in the upright position. In the supine position, the pressure is consistent across the midline with pressure enhancement at M1 and M2. As many questions remain about this appliance and appropriate intruding force, further clinical and basic studies are required prior to its clinical implementation.

  13. Assessing intravascular volume by difference in pulse pressure in pigs submitted to graded hemorrhage.

    Science.gov (United States)

    Pestel, Gunther J; Hiltebrand, Luzius B; Fukui, Kimiko; Cohen, Delphine; Hager, Helmut; Kurz, Andrea M

    2006-10-01

    We assessed changes in intravascular volume monitored by difference in pulse pressure (dPP%) after stepwise hemorrhage in an experimental pig model. Six pigs (23-25 kg) were anesthetized (isoflurane 1.5 vol%) and mechanically ventilated to keep end-tidal CO2 (etCO2) at 35 mmHg. A PA-catheter and an arterial catheter were placed via femoral access. During and after surgery, animals received lactated Ringer's solution as long as they were considered volume responders (dPP>13%). Then animals were allowed to stabilize from the induction of anesthesia and insertion of catheters for 30 min. After stabilization, baseline measurements were taken. Five percent of blood volume was withdrawn, followed by another 5%, and then in 10%-increments until death from exsanguination occurred. After withdrawal of 5% of blood volume, all pigs were considered volume responders (dPP>13%); dPP rose significantly from 6.1+/-3.3% to 19.4+/-4.2%. The regression analysis of stepwise hemorrhage revealed a linear relation between blood loss (hemorrhage in %) and dPP (y=0.99*x+14; R2=0.7764; P<.0001). In addition, dPP was the only parameter that changed significantly between baseline and a blood loss of 5% (P<0.01), whereas cardiac output, stroke volume, heart rate, MAP, central venous pressure, pulmonary artery occlusion pressure, and systemic vascular resistance, respectively, remained unchanged. We conclude that in an experimental hypovolemic pig model, dPP correlates well with blood loss.

  14. Positive Association Between Posterior Subgenual Cingulate and Pituitary Volumes in Psychotic Major Depression

    Directory of Open Access Journals (Sweden)

    Konstantina Vassilopoulou

    2015-03-01

    Full Text Available Posterior subgenual cingulate cortex has been consistently linked with the pathophysiology of major depression in both structural and functional brain imaging studies. Likewise, the hyperactivity of the hypothalamic-pituitary-adrenal axis in major depression is well established, especially in its psychotic subtype. Moreover, posterior subgenual cingulate cortex exerts an inhibitory effect on the hypothalamic-pituitary-adrenal axis. While studies show pituitary volume to be a valid marker of hypothalamic-pituitary-adrenal axis activity, none have investigated the volumetric relationships between posterior subgenual cingulate cortex and pituitary volume in subtypes of major depressive disorder, which was precisely the aim of our study. We hypothesized a differential volumetric relationship in psychotic depression. We assessed posterior subgenual cingulate and pituitary volume using Magnetic Resonance Imaging scanning and investigated their volumetric relationships in 39 patients with major depressive disorder (17 psychotic and 22 melancholic and 18 normal controls. We found strong positive correlations between both left and right posterior subgenual volumes and pituitary volume only in the psychotic depression group (left: rs=0.77, p<0.001, right: rs=0.67, p=0.003. These positive associations were confirmed by regression analyses controlling for patient’s age and type of medications. By contrast, no significant volumetric associations were detected in the groups of melancholic patients and normal controls. Our findings provide support to the hypothesis that posterior subgenual cingulate is differentially involved in the pathophysiology of psychotic symptoms in major depressive disorder.

  15. High intensity positive pressure ventilation and long term pulmonary function responses in severe stable COPD. A delicate and difficult balance.

    Science.gov (United States)

    Esquinas, Antonio M; Petroianni, Angelo

    2014-06-01

    Method to improve minute ventilation (MV) during spontaneous breathing (SB) in stable severe chronic obstructive pulmonary disease (COPD) have a great clinical relevant in long term outcome. In this scenario, recommendations of early use of high-Intensity non-invasive Positive pressure Ventilation (HI-NPPV) or intelligent Volume Assured Pressure (iVAP) Support in Hypercapnic COPD have been proposed by safe therapeutics options. We analyze in this letter, Ekkernkamp et al. study that described the effect of HI-NPPV compared with SB on MV in patients receiving long-term treatment. We consider that interpretation of relationships between ABG, functional parameters, and respiratory mechanics reported need clarifications. Further prospective large clinical trials identifying the best mode of ventilation according to the characteristics in severe stable COPD are necessary to balance an effective approach and response on clinical symptoms and long-term effects.

  16. Severe bronchopulmonary dysplasia improved by noninvasive positive pressure ventilation: a case report

    Directory of Open Access Journals (Sweden)

    Mann Christian

    2011-09-01

    Full Text Available Abstract Introduction This is the first report to describe the feasibility and effectiveness of noninvasive positive pressure ventilation in the secondary treatment of bronchopulmonary dysplasia. Case presentation A former male preterm of Caucasian ethnicity delivered at 29 weeks gestation developed severe bronchopulmonary dysplasia. At the age of six months he was in permanent tachypnea and dyspnea and in need of 100% oxygen with a flow of 2.0 L/minute via a nasal cannula. Intermittent nocturnal noninvasive positive pressure ventilation was then administered for seven hours daily. The ventilator was set at a positive end-expiratory pressure of 6 cmH2O, with pressure support of 4 cmH2O, trigger at 1.4 mL/second, and a maximum inspiratory time of 0.7 seconds. Over the course of seven weeks, the patient's maximum daytime fraction of inspired oxygen via nasal cannula decreased from 1.0 to 0.75, his respiratory rate from 64 breaths/minute to 50 breaths/minute and carbon dioxide from 58 mmHg to 44 mmHg. Conclusion Noninvasive positive pressure ventilation may be a novel therapeutic option for established severe bronchopulmonary dysplasia. In the case presented, noninvasive positive pressure ventilation achieved sustained improvement in ventilation and thus prepared our patient for safe home oxygen therapy.

  17. Influence of body position on the displacement of nasal prongs in preterm newborns receiving continuous positive airway pressure

    Science.gov (United States)

    Brunherotti, Marisa Afonso Andrade; Martinez, Francisco Eulógio

    2015-01-01

    Abstract Objective: To evaluate the influence of body position on the displacement of nasal prongs in preterm infants. Methods: This prospective, randomized, crossover study enrolled infants born at a mean gestational age of 29.7±2 weeks, birth weight of 1353±280g and 2.9±2.2 days of life, submitted to continuous positive airway pressure by nasal prongs. The main outcome was the number of times that the nasal prongs were displaced following infant positioning in the following body positions: prone, right lateral, left lateral, and supine, according to a pre-established random order. Moreover, cardiorespiratory variables (respiratory rate, heart rate, and oxygen saturation) were evaluated for each body position. Data for each position were collected every 10 min, over a period of 60 min. An occurrence was defined when the nasal prongs were displaced from the nostrils after 3 min in the desired position, requiring intervention of the examiner. Results: Among the 16 studied infants, the occurrence of nasal prong displacement was only observed in the prone position (9 infants - 56.2%) and in the left lateral position (2 infants - 12.5%). The number of times that the prongs were displaced was 11 in the prone position (7 within the first 10min) and 2 in the left lateral position (1 within the first 10min). No clinically significant changes were observed in the cardiorespiratory variables. Conclusions: Maintenance of the nasal prongs to provide adequate noninvasive respiratory support was harder in the prone position. PMID:26116326

  18. [Influence of body position on the displacement of nasal prongs in preterm newborns receiving continuous positive airway pressure].

    Science.gov (United States)

    Brunherotti, Marisa Afonso Andrade; Martinez, Francisco Eulógio

    2015-01-01

    To evaluate the influence of body position on the displacement of nasal prongs in preterm infants. This prospective, randomized, crossover study enrolled infants born at a mean gestational age of 29.7±2 weeks, birth weight of 1.353±280g and 2.9±2.2 days of life, submitted to continuous positive airway pressure by nasal prongs. The main outcome was the number of times that the nasal prongs were displaced following infant positioning in the following body positions: prone, right lateral, left lateral, and supine, according to a pre-established random order. Moreover, cardiorespiratory variables (respiratory rate, heart rate, and oxygen saturation) were evaluated for each body position. Data for each position were collected every 10 minutes, over a period of 60minutes. An occurrence was defined when the nasal prongs were displaced from the nostrils after 3 minutes in the desired position, requiring intervention of the examiner. Among the 16 studied infants, the occurrence of nasal prong displacement was only observed in the prone position (9 infants-56.2%) and in the left lateral position (2 infants-12.5%). The number of times that the prongs were displaced was 11 in the prone position (seven within the first 10minutes) and two in the left lateral position (one within the first 10minutes). No clinically significant changes were observed in the cardiorespiratory variables. Maintenance of the nasal prongs to provide adequate noninvasive respiratory support was harder in the prone position. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  19. Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    CHEN Hong; LIANG Bin-miao; XU Zhi-bo; TANG Yong-jiang; WANG Ke; XIAO Jun; YI Qun; SUN Jian; FENG Yu-lin

    2011-01-01

    Background The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient.The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change,lung function,health-related quality of life (HRQL),survival and mortality in severe stable COPD patients.Methods Randomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010.Two reviewers independently assessed study quality.Data were combined using Review Manager 5.0.Both pooled effects and 95% confidence intervals were calculated.Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included.NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures.The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26,-1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23,5.44) mmHg.There were significant improvements in dyspnea and sleep quality,but gained no benefits on lung function.The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV1)was 0.00 (0.29,0.29).And the benefits for exercise tolerance,mood,survival and mortality remained unclear.Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV,especially improvements in gas change,dyspnea and sleep quality.Studies of high methodological quality with large population,especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.

  20. The effects of positive end-expiratory pressure in alveolar recruitment during mechanical ventilation in pigs

    OpenAIRE

    Madke,Gabriel Ribeiro; Pilla,Eduardo Sperb; Sanchez,Pablo Geraldo; Foernges, Rafael; Grün, Gustavo; Vendrami,Giovani; Fontena,Eduardo; Andrade, Cristiano Feijó; Cardoso, Paulo Francisco Guerreiro

    2008-01-01

    PURPOSE: To evaluate the effects of alveolar recruitment based on mean airway pressure (MAP) on pig lungs submitted to thoracotomy through blood gas exchange and hemodynamic parameters. METHODS: Twelve pigs weighting approximately 25Kg were intubated and ventilated on volume controlled ventilation (tidal volume 10ml/Kg, respiratory rate 16min, FiO2 1.0, inspiratory:expiratory ratio 1:2, PEEP 5cmH2O). The animals were then randomized into two groups: control and left lateral thoracotomy. The P...

  1. Noninvasive Intracranial Volume and Pressure Measurements Using Ultrasound (Head and Spinal)

    Science.gov (United States)

    Hargens, Alan R.

    1999-01-01

    Prevention of secondary brain injuries following head trauma can be accomplished most easily when intracranial pressure (ICP) is monitored. However, current measurement techniques are invasive and thus not practical in the combat environment. The Pulsed Phase Lock Loop device, which was developed and patented by consultants Drs. Yost and Cantrell, uses a unique, noninvasive ultrasonic phase comparison method to measure slight changes in cranial volume which occur with changes in ICP. Year two studies included whole body head-up and head-down tilting effects on intracranial compliance and pressure in six healthy volunteers.

  2. Increasing inspiratory time exacerbates ventilator-induced lung injury during high-pressure/high-volume mechanical ventilation.

    Science.gov (United States)

    Casetti, Alfredo V; Bartlett, Robert H; Hirschl, Ronald B

    2002-10-01

    Ventilator-induced lung injury may be caused by overdistension of alveoli during high-pressure ventilation. In this study, we examined the effects of increasing inspiratory time on ventilator-induced lung injury. Sprague-Dawley rats were divided into four different groups with ten animals per group. Each group was then ventilated for 30 mins with one of four ventilator strategies. All groups were ventilated with an Fio2 of 1.0 and a positive end-expiratory pressure of 0 cm H2O. Group LoP was the negative control group and was ventilated with low pressures (peak inspiratory pressure = 12 cm H2O, rate = 30, and inspiratory time = 0.5 secs). Groups iT = 0.5, iT = 1.0, and iT = 1.5 were the experimental groups and were ventilated with high pressures (peak inspiratory pressure = 45 cm H2O, rate = 10, and inspiratory times = 0.5 secs, iT = 1.0 sec, and iT = 1.5 secs, respectively). Outcome measures included lung compliance, Pao /Fio ratio, wet/dry lung weight, and dry lung/body weight. Final static lung compliance (p =.0002) and Pao2/Fio2 (p =.001) decreased as inspiratory time increased. Wet/dry lung weights (p <.0001) and dry lung/body weights (p <.0001) increased as inspiratory time increased. Light microscopy revealed evidence of intra-alveolar edema and hemorrhage in the iT = 1.0 and iT = 1.5 animals but not the LoP and iT = 0.5 animals. Increasing inspiratory time during high-pressure/high-volume mechanical ventilation is associated with an increase in variables of lung injury.

  3. Amount of lifetime video gaming is positively associated with entorhinal, hippocampal and occipital volume.

    Science.gov (United States)

    Kühn, S; Gallinat, J

    2014-07-01

    Playing video games is a popular leisure activity among children and adults, and may therefore potentially influence brain structure. We have previously shown a positive association between probability of gray matter (GM) volume in the ventral striatum and frequent video gaming in adolescence. Here we set out to investigate structural correlates of video gaming in adulthood, as the effects observed in adolescents may reflect only a fraction of the potential neural long-term effects seen in adults. On magnetic resonance imaging (MRI) scans of 62 male adults, we computed voxel-based morphometry to explore the correlation of GM with the lifetime amount of video gaming (termed joystick years). We found a significant positive association between GM in bilateral parahippocamal region (entorhinal cortex) and left occipital cortex/inferior parietal lobe and joystick years (Pvideo game genres played, such as logic/puzzle games and platform games contributing positively, and action-based role-playing games contributing negatively. Furthermore, joystick years were positively correlated with hippocampus volume. The association of lifetime amount of video game playing with bilateral entorhinal cortex, hippocampal and occipital GM volume could reflect adaptive neural plasticity related to navigation and visual attention.

  4. Hypertonic/Hyperoncotic Resuscitation from Shock: Reduced Volume Requirement and Lower Intracranial Pressure

    Science.gov (United States)

    1989-10-01

    Volume 15, No. 4 ABSTRACTS OF PAPERS 433 INTRACRANIAL PRESSURE FOLLOWING RESUSCITATION FROM HEMORRHAGIC SHOCK John H. Whitley, Donald S. Prough, Michael ...SHOCK: COMPARISON OF FLUIDS John M. Whitley, PhD, Michael A. Olympio, MD, Donald S. Prough, MD Department of Anesthesia, Bowman Gray School of Medicine...fluid infused within the range of sodium and colloid concentrations examined in this study. In contrast, Gunnar et al.7’ 2 and Ducey et al.,8

  5. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index

    DEFF Research Database (Denmark)

    Henriksen, J H; Fuglsang, Stefan; Bendtsen, Flemming;

    2001-01-01

    Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40...... predictors of SV/PP (P index seems to reflect abnormalities in the arterial compliance of these patients....

  6. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index

    DEFF Research Database (Denmark)

    Fuglsang, S; Bendtsen, F; Christensen, E

    2001-01-01

    Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40...... predictors of SV/PP (P compliance is elevated in cirrhosis. A simplified SV/PP index seems to reflect abnormalities in the arterial compliance of these patients....

  7. Comparison of knee-high Mediven ulcer kit and Mediven Plus compression stockings: measurement of leg volume, interface pressure and static stiffness index changes

    Directory of Open Access Journals (Sweden)

    Győző Szolnoky

    2013-06-01

    Full Text Available Ulcer stockings are produced to have higher interface pressure and easier application compared to those of classic medical compression stockings. We aimed to compare volume decrease, pressure loss and stiffness index of a classical medical compression stocking and an ulcer stocking of the same interface pressure range in 10 patients with bilateral venous and 10 persons with lymphatic insufficiency. Interface pressure measurement in supine and standing positions and optoelectronic volumetry served for primary outcome variables. Both stockings were capable of inducing remarkable gradual volume reductions in different time points except classic stocking at 2 h in phleboedema care. Ulcer stocking pressures in lymph- and phleboedema were highly superior. In lymphedema a gradual interface pressure loss was attributed to both stockings regardless of body positions. Static stiffness indices did not differ statistically except classic stocking at baseline (P=0.0312 and 2 h (P=0.0082 comprising venous edema patients. Both stockings acted similarly but ulcer stocking had considerably higher interface pressures in each measurement and raised stiffness indices initially and the two-layer system facilitates donning therefore ulcer stocking could serve an alternative of classic medical compression stocking even in the treatment of leg edema.

  8. A switched energy saving position controller for variable-pressure electro-hydraulic servo systems.

    Science.gov (United States)

    Tivay, Ali; Zareinejad, Mohammad; Rezaei, S Mehdi; Baghestan, Keivan

    2014-07-01

    The electro-hydraulic servo system (EHSS) demonstrates a relatively low level of efficiency compared to other available actuation methods. The objective of this paper is to increase this efficiency by introducing a variable supply pressure into the system and controlling this pressure during the task of position tracking. For this purpose, an EHSS structure with controllable supply pressure is proposed and its dynamic model is derived from the basic laws of physics. A switching control structure is then proposed to control both the supply pressure and the cylinder position at the same time, in a way that reduces the overall energy consumption of the system. The stability of the proposed switching control system is guaranteed by proof, and its performance is verified by experimental testing.

  9. New parachute cuff and positive end-expiratory pressure to minimize tracheal injury and prevent aspiration.

    Science.gov (United States)

    Nordin, U; Lyttkens, L

    1979-01-01

    A new parachute cuff has been tested in combination with a positive end-expiratory pressure (PEEP) on mongrel dogs. During positive-pressure ventilation the intracuff and intratracheal pressures showed synchronous, identical pressure variations, and therefore theoretically with this type of cuff the pressure against the tracheal wall would be minimal. The cuff provided a seal against gas leakage from the lungs throughout the entire test period, i.e., for up to 7 h. To avoid aspiration of mouth contents during the passive exhalation phase, different amounts of PEEP were tested. A PEEP of 4.0--8.0 cm H2O always produced a seal against a column of fluid in the mouth exerting a hydrostatic pressure of 5.4--8.8 cm H2O against the cuff. This seal was maintained during the whole test period. No difference in sealing capacity was found when the cuff was used with a normal respiratory frequency (20/min) and with high-frequency positive-pressure ventilation (60/min). When the PEEP is eliminated, e.g., when the respirator is disconnected for suction of the endotracheal tube, the sealing effect will be abolished. As the cuff extends up into the larynx there will be no pooling of fluid above the cuff. The risk of aspiration can therefore be diminished by suction of oral cavity before disconnecting the respirator. With the use of the pneumatic valve principle together with high-frequency positive-pressure ventilation, an open respirator system can produce a continuous PEEP, thereby preventing aspiration even during suctioning of the tracheal tube.

  10. Pressure-induced volume expansion of zeolites in the natrolite family.

    Science.gov (United States)

    Lee, Yongjae; Vogt, Thomas; Hriljac, Joseph A; Parise, John B; Artioli, Gilberto

    2002-05-15

    Powder diffraction patterns of the zeolites natrolite (Na(16)Al(16)Si(24)O(80).16H(2)O), mesolite (Na(5.33)Ca(5.33)Al(16)Si(24)O(80).21.33H(2)O), scolecite (Ca(8)Al(16)Si(24)O(80).24H(2)O), and a gallosilicate analogue of natrolite (K(16)Ga(16)Si(24)O(80).12H(2)O), all crystallizing with a natrolite framework topology, were measured as a function of pressure up to 5.0 GPa with use of a diamond-anvil cell and a 200 microm focused monochromatic synchrotron X-ray beam. Under the hydrostatic conditions mediated by an alcohol and water mixture, all these materials showed an abrupt volume expansion (ca. 2.5% in natrolite) between 0.8 and 1.5 GPa without altering the framework topology. Rietveld refinements using the data collected on natrolite show that the anomalous swelling is due to the selective sorption of water from the pressure-transmission fluid expanding the channels along the a- and b-unit cell axes. This gives rise to a "superhydrated" phase of natrolite with an approximate formula of Na(16)Al(16)Si(24)O(80).32H(2)O, which contains hydrogen-bonded helical water nanotubes along the channels. In mesolite, which at ambient pressure is composed of ordered layers of sodium- and calcium-containing channels in a 1:2 ratio along the b-axis, this anomalous swelling is accompanied by a loss of the superlattice reflections (b(mesolite) = 3b(natrolite)). This suggests a pressure-induced order-disorder transition involving the motions of sodium and calcium cations either through cross-channel diffusion or within the respective channels. The powder diffraction data of scolecite, a monoclinic analogue of natrolite where all sodium cations are substituted by calcium and water molecules, reveal a reversible pressure-induced partial amorphization under hydrostatic conditions. Unlike the 2-dimensional swelling observed in natrolite and mesolite, the volume expansion of the potassium gallosilicate natrolite is 3-dimensional and includes the lengthening of the channel axis. In

  11. Volume and Pressure Delivery During Pediatric High-Frequency Oscillatory Ventilation.

    Science.gov (United States)

    Wong, Ronald; Deakers, Timothy; Hotz, Justin; Khemani, Robinder G; Ross, Patrick A; Newth, Christopher J

    2017-04-01

    Identify variables independently associated with delivered tidal volume (VT) and measured mean airway pressure during high-frequency oscillatory ventilation across the range of pediatric endotracheal tube sizes. In vitro study. Research laboratory. An in vitro bench model of the intubated pediatric respiratory system during high-frequency oscillatory ventilation was used to obtain delivered VT and mean airway pressure (in the distal lung) for various endotracheal tube sizes. Measurements were taken at different combinations of ventilator set mean airway pressure (Paw), amplitude (ΔP), frequency, and test lung compliance. Multiple regression analysis was used to construct multivariable models predicting delivered VT and mean airway pressure. Variables independently associated with higher delivered VT for all endotracheal tube sizes include higher ΔP (p frequency (p frequency and ΔP magnifies the delivered VT when ΔP is high and frequency is low (p frequency increases (p frequency in delivered VT and the effect of ΔP and frequency on delivered mean airway pressure. These results demonstrate the need to measure or estimate VT and delivered pressures during high-frequency oscillatory ventilation and may be useful in determining optimal strategies for lung protective ventilation during high-frequency oscillatory ventilation.

  12. Non-invasive positive pressure ventilation for acute asthma in children

    DEFF Research Database (Denmark)

    Korang, Steven Kwasi; Feinberg, Joshua; Wetterslev, Jørn

    2016-01-01

    BACKGROUND: Asthma is one of the most common reasons for hospital admission among children and constitutes a significant economic burden. Use of non-invasive positive pressure ventilation (NPPV) in the care of children with acute asthma has increased even though evidence supporting the intervention......: To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children with acute asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Group Specialised Register (CAGR). The Register contains trial reports identified through...... both studies as having high risk of bias; both trials assessed effects of bilateral positive airway pressure (BiPAP). Neither trial used continuous positive airway pressure (CPAP). Controls received standard care. Investigators reported no deaths and no serious adverse events (Grades of Recommendation...

  13. Successful management of occult pneumothorax without tube thoracostomy despite positive pressure ventilation.

    Science.gov (United States)

    Barrios, Cristobal; Tran, Tuan; Malinoski, Darren; Lekawa, Michael; Dolich, Matthew; Lush, Stephanie; Hoyt, David; Cinat, Marianne E

    2008-10-01

    The objective of this study was to determine whether tube thoracostomy can be safely avoided in a subset of patients with blunt occult pneumothorax. A retrospective review was performed. Management without tube thoracostomy was attempted for 59 occult pneumothoraces and was successful in 51 (86%). Observation was successful in 16 of 20 occult pneumothoraces (80%) exposed to positive pressure ventilation within 72 hours of admission. Eight delayed tube thoracostomies were required an average of 19.7 hours post admission. Patients who failed observant management had more significant physiologic derangement on admission (revised trauma score 6.96 vs 7.66, P = 0.04), were more likely to have significant multisystem trauma (88% vs 37%, P = 0.007), but were not more likely to require positive pressure ventilation (PPV) (50% vs 31%, P = 0.31). This study demonstrates that a subset of patients with blunt occult pneumothorax requiring positive pressure ventilation may be safely managed without tube thoracostomy.

  14. Pressure effect in the X-ray intrinsic position resolution in noble gases and mixtures

    CERN Document Server

    Azevedo, C.D.R.

    2016-01-01

    A study of the gas pressure effect in the position resolution of an interacting X- or gamma-ray photon in a gas medium is performed. The intrinsic position resolution for pure noble gases (Argon and Xenon) and their mixtures with CO2 and CH4 were calculated for several gas pressures (1-10bar) and for photon energies between 5.4 and 60.0 keV, being possible to establish a linear match between the intrinsic position resolution and the inverse of the gas pressure in that energy range. In order to evaluate the quality of the method here described, a comparison between the available experimental data and the calculated one in this work, is done and discussed. In the majority of the cases, a strong agreement is observed.

  15. Use of Biphasic Continuous Positive Airway Pressure in Premature Infant with Cleft Lip–Cleft Palate

    Directory of Open Access Journals (Sweden)

    Lovya George

    2015-10-01

    Full Text Available Preterm infants (PIs often require respiratory support due to surfactant deficiency. Early weaning from mechanical ventilation to noninvasive respiratory support decreases ventilation-associated irreversible lung damage. This wean is particularly challenging in PIs with cleft lip and cleft palate due to anatomical difficulties encountered in maintaining an adequate seal for positive pressure ventilation. PI with a cleft lip and palate often fail noninvasive respiratory support and require continued intubation and mechanical ventilation. We are presenting the first case report of a PI with cleft lip and palate who was managed by biphasic nasal continuous positive airway pressure.

  16. AV interval optimization using pressure volume loops in dual chamber pacemaker patients with maintained systolic left ventricular function.

    Science.gov (United States)

    Eberhardt, Frank; Hanke, Thorsten; Fitschen, Joern; Heringlake, Matthias; Bode, Frank; Schunkert, Heribert; Wiegand, Uwe K H

    2012-08-01

    Atrioventricular (AV) interval optimization is often deemed too time-consuming in dual-chamber pacemaker patients with maintained LV function. Thus the majority of patients are left at their default AV interval. To quantify the magnitude of hemodynamic improvement following AV interval optimization in chronically paced dual chamber pacemaker patients. A pressure volume catheter was placed in the left ventricle of 19 patients with chronic dual chamber pacing and an ejection fraction >45 % undergoing elective coronary angiography. AV interval was varied in 10 ms steps from 80 to 300 ms, and pressure volume loops were recorded during breath hold. The average optimal AV interval was 152 ± 39 ms compared to 155 ± 8 ms for the average default AV interval (range 100-240 ms). The average improvement in stroke work following AV interval optimization was 935 ± 760 mmHg/ml (range 0-2,908; p AV interval changes the average stroke work by 207 ± 162 mmHg/ml. AV interval optimization also leads to improved systolic dyssynchrony indices (17.7 ± 7.0 vs. 19.4 ± 7.1 %; p = 0.01). The overall hemodynamic effect of AV interval optimization in patients with maintained LV function is in the same range as for patients undergoing cardiac resynchronization therapy for several parameters. The positive effect of AV interval optimization also applies to patients who have been chronically paced for years.

  17. Respiratory dynamics and dead space to tidal volume ratio of volume-controlled versus pressure-controlled ventilation during prolonged gynecological laparoscopic surgery.

    Science.gov (United States)

    Lian, Ming; Zhao, Xiao; Wang, Hong; Chen, Lianhua; Li, Shitong

    2016-12-30

    Laparoscopic operations have become longer and more complex and applied to a broader patient population in the last decades. Prolonged gynecological laparoscopic surgeries require prolonged pneumoperitoneum and Trendelenburg position, which can influence respiratory dynamics and other measurements of pulmonary function. We investigated the differences between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) and tried to determine the more efficient ventilation mode during prolonged pneumoperitoneum in gynecological laparoscopy. Twenty-six patients scheduled for laparoscopic radical hysterectomy combined with or without laparoscopic pelvic lymphadenectomy were randomly allocated to be ventilated by either VCV or PCV. Standard anesthesic management and laparoscopic procedures were performed. Measurements of respiratory and hemodynamic dynamics were obtained after induction of anesthesia, at 10, 30, 60, and 120 min after establishing pneumoperitoneum, and at 10 min after return to supine lithotomy position and removal of carbon dioxide. The logistic regression model was applied to predict the corresponding critical value of duration of pneumoperitoneum when the Ppeak was higher than 40 cmH2O. Prolonged pneumoperitoneum and Trendelenburg position produced significant and clinically relevant changes in dynamic compliance and respiratory mechanics in anesthetized patients under PCV and VCV ventilation. Patients under PCV ventilation had a similar increase of dead space/tidal volume ratio, but had a lower Ppeak increase compared with those under VCV ventilation. The critical value of duration of pneumoperitoneum was predicted to be 355 min under VCV ventilation, corresponding to the risk of Ppeak higher than 40 cmH2O. Both VCV and PCV can be safely applied to prolonged gynecological laparoscopic surgery. However, PCV may become the better choice of ventilation after ruling out of other reasons for Ppeak increasing.

  18. Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volumes

    Directory of Open Access Journals (Sweden)

    Clarice Daniele Alves de Oliveira-Costa

    2012-07-01

    Full Text Available OBJECTIVE: To determine the utility of pulse pressure variation (ΔRESP PP in predicting fluid responsiveness in patients ventilated with low tidal volumes (V T and to investigate whether a lower ΔRESP PP cut-off value should be used when patients are ventilated with low tidal volumes. METHOD: This cross-sectional observational study included 37 critically ill patients with acute circulatory failure who required fluid challenge. The patients were sedated and mechanically ventilated with a V T of 6-7 ml/kg ideal body weight, which was monitored with a pulmonary artery catheter and an arterial line. The mechanical ventilation and hemodynamic parameters, including ΔRESP PP, were measured before and after fluid challenge with 1,000 ml crystalloids or 500 ml colloids. Fluid responsiveness was defined as an increase in the cardiac index of at least 15%. ClinicalTrial.gov: NCT01569308. RESULTS: A total of 17 patients were classified as responders. Analysis of the area under the ROC curve (AUC showed that the optimal cut-off point for ΔRESP PP to predict fluid responsiveness was 10% (AUC = 0.74. Adjustment of the ΔRESP PP to account for driving pressure did not improve the accuracy (AUC = 0.76. A ΔRESP PP>10% was a better predictor of fluid responsiveness than central venous pressure (AUC = 0.57 or pulmonary wedge pressure (AUC = 051. Of the 37 patients, 25 were in septic shock. The AUC for ΔRESP PP>10% to predict responsiveness in patients with septic shock was 0.484 (sensitivity, 78%; specificity, 93%. CONCLUSION: The parameter D RESP PP has limited value in predicting fluid responsiveness in patients who are ventilated with low tidal volumes, but a ΔRESP PP>10% is a significant improvement over static parameters. A ΔRESP PP > 10% may be particularly useful for identifying responders in patients with septic shock.

  19. Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Sandeep Kumar Mishra

    2015-01-01

    Full Text Available Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis and ventilation scores between ProSeal LMA and the I-gel. Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left. The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2 were noted in all positions. Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation, lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups. Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA.

  20. A mobile, web-based system can improve positive airway pressure adherence.

    Science.gov (United States)

    Hostler, Jordanna M; Sheikh, Karen L; Andrada, Teotimo F; Khramtsov, Andrei; Holley, Paul R; Holley, Aaron B

    2017-04-01

    SleepMapper is a mobile, web-based system that allows patients to self-monitor their positive airway pressure therapy, and provides feedback and education in real time. In addition to the usual, comprehensive support provided at our clinic, we gave the SleepMapper to 30 patients initiating positive airway pressure. They were compared with patients initiating positive airway pressure at our clinic without SleepMapper (controls) to determine whether SleepMapper affected adherence. A total of 61 patients had polysomnographic and adherence data analysed, 30 were given SleepMapper and 31 received our standard of care. The two groups were well matched at baseline to include no significant differences in age, apnea-hypopnea index, percentage receiving split-night polysomnographs and starting pressures. Patients in the control group received significantly more non-benzodiazepine sedative hypnotics the night of their polysomnography and during positive airway pressure initiation. At 11 weeks, patients in the SleepMapper group had a greater percentage of nights with any use (78.0 ± 22.0 versus 55.5 ± 24.0%; P 4 h positive airway pressure use (78.0 ± 22.0 versus 55.5 ± 24.0%; P = 0.02). There was a trend toward more patients in the SleepMapper group achieving >4 h of use for at least 70% of nights [9/30 (30%) versus 3/31 (9.7%); P = 0.06]. In multivariate linear regression, the SleepMapper remained significantly associated with percentage of nights >4 h positive airway pressure use (β coefficient = 0.18; P = 0.02). Added to our usual, comprehensive programme to maximize positive airway pressure adherence in new users, the SleepMapper was independently associated with an 18% increase in nights >4 h of use. © 2016 European Sleep Research Society.

  1. A Study on the Optimal Position for the Secondary Neutron Source in Pressurized Water Reactors

    Directory of Open Access Journals (Sweden)

    Jungwon Sun

    2016-12-01

    Full Text Available This paper presents a new and efficient scheme to determine the optimal neutron source position in a model near-equilibrium pressurized water reactor, which is based on the OPR1000 Hanul Unit 3 Cycle 7 configuration. The proposed scheme particularly assigns importance of source positions according to the local adjoint flux distribution. In this research, detailed pin-by-pin reactor adjoint fluxes are determined by using the Monte Carlo KENO-VI code from solutions of the reactor homogeneous critical adjoint transport equations. The adjoint fluxes at each allowable source position are subsequently ranked to yield four candidate positions with the four highest adjoint fluxes. The study next simulates ex-core detector responses using the Monte Carlo MAVRIC code by assuming a neutron source is installed in one of the four candidate positions. The calculation is repeated for all positions. These detector responses are later converted into an inverse count rate ratio curve for each candidate source position. The study confirms that the optimal source position is the one with very high adjoint fluxes and detector responses, which is interestingly the original source position in the OPR1000 core, as it yields an inverse count rate ratio curve closest to the traditional 1/M line. The current work also clearly demonstrates that the proposed adjoint flux-based approach can be used to efficiently determine the optimal geometry for a neutron source and a detector in a modern pressurized water reactor core.

  2. Relationship between pulmonary artery volumes at computed tomography and pulmonary artery pressures in patients with- and without pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Froelich, Jens J. [Department of Radiology, Philipps-University Hospital, Baldingerstrasse, 35043 Marburg (Germany)], E-mail: jens.froelich@klinikum-hef.de; Koenig, Helmut [Department of Radiology, Philipps-University Hospital, Baldingerstrasse, 35043 Marburg (Germany)], E-mail: helmut.koenig@siemens.com; Knaak, Lennard [Department of Medicine, Philipps-University Hospital, Baldingerstrasse, 35043 Marburg (Germany)], E-mail: froehlic@staff.uni-marburg.de; Krass, Stefan [MeVis Research, Universitaetsallee 29, 28359 Bremen (Germany)], E-mail: krass@mevis.de; Klose, Klaus J. [Department of Radiology, Philipps-University Hospital, Baldingerstrasse, 35043 Marburg (Germany)], E-mail: klose@med.uni-marburg.de

    2008-09-15

    Objectives: This study was designed to determine the relationship between pulmonary artery (PA) volumes at computed tomography (CT) and PA pressures at right-sided heart catheterization in patients with and without pulmonary hypertension (PAH) to develop a noninvasive CT method of PA pressure quantification. Materials and methods: Sixteen patients with chronic sleep apnea syndrome underwent contrast enhanced helical CT (slice thickness 3 mm; pitch 2; increment 2 mm) at inspiration. Eight patients had PAH while cardiopulmonary disease has been excluded in eight other patients. Vascular volumes were determined using a 3D technique (threshold seeded vascular tracing algorithm; thresholds -600 H [lower] and 3000 H [upper]). Right-sided heart catheterization measurements were available for linear regression analysis of PA volumes and pressures. Results: Correlation between PA pressures and volumes (normalized for BMI), was high in both groups (without PAH: r = .85; with PAH .90, Pearson). Compared to elevated PA pressures in patients with pulmonary hypertension (p < .005), PA volumes also were significantly increased (p < .05) among the groups. Conclusions: High correlation was found between PA volumes and mean PA pressures in patients with- and without PAH. Significant differences in PA volumes at CT-volumetry may admit non-invasive determination of pulmonary hypertension.

  3. Experimental tests for foot pressure analysis during orthostatic position and gait

    Directory of Open Access Journals (Sweden)

    Ganea Daniel

    2017-01-01

    Full Text Available Human body postural deviation during normal activities such as gait or orthostatic position can cause injuries. The paper presents an experimental study regarding the distribution of contact pressures during gait and orthostatic position, aiming to evaluate the load distribution between forefoot (FF and rear-foot (RF, the projection of center of gravity and the support area variation while conducting stability metering and feet load distribution tests.

  4. Combined Negative- and Positive-Pressure Ventilation for the Treatment of ARDS

    Directory of Open Access Journals (Sweden)

    Konstantinos Raymondos

    2015-01-01

    Full Text Available Objective. Tracheal intubation and positive-pressure ventilation as the current standard of care for the adult respiratory distress syndrome (ARDS seem to have reached their limit in terms of a further relevant reduction of the still very high mortality. Case Presentation. A 75-year-old male patient developed ARDS after abscess drainage with deteriorating oxygenation, despite positive end-expiratory pressure (PEEP values above 15 cm H2O. We applied external negative-pressure ventilation with a chamber respirator using −33 cm H2O at inspiration and −15 cm H2O at expiration, combined with conventional pressure support using a PEEP of about 8 cm H2O and a pressure support of 4–12 cm H2O. Alveolar infiltrates disappeared rapidly and PaO2/FiO2 values surpassed 300 mmHg after the first application and 500 mmHg after the second. Negative-pressure ventilation was used for 6–18 hours/day over five days. Now, 13 years later, the patient is still alive and has a good quality of life. Conclusion. Using this or similar concepts, not only in intubated patients but also as a noninvasive approach in patients with ARDS, offers new options that may genuinely differ from the present therapeutic approaches and may, therefore, have the potential to decrease the present high mortality from ARDS.

  5. Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting.

    Science.gov (United States)

    Matte, P; Jacquet, L; Van Dyck, M; Goenen, M

    2000-01-01

    Coronary artery bypass graft (CABG) surgery with the use of mammary arteries is associated with severe alteration of lung function parameters. The purpose of the present study was to compare the effect on lung function tests of conventional physiotherapy using incentive spirometry (IS) with non-invasive ventilation on continuous positive airway pressure (CPAP) and with non-invasive ventilation on bilevel positive airway pressure (BiPAP or NIV-2P), METHODS: Ninety-six patients were randomly assigned to 1 of 3 groups: NIV-2P (1 h/3 h), CPAP (1 h/3 h) and IS (20/2 h). Pulmonary function tests and arterial blood gases analyses were obtained before surgery. On the 1st and 2nd postoperative days, these parameters were collected together with cardiac output and calculation of venous admixture. For the 3 groups a severe restrictive pulmonary defect was observed during the 1st postoperative day. On the 2nd postoperative day, in opposition to IS, intensive use of CPAP and NIV-2P reduced significantly the venous admixture (Ppreventive use of NIV can be considered as an effective means to decrease the negative effect of coronary surgery on pulmonary function.

  6. Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis

    Directory of Open Access Journals (Sweden)

    Marcelo Adriano da Cunha Silva Vieira

    2015-04-01

    Full Text Available Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001. The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis.

  7. Implementation of Boussignac continuous positive airway pressure in the coronary care unit : Experiences and attitudes

    NARCIS (Netherlands)

    Dieperink, Willem; Nijsten, Maarten W. N.; van de Stadt, Mark; van der Horst, Iwan C. C.; Aarts, Leon P. H. J.; Zijlstra, Felix; Jaarsma, Tiny

    2008-01-01

    OBJECTIVE: Boussignac continuous positive airway pressure (BCPAP) delivered by face mask is useful for patients with acute cardiogenic Pulmonary edema (ACPE). Although BCPAP is medically effective, we observed that not 611 suitable patients received it. In this descriptive, prospective, cohort study

  8. Pressure effects on the X-ray intrinsic position resolution in noble gases and mixtures

    Science.gov (United States)

    Azevedo, C. D. R.; González-Díaz, D.; Correia, P. M. M.; Biagi, S.; Silva, A. L. M.; Carramate, L. F. N. D.; Veloso, J. F. C. A.

    2016-12-01

    A study of the effect of gas pressure in the position resolution of an interacting X or γ-ray photon in a gas medium is performed. The intrinsic position resolution for pure noble gases (Argon and Xenon) and their mixtures with CO2 and CH4 was calculated for several gas pressures (1-10 bar) and for photon energies between 1 and 60 keV, being possible to establish a linear relation between the intrinsic position resolution and the inverse of the gas pressure in the indicated energy range, as intuitively expected. We show how, at high pressures and low photoelectron energies, this intrinsic 1/P scaling is modified due to the diffusion of the primary ionization in the direction perpendicular to the electric field. In order to evaluate the quality of the method here described, a comparison between the available experimental data and microscopic simulations is presented in this work and discussed. In the majority of cases, a good agreement is observed. The conditions to achieve position resolutions down to 10 μm in a realistic detector are shown and discussed.

  9. Evaluation of the Operator Protection Factors Offered by Positive Pressure Air Suits against Airborne Microbiological Challenge

    Directory of Open Access Journals (Sweden)

    Jackie A. Steward

    2012-08-01

    Full Text Available Laboratories throughout the world that perform work with Risk Group 4 Pathogens generally adopt one of two approaches within BSL-4 environments: either the use of positive pressure air-fed suits or using Class III microbiological safety cabinets and isolators for animal work. Within the UK at present, all laboratories working with Risk Group 4 agents adopt the use of Class III microbiological safety cabinet lines and isolators. Operator protection factors for the use of microbiological safety cabinets and isolators are available however; there is limited published data on the operator protection factors afforded by the use of positive pressure suits. This study evaluated the operator protection factors provided by positive pressure air suits against a realistic airborne microbiological challenge. The suits were tested, both intact and with their integrity compromised, on an animated mannequin within a stainless steel exposure chamber. The suits gave operator protection in all tests with an intact suit and with a cut in the leg. When compromised by a cut in the glove, a very small ingress of the challenge was seen as far as the wrist. This is likely to be due to the low airflow in the gloves of the suit. In all cases no microbiological penetration of the respiratory tract was observed. These data provide evidence on which to base safety protocols for use of positive pressure suits within high containment laboratories.

  10. Evaluation of the operator protection factors offered by positive pressure air suits against airborne microbiological challenge.

    Science.gov (United States)

    Steward, Jackie A; Lever, Mark S

    2012-08-01

    Laboratories throughout the world that perform work with Risk Group 4 Pathogens generally adopt one of two approaches within BSL-4 environments: either the use of positive pressure air-fed suits or using Class III microbiological safety cabinets and isolators for animal work. Within the UK at present, all laboratories working with Risk Group 4 agents adopt the use of Class III microbiological safety cabinet lines and isolators. Operator protection factors for the use of microbiological safety cabinets and isolators are available however; there is limited published data on the operator protection factors afforded by the use of positive pressure suits. This study evaluated the operator protection factors provided by positive pressure air suits against a realistic airborne microbiological challenge. The suits were tested, both intact and with their integrity compromised, on an animated mannequin within a stainless steel exposure chamber. The suits gave operator protection in all tests with an intact suit and with a cut in the leg. When compromised by a cut in the glove, a very small ingress of the challenge was seen as far as the wrist. This is likely to be due to the low airflow in the gloves of the suit. In all cases no microbiological penetration of the respiratory tract was observed. These data provide evidence on which to base safety protocols for use of positive pressure suits within high containment laboratories.

  11. Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

    NARCIS (Netherlands)

    Fournell, A.; Scheeren, T. W. L.; Picker, O.; Schwarte, L. A.; Wolf, M; Bucher, HU; Rudin, M; VanHuffel, S; Wolf, U; Bruley, DF; Harrison, DK

    2012-01-01

    Mechanical ventilation with positive end-expiratory pressure (PEEP) is an indispensable tool in the management of respiratory failure to preserve or improve lung function and systemic oxygenation. However, PEEP per se may also, as has been shown in experimental animals, impair regional microcirculat

  12. A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD

    NARCIS (Netherlands)

    Wijkstra, PJ; Lacasse, Y; Guyatt, GH; Casanova, C; Gay, PC; Jones, JM; Goldstein, RS

    2003-01-01

    Study objectives: The potential benefits of noninvasive positive pressure ventilation (NIPPV) for patients with COPD remains inconclusive, as most studies have included only a small number of patients. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) that compared noctur

  13. EFFECT OF POSITIVE EXPIRATORY PRESSURE BREATHING IN PATIENTS WITH CYSTIC-FIBROSIS

    NARCIS (Netherlands)

    VANDERSCHANS, CP; VANDERMARK, TW; DEVRIES, G; PIERS, DA; BEEKHUIS, H; DANKERTROELSE, JE; POSTMA, DS; KOETER, GH

    The effect of positive expiratory pressure breathing, alone and in combination with coughing, was investigated in eight patients with cystic fibrosis. Functional residual capacity and total lung capacity was measured with a body plethysmograph before, during, and immediately after breathing with

  14. Nap-titration : An effective alternative for continuous positive airway pressure titration

    NARCIS (Netherlands)

    Hoekema, A; Stegenga, B; Meinesz, AF; van der Hoeven, JH; Wijkstra, PJ

    2006-01-01

    When treating Obstructive Steep Apnea-Hypopnea Syndrome (OSAHS) several alternatives for standard (manual) continuous positive airway pressure (CPAP) titration are feasible. A practical alternative is titration without polysomnography during an afternoon nap (Nap-titration). The aim of the present s

  15. Positive airway pressure adherence and mask interface in the setting of sinonasal symptoms.

    Science.gov (United States)

    Schell, Amy E; Soose, Ryan J

    2017-10-01

    Despite reports of lower positive pressure adherence rates with oronasal masks, patients with sinonasal problems are often prescribed this interface over a nasal interface. The aim of this study was to characterize the relationship between mask type and therapy adherence in the setting of sinonasal symptoms. Retrospective case series with chart review. We reviewed 328 patients who underwent positive pressure titration between January 2012 and May 2015. Follow-up adherence data were available for 218 patients (66.5%). Multivariate analysis examined whether patients with sinonasal symptoms have improved adherence with oronasal masks compared to nasal or nasal pillow interfaces. At a median follow-up of 95 days, positive pressure adherence in patients with sinonasal symptoms was highest with the nasal pillow interface. When compared with oronasal interfaces, the odds of adequate therapy adherence were >5 times greater with nasal pillow interfaces (odds ratio [OR] = 5.20, 95% confidence interval [CI] = 1.61-16.80, P = .006) and >3 times greater with nasal interfaces (OR = 3.67, 95% CI = 1.20-11.26, P = .02) in these symptomatic patients. The presence of nasal problems does not predict the need for an oronasal mask. Positive pressure adherence rates are higher with nasal and nasal pillow interfaces compared to oronasal masks, even in patients with sinonasal complaints. 4. Laryngoscope, 127:2418-2422, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Impact of ultrasound probe pressure on uterine positional displacement in gynecologic cancer patients

    DEFF Research Database (Denmark)

    Baker, Mariwan; Juhler-Nøttrup, Trine; Behrens, Claus F.

    2014-01-01

    Aim: The aim of this study was to quantify the uterine positional displacement induced by ultrasound probe pressure on a phantom and address the daily uterine motion in a healthy volunteer. Materials & methods: The phantom mimics the female pelvic region. The incorporated organs were subjected to...

  17. Motivational Interviewing (MINT) Improves Continuous Positive Airway Pressure (CPAP) Acceptance and Adherence: A Randomized Controlled Trial

    Science.gov (United States)

    Olsen, Sara; Smith, Simon S.; Oei, Tian P. S.; Douglas, James

    2012-01-01

    Objective: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with…

  18. Oscillating Positive Airway Pressure Versus CPAP for the Treatment of Obstructive Sleep Apnea

    Science.gov (United States)

    Haba-Rubio, José; Petitpierre, Nicolas Julien; Cornette, Françoise; Tobback, Nadia; Vat, Sopharat; Giallourou, Theresia; Al-Jumaily, Ahmed; Heinzer, Raphael

    2015-01-01

    Although continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnea (OSA), it is not always well tolerated by the patients. Previous physiological studies showed that pressure oscillations applied to the pharynx could activate upper airway muscles, but it is not clear whether these pressure oscillations could be tolerated during sleep in OSA patients. The aim of this study was to assess the tolerance of oscillating positive airway pressure (O-PAP) (a CPAP device delivering high-frequency pressure oscillations to the upper airway) compared to CPAP. Fourteen OSA patients currently on CPAP [age 59.9 ± 10.1 years old, BMI 34.8 ± 7.2 kg/m2, initial apnea–hypopnea index (AHI): 58.7 ± 25.2 events/h] used O-PAP or CPAP on two consecutive nights under polysomnography, in a single-blind randomized crossover design to assess sleep quality. A subtherapeutic pressure (70% of the optimal titrated pressure) was applied in both conditions and the residual AHI with each technique was also compared. There was no difference in measured or perceived sleep quality between the two treatment modalities (sleep efficiency 90.0% versus 88.1%, p = 0.54). Despite the small sample, we also found a trend toward a decrease in residual respiratory events with O-PAP compared to CPAP (median AHI 14.3 versus 20.5/h, p = 0.194). The good tolerance of O-PAP and the positive trend toward a reduction in residual AHI should stimulate further research on the effects of O-PAP in OSA patients. PMID:26029694

  19. A comparison between the dimensions of positive transtibial residual limb molds prepared by air pressure casting and weight-bearing casting methods

    Science.gov (United States)

    Hajiaghaei, Behnam; Ebrahimi, Ismail; Kamyab, Mojtaba; Saeedi, Hassan; Jalali, Maryam

    2016-01-01

    Background: Creating a socket with proper fit is an important factor to ensure the comfort and control of prosthetic devices. Several techniques are commonly used to cast transtibial stumps but their effect on stump shape deformation is not well understood. This study compares the dimensions, circumferences and volumes of the positive casts and also the socket comfort between two casting methods. Our hypothesis was that the casts prepared by air pressure method have less volume and are more comfortable than those prepared by weight bearing method. Methods: Fifteen transtibial unilateral amputees participated in the study. Two weight bearing and air pressure casting methods were utilized for their residual limbs. The diameters and circumferences of various areas of the residual limbs and positive casts were compared. The volumes of two types of casts were measured by a volumeter and compared. Visual Analogue Scale (VAS) was used to measure the sockets fit comfort. Results: Circumferences at 10 and 15 cm below the patella on the casts were significantly smaller in air pressure casting method compared to the weight bearing method (p=0.00 and 0.01 respectively). The volume of the cast in air pressure method was lower than that of the weight bearing method (p=0.006). The amputees found the fit of the sockets prepared by air pressure method more comfortable than the weight bearing sockets (p=0.015). Conclusion: The air pressure casting reduced the circumferences of the distal portion of residual limbs which has more soft tissue and because of its snug fit it provided more comfort for amputees, according to the VAS measurements. PMID:27390711

  20. Midlife exercise blood pressure, heart rate, and fitness relate to brain volume 2 decades later.

    Science.gov (United States)

    Spartano, Nicole L; Himali, Jayandra J; Beiser, Alexa S; Lewis, Gregory D; DeCarli, Charles; Vasan, Ramachandran S; Seshadri, Sudha

    2016-04-05

    To determine whether poor cardiovascular (CV) fitness and exaggerated exercise blood pressure (BP) and heart rate (HR) were associated with worse brain morphology in later life. Framingham Offspring participants (n = 1,094, 53.9% female) free from dementia and CV disease (CVD) underwent an exercise treadmill test at a mean age of 40 ± 9 years. A second treadmill test and MRI scans of the brain were administered 2 decades later at mean age of 58 ± 8 years. Poor CV fitness and greater diastolic BP and HR response to exercise at baseline were associated with a smaller total cerebral brain volume (TCBV) almost 2 decades later (all p exercise systolic BP was also associated with smaller TCBV (p exercise BP and HR responses in middle-aged adults are associated with smaller brain volume nearly 2 decades later. Promotion of midlife CV fitness may be an important step towards ensuring healthy brain aging. © 2016 American Academy of Neurology.

  1. The use of nasal dilator strips as a placebo for trials evaluating continuous positive airway pressure

    Directory of Open Access Journals (Sweden)

    Aline C.S. Amaro

    2012-01-01

    Full Text Available OBJECTIVES: The aim of the current study was to compare the objective and subjective effects of continuous positive airway pressure to the use of nasal dilator strips in patients with acromegaly and moderate to severe obstructive sleep apnea. METHODS: We studied 12 patients with acromegaly and moderate to severe obstructive sleep apnea (male/ females = 8/4, age = 52±8 ys, body mass index = 33.5±4.6 Kg/m², apnea-hypopnea index = 38±14 events/h who had been included in a randomized, crossover study to receive three months of treatment with continuous positive airway pressure and nasal dilator strips. All patients were evaluated at study entry and at the end of each treatment by polysomnography, and Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and treatment satisfaction questionnaires. ClinicalTrials.gov: NCT01265121 RESULTS: The apnea-hypopnea index values decreased significantly with continuous positive airway pressure treatment but did not change with the use of nasal dilator strips. All of the subjective symptoms improved with both treatments, but these improvements were significantly greater with continuous positive airway pressure than with the nasal dilator strips CONCLUSION: The use of nasal dilator strips had a much smaller effect on the severity of obstructive sleep apnea in patients with acromegaly and moderate to severe obstructive sleep apnea in comparison to the use of continuous positive airway pressure. Moreover, the improvement in several subjective parameters without any significant objective improvement in obstructive sleep apnea resulting from the use of nasal dilator strips is compatible with a placebo effect.

  2. Optimization of Design Pressure Ratio of Positive Displacement Expander for Vehicle Engine Waste Heat Recovery

    Directory of Open Access Journals (Sweden)

    Young Min Kim

    2014-09-01

    Full Text Available This study investigated the effect of the built-in volume ratio of an expander on the performance of a dual-loop Rankine cycle system for the engine waste heat recovery of a vehicle. Varying vehicle operating conditions can cause a positive displacement expander to operate in both under- and over-expansion states. Therefore, analysis of the off-design performance of the expander is very important. Furthermore, the volume and weight of the expander must be considered in its optimization along with the efficiency. A simple modeling of the off-design operation of the expander showed that a built-in volume ratio that causes under-expansion rather than over-expansion at the target condition is more desirable.

  3. Positive end-expiratory pressure (PEEP) does not depress left ventricular function in patients with pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Calvin, J.E.; Driedger, A.A.; Sibbald, W.J.

    1981-08-01

    Researchers evaluated the effects of positive end-expiratory pressure (PEEP) on left ventricular function in 15 patients with acute respiratory insufficiency secondary to pulmonary edema with invasive (pressure; flow) measurements and radionuclide angiography (RA). Using RNA allowed a definition of the left ventricular ejection fraction (LVEF), and then calculation of the left ventricular end-diastolic volume (LVEDV), both before and after PEEP. With a mean PEEP of 14.2 +/- 1.8 cm H2O (mean +/- SD) (range, 10 to 15), a fall in the cardiac index (4.34 +/- 1.5 to 3.84 +/- 1.4 L/min/M2; p less than 0.001) was accompanied by a significant decrease in the stroke volume index (42 +/- 13 to 39 +/- 12 ml/beat M2; p less than 0.01) and pulse rate (103.4 +/- 14.3 to 98 +/- 13.5 beats/min; p less than 0.01). The decrease in the stroke volume index was primarily due to a significant decrease in left ventricular preload (LVEDV) from 85.9 +/- 19 to 71.4 +/- 21.4 ml/m2 (p less than 0.01). Simultaneously, the mean LVEF increased from 0.47 +/- 0.10 to 0.53 +/- 0.08 (p less than 0.05), despite a significant increase in the systemic vascular resistance (1,619 +/- 575 to 1,864 +/- 617 dynes . s. cm-5/M2; p less than 0.01). Researchers concluded that the use of PEEP in patients with acute pulmonary edema, to the degree used in this study, may depress cardiac output by simply decreasing left ventricular preload. Researchers were unable to produce any evidence that would support a change in the contractile state of the left ventricle as a cause of depressed forward flow with the use of PEEP.

  4. Predicting the pressure-volume curve of an elastic microsphere composite

    CERN Document Server

    De Pascalis, Riccardo; Parnell, William J

    2012-01-01

    The effective macroscopic response of nonlinear elastomeric inhomogeneous materials is of great interest in many applications including nonlinear composite materials and soft biological tissues. The interest of the present work is associated with a microsphere composite material, which is modelled as a matrix-inclusion composite. The matrix phase is a homogeneous isotropic nonlinear rubber-like material and the inclusion phase is more complex, consisting of a distribution of sizes of stiff thin spherical shells filled with gas. Experimentally, such materials have been shown to undergo complex deformation under cyclic loading. Here, we consider microspheres embedded in an unbounded host material and assume that a hydrostatic pressure is applied in the "far-field". Taking into account a variety of effects including buckling of the spherical shells, large deformation of the host phase and evolving microstructure, we derive a model predicting the pressure-relative volume change load curves. Nonlinear constitutive...

  5. Can a central blood volume deficit be detected by systolic pressure variation during spontaneous breathing?

    DEFF Research Database (Denmark)

    Dahl, Michael; Hayes, Chris; Steen Rasmussen, Bodil

    2016-01-01

    cardiac output (CO). This study tested that hypothesis in healthy volunteers exposed to central hypovolemia by head-up tilt. METHODS: Thirteen healthy volunteers were exposed to central hypovolemia by 45° head-up tilt while breathing through a facemask with 7.5 cmH2O inspiratory and/or expiratory......BACKGROUND: Whether during spontaneous breathing arterial pressure variations (APV) can detect a volume deficit is not established. We hypothesized that amplification of intra-thoracic pressure oscillations by breathing through resistors would enhance APV to allow identification of a reduced...... (from 21 (±15)% to 30 (±13)%). Yet during head-up tilt, a SPV ≥ 37 % predicted a decrease in CO ≥ 10 % with a sensitivity and specificity of 78 % and 100 %, respectively. CONCLUSION: In spontaneously breathing healthy volunteers combined inspiratory and expiratory resistors enhance SPV during head...

  6. Gas permeation measurement under defined humidity via constant volume/variable pressure method

    KAUST Repository

    Jan Roman, Pauls

    2012-02-01

    Many industrial gas separations in which membrane processes are feasible entail high water vapour contents, as in CO 2-separation from flue gas in carbon capture and storage (CCS), or in biogas/natural gas processing. Studying the effect of water vapour on gas permeability through polymeric membranes is essential for materials design and optimization of these membrane applications. In particular, for amine-based CO 2 selective facilitated transport membranes, water vapour is necessary for carrier-complex formation (Matsuyama et al., 1996; Deng and Hägg, 2010; Liu et al., 2008; Shishatskiy et al., 2010) [1-4]. But also conventional polymeric membrane materials can vary their permeation behaviour due to water-induced swelling (Potreck, 2009) [5]. Here we describe a simple approach to gas permeability measurement in the presence of water vapour, in the form of a modified constant volume/variable pressure method (pressure increase method). © 2011 Elsevier B.V.

  7. Blood volume, blood pressure and total body sodium: internal signalling and output control

    DEFF Research Database (Denmark)

    Bie, P

    2009-01-01

    , and under experimental conditions, ABP is a powerful, independent controller of NaEx. Blood volume is a function of dietary salt intake; however, ABP is not, at least not in steady states. A transient increase in ABP after a step-up in sodium intake could provide a causal relationship between ABP......Total body sodium and arterial blood pressure (ABP) are mutually dependent variables regulated by complex control systems. This review addresses the role of ABP in the normal control of sodium excretion (NaEx), and the physiological control of renin secretion. NaEx is a pivotal determinant of ABP...... and the regulation of NaEx via a hypothetical integrative control system. However, recent data show that subtle sodium loading (simulating salty meals) causes robust natriuresis without changes in ABP. Changes in ABP are not necessary for natriuresis. Normal sodium excretion is not regulated by pressure. Plasma...

  8. Efficacy of Home Single-Channel Nasal Pressure for Recommending Continuous Positive Airway Pressure Treatment in Sleep Apnea

    Science.gov (United States)

    Masa, Juan F.; Duran-Cantolla, Joaquin; Capote, Francisco; Cabello, Marta; Abad, Jorge; Garcia-Rio, Francisco; Ferrer, Antoni; Fortuna, Ana M.; Gonzalez-Mangado, Nicolas; de la Peña, Monica; Aizpuru, Felipe; Barbe, Ferran; Montserrat, Jose M.; Larrateguy, Luis D.; de Castro, Jorge Rey; Garcia-Ledesma, Estefania; Corral, Jaime; Martin-Vicente, Maria J.; Martinez-Null, Cristina; Egea, Carlos; Cancelo, Laura; García-Díaz, Emilio; Carmona-Bernal, Carmen; Sánchez-Armengol, Ángeles; Mayos, Merche; Miralda, Rosa M; Troncoso, Maria F.; Gonzalez, Monica; Martinez-Martinez, Marian; Cantalejo, Olga; Piérola, Javier; Vigil, Laura; Embid, Cristina; del Mar Centelles, Mireia; Prieto, Teresa Ramírez; Rojo, Blas; Lores, Vanesa

    2015-01-01

    Introduction: Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored. Objectives: To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables. Methods: Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points. Results: Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP. Conclusion: Automatic home single-channel nasal pressure scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary. Clinical Trials Information: Clinicaltrial.gov identifier: NCT01347398. Citation: Masa JF, Duran-Cantolla J, Capote F, Cabello

  9. [A project to reduce the incidence of facial pressure ulcers caused by prolonged surgery with prone positioning].

    Science.gov (United States)

    Lee, Wen-Yi; Lin, Pao-Chen; Weng, Chia-Hsing; Lin, Yi-Lin; Tsai, Wen-Lin

    2012-06-01

    We observed in our institute a 13.6% incidence of prolonged surgery (>4 hours) induced facial pressure ulcers that required prone positioning. Causes identified included: (1) customized silicon face pillows used were not suited for every patient; (2) our institute lacked a standard operating procedure for prone positioning; (3) our institute lacked a postoperative evaluation and audit procedure for facial pressure ulcers. We designed a strategy to reduce post-prolonged surgery facial pressure ulcer incidence requiring prone positioning by 50% (i.e., from 13.6% to 6.8%). We implemented the following: (1) Created a new water pillow to relieve facial pressure; (2) Implemented continuing education pressure ulcer prevention and evaluation; (3) Established protocols on standard care for prone-position patients and proper facial pressure ulcer identification; (4) Established a face pressure ulcers accident reporting mechanism; and (5) Established an audit mechanism facial pressure ulcer cases. After implementing the resolution measures, 116 patients underwent prolonged surgery in a prone position (mean operating time: 298 mins). None suffered from facial pressure ulcers. The measures effectively reduced the incidence of facial pressure ulcers from 13.6% to 0.0%. The project used a water pillow to relieve facial pressure and educated staff to recognize and evaluate pressure ulcers. These measures were demonstrated effective in reducing the incidence of facial pressure ulcers caused by prolonged prone positioning.

  10. Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure

    DEFF Research Database (Denmark)

    Møller, Tom; Moser, Claus; Adamsen, Lis

    2016-01-01

    of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty-five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between...... fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient-performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness...... intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80-76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients...

  11. Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis.

    Science.gov (United States)

    McIlwaine, Maggie; Button, Brenda; Dwan, Kerry

    2015-06-17

    Chest physiotherapy is widely prescribed to assist the clearance of airway secretions in people with cystic fibrosis. Positive expiratory pressure (PEP) devices provide back pressure to the airways during expiration. This may improve clearance by building up gas behind mucus via collateral ventilation and by temporarily increasing functional residual capacity. Given the widespread use of PEP devices, there is a need to determine the evidence for their effect. This is an update of a previously published review. To determine the effectiveness and acceptability of PEP devices compared to other forms of physiotherapy as a means of improving mucus clearance and other outcomes in people with cystic fibrosis. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. The electronic database CINAHL was also searched from 1982 to 2013.Most recent search of the Group's Cystic Fibrosis Trial Register: 02 December 2014. Randomised controlled studies in which PEP was compared with any other form of physiotherapy in people with cystic fibrosis. This included, postural drainage and percussion, active cycle of breathing techniques, oscillating PEP devices, thoracic oscillating devices, bilevel positive airway pressure (BiPaP) and exercise. Studies also had to include one or more of the following outcomes: change in forced expiratory volume in one second; number of respiratory exacerbations; a direct measure of mucus clearance; weight of expectorated secretions; other pulmonary function parameters; a measure of exercise tolerance; ventilation scans; cost of intervention; and adherence to treatment. Three authors independently applied the inclusion and exclusion criteria to publications and assessed the risk of bias of the included studies. A total of 26 studies (involving 733 participants

  12. Estimation of central aortic pressure waveform features derived from the brachial cuff volume displacement waveform.

    Science.gov (United States)

    Butlin, Mark; Qasem, Ahmad; Avolio, Alberto P

    2012-01-01

    There is increasing interest in non-invasive estimation of central aortic waveform parameters in the clinical setting. However, controversy has arisen around radial tonometric based systems due to the requirement of a trained operator or lack of ease of use, especially in the clinical environment. A recently developed device utilizes a novel algorithm for brachial cuff based assessment of aortic pressure values and waveform (SphygmoCor XCEL, AtCor Medical). The cuff was inflated to 10 mmHg below an individual's diastolic blood pressure and the brachial volume displacement waveform recorded. The aortic waveform was derived using proprietary digital signal processing and transfer function applied to the recorded waveform. The aortic waveform was also estimated using a validated technique (radial tonometry based assessment, SphygmoCor, AtCor Medical). Measurements were taken in triplicate with each device in 30 people (17 female) aged 22 to 79 years of age. An average for each device for each individual was calculated, and the results from the two devices were compared using regression and Bland-Altman analysis. A high correlation was found between the devices for measures of aortic systolic (R(2)=0.99) and diastolic (R(2)=0.98) pressure. Augmentation index and subendocardial viability ratio both had a between device R(2) value of 0.82. The difference between devices for measured aortic systolic pressure was 0.5±1.8 mmHg, and for augmentation index, 1.8±7.0%. The brachial cuff based approach, with an individualized sub-diastolic cuff pressure, provides an operator independent method of assessing not only systolic pressure, but also aortic waveform features, comparable to existing validated tonometric-based methods.

  13. Determination of saturation pressure and enthalpy of vaporization of semi-volatile aerosols: the integrated volume mentod

    Science.gov (United States)

    This study presents the integrated volume method for estimating saturation pressure and enthalpy of vaporization of a whole aerosol distribution. We measure the change of total volume of an aerosol distribution between a reference state and several heated states, with the heating...

  14. Plasma norepinephrine, blood pressure and heart rate response to graded change in body position.

    Science.gov (United States)

    Fiorica, V; Kem, D C

    1985-12-01

    In this study, 44 human subjects underwent either an orthostatic postural change (supine to stand, n = 17) or a graded change in body position (head-up) on a tilt-table (n = 27). No significant changes in systolic blood pressure or mean blood pressure were observed during either maneuver; significant increases, under both conditions, were observed in diastolic blood pressure and heart rate. Plasma norepinephrine concentrations after orthostatic position change increased significantly (supine 181 +/- 14 (S.E.M.) pg X ml-1; stand, 472 +/- 35 pg X ml-1, p less than 0.01). Plasma norepinephrine concentrations during graded postural change increased proportionately with increasing degrees of tilt (r = 0.76, p less than 0.01). A significant correlation between plasma norepinephrine and heart rate was observed during both positional change maneuvers (graded tilt-table, r = 0.80, p less than 0.01; orthostatic, r = 0.50, p less than 0.01). These results suggest that the degree of sympathetic nervous system activity for blood pressure regulation during graded postural change is appropriately reflected by plasma norepinephrine concentrations.

  15. Early socioeconomic position and blood pressure in childhood and adulthood: the Cardiovascular Risk in Young Finns Study.

    OpenAIRE

    Kivimäki, M.; Lawlor, D A; Smith, G. D.; Keltikangas-Järvinen, L.; Elovainio, M; Vahtera, J.; Pulkki-Råback, L.; Taittonen, L.; Viikari, J. S. A.; Raitakari, O. T.

    2006-01-01

    Studies have found an association between low socioeconomic position in childhood and high adult blood pressure. It is unclear whether this association is explained by a pathway directly linking disadvantage to elevated blood pressure in childhood and adolescence, which then tracks into adulthood. We assessed parental socioeconomic position and systolic blood pressure in 1807 children and adolescents ages 3 to 18 years at baseline. Adult systolic blood pressure was measured 21 years later at ...

  16. A sigmoidal fit for pressure-volume curves of idiopathic pulmonary fibrosis patients on mechanical ventilation: clinical implications

    Directory of Open Access Journals (Sweden)

    Juliana C. Ferreira

    2011-01-01

    Full Text Available OBJECTIVE: Respiratory pressure-volume curves fitted to exponential equations have been used to assess disease severity and prognosis in spontaneously breathing patients with idiopathic pulmonary fibrosis. Sigmoidal equations have been used to fit pressure-volume curves for mechanically ventilated patients but not for idiopathic pulmonary fibrosis patients. We compared a sigmoidal model and an exponential model to fit pressure-volume curves from mechanically ventilated patients with idiopathic pulmonary fibrosis. METHODS: Six idiopathic pulmonary fibrosis patients and five controls underwent inflation pressure-volume curves using the constant-flow technique during general anesthesia prior to open lung biopsy or thymectomy. We identified the lower and upper inflection points and fit the curves with an exponential equation, V = A-B.e-k.P, and a sigmoid equation, V = a+b/(1+e-(P-c/d. RESULTS: The mean lower inflection point for idiopathic pulmonary fibrosis patients was significantly higher (10.5 ± 5.7 cm H2O than that of controls (3.6 ± 2.4 cm H2O. The sigmoidal equation fit the pressure-volume curves of the fibrotic and control patients well, but the exponential equation fit the data well only when points below 50% of the inspiratory capacity were excluded. CONCLUSION: The elevated lower inflection point and the sigmoidal shape of the pressure-volume curves suggest that respiratory system compliance is decreased close to end-expiratory lung volume in idiopathic pulmonary fibrosis patients under general anesthesia and mechanical ventilation. The sigmoidal fit was superior to the exponential fit for inflation pressure-volume curves of anesthetized patients with idiopathic pulmonary fibrosis and could be useful for guiding mechanical ventilation during general anesthesia in this condition.

  17. Use of a positive pressure endoscopic mask to assist with positive pressure ventilation in a morbidly obese patient during fiberoptic intubation: a case report.

    Science.gov (United States)

    De Jarnett, Dewi

    2013-08-01

    Airway management in the morbidly obese, anesthetized patient can be especially challenging. Difficulties in fiberoptic intubation (FOI) can be experienced due to alterations in airway anatomy associated with morbid obesity and the effects of anesthesia. The loss of upper airway muscle tone that occurs during anesthesia compromises the structure of the pharynx, causing a tendency toward airway collapse. This collapsibility can prevent the identification of anatomical structures during FOI, making this advanced airway technique difficult or impossible. The application of positive pressure via endoscopic mask ventilation during FOI can help to stent open collapsible airways and reestablish airway anatomy in morbidly obese patients. Although drawbacks exist, the endoscopic mask may be most effective at accomplishing this goal.

  18. Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

    Directory of Open Access Journals (Sweden)

    Daniela Franco Rizzo Komatsu

    Full Text Available Summary Objective: To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV and continuous positive airway pressure (nCPAP. Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA ≤ 36 weeks and birth weight (BW > 750 g, who required tracheal intubation and mechanical ventilation. The study was controlled and randomized in order to ensure that the members of the groups used in the research were chosen at random. Randomization was performed at the time of extubation using sealed envelopes. Extubation failure was defined as the need for re-intubation and mechanical ventilation during the first 72 hours after extubation. Results: Among the 36 premature infants randomized to nIPPV, six (16.6% presented extubation failure in comparison to 11 (30.5% of the 36 premature infants randomized to nCPAP. There was no statistical difference between the two study groups regarding BW, GA, classification of the premature infant, and MV time. The main cause of extubation failure was the occurrence of apnea. Gastrointestinal and neurological complications did not occur in the premature infants participating in the study. Conclusion: We found that, despite the extubation failure of the group of premature infants submitted to nIPPV being numerically smaller than in premature infants submitted to nCPAP, there was no statistically significant difference between the two modes of ventilatory support after extubation.

  19. Obstructive sleep apnea syndrome, continuous positive airway pressure and treatment of hypertension.

    Science.gov (United States)

    Floras, John S

    2015-09-15

    Obstructive sleep apnea (OSA), present in ~15% of the general population, increases the risks of stroke, heart failure, and premature death. Importantly, individuals with cardiovascular disease have a higher prevalence yet they often have few symptoms to alert clinicians to its presence. OSA with an apnea-hypopnea index (AHI) ≥15 events/hour is present in ≥30% of patients with primary hypertension and in up to 80% of those with drug resistant hypertension, suggesting that the neural, hormonal, inflammatory and vascular cascades triggered by OSA may elevate blood pressure chronically. The purpose of this review is to summarize: (1) the epidemiology of OSA and its relation to cardiovascular risk; (2) potential mechanisms by which OSA could promote conditions known to increase the risk of hypertension or contribute to its development and progression; (3) evidence for and against a pro-hypertensive effect of OSA; and, (4) the impact of treatment with continuous positive airway pressure (CPAP) on blood pressure and blood pressure-related morbidities. The prevailing view that the effect of treatment on blood pressure is modest arises from the inability of most contemporary technology to measure accurately the true impact of CPAP on OSA-entrained surges in nocturnal blood pressure. Moreover the exclusive focus on blood pressure, as if this is the principal determinant of cardiovascular event rates in this population, is naïve. The capacity to reduce cardiovascular risk by treating OSA with CPAP likely transcends a simple blood pressure effect; formal testing of this hypothesis will require adequately powered randomized clinical trials.

  20. Target Centroid Position Estimation of Phase-Path Volume Kalman Filtering

    Directory of Open Access Journals (Sweden)

    Fengjun Hu

    2016-01-01

    Full Text Available For the problem of easily losing track target when obstacles appear in intelligent robot target tracking, this paper proposes a target tracking algorithm integrating reduced dimension optimal Kalman filtering algorithm based on phase-path volume integral with Camshift algorithm. After analyzing the defects of Camshift algorithm, compare the performance with the SIFT algorithm and Mean Shift algorithm, and Kalman filtering algorithm is used for fusion optimization aiming at the defects. Then aiming at the increasing amount of calculation in integrated algorithm, reduce dimension with the phase-path volume integral instead of the Gaussian integral in Kalman algorithm and reduce the number of sampling points in the filtering process without influencing the operational precision of the original algorithm. Finally set the target centroid position from the Camshift algorithm iteration as the observation value of the improved Kalman filtering algorithm to fix predictive value; thus to make optimal estimation of target centroid position and keep the target tracking so that the robot can understand the environmental scene and react in time correctly according to the changes. The experiments show that the improved algorithm proposed in this paper shows good performance in target tracking with obstructions and reduces the computational complexity of the algorithm through the dimension reduction.

  1. Comparative Study of pressure-control ventilation and volume-control ventilation in treating traumatic acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    杨云梅; 黄卫东; 沈美亚; 徐哲荣

    2005-01-01

    Objective: To observe the clinical therapeutic effect and side effect of pressure-control ventilation (PCV) on traumatic acute respiratory distress syndrome (ARDS) compared with volume-control ventilation (VCV).Methods: Forty patients with traumatic ARDS were hospitalized in our department from June 1996 to December 2002. Twenty were treated with PCV (PCV group) and 20 with VCV (VCV group). The changes of the peak inflating pressure and the mean pressure of the airway were observed at the very beginning of the mechanical ventilation and the following 12 and 24 hours, respectively. The transcutaneous saturation of oxygen pressure, the pressure of oxygen in artery, the mean blood pressure, the central venous pressure, the heart rate and the incidence of the pressure injury were also monitored before ventilation and 12 hours after ventilation.Results: The pressure of oxygen in artery, the transcutaneous saturation of oxygen pressure, the heart rate and the respiratory rate in the PCV group were obviously improved after ventilation treatment. The peak inflating pressure, the mean pressure of the airway and the central venous pressure in the PCV group were lower than in the VCV group. The incidence of pressure injury was 0 in the PCV group while 10% in the VCV group. Conclusions: The clinical effect of PCV on traumatic ARDS is better and the incidence rate of pressure injury is lower than that of VCV. PCV has minimal effects on the hemodynamics.

  2. The role of equilibrium volume and magnetism on the stability of iron phases at high pressures.

    Science.gov (United States)

    Alnemrat, S; Hooper, J P; Vasiliev, I; Kiefer, B

    2014-01-29

    The present study provides new insights into the pressure dependence of magnetism by tracking the hybridization between crystal orbitals for pressures up to 600 GPa in the known hcp, bcc and fcc iron. The Birch-Murnaghan equation of state parameters are; bcc: V0 = 11.759 A(3)/atom, K0 = 177.72 GPa; hcp: V0 = 10.525 A(3)/atom, K0 = 295.16 GPa; and fcc: V0 = 10.682 A(3)/atom, K0 = 274.57 GPa. These parameters compare favorably with previous studies. Consistent with previous studies we find that the close-packed hcp and fcc phases are non-magnetic at pressures above 50 GPa and 60 GPa, respectively. The principal features of magnetism in iron are predicted to be invariant, at least up to ∼6% overextension of the equilibrium volume. Our results predict that magnetism for overextended fcc iron disappears via an intermediate spin state. This feature suggests that overextended lattices can be used to stabilize particular magnetic states. The analysis of the orbital hybridization shows that the magnetic bcc structure at high pressures is stabilized by splitting the majority and minority spin bands. The bcc phase is found to be magnetic at least up to 600 GPa; however, magnetism is insufficient to stabilize the bcc phase itself, at least at low temperatures. Finally, the analysis of the orbital contributions to the total energy provides evidence that non-magnetic hcp and fcc phases are likely more stable than bcc at core earth pressures.

  3. Positive pressure therapy for Ménière's disease or syndrome.

    Science.gov (United States)

    van Sonsbeek, Sanne; Pullens, Bas; van Benthem, Peter Paul

    2015-03-10

    Ménière's disease is an incapacitating disease in which recurrent attacks of vertigo are accompanied by hearing loss, tinnitus and/or aural fullness, all of which are discontinuous and variable in intensity. A number of different therapies have been identified for patients with this disease, ranging from dietary measures (e.g. a low-salt diet) and medication (e.g. betahistine (Serc®), diuretics) to extensive surgery (e.g. endolymphatic sac surgery). The Meniett® low-pressure pulse generator (Medtronic ENT, 1999) is a device that is designed to generate a computer-controlled sequence of low-pressure (micro-pressure) pulses, which are thought to be transmitted to the vestibular system of the inner ear. The pressure pulse passes via a tympanostomy tube (grommet) to the middle ear, and hence to the inner ear via the round and/or oval window. The hypothesis is that these low-pressure pulses reduce endolymphatic hydrops. To assess the effects of positive pressure therapy (e.g. the Meniett device) on the symptoms of Ménière's disease or syndrome. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 6 June 2014. Randomised controlled trials (RCTs) comparing positive pressure therapy (using the Meniett or a similar device) with placebo in patients with Ménière's disease. The primary outcome was control of vertigo; secondary outcomes were loss or gain of hearing, severity of tinnitus, perception of aural fullness, functional level, complications or adverse effects, and sick days. Two authors independently selected studies, assessed risk of bias and extracted data. We contacted authors for additional data. Where possible, we pooled study results using a fixed-effect, mean difference (MD) meta-analysis and tested for

  4. Safety and effectiveness of alveolar recruitment maneuvers and positive end-expiratory pressure during general anesthesia for cesarean section: a prospective, randomized trial.

    Science.gov (United States)

    Aretha, D; Fligou, F; Kiekkas, P; Messini, C; Panteli, E; Zintzaras, E; Karanikolas, M

    2017-05-01

    During cesarean section, the supine position reduces functional residual capacity and worsens lung compliance. We tested the hypothesis that alveolar recruitment maneuvers and positive end-expiratory pressure improve lung compliance in women undergoing general anesthesia for cesarean section. Ninety women undergoing cesarean section were randomly assigned to one of two groups in a prospective, double-blind trial. In the alveolar recruitment maneuver group, pressure-control ventilation was used and inspiratory time was increased to 50% after delivery; positive end-expiratory pressure was increased to 20cmH2O and peak airway inspiratory pressure gradually increased to 45-50cmH2O. Volume-control ventilation was then used with low tidal volumes (6mL/kg) and positive end-expiratory pressure was reduced stepwise to 8cmH2O. In the control group, alveolar recruitment maneuvers were not used. Data were collected before and 3, 10 and 20min after the alveolar recruitment maneuver, before extubation and postoperatively at 10 and 20min. Dynamic compliance, peak airway inspiratory pressure, PaO2 and PaO2/FiO2 were significantly different in the alveolar recruitment maneuver group compared to controls at all time points during surgery except at baseline. Oxygen saturation was significantly greater in the alveolar recruitment maneuver group at 10 and 20min and before extubation. Dynamic compliance was 29.7-42.5% higher and peak airway inspiratory pressure 3.6-10.2% lower in the alveolar recruitment maneuver group compared to controls. The PaO2, PaO2/FiO2 and oxygen saturation were higher (9.4-12%, 10.3-11.9% and 0.4-1.3%, respectively) in the alveolar recruitment maneuver group. Postoperatively, PaO2 and oxygen saturation were significantly higher in the alveolar recruitment maneuver group compared to controls (PaO2 9.2% at 10min and 8.4% at 20min, oxygen saturation 0.8% at 10min and 1.1% at 20min). There were no significant differences in hemodynamic stability or adverse events

  5. Short-term effects of positive expiratory airway pressure in patients being weaned from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Marcelo de Mello Rieder

    2009-05-01

    Full Text Available OBJECTIVE: To investigate the feasibility and the cardiorespiratory effects of using positive expiratory airway pressure, a physiotherapeutic tool, in comparison with a T-tube, to wean patients from mechanical ventilation. METHODS/DESIGN: A prospective, randomized, cross-over study. SETTING: Two intensive care units. PATIENTS AND INTERVENTIONS: We evaluated forty patients who met weaning criteria and had been mechanically-ventilated for more than 48 hours, mean age 59 years, including 23 males. All patients were submitted to the T-tube and Expiratory Positive Airway Pressure devices, at 7 cm H2O, during a 30-minute period. Cardiorespiratory variables including work of breathing, respiratory rate (rr, peripheral oxygen saturation (SpO2, heart rate (hr, systolic, diastolic and mean arterial pressures (SAP, DAP, MAP were measured in the first and thirtieth minutes. The condition was analyzed as an entire sample set (n=40 and was also divided into subconditions: chronic obstructive pulmonary disease (n=14 and non-chronic obstructive pulmonary disease (non- chronic obstructive pulmonary disease (n=26 categories. Comparisons were made using a t-test and Analysis of Variance. The level of significance was p < 0.05. RESULTS: Our data showed an increase in work of breathing in the first and thirtieth minutes in the EPAP condition (0.86+ 0.43 and 1.02+1.3 as compared with the T-tube condition (0.25+0.26 and 0.26+0.35 (p<0.05, verified by the flow-sensor monitor (values in J/L. No statistical differences were observed when comparing the Expiratory Positive Airway Pressure and T-tube conditions with regard to cardiorespiratory measurements. The same result was observed for both chronic obstructive pulmonary disease and non- chronic obstructive pulmonary disease subconditions. CONCLUSIONS: Our study demonstrated that, in weaning patients from mechanical ventilation, the use of a fixed level of Expiratory Positive Airway Pressure caused an increase in work of

  6. Early predictors of success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

    Science.gov (United States)

    Bhattacharyya, D; Prasad, Bnbm; Tampi, P S; Ramprasad, R

    2011-10-01

    Non-invasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute hypercapnic respiratory failure. Patients with hypercapnic respiratory failure requiring ventilation therapy (respiratory rate [RR] of > 30 breaths per minutes, PaCO2 > 55 mmHg and arterial pH intubation was evaluated. Of the 100 patients, 76 (76%) showed improvement in clinical parameters and ABG. There was improvement in HR and RR, pH, and PCO2 within the first hour in the success group and these parameters continued to improve even after four and 24 hours of NIPPV treatment. Out of 24 (24%) patients who failed to respond, 13 (54%) needed endotracheal intubation within one hour. The failure group had higher baseline HR than the success group. Improvement in HR, RR, pH, and PCO2 one hour after putting the patient on NIPPV predicts success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

  7. Thoracic Block Technique Associated with Positive End-Expiratory Pressure in Reversing Atelectasis

    Directory of Open Access Journals (Sweden)

    Luciana Carnevalli Pereira

    2015-01-01

    Full Text Available A preschool four-year-old male patient had been admitted to the Mandaqui Hospital with a diagnosis of lobar pneumonia, pleural effusion, and right lung atelectasis. Treatment consisted of antibiotics and physiotherapy sessions, using a technique described in the literature as Insufflation Technique to Reverse Atelectasis (ITRA, which consists of a thoracic block of healthy lung tissue, leaving only the atelectasis area free, associated with the use of invasive or noninvasive mechanical ventilation with positive airway pressure for reversal of atelectasis. Two physiotherapy sessions were conducted daily. The sessions lasted 20 minutes and were fractionated into four series of five minutes each. Each series bilateral thoracic block was performed for 20 seconds with a pause lasting for the same time. Associated with the thoracic block, a continuous positive airways pressure was used using a facial mask and 7 cm H2O PEEP provided via CPAP. Conclusion. ITRA technique was effective in reversing atelectasis in this patient.

  8. Influence of thermal inhibitor position and temperature on vortex-shedding-driven pressure oscillations

    Institute of Scientific and Technical Information of China (English)

    Su Wanxing; Li Shipeng; Zhang Qiao; Li Junwei; Ye Qingqing; Wang Ningfei

    2013-01-01

    Vortex-acoustic coupling is one of the most important potential sources of combustion instability in solid rocket motors (SRMs).Based on the Von Karman Institute for Fluid Dynamics (VKI) experimental motor,the influence of the thermal inhibitor position and temperature on vortex-shedding-driven pressure oscillations is numerically studied via the large eddy simulation (LES)method.The simulation results demonstrate that vortex shedding is a periodic process and its accurate frequency can be numerically obtained.Acoustic modes could be easily excited by vortex shedding.The vortex shedding frequency and second acoustic frequency dominate the pressure oscillation characteristics in the chamber.Thermal inhibitor position and gas temperature have little effect on vortex shedding frequency,but have great impact on pressure oscillation amplitude.Pressure amplitude is much higher when the thermal inhibitor locates at the acoustic velocity anti-nodes.The farther the thermal inhibitor is to the nozzle head,the more vortex energy would be dissipated by the turbulence.Therefore,the vortex shedding amplitude at the second acoustic velocity antinode near 3/4L (L is chamber length) is larger than those of others.Besides,the natural acoustic frequencies increase with the gas temperature.As the vortex shedding frequency departs from the natural acoustic frequency,the vortex-acoustic feedback loop is decoupled.Consequently,both the vortex shedding and acoustic amplitudes decrease rapidly.

  9. Positive Selection Pressure Drives Variation on the Surface-Exposed Variable Proteins of the Pathogenic Neisseria.

    Science.gov (United States)

    Wachter, Jenny; Hill, Stuart

    2016-01-01

    Pathogenic species of Neisseria utilize variable outer membrane proteins to facilitate infection and proliferation within the human host. However, the mechanisms behind the evolution of these variable alleles remain largely unknown due to analysis of previously limited datasets. In this study, we have expanded upon the previous analyses to substantially increase the number of analyzed sequences by including multiple diverse strains, from various geographic locations, to determine whether positive selective pressure is exerted on the evolution of these variable genes. Although Neisseria are naturally competent, this analysis indicates that only intrastrain horizontal gene transfer among the pathogenic Neisseria principally account for these genes exhibiting linkage equilibrium which drives the polymorphisms evidenced within these alleles. As the majority of polymorphisms occur across species, the divergence of these variable genes is dependent upon the species and is independent of geographical location, disease severity, or serogroup. Tests of neutrality were able to detect strong selection pressures acting upon both the opa and pil gene families, and were able to locate the majority of these sites within the exposed variable regions of the encoded proteins. Evidence of positive selection acting upon the hypervariable domains of Opa contradicts previous beliefs and provides evidence for selection of receptor binding. As the pathogenic Neisseria reside exclusively within the human host, the strong selection pressures acting upon both the opa and pil gene families provide support for host immune system pressure driving sequence polymorphisms within these variable genes.

  10. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, Jeffrey D. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Lawrence, Yaacov R. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Appel, Sarit; Landau, Efrat; Ben-David, Merav A.; Rabin, Tatiana; Benayun, Maoz; Dubinski, Sergey; Weizman, Noam; Alezra, Dror; Gnessin, Hila; Goldstein, Adam M.; Baidun, Khader [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Segel, Michael J.; Peled, Nir [Department of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Symon, Zvi, E-mail: symonz@sheba.health.gov.il [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2015-10-01

    Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.

  11. Activity of the positive and negative reinforcement motivation systems and baseline arterial blood pressure in humans.

    Science.gov (United States)

    Aftanas, L I; Sidorova, P V; Pavlov, S V; Makhnev, V P; Korenek, V V; Reva, N V; Amstislavskaya, T G

    2008-10-01

    The aim of the present work was to identify possible associations between individual balances in the activity of the positive and negative reinforcement motivation systems using a method based on emotional modulation of the startle reaction (EMSR) by motivationally significant emotionally positive and negative contextual visual stimuli and measures of cardiovascular system activity. Studies were performed using healthy males (mean age 30.29 +/- 9.8 years) with normal and first-episode excessive increases in arterial blood pressure (systolic blood pressure to greater than 140 mmHg, diastolic to greater than 90 mmHg). Cluster analysis of EMSR data identified groups of individuals with different activity profiles for the positive and negative reinforcement systems. Groups of subjects with changes in the balance of activity towards a lower level of positive reinforcement system activity (smaller startle reflexes to positive contextual stimuli) or a higher level of negative reinforcement system activity (larger startle reactions to threatening contextual stimuli) showed significantly greater baseline SBP and DBP. The possible mechanisms of the modulatory influences of the balance of system activities on autonomic vascular regulatory processes are discussed.

  12. Benefit of educational feedback for the use of positive expiratory pressure device

    Science.gov (United States)

    Reychler, Gregory; Jacquemart, Manon; Poncin, William; Aubriot, Anne-Sophie; Liistro, Giuseppe

    2015-01-01

    BACKGROUND: Positive expiratory pressure (PEP) is regularly used as a self-administered airway clearance technique. OBJECTIVE: The aim of this study was to evaluate the need to teach the correct use of the PEP device and to measure the progress of the success rate of the maneuver after training. METHOD: A PEP system (PariPEP-S Sytem) was used to generate PEP in 30 healthy volunteers. They were instructed by a qualified physical therapist to breathe correctly through the PEP device. Then they were evaluated during a set of ten expirations. Two other evaluations were performed at day 2 and day 8 (before and after feedback). The mean PEP and the success rate were calculated for each set of expirations. The number of maneuvers needed to obtain a correct use was calculated on the first session. RESULTS: An optimal PEP was reached after 7.5 SD 2.7 attempts by all subjects. Success rates and mean pressures were similar between the different sets of expirations (p=0.720 and p=0.326, respectively). Pressure variability was around 10%. After one week, 30% of subjects generated more than two non-optimal pressures in the set of ten expirations. No difference in success rate was observed depending on the evaluations. CONCLUSION: This study demonstrates that good initial training on the use of the PEP device and regular follow-up are required for the subject to reach optimal expiratory pressure. PMID:26647746

  13. Gas Breakthrough Pressure (GBP through Claystones: Correlation with FIB/SEM Imaging of the Pore Volume

    Directory of Open Access Journals (Sweden)

    Song Yang

    2016-07-01

    Full Text Available This contribution uses six claystone samples imaged by FIB/SEM (Focused Ion Beam/Scanning Electron Microscopy, within micrometric volumes located in the clay matrix; their 3D connected pore network is identified down to 17-22 nm pore size. All samples are gently dried to minimize damage, and several are impregnated with Poly(Methyl MethAcrylate (PMMA resin to avoid further damage during FIB/SEM observations. Three pore volumes out of six are connected between two parallel end surfaces through crack-like pores; two are not connected between any two parallel end surfaces; only one sample has a connected pore network distinct from cracks. By assuming varied pathways for gas to migrate by capillarity through the connected pore volumes (either by taking the shortest path, or through the largest path, or through the most frequent pore size, or by simulating the ingress of a non wetting fluid, we determine the Gas Breakthrough Pressure (GBP through the initially fully liquid saturated claystone, from these micrometric volumes. The scale change (from the micrometric to the macroscopic scale is assumed possible without changing the GBP value, and clay/water interactions are not accounted for. By comparison with GBP values measured in the laboratory on centimetric-sized claystone samples, it is concluded that breakthrough occurs most probably by capillary digitation; micro-cracks are the most probable pathways for gas, so that gas does not progress in a homogeneous manner through the claystone, as standard macroscopic finite element models would represent it. For intact claystone, predictions based on the capillary ingress of a non wetting fluid provide a GBP value ranging between 7-14 MPa.

  14. Radical prostatectomy and positive surgical margins: tumor volume and Gleason score predicts cancer outcome

    Energy Technology Data Exchange (ETDEWEB)

    La Roca, Ricardo L.R. Felts de, E-mail: Ricardo@delarocaurologia.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil); Fonseca, Francisco Paula da, E-mail: fpf@uol.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Divisao de Urologia. Dept. de Cirurgia Pelvica; Cunha, Isabela Werneck da; Bezerra, Stephania Martins, E-mail: iwerneck@gmail.com, E-mail: stephaniab@gmail.com [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Patologia

    2013-07-01

    Introduction: positive surgical margins (PSMs) are common adverse factors to predict the outcome of a patient submitted to radical prostatectomy (PR). However, not all of these men will follow with biochemical (BCR) or clinical (CR) recurrence. Relationship between PSMs with these recurrent events has to be correlated with other clinicopathological findings in order to recognize more aggressive tumors in order to recommend complementary treatment to these selected patients. Materials and methods: we retrospectively reviewed the outcome of 228 patients submitted to open retropubic RP between March 1991 and June 2008, where 161 had and 67 did not have PSMs. Minimum follow-up time was considered 2 years after surgery. BCR was considered when PSA {>=} 0.2 ng/ml. CR was determined when clinical evidence of tumor appeared. Chi-square test was used to correlate clinical and pathologic variables with PSMs. The estimated 5-year risk of BCR and CR in presence of PSMs was determined using the Kaplan-Meier method and compared to log-rank tests. Results: from the total of 228 patients, 161 (71%) had PSMs, while 67 (29%) had negative surgical margins (NSMs). Prostatic circumferential margin was the most common (43.4%) site. Univariate analysis showed statistically significant (p < 0.001) associations between the presence of PSMs and BCR, but not with CR (p = 0.06). Among 161 patients with PSMs, 61 (37.8%) presented BCR, while 100 (62.8%) did not. Predicting progression-free survival for 5 years, BCR was correlated with pathological stage; Gleason score; pre-treatment PSA; tumor volume in specimen; capsular and perineural invasion; presence and number of PSMs. RC correlated only with angiolymphatic invasion and Gleason score. Considering univariate analyses the clinicopathological factors predicting BCR for 5 years, results statistically significant links with prostate weight; pre-treatment PSA; Gleason score; pathological stage; tumor volume; PSMs; capsular and perineural

  15. Relations between thickness of UHMWPE's wear debris and positive pressure of tribological system

    Institute of Scientific and Technical Information of China (English)

    LIU HongTao; GE ShiRong

    2008-01-01

    MiaoXAM2.5X-50X Ultrahigh Precision Surface 3D Profiler is introduced to research the relations be-tween thickness of UHMWPE's wear debris and positive pressure of tribological system. Research re-sults show that thickness of wear debris owns evident classification, and the first grade thickness math model and the second grade thickness math model are built. By the second grade thickness math model, the true force condition in the tribological system can be gotten, and the model can be used as a tool to modify simulating parameters of the tribological system, and it is an important inspecting method to the airtight system which cannot be examined in real time. The first grade thickness math model can describe the true working load and surface condition of work piece in the tribological sys-tem, and is an effective description method for the running condition of frictional pairs. The research results at different lubricating conditions testify the relations between thicknesses of wear debris and positive pressure of the tribological system. The fractal relation between maximal thickness of wear debris and positive pressure is discussed. The conceptions of the immutability principle and charac-teristic granularity of wear debris thickness are brought forward and discussed. In conclusion, as a stable tribological parameter owning mechanical theory basis, wear debris thickness will play an im-portant part in fault diagnosis, especially for the airtight system such as artificial joint.

  16. Pulse pressure variation and stroke volume variation under different inhaled concentrations of isoflurane, sevoflurane and desflurane in pigs undergoing hemorrhage

    Directory of Open Access Journals (Sweden)

    Alexandre Hideaki Oshiro

    2015-12-01

    Full Text Available OBJECTIVES: Inhalant anesthesia induces dose-dependent cardiovascular depression, but whether fluid responsiveness is differentially influenced by the inhalant agent and plasma volemia remains unknown. The aim of this study was to compare the effects of isoflurane, sevoflurane and desflurane on pulse pressure variation and stroke volume variation in pigs undergoing hemorrhage. METHODS: Twenty-five pigs were randomly anesthetized with isoflurane, sevoflurane or desflurane. Hemodynamic and echocardiographic data were registered sequentially at minimum alveolar concentrations of 1.00 (M1, 1.25 (M2, and 1.00 (M3. Then, following withdrawal of 30% of the estimated blood volume, these data were registered at a minimum alveolar concentrations of 1.00 (M4 and 1.25 (M5. RESULTS: The minimum alveolar concentration increase from 1.00 to 1.25 (M2 decreased the cardiac index and increased the central venous pressure, but only modest changes in mean arterial pressure, pulse pressure variation and stroke volume variation were observed in all groups from M1 to M2. A significant decrease in mean arterial pressure was only observed with desflurane. Following blood loss (M4, pulse pressure variation, stroke volume variation and central venous pressure increased (p <0.001 and mean arterial pressure decreased in all groups. Under hypovolemia, the cardiac index decreased with the increase of anesthesia depth in a similar manner in all groups. CONCLUSION: The effects of desflurane, sevoflurane and isoflurane on pulse pressure variation and stroke volume variation were not different during normovolemia or hypovolemia.

  17. Stomach position versus liver-to-thoracic volume ratio in left-sided congenital diaphragmatic hernia.

    Science.gov (United States)

    Cordier, Anne-Gaël; Cannie, Mieke M; Guilbaud, Lucie; De Laveaucoupet, Jocelyne; Martinovic, Jéléna; Nowakowska, Dorota; Milejska-Lewandowska, Malgorzata; Rodó, Carlota; Viaris de Lesegno, Benjamin; Votino, Carmela; Senat, Marie-Victoire; Jani, Jacques C; Benachi, Alexandra

    2015-01-01

    To describe a new grading method for stomach position (SP) in fetuses with left-sided congenital diaphragmatic hernia (L-CDH) using ultrasound and to correlate SP to liver position and to liver-to-thoracic cavity volume ratio (LiTR) using magnetic resonance imaging. SP were graded at the level of the 4-chamber view as following: grade 1-to-4 for stomach not visualised, visualised anteriorly at the apex of the heart, stomach showing abdominal structures anteriorly and stomach with its larger part posterior to the level of the atrial-ventricular heart valves, respectively. The LiTR was calculated and correlated to SP using the Mann-Whitney U test. Seventy-four fetuses were included. Median LiTR for grade 1 SP was 0% and was not different from median LiTR for grade 2 SP (0%, p=NS). Median LiTR for grade 3 SP was 14.9% and was significantly higher than for grade 2 SP (p<0.001). Similarly, median LiTR for grade 4 SP was 20.7% and was significantly higher than for grade 3 SP (p<0.05). When SP was grade 1 or 2, liver was intra-abdominal in 21 (84%) out of 25 fetuses while it was always intrathoracic for SP 3 or 4. In L-CDH, SP as described represents a simple indirect measurement of intrathoracic position and quantification of liver.

  18. Performance studies on high pressure 1-D position sensitive neutron detectors

    Indian Academy of Sciences (India)

    S S Desai; A M Shaikh

    2008-11-01

    The powder diffractometer and Hi-Q diffractometer at Dhruva reactor make use of five identical 1-D position sensitive detectors (PSDs) to scan scattering angles in the range 3° to 140°. In order to improve the overall throughput of these spectrometers, it is planned to install a bank of 15 high-efficiency and high-resolution PSDs arranged in three layers with five PSDs in each layer. With each high pressure PSD (3He 10 bar + Kr 2 bar) showing the efficiency gain of 1.8 at 1.2 Å, detector bank is expected to show overall gain of 5.5 times the present detection efficiency and reduction in data collection time by equivalent factor. The 1-D PSDs are developed in batches of five, and are characterized so that all PSDs operate at uniform parameters such as position resolution, uniformity of efficiency and linearity of response. Position spectrum indicates the differential position resolution to be ∼ 1 mm and integral position resolution to be 3–4 mm. Broadening of position spectrum at the extreme end of sensitive length of PSD is analysed using fine shift of the beam. Dependence of position resolution and dynamic range of output pulse on the input impedance of pre-amplifier is also presented.

  19. Proceedings of the DOE/SNL/EPRI sponsored Reactor Pressure Vessel Thermal Annealing Workshop. Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    Rosinski, S.T. [ed.] [Sandia National Labs., Albuquerque, NM (United States); Carter, R.G. [ed.] [Electric Power Research Institute, Charlotte, NC (United States)

    1994-09-01

    The purpose of the Reactor Pressure Vessel Thermal Annealing Workshop was to provide a forum for US utilities and interested parties to discuss relevant experience and issues and identify potential solutions/approaches related to: (1) an understanding of the potential benefits of thermal annealing for US commercial reactors; (2) on-going technical research activities; (3) technical aspects of a generic, full-scale, in-place vessel annealing demonstration; and (4) the impact of economic, regulatory, and technical issues on the application of thermal annealing technology to US plants. Experts from the international nuclear reactor community were brought together to discuss issues regarding application of thermal annealing technology in the US and identify the steps necessary to commercialize this technology for US reactors. These proceedings contain all presentation materials discussed during the Workshop. This document, Volume 2, contains sections 10 through 13, Individual papers have been cataloged separately.

  20. Complex positive selection pressures drive the evolution of HIV-1 with different co-receptor tropisms

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    HIV-1 co-receptor tropism is central for understanding the transmission and pathogenesis of HIV-1 infection. We performed a genome-wide comparison between the adaptive evolution of R5 and X4 variants from HIV-1 subtypes B and C. The results showed that R5 and X4 variants experienced differential evolutionary patterns and different HIV-1 genes encountered various positive selection pressures, suggesting that complex selection pressures are driving HIV-1 evolution. Compared with other hypervariable regions of Gp120, significantly more positively selected sites were detected in the V3 region of subtype B X4 variants, V2 region of subtype B R5 variants, and V1 and V4 regions of subtype C X4 variants, indicating an association of positive selection with co-receptor recognition/binding. Intriguingly, a significantly higher proportion (33.3% and 55.6%, P<0.05) of positively selected sites were identified in the C3 region than other conserved regions of Gp120 in all the analyzed HIV-1 variants, indicating that the C3 region might be more important to HIV-1 adaptation than previously thought. Approximately half of the positively selected sites identified in the env gene were identical between R5 and X4 variants. There were three common positively selected sites (96, 113 and 281) identified in Gp41 of all X4 and R5 variants from subtypes B and C. These sites might not only suggest a functional importance in viral survival and adaptation, but also imply a potential cross-immunogenicity between HIV-1 R5 and X4 variants, which has important implications for AIDS vaccine development.

  1. Auto-trilevel versus bilevel positive airway pressure ventilation for hypercapnic overlap syndrome patients.

    Science.gov (United States)

    Su, Mei; Huai, De; Cao, Juan; Ning, Ding; Xue, Rong; Xu, Meijie; Huang, Mao; Zhang, Xilong

    2017-06-13

    Although bilevel positive airway pressure (Bilevel PAP) therapy is usually used for overlap syndrome (OS), there is still a portion of OS patients in whom Bilevel PAP therapy could not simultaneously eliminate residual apnea events and hypercapnia. The current study was expected to explore whether auto-trilevel positive airway pressure (auto-trilevel PAP) therapy with auto-adjusting end expiratory positive airway pressure (EEPAP) can serve as a better alternative for these patients. From January of 2014 to June of 2016, 32 hypercapnic OS patients with stable chronic obstructive pulmonary diseases (COPD) and moderate-to-severe obstructive sleep apnea syndrome (OSAS) were recruited. Three variable modes of positive airway pressure (PAP) from the ventilator (Prisma25ST, Weinmann Inc., Germany) were applicated for 8 h per night. We performed the design of each mode at each night with an interval of two nights with no PAP treatment as a washout period among different modes. In Bilevel-1 mode (Bilevel-1), the expiratory positive airway pressure (EPAP) delivered from Bilevel PAP was always set as the lowest PAP for abolishment of snoring. For each patient, the inspiratory positive airway pressure (IPAP) was constantly set the same as the minimal pressure for keeping end-tidal CO2 (ETCO2) ≤45 mmHg for all three modes. However, the EPAP issued by Bilevel PAP in Bilevel-2 mode (Bilevel-2) was kept 3 cmH2O higher than that in Bilevel-1. In auto-trilevel mode (auto-trilevel) with auto-trilevel PAP, the initial part of EPAP was fixed at the same PAP as that in Bilevel-1 while the EEPAP was automatically regulated to rise at a range of ≤4 cmH2O based on nasal airflow wave changes. Comparisons were made for parameters before and during or following treatment as well as among different PAP therapy modes. The following parameters were compared such as nocturnal apnea hypopnea index (AHI), minimal SpO2 (minSpO2), arousal index, sleep structure and efficiency, morning PaCO2

  2. Change of positive selection pressure on HIV-1 envelope gene inferred by early and recent samples.

    Directory of Open Access Journals (Sweden)

    Izumi Yoshida

    Full Text Available HIV-1 infection has been on the rise in Japan recently, and the main transmission route has changed from blood transmission in the 1980s to homo- and/or hetero-sexual transmission in the 2000s. The lack of early viral samples with clinical information made it difficult to investigate the possible virological changes over time. In this study, we sequenced 142 full-length env genes collected from 16 Japanese subjects infected with HIV-1 in the 1980s and in the 2000s. We examined the diversity change in sequences and potential adaptive evolution of the virus to the host population. We used a codon-based likelihood method under the branch-site and clade models to detect positive selection operating on the virus. The clade model was extended to account for different positive selection pressures in different viral populations. The result showed that the selection pressure was weaker in the 2000s than in the 1980s, indicating that it might have become easier for the HIV to infect a new host and to develop into AIDS now than 20 years ago and that the HIV may be becoming more virulent in the Japanese population. The study provides useful information on the surveillance of HIV infection and highlights the utility of the extended clade models in analysis of virus populations which may be under different selection pressures.

  3. Scale-4 Analysis of Pressurized Water Reactor Critical Configurations: Volume 1-Summary

    Energy Technology Data Exchange (ETDEWEB)

    DeHart, M.D.

    1995-01-01

    The requirements of ANSI/ANS 8.1 specify that calculational methods for away-from-reactor criticality safety analyses be validated against experimental measurements. If credit is to be taken for the reduced reactivity of burned or spent fuel relative to its original ''fresh'' composition, it is necessary to benchmark computational methods used in determining such reactivity worth against spent fuel reactivity measurements. This report summarizes a portion of the ongoing effort to benchmark away-from-reactor criticality analysis methods using critical configurations from commercial pressurized- water reactors (PWR). The analysis methodology utilized for all calculations in this report is based on the modules and data associated with the SCALE-4 code system. Isotopic densities for spent fuel assemblies in the core were calculated using the SAS2H analytical sequence in SCALE-4. The sources of data and the procedures for deriving SAS2H input parameters are described in detail. The SNIKR code sequence was used to extract the necessary isotopic densities from SAS2H results and to provide the data in the format required for SCALE-4 criticality analysis modules. The CSASN analytical sequence in SCALE-4 was used to perform resonance processing of cross sections. The KENO V.a module of SCALE-4 was used to calculate the effective multiplication factor (k{sub eff}) for the critical configuration. The SCALE-4 27-group burnup library containing ENDF/B-IV (actinides) and ENDF/B-V (fission products) data was used for analysis of each critical configuration. Each of the five volumes comprising this report provides an overview of the methodology applied. Subsequent volumes also describe in detail the approach taken in performing criticality calculations for these PWR configurations: Volume 2 describes criticality calculations for the Tennessee Valley Authority's Sequoyah Unit 2 reactor for Cycle 3; Volume 3 documents the analysis of Virginia Power

  4. Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea.

    Science.gov (United States)

    Carter, Jason R; Fonkoue, Ida T; Grimaldi, Daniela; Emami, Leila; Gozal, David; Sullivan, Colin E; Mokhlesi, Babak

    2016-04-01

    Positive airway pressure (PAP) treatment has been shown to have a modest effect on ambulatory blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, there is a paucity of data on the effect of PAP therapy on rapid, yet significant, BP swings during sleep, particularly in obesity hypoventilation syndrome (OHS). The present study hypothesizes that PAP therapy will improve nocturnal BP on the first treatment night (titration PAP) in OHS patients with underlying OSA, and that these improvements will become more significant with 6 wk of PAP therapy. Seventeen adults (7 men, 10 women; age 50.4 ± 10.7 years, BMI 49.3 ± 2.4 kg/m(2)) with OHS and clinically diagnosed OSA participated in three overnight laboratory visits that included polysomnography and beat-to-beat BP monitoring via finger plethysmography. Six weeks of PAP therapy, but not titration PAP, lowered mean nocturnal BP. In contrast, when nocturnal beat-to-beat BPs were aggregated into bins consisting of at least three consecutive cardiac cycles with a >10 mmHg BP surge (i.e., Δ10-20, Δ20-30, Δ30-40, and Δ>40 mmHg), titration, and 6-wk PAP reduced the number of BP surges per hour (time × bin, P < 0.05). PAP adherence over the 6-wk period was significantly correlated to reductions in nocturnal systolic (r = 0.713, P = 0.001) and diastolic (r = 0.497, P = 0.043) BP surges. Despite these PAP-induced improvements in nocturnal beat-to-beat BP surges, 6 wk of PAP therapy did not alter daytime BP. In conclusion, PAP treatment reduces nocturnal beat-to-beat BP surges in OHS patients with underlying OSA, and this improvement in nocturnal BP regulation was greater in patients with higher PAP adherence.

  5. Limitations of stroke volume estimation by non-invasive blood pressure monitoring in hypergravity.

    Directory of Open Access Journals (Sweden)

    Olivier Manen

    Full Text Available Altitude and gravity changes during aeromedical evacuations induce exacerbated cardiovascular responses in unstable patients. Non-invasive cardiac output monitoring is difficult to perform in this environment with limited access to the patient. We evaluated the feasibility and accuracy of stroke volume estimation by finger photoplethysmography (SVp in hypergravity.Finger arterial blood pressure (ABP waveforms were recorded continuously in ten healthy subjects before, during and after exposure to +Gz accelerations in a human centrifuge. The protocol consisted of a 2-min and 8-min exposure up to +4 Gz. SVp was computed from ABP using Liljestrand, systolic area, and Windkessel algorithms, and compared with reference values measured by echocardiography (SVe before and after the centrifuge runs.The ABP signal could be used in 83.3% of cases. After calibration with echocardiography, SVp changes did not differ from SVe and values were linearly correlated (p<0.001. The three algorithms gave comparable SVp. Reproducibility between SVp and SVe was the best with the systolic area algorithm (limits of agreement -20.5 and +38.3 ml.Non-invasive ABP photoplethysmographic monitoring is an interesting technique to estimate relative stroke volume changes in moderate and sustained hypergravity. This method may aid physicians for aeronautic patient monitoring.

  6. Effect of Nasal Obstruction on Continuous Positive Airway Pressure Treatment: Computational Fluid Dynamics Analyses.

    Directory of Open Access Journals (Sweden)

    Tadashi Wakayama

    Full Text Available Nasal obstruction is a common problem in continuous positive airway pressure (CPAP therapy for obstructive sleep apnea and limits treatment compliance. The purpose of this study is to model the effects of nasal obstruction on airflow parameters under CPAP using computational fluid dynamics (CFD, and to clarify quantitatively the relation between airflow velocity and pressure loss coefficient in subjects with and without nasal obstruction.We conducted an observational cross-sectional study of 16 Japanese adult subjects, of whom 9 had nasal obstruction and 7 did not (control group. Three-dimensional reconstructed models of the nasal cavity and nasopharynx with a CPAP mask fitted to the nostrils were created from each subject's CT scans. The digital models were meshed with tetrahedral cells and stereolithography formats were created. CPAP airflow simulations were conducted using CFD software. Airflow streamlines and velocity contours in the nasal cavities and nasopharynx were compared between groups. Simulation models were confirmed to agree with actual measurements of nasal flow rate and with pressure and flow rate in the CPAP machine.Under 10 cmH2O CPAP, average maximum airflow velocity during inspiration was 17.6 ± 5.6 m/s in the nasal obstruction group but only 11.8 ± 1.4 m/s in the control group. The average pressure drop in the nasopharynx relative to inlet static pressure was 2.44 ± 1.41 cmH2O in the nasal obstruction group but only 1.17 ± 0.29 cmH2O in the control group. The nasal obstruction and control groups were clearly separated by a velocity threshold of 13.5 m/s, and pressure loss coefficient threshold of approximately 10.0. In contrast, there was no significant difference in expiratory pressure in the nasopharynx between the groups.This is the first CFD analysis of the effect of nasal obstruction on CPAP treatment. A strong correlation between the inspiratory pressure loss coefficient and maximum airflow velocity was found.

  7. Experience of step-wise protocol using noninvasive positive pressure ventilation for treating cardiogenic pulmonary edema.

    Science.gov (United States)

    Momii, Hidetoshi; Tashima, Yuki; Kadokami, Toshiaki; Narita, Sumito; Yoshida, Masayoshi; Ando, Shin-ichi

    2012-08-01

    Initiating and weaning procedure of noninvasive positive pressure ventilation (NIPPV) on acute cardiogenic pulmonary edema (ACPE) has been determined empirically, and the total time of its use has been sometimes prolonged unnecessarily. A simple protocol for its use may facilitate initiation and avoids prolongation of the NIPPV treatment. We designed a step-wise protocol for NIPPV use and retrospectively examined the clinical outcome of our protocol for initiation and weaning of NIPPV in 45 patients with ACPE. Almost all patients recovered from respiratory distress successfully. There was no intubation nor complication related to NIPPV. In most of the cases, maximal-end expiratory pressure was less than 7-cm H2O. The mean duration of NIPPV was 19.5±28.0 h and the median duration was 8.0 h (interquartile range=14.0 h). This simple step-wise NIPPV protocol for ACPE can facilitate quick and safe initiation and termination of the treatment.

  8. Continuous positive airway pressure ameliorated severe pulmonary hypertension associated with obstructive sleep apnea.

    Directory of Open Access Journals (Sweden)

    Ogawa,Aiko

    2006-06-01

    Full Text Available

    A 52-year-old obese woman was admitted to our institution for evaluation of dyspnea and pulmonary hypertension (PH. Polysomnography revealed severe obstructive sleep apnea (OSA with an apnea hypopnea index of 99.8. Treatment with nocturnal continuous positive airway pressure (CPAP resulted in correction of daytime hypoxemia, hypercapnia, and near-normalization of pulmonary artery pressure. To our knowledge, this is the most severe case of OSA-associated PH (approximately70 mmHg reported to date, and it was successfully treated with nocturnal CPAP. This case demonstrates that OSA should be considered and polysomnography performed in all patients with PH, irrespective of severity, and that nocturnal CPAP has therapeutic effects on both OSA and daytime PH.

  9. Analysis of vibration and pressure pulsation in positive displacement drilling motors

    Energy Technology Data Exchange (ETDEWEB)

    Hamlin, D.B.; Dreesen, D.S.

    1998-12-31

    Three, Moineau principle, positive displacement (drilling) motors were tested on a dynamometer using water, air/mist, and foam. In conjunction with a traditional motor performance test, data were collected at 5000 samples per second using an adapted seismic data acquisition system. Shaft speed, torque, pressure, and three-axis vibration data were processed using Seismic Analysis Code (SAC) to obtain energy density spectrums (EDSs). Cascade plots were generated by plotting the EDSs against shaft speed. The cascade plots revealed that pressure pulses and motor vibrations are closely related to the eccentric rotation of the rotor in the power section. Excessive no-load vibrations were not observed in the small motors and test apparatus used; increasing torque usually decreases the amplitude of vibrations observed. Motor vibration amplitudes were as a rule not increased when compressible fluids were substituted for water.

  10. Adjoint complement to viscous finite-volume pressure-correction methods

    Science.gov (United States)

    Stück, Arthur; Rung, Thomas

    2013-09-01

    A hybrid-adjoint Navier-Stokes method for the pressure-based computation of hydrodynamic objective functional derivatives with respect to the shape is systematically derived in three steps: The underlying adjoint partial differential equations and boundary conditions for the frozen-turbulence Reynolds-averaged Navier-Stokes equations are considered in the first step. In step two, the adjoint discretisation is developed from the primal, unstructured finite-volume discretisation, such that adjoint-consistent approximations to the adjoint partial differential equations are obtained following a so-called hybrid-adjoint approach. A unified, discrete boundary description is outlined that supports high- and low-Reynolds number turbulent wall-boundary treatments for both the adjoint boundary condition and the boundary-based gradient formula. The third component focused in the development of the industrial adjoint CFD method is the adjoint counterpart to the primal pressure-correction algorithm. The approach is verified against the direct-differentiation method and an application to internal flow problems is presented.

  11. [Continuous positive airway pressure and high-frequency independent lung ventilation in patients with chronic obstructive lung diseases].

    Science.gov (United States)

    Fedorova, E A; Vyzhigina, M A; Gal'perin, Iu S; Zhukova, S G; Titov, V A; Godin, A V

    2004-01-01

    The original hypoxemia, hypercapnia, high pulmonary hypertension, high resistance of microcirculation vessels, right volumetric ventricular overload, persistent sub-edema of pulmonary intersticium as well as disparity of ventilation and perfusion between both lungs are the main problems in patients with chronic obstructive disease of the lungs (CODL). Such patients are, as a rule, intolerant to the independent lung collaboration or artificial single-stage ventilation (ASV). Patients with respiratory insufficiency, stages 2 and 3, and with a pronounced impaired type of ventilation have originally a deranged blood gas composition, like hypoxemia or hypercapnia. The application of volume-controllable bi-pulmonary ASV in such patients maintains an adequate gas exchange hemodynamics. However, ASV is accompanied by a significantly reduced gas-exchange function of the single ventilated lung and by essentially worsened intrapulmonary hemodynamics. Therefore, what is needed is to use alternative methods of independent lung ventilation in order to eliminate the gas-exchange impairments and to enable surgical interventions at thoracic organs in such patients (who are intolerant to ASV). A choice of a method and means of oxygen supply to the independent lung is of great importance. The possibility to avoid a high pressure in the airways, while maintaining, simultaneously, an adequate gas exchange, makes the method related with maintaining a constant positive pressure in the airways (CPPA) a priority one in case of CODL patients. The use of constant high-frequency ventilation in the independent lung in patients with obstructive pulmonary lesions does not improve the gas exchange or hemodynamics. Simultaneously, a growing total pulmonary resistance and an increasing pressure in the pulmonary artery are observed. Consequently, the discussed method must not be used for the ventilation support of the independent lung in patients with the obstructive type of the impaired external

  12. Body position and intraocular pressure fluctuation%体位与眼压波动

    Institute of Scientific and Technical Information of China (English)

    柯瑞莉; 李金瑛

    2013-01-01

    眼压较大波动是造成青光眼视神经损伤的重要因素,而眼压波动受多重因素影响,体位是其中之一.本文通过介绍体位变化时间对眼压的影响、连续体位变化对眼压的影响、不同卧位对眼压的影响、倒立举重等对眼压的影响、正常人与青光眼患者体位变化眼压比较等来阐述体位变化与眼压的关系,从上巩膜静脉压、血压、眼内容物与前房深度、眼灌注压、激素等五个方面解释体位变化如何影响眼压,并阐述了体位影响眼压的意义.%The fluctuation of intraocular pressure(IOP) is an important factor causing glaucomatous optic nerve injury,and posture is one of the most important factors affecting IOP.The effects of body posision on IOP is receiving more and more attention.This article reviews the research progress about the posture impacts on IOP.The objective is to explain the relationship between position change and IOP by presenting the effects of postural changing time,continuous postural change,different supine position,handstand and weightlifling,and summarize how the postural change affect the IOP from five aspects:episcleral venous pressure,blood pressure,intraocular contents and anterior chamber depth,ocular perfusion pressure,and the change of adrenalin.

  13. Inhibitory Effect of Nasal Intermittent Positive Pressure Ventilation on Gastroesophageal Reflux.

    Directory of Open Access Journals (Sweden)

    Danny Cantin

    Full Text Available Non-invasive intermittent positive pressure ventilation can lead to esophageal insufflations and in turn to gastric distension. The fact that the latter induces transient relaxation of the lower esophageal sphincter implies that it may increase gastroesophageal refluxes. We previously reported that nasal Pressure Support Ventilation (nPSV, contrary to nasal Neurally-Adjusted Ventilatory Assist (nNAVA, triggers active inspiratory laryngeal closure. This suggests that esophageal insufflations are more frequent in nPSV than in nNAVA. The objectives of the present study were to test the hypotheses that: i gastroesophageal refluxes are increased during nPSV compared to both control condition and nNAVA; ii esophageal insufflations occur more frequently during nPSV than nNAVA. Polysomnographic recordings and esophageal multichannel intraluminal impedance pHmetry were performed in nine chronically instrumented newborn lambs to study gastroesophageal refluxes, esophageal insufflations, states of alertness, laryngeal closure and respiration. Recordings were repeated without sedation in control condition, nPSV (15/4 cmH2O and nNAVA (~ 15/4 cmH2O. The number of gastroesophageal refluxes recorded over six hours, expressed as median (interquartile range, decreased during both nPSV (1 (0, 3 and nNAVA [1 (0, 3] compared to control condition (5 (3, 10, (p < 0.05. Meanwhile, the esophageal insufflation index did not differ between nPSV (40 (11, 61 h-1 and nNAVA (10 (9, 56 h-1 (p = 0.8. In conclusion, nPSV and nNAVA similarly inhibit gastroesophageal refluxes in healthy newborn lambs at pressures that do not lead to gastric distension. In addition, the occurrence of esophageal insufflations is not significantly different between nPSV and nNAVA. The strong inhibitory effect of nIPPV on gastroesophageal refluxes appears identical to that reported with nasal continuous positive airway pressure.

  14. Type of mask may impact on continuous positive airway pressure adherence in apneic patients.

    Directory of Open Access Journals (Sweden)

    Jean Christian Borel

    Full Text Available RATIONALE: In obstructive sleep apnea patients (OSA, continuous positive airway pressure (CPAP adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly. OBJECTIVE: To evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA. METHODS: Newly CPAP treated OSA participating in "Observatoire Sommeil de la Fédération de Pneumologie", a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence. RESULTS: 2311 OSA (age = 57(12 years, apnea+hypopnea index = 41(21/h, 29% female were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5, depression, low effective pressure, and side effects. CONCLUSION: As oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.

  15. Stroke Volume and Sympathetic Responses to Lower-Body Negative Pressure Reveal New Insight into Circulatory Shock in Humans

    Science.gov (United States)

    2004-01-01

    of SBP and twice DBP by three. 2.4. Measurement of stroke volume Stroke volume was measured noninvasively using tho- racic electrical bioimpedance ...received in revised form 25 February 2004; accepted 26 February 2004 Abstract We measured various hemodynamic responses and muscle sympathetic nerve...responses to central hypovolemia. We measured heart rates, arterial blood pressures, sympathetic neural activity (MSNA; peroneal nerve microneurography), and

  16. Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization: Causes and Management.

    Science.gov (United States)

    Chapman, Julia L; Serinel, Yasmina; Marshall, Nathaniel S; Grunstein, Ronald R

    2016-09-01

    Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), but it is also common in the general population. When sleepiness remains after continuous positive airway pressure (CPAP) treatment of OSA, comorbid conditions or permanent brain injury before CPAP therapy may be the cause of the residual sleepiness. There is currently no broad approach to treating residual EDS in patients with OSA. Individual assessment must be made of comorbid conditions and medications, and of lifestyle factors that may be contributing to the sleepiness. Modafinil and armodafinil are the only pharmacologic agents indicated for residual sleepiness in these patients.

  17. [Management of patients receiving home respiratory care with tracheostomy and positive-pressure ventilation].

    Science.gov (United States)

    Aoki, Masashi

    2013-01-01

    On March 11, 2011, the Great East Japan Earthquake occurred and a massive tsunami hit the northeastern coast of Japan. In Miyagi prefecture in Tokoku district, 49 patients with amyotrophic lateral sclerosis were supported by home respiratory care with tracheostomy and positive-pressure ventilation at that time. Among them, two patients were died in the tsunami and 25 patients were forced to evacuate to hospitals. We should hurry to submit a guideline for medical transportation for patients with neuromuscular diseases requiring artificial ventilation. We also should research the disaster medicine in the field of neurology.

  18. Effect of lower-body positive pressure on postural fluid shifts in men

    Science.gov (United States)

    Hinghofer-Szalkay, H.; Kravik, S. E.; Greenleaf, J. E.

    1988-01-01

    The effect of the lower-body positive pressure (LBPP) on the orthostatic fluid and protein shifts were investigated in five men during combined tilt-table/antigravity suit inflation and deflation experiments. Changes in the mass densities of venous blood and plasma were measured and the values were used to calculate the densities of erythrocytes, whole-body blood, and shifted fluid. It was found that the application of 60 mm Hg LBPP during 60-deg head-up tilt prevented about half of the postural hemoconcentration occurring during passive head-up tilt.

  19. Independent and interactive effects of blood pressure and cardiac function on brain volume and white matter hyperintensities in heart failure.

    Science.gov (United States)

    Alosco, Michael L; Brickman, Adam M; Spitznagel, Mary Beth; Griffith, Erica Y; Narkhede, Atul; Raz, Naftali; Cohen, Ronald; Sweet, Lawrence H; Hughes, Joel; Rosneck, Jim; Gunstad, John

    2013-01-01

    Reduced systemic perfusion and comorbid medical conditions are key contributors to adverse brain changes in heart failure (HF). Hypertension, the most common co-occurring condition in HF, accelerates brain atrophy in aging populations. However, the independent and interactive effects of blood pressure and systemic perfusion on brain structure in HF have yet to be investigated. Forty-eight older adults with HF underwent impedance cardiography to assess current systolic blood pressure status and cardiac index to quantify systemic perfusion. All participants underwent brain magnetic resonance imaging to quantify total brain, total and subcortical gray matter volume, and white matter hyperintensities (WMH) volume. Regression analyses adjusting for medical and demographic factors showed decreased cardiac index was associated with smaller subcortical gray matter volume (P cardiac index exacerbated WMH (P = .048). Higher blood pressure and systemic hypoperfusion are associated with smaller brain volume, and these factors interact to exacerbate WMH in HF. Prospective studies are needed to clarify the effects of blood pressure on the brain in HF, including the role of long-term blood pressure fluctuations. Copyright © 2013 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  20. Pressure--volume--temperature properties of perfluorocyclobutane: equations of state, virial coefficients, and intermolecular potential energy functions

    Energy Technology Data Exchange (ETDEWEB)

    Douslin, D.R.; Moore, R.T.; Waddington, G.

    1959-11-01

    Studies of the pressure-volume-temperature properties of perfluorocyclobutane, in the ranges 3-394 atm and 30-350/sup 0/, yielded values of gas compressibility, critical constants, vapor pressure and orthobaric liquid and vapor densities. The results were correlated by the Beattie Bridgeman, Benedict Webb Rubin, and Martin-Hou equations of state and by the Stockmayer and the Kihara intermolecular potential energy functions. The merits of the several correlational methods are discussed.

  1. Ambulatory instrument for monitoring indirect beat-to-beat blood pressure in superficial temporal artery using volume-compensation method.

    Science.gov (United States)

    Tanaka, S; Yamakoshi, K

    1996-11-01

    A portable instrument, based on a volume-compensation technique, is designed for ambulatory monitoring of indirect beat-to-beat blood pressure (BP) in the superficial temporal artery. The instrument consists of a small disc-type cuff and a portable unit carried by the subject. Several components are integrated in the cuff for applying counter-pressure to the artery, i.e. a reflectance-type photo-plethysmographic sensor for arterial volume detection, a pressure sensor for cuff pressure Pc measurement and a nozzle flapper-type- electro-pneumatic convertor for controlling Pc. The portable unit includes volume servo control circuitry and a microprocessor-based signal-processing and recording unit. This automatically performs all the necessary measurement procedures and stores into a memory IC element the processed systolic, mean and diastolic blood pressure data, together with pulse intervals on a beat-to-beat basis from the servo-controlled Pc (indirectly measured BP waveform). With this instrument, momentary changes in BP during ambulatory situations such as bicycle ergometer exercise and daily activities including motorway driving are successfully recorded. From the results of simultaneous measurement of the subject's posture changes, the effect of posture change on blood pressure, e.g. baroreceptor-cardiac reflex, is also clearly demonstrated.

  2. Changes in cardiac index and blood pressure on positioning children prone for scoliosis surgery.

    Science.gov (United States)

    Brown, Z E; Görges, M; Cooke, E; Malherbe, S; Dumont, G A; Ansermino, J M

    2013-07-01

    In this prospective observational study we investigated the changes in cardiac index and mean arterial pressure in children when positioned prone for scoliosis correction surgery. Thirty children (ASA 1-2, aged 13-18 years) undergoing primary, idiopathic scoliosis repair were recruited. The cardiac index and mean arterial blood pressure (median (IQR [range])) were 2.7 (2.3-3.1 [1.4-3.7]) l.min(-1).m(-2) and 73 (66-80 [54-91]) mmHg, respectively, at baseline; 2.9 (2.5-3.2 [1.7-4.4]) l.min(-1).m(-2) and 73 (63-81 [51-96]) mmHg following a 5-ml.kg(-1) fluid bolus; and 2.5 (2.2-2.7 [1.4-4.8]) l.min(-1).m(-2) and 69 (62-73 [46-85]) mmHg immediately after turning prone. Turning prone resulted in a median reduction in cardiac index of 0.5 l.min(-1).m(-2) (95% CI 0.3-0.7 l.min(-1).m(-2), p=0.001), or 18.5%, with a large degree of inter-subject variability (+10.3% to -40.9%). The changes in mean arterial blood pressure were not significant. Strategies to predict, prevent and treat decreases in cardiac index need to be developed.

  3. Otic Barotrauma Resulting from Continuous Positive Airway Pressure: Case Report and Literature Review

    Science.gov (United States)

    McCormick, Justin P.; Hildrew, Douglas M.; Lawlor, Claire M.; Guittard, Jesse A.; Worley, N. Knight

    2016-01-01

    Background: Obstructive sleep apnea (OSA) is a growing problem affecting millions of people in the United States. The prevalence of OSA has risen drastically in the past few decades concurrently with the increasing prevalence of obesity. Subsequently, there has been an ever-increasing rise in the use of continuous positive airway pressure (CPAP) devices. While using CPAP devices may lead to many adverse effects, the majority of these effects are described as relatively benign. Case Report: We describe the detailed clinical course and outcome for a patient with otic barotrauma as a result of excessive self-titration of CPAP therapy in an in-home setting. We also discuss the pathophysiology of otic barotrauma and present a review of current literature on the topic. Conclusion: While the benefits of CPAP are clear, we must take into account the rare but possible effects on ear structure and function. Many studies describe an increase in middle ear pressure with the use of CPAP, but few describe the effects of this increased pressure on the middle ear, such as the otic barotrauma described in this case. Given the increased prevalence of OSA, it is important to understand the risks associated with CPAP therapy. PMID:27303224

  4. Continuous positive airway pressure therapy for infants with respiratory distress in non tertiary care centers: a randomized, controlled trial.

    Science.gov (United States)

    Buckmaster, Adam G; Arnolda, Gaston; Wright, Ian M R; Foster, Jann P; Henderson-Smart, David J

    2007-09-01

    Our objective was to determine whether continuous positive airway pressure therapy would safely reduce the need for up-transfer of infants with respiratory distress from nontertiary centers. We randomly assigned 300 infants at >30 weeks of gestation with respiratory distress to receive either Hudson prong bubble continuous positive airway pressure therapy or headbox oxygen treatment (standard care). The primary end point was "up-transfer or treatment failure." Secondary end points included death, length of nursery stay, time receiving oxygen therapy, cost of care, and other measures of morbidity. Of 151 infants who received continuous positive airway pressure therapy, 35 either were up-transferred or experienced treatment failure, as did 60 of the 149 infants given headbox oxygen treatment. There was no difference in the length of stay or the duration of oxygen treatment. For every 6 infants treated with continuous positive airway pressure therapy, there was an estimated cost saving of $10,000. Pneumothorax was identified for 14 infants in the continuous positive airway pressure group and 5 in the headbox group. There was no difference in any other measure of morbidity or death. Hudson prong bubble continuous positive airway pressure therapy reduces the need for up-transfer of infants with respiratory distress in nontertiary centers. There is a clinically relevant but not statistically significant increase in the risk of pneumothorax. There are significant benefits associated with continuous positive airway pressure use in larger nontertiary centers.

  5. Flow-synchronized nasal intermittent positive pressure ventilation in the preterm infant: development of a project

    Directory of Open Access Journals (Sweden)

    Corrado Moretti

    2013-06-01

    Full Text Available This manuscript describes the experience of our team in developing a flow-triggered nasal respiratory support for the neonate and its related clinical applications. Although mechanical ventilation (MV via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to the development of many possible complications, first of all, bronchopulmonary dysplasia (BPD. Avoiding mechanical ventilation is thought to be a critical goal, and different modes of non invasive respiratory support may reduce the intubation rate: nasal continuous positive airway pressure (NCPAP, nasal intermittent positive pressure ventilation (NIPPV and its more advantageous form, synchronized nasal intermittent positive pressure ventilation (SNIPPV. SNIPPV was initially performed by a capsule placed on the baby’s abdomen. To overcome the disadvantages of the abdominal capsule, our team decided to create a flow-sensor that could be interposed between the nasal prongs and the Y piece. Firstly we developed a hot-wire flow-sensor to trigger the ventilator and we showed that flow-SNIPPV can support the inspiratory effort in the post-extubation period more effectively than NCPAP. But, although accurate, the proper functioning of the hot-wire flow-sensor was easily compromised by secretions or moisture, and therefore we started to use as flow-sensor a simpler differential pressure transducer. In a following trial using the new device, we were able to demonstrate that flow-SNIPPV was more effective than conventional NCPAP in decreasing extubation failure in preterm infants who had been ventilated for respiratory distress syndrome (RDS. More recently we used flow-SNIPPV as the primary mode of ventilation, after surfactant replacement, reducing MV need and favorably affecting short-term morbidities of treated premature infants. We also successfully applied SNIPPV to treat apnea of

  6. Ulcer piercing: cleansing of complicated diabetic neuropathic foot ulcers by positive pressure irrigation.

    Science.gov (United States)

    Cavallini, M

    2014-02-01

    To demonstrate the efficacy of the ulcer piercing procedure, which allows constant cleansing of the ulcer and facilitates a positive pressure irrigation of any pierced hidden tracts, in order to reduce the negative impact of stasis on wound healing. We designed a surgical procedure of ulcer piercing and drainage with a silastic tube, which allows positive pressure irrigation of any pierced tracts. This procedure was performed in a continuous series of 25 selected diabetic patients affected by a Wagner stage 3 ulcer of the toe (n=16), metatarsal midfoot (n=5) and plantar Charcot foot (n=4), and with adequate foot arterial blood supply. Within 6 months of the ulcer piercing procedure, 23/25 of ulcers had completely healed. In two further cases, the ulcer piercing ring was still in place after 3 and 5 months, progressively healing with no active signs of infection. Taking into consideration the advantages and the lack of side effects afforded by this procedure, ulcer piercing represents a small but effective step towards an easier and safer approach to treating complicated diabetic neuropathic foot ulcers with adequate arterial blood supply. There were no external sources of funding for this study. The author has no conflicts of interest to declare with regard to the manuscript or its content.

  7. Monolith disk chromatography separates PEGylated protein positional isoforms within minutes at low pressure.

    Science.gov (United States)

    Isakari, Yu; Podgornik, Ales; Yoshimoto, Noriko; Yamamoto, Shuichi

    2016-01-01

    Although PEGylation makes proteins drugs more effective, the PEGylation reaction must be controlled carefully in order to obtain a desired PEGylated protein form since various different PEGylated forms may be produced during the reaction. For monitoring the PEGylation reaction, a method with monolith disk ion exchange chromatography, which can separate positional isomers as well as PEGmers, has been developed as a process analytical tool (PAT). The method was optimized for separation of randomly PEGylated protein (lysozyme) isoforms based on the number of resolved peaks, peak resolution, analysis time and pressure drop. In order to increase the retention of mono- and di-PEGylated protein isomers the mobile phase was decreased to pH 4.5, where a large number of mono- and di-PEGylated isomers were resolved within a few minutes. Based on the linear gradient elution optimization model, the following values were determined: gradient slope 0.016 M/mL, disk thickness 3 mm (single disk) and flow rate 10 mL/min. Under these optimal conditions, the analysis was completed within ca. 4 min while the pressure drop was below 1 MPa. As the method was successfully applied to monitoring mono and di-PEGylated positional isoforms in the reaction mixture of random PEGylation of lysozyme, it is expected to be an efficient PAT tool.

  8. Effect of high-frequency positive-pressure ventilation on halothane ablation of hypoxic pulmonary vasoconstriction.

    Science.gov (United States)

    Hall, S M; Chapleau, M; Cairo, J; Levitzky, M G

    1985-08-01

    High-frequency positive-pressure ventilation (HFPPV) was compared to intermittent positive-pressure ventilation (IPPV) during unilateral atelectasis with and without halothane anesthesia. Dogs with electromagnetic flow probes chronically implanted on their main (Qt) and left (Ql) pulmonary arteries were ventilated via Carlen's dual-lumen endotracheal tubes. In eight closed-chest dogs, about 43% of the cardiac output perfused the left lung during bilateral ventilation by either a Harvard animal respirator (IPPV) or a Health-dyne model 300 high-frequency ventilator (HFPPV). Unilateral atelectasis decreased blood flow (Ql/Qt) to that lung. Ql/Qt was 19 +/- 1% with HFPPV during left-lung atelectasis and right-lung ventilation, compared to 32 +/- 1% with unilateral IPPV. This suggests that HFPPV permits stronger hypoxic pulmonary vasoconstriction. Addition of 1% halothane increased blood flow to the atelectatic left lung during unilateral ventilation with IPPV but not with HFPPV. This suggests that halothane decreases the effects of hypoxic pulmonary vasoconstriction during conventional ventilation but not during HFPPV.

  9. Bilateral parotitis in a patient under continuous positive airway pressure treatment.

    Science.gov (United States)

    Abdullayev, Ruslan; Saral, Filiz Cosku; Kucukebe, Omer Burak; Sayiner, Hakan Sezgin; Bayraktar, Cem; Akgun, Sadik

    Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit. A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications. Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  10. [Bilateral parotitis in a patient under continuous positive airway pressure treatment].

    Science.gov (United States)

    Abdullayev, Ruslan; Saral, Filiz Cosku; Kucukebe, Omer Burak; Sayiner, Hakan Sezgin; Bayraktar, Cem; Akgun, Sadik

    Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit. A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications. Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  11. A self-calibrating telemetry system for measurement of ventricular pressure-volume relations in conscious, freely moving rats.

    Science.gov (United States)

    Uemura, Kazunori; Kawada, Toru; Sugimachi, Masaru; Zheng, Can; Kashihara, Koji; Sato, Takayuki; Sunagawa, Kenji

    2004-12-01

    Using Bluetooth wireless technology, we developed an implantable telemetry system for measurement of the left ventricular pressure-volume relation in conscious, freely moving rats. The telemetry system consisted of a pressure-conductance catheter (1.8-Fr) connected to a small (14-g) fully implantable signal transmitter. To make the system fully telemetric, calibrations such as blood resistivity and parallel conductance were also conducted telemetrically. To estimate blood resistivity, we used four electrodes arranged 0.2 mm apart on the pressure-conductance catheter. To estimate parallel conductance, we used a dual-frequency method. We examined the accuracy of calibrations, stroke volume (SV) measurements, and the reproducibility of the telemetry. The blood resistivity estimated telemetrically agreed with that measured using an ex vivo cuvette method (y=1.09x - 11.9, r2= 0.88, n=10). Parallel conductance estimated by the dual-frequency (2 and 20 kHz) method correlated well with that measured by a conventional saline injection method (y=1.59x - 1.77, r2= 0.87, n=13). The telemetric SV closely correlated with the flowmetric SV during inferior vena cava occlusions (y=0.96x + 7.5, r2=0.96, n=4). In six conscious rats, differences between the repeated telemetries on different days (3 days apart on average) were reasonably small: 13% for end-diastolic volume, 20% for end-systolic volume, 28% for end-diastolic pressure, and 6% for end-systolic pressure. We conclude that the developed telemetry system enables us to estimate the pressure-volume relation with reasonable accuracy and reproducibility in conscious, untethered rats.

  12. Changes in intraocular pressure during surgery in the lateral decubitus position under sevoflurane and propofol anesthesia.

    Science.gov (United States)

    Yamada, Makiko Hardy; Takazawa, Tomonori; Iriuchijima, Nobuhisa; Horiuchi, Tatsuo; Saito, Shigeru

    2016-12-01

    Intraocular pressure (IOP) has been shown to change with body position. Several studies have shown that the lateral decubitus position (LDP) is associated with a significant increase in IOP in the dependent eye. However, whether anesthetic agents alter IOP in the LDP remains unclear. This study investigated the effect of sevoflurane and propofol anesthesia on IOP in the LDP. A total of 28 patients undergoing surgery in the LDP were included. Patients were randomly allocated to sevoflurane or propofol groups. IOP in both eyes was recorded and compared between groups at five time points: after anesthesia induction, after endotracheal intubation, at 5 min and 1 h after a positional change to the LDP, and 5 min after returning to the supine position. In the sevoflurane group, IOP was significantly increased in both dependent and non-dependent eyes 1 h after changing to the LDP. In the propofol group, IOP decreased in both dependent and non-dependent eyes after tracheal intubation, but did not increase after changing to the LDP. The number of patients in whom IOP increased to ≥28 mmHg was greater in the sevoflurane group than in the propofol group. Propofol may be better than sevoflurane for the maintenance of anesthesia in the LDP. Monitoring of IOP in the LDP might help avoid ophthalmic complications.

  13. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant.

    Science.gov (United States)

    Diblasi, Robert M

    2009-09-01

    Nasal continuous positive airway pressure (CPAP) is a noninvasive form of respiratory assistance that has been used to support spontaneously breathing infants with lung disease for nearly 40 years. Following reports that mechanical ventilation contributes to pulmonary growth arrest and the development of chronic lung disease, there is a renewed interest in using CPAP as the prevailing method for supporting newborn infants. Animal and human research has shown that CPAP is less injurious to the lungs than is mechanical ventilation. The major concepts that embrace lung protection during CPAP are the application of spontaneous breathing at a constant distending pressure and avoidance of intubation and positive-pressure inflations. A major topic for current research focuses on whether premature infants should be supported initially with CPAP following delivery, or after the infant has been extubated following prophylactic surfactant administration. Clinical trials have shown that CPAP reduces the need for intubation/mechanical ventilation and surfactant administration, but it is still unclear whether CPAP reduces chronic lung disease and mortality, compared to modern lung-protective ventilation techniques. Despite the successes, little is known about how best to manage patients using CPAP. It is also unclear whether different strategies or devices used to maintain CPAP play a role in improving outcomes in infants. Nasal CPAP technology has evolved over the last 10 years, and bench and clinical research has evaluated differences in physiologic effects related to these new devices. Ultimately, clinicians' abilities to perceive changes in the pathophysiologic conditions of infants receiving CPAP and the quality of airway care provided are likely to be the most influential factors in determining patient outcomes.

  14. The pressure/volume relationship during dobutamine stress echocardiography in transplanted heart: comparison with quality of life and coronary anatomy

    Directory of Open Access Journals (Sweden)

    Minardi Giovanni

    2012-11-01

    Full Text Available Abstract Background Cardiac allograft vasculopathy (CAV is a major late complication in cardiac transplant recipients and has a relevant impact on outcome of these patients. Aims of this study: to compare, in cardiac transplant recipients patients, the diagnostic value of pressure/volume relationship (ESPVR during dobutamine stress echocardiography (DSE for coronary artery disease, assessed by Multislice Computed Tomography (MSCT, and by coronary angiography (CA. We also analyzed any possible relationship between ESPVR and the Health Related Quality of Life of the patients (HRQoL, evaluated by SF–36 questionnaire. Methods 25 consecutive patients underwent DSE within 24 hours after MSCT coronary angiogram and then they underwent CA. The HRQoL questionnaire was administered to the patients in the settings of DSE. They were followed-up for 6 months. Results DSE has a sensitivity in detecting CAV of 67%, specificity of 95%, positive predictive value of 67% and negative predictive value of 95%; DSE with ESPVR has a sensitivity of 100%, specificity of 95%, positive predictive value of 75%, negative predictive value of 100%; MSCT has a sensitivity of 100%; specificity of 82%; positive predictive value of 43%; negative predictive value of 100%. Htx recipients with a flat-biphasic ESPVR, although asymptomatic, perceived a worst HRQoL compared with the up-sloping ESPVR population, and this is statistically significant for the general health (p 0.0004, the vitality (p 0.0013 and the mental health (p 0.021 SF-36 subscale. Conclusions Evaluation with DSE and ESPVR is accurate in the clinical control of heart transplant recipients reserving invasive evaluation only for patients with abnormal contractility indexes.

  15. Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks.

    Science.gov (United States)

    Perchiazzi, Gaetano; Rylander, Christian; Pellegrini, Mariangela; Larsson, Anders; Hedenstierna, Göran

    2016-04-11

    Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPapp and intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEPtot from flow and pressure tracings during ongoing mechanical ventilation. Ten pigs were mechanically ventilated, and the time constant of their respiratory system (τRS) was measured. We shortened their expiratory time (TE) according to multiples of τRS, obtaining different respiratory patterns (Rpat). Pressure (PAW) and flow (V'AW) at the airway opening during ongoing mechanical ventilation were simultaneously recorded, with and without the addition of external resistance. The last breath of each Rpat included an EEHM, which was used to compute the reference PEEPtot. The entire protocol was repeated after the induction of ALI with i.v. injection of oleic acid, and 382 tracings were obtained. The ANN had to extract the PEEPtot, from the tracings without an EEHM. ANN agreement with reference PEEPtot was assessed with the Bland-Altman method. Bland Altman analysis of estimation error by ANN showed -0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmH2O). The ANNs estimated the PEEPtot well at different levels of PEEPapp under dynamic conditions, opening up new possibilities in monitoring PEEPi in critically ill patients who require ventilator treatment.

  16. Influence of lung volume, fluid and capillary recruitment during positional changes and exercise on thoracic impedance in heart failure.

    Science.gov (United States)

    Kim, Chul-Ho; Fuglestad, Matthew A; Richert, Maile L Ceridon; Shen, Win K; Johnson, Bruce D

    2014-10-01

    It is unclear how dynamic changes in pulmonary-capillary blood volume (Vc), alveolar lung volume (derived from end-inspiratory lung volume, EILV) and interstitial fluid (ratio of alveolar capillary membrane conductance and pulmonary capillary blood volume, Dm/Vc) influence lung impedance (Z(T)). The purpose of this study was to investigate if positional change and exercise result in increased EILV, Vc and/or lung interstitial fluid, and if Z(T) tracks these variables. 12 heart failure (HF) patients underwent measurements (Z(T), EILV, Vc/Dm) at rest in the upright and supine positions, during exercise and into recovery. Inspiratory capacity was obtained to provide consistent measures of EILV while assessing Z(T). Z(T) increased with lung volume during slow vital capacity maneuvers (p0.05). Impedance appears sensitive to changes in lung volume and body position which appear to generally overwhelm small acute changes in lung fluid when assed dynamically at rest or during exercise. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Clinical predictors of central sleep apnea evoked by positive airway pressure titration

    Directory of Open Access Journals (Sweden)

    Moro M

    2016-07-01

    Full Text Available Marilyn Moro,1 Karen Gannon,1 Kathy Lovell,1 Margaret Merlino,1 James Mojica,2 Matt T Bianchi,1,3 1Neurology Department, 2Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Purpose: Treatment-emergent central sleep apnea (TECSA, also called complex apnea, occurs in 5%–15% of sleep apnea patients during positive airway pressure (PAP therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management.Methods: We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split night; n=306 two-night. Demographics and self-reported medical comorbidities, medications, and behaviors as well as standard physiological parameters from the polysomnography (PSG data were analyzed. We used regression analysis to assess predictors of binary presence or absence of central apnea index (CAI ≥5 during split PSG (SN-PSG versus full-night PSG (FN-PSG titrations.Results: CAI ≥5 was present in 24.2% of SN-PSG and 11.4% of FN-PSG patients during titration. Male sex, maximum continuous positive airway pressure, and use of bilevel positive airway pressure were predictors of TECSA, and rapid eye movement dominance was a negative predictor, for both SN-PSG and FN-PSG patients. Self-reported narcotics were a positive predictor of TECSA, and the time spent in stage N2 sleep was a negative predictor only for SN-PSG patients. Self-reported history of stroke and the CAI during the diagnostic recording predicted TECSA only for FN-PSG patients.Conclusion: Clinical predictors of treatment-evoked central apnea spanned demographic, medical history, sleep physiology, and titration factors. Improved predictive models may be increasingly important as diagnostic and therapeutic modalities move away from the

  18. Ultrasound as a Noninvasive Method to Assess Changes of Intracranial Volume and Pressure During Simulated Microgravity

    Science.gov (United States)

    Murthy, G.; Yost, W. T.; Ballard, R. E.; Watenpaugh, D. E.; Kawai, Y.; Hargens, A. R.

    1994-01-01

    Headaches are commonly experienced by astronauts in microgravity and by subjects undergoing head-down tilt (simulated microgravity on Earth). Exposure to microgravity probably elevates blood pressure and flow in the head which may increase intracranial volume (ICV) and pressure (ICP) and in turn cause headache. Due to the slightly compliant nature of the cranial vault and the encasement of brain and its vasculature within this vault, any increase of ICV will increase ICP and slightly distend the cranium. Previous studies document perivascular edema and increased ICP in rhesus monkeys during head-down tilt. Elevated ICP has also been reported in humans during head-down tilt. ICP measurements in healthy humans are rare because of the invasiveness of currently-available measurement techniques. Therefore, we proposed a noninvasive ultrasound technique to assess changes of ICV and JCP. The ultrasound principle is based on compliance of the cranial vault. A 450 kHz ultrasound stimulus is transmitted through the cranium by a transducer every 7.5-10 msec. The ultrasound wave enters the brain tissue, reflects off the opposite side of the cranium and is received by the same transducer. The detected wave is compared for phase quadrature (90 deg.to transmitted wave). Because the electronic circuitry of the device maintains a 90 deg. phase (phi), any alterations in the detected wave caused by an increase of ICV and ICP will be reflected as a change in the wave frequency. Phase shift is directly proportional to path length of the wave, DELTA x, which is expressed as DELTA x = phi lambda/2 pi where lambda is wavelength. Elevated ICV and ICP expand the cranial vault and increase path length of the wave (a measure of intracranial distance). Increased path length equals reduced frequency of the detected wave. Reduced frequency is then related to elevated ICP. This technique has potential uses for ICP studies of astronauts in space and head trauma patients on Earth.

  19. Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation

    DEFF Research Database (Denmark)

    Perner, A; Faber, T

    2006-01-01

    Stroke volume variation (SVV)--as measured by the pulse contour cardiac output (PiCCO) system--predicts the cardiac output response to a fluid challenge in patients on controlled ventilation. Whether this applies to patients on pressure support ventilation is unknown....

  20. Experimental evidence for negative turgor pressure in small leaf cells of Robinia pseudoacacia L versus large cells of Metasequoia glyptostroboides Hu et W.C. Cheng. 2. Höfler diagrams below the volume of zero turgor and the theoretical implication for pressure-volume curves of living cells.

    Science.gov (United States)

    Yang, Dongmei; Li, Junhui; Ding, Yiting; Tyree, Melvin T

    2017-03-01

    The physiological advantages of negative turgor pressure, Pt , in leaf cells are water saving and homeostasis of reactants. This paper advances methods for detecting the occurrence of negative Pt in leaves. Biomechanical models of pressure-volume (PV) curves predict that negative Pt does not change the linearity of PV curve plots of inverse balance pressure, PB , versus relative water loss, but it does predict changes in either the y-intercept or the x-intercept of the plots depending on where cell collapse occurs in the PB domain because of negative Pt . PV curve analysis of Robinia leaves revealed a shift in the x-intercept (x-axis is relative water loss) of PV curves, caused by negative Pt of palisade cells. The low x-intercept of the PV curve was explained by the non-collapse of palisade cells in Robinia in the PB domain. Non-collapse means that Pt smoothly falls from positive to negative values with decreasing cell volume without a dramatic change in slope. The magnitude of negative turgor in non-collapsing living cells was as low as -1.3 MPa and the relative volume of the non-collapsing cell equaled 58% of the total leaf cell volume. This study adds to the growing evidence for negative Pt . © 2016 John Wiley & Sons Ltd.

  1. Influence of pulsed nanosecond volume discharge in atmospheric-pressure air on the electrical characteristics of MCT epitaxial films

    Science.gov (United States)

    Grigoryev, Denis V.; Voitsekhovskii, Alexandr V.; Lozovoy, Kirill A.; Nesmelov, Sergey N.; Dzyadukh, Stanislav M.; Tarasenko, Viktor F.; Shulepov, Michail A.; Dvoretskii, Sergei A.

    2015-12-01

    The purpose of this paper was investigating the effect of volume nanosecond discharge in air at atmospheric pressure on the electro-physical properties of the HgCdTe (MCT) epitaxial films grown by molecular beam epitaxy. Hall measurements of electro-physical parameters of MCT samples after irradiation have shown that there is a layer of epitaxial films exhibiting n-type conductivity that is formed in the near-surface area. After more than 600 pulses of influence parameters and thickness of the resulting n-layer is such that the measured field dependence of Hall coefficient corresponds to the material of n-type conductivity. Also it is shown that the impact of the discharge leads to significant changes in electro-physical characteristics of MIS structures. This fact is demonstrated by increase in density of positive fixed charge, change in the hysteresis type of the capacitance-voltage characteristic, an increase in density of surface states. The preliminary results show that it is possible to use such actions in the development of technologies of the controlled change in the properties of MCT.

  2. High-order accurate finite-volume formulations for the pressure gradient force in layered ocean models

    CERN Document Server

    Engwirda, Darren; Marshall, John

    2016-01-01

    The development of a set of high-order accurate finite-volume formulations for evaluation of the pressure gradient force in layered ocean models is described. A pair of new schemes are presented, both based on an integration of the contact pressure force about the perimeter of an associated momentum control-volume. The two proposed methods differ in their choice of control-volume geometries. High-order accurate numerical integration techniques are employed in both schemes to account for non-linearities in the underlying equation-of-state definitions and thermodynamic profiles, and details of an associated vertical interpolation and quadrature scheme are discussed in detail. Numerical experiments are used to confirm the consistency of the two formulations, and it is demonstrated that the new methods maintain hydrostatic and thermobaric equilibrium in the presence of strongly-sloping layer-wise geometry, non-linear equation-of-state definitions and non-uniform vertical stratification profiles. Additionally, one...

  3. Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position

    Directory of Open Access Journals (Sweden)

    Shagun Bhatia Shah

    2015-01-01

    Full Text Available Background: Recent reports of increased intracranial pressure (ICP due to steep Trendelenburg (ST position causing neurological deterioration, decreased regional cerebral oxygen saturation and postoperative visual loss after robotic urological and gynecological surgeries led us to consider a simple technique of ICP monitoring. Ours is one of the first instances reported of quantitative noninvasive measurement of increase in ICP with ST position by serial measurement of binocular optic nerve sheath diameter (ONSD in patients undergoing robot assisted urological and gynecological oncosurgery. We tested whether ONSD values rose to above the upper limits of normal and for what length of time they remained elevated. Materials and Methods: Prospective, randomized, interventional, parallel group, active control study conducted on 252 American Society of Anesthesiologists I and II patients. ONSD was measured using 7.5 MHz linear ultrasound probe in supine and Trendelenburg positions. Statistics: Student′s t-test to compare the inter-group mean ONSD and the repetitive t-test for intra-group analysis. Result: Comparison of the mean ONSD values of both groups yielded a 2-tailed significance P <0.01 at all compared time points intra- and post-operatively. In Group-O (open surgery; supine position, the baseline mean bilateral ONSD was 4.36 mm, which did not show any statistically significant change throughout open surgery and postoperative period. On de-docking the robot, 6.2 mm was the mean ONSD value in Group-R (robotic group while 4.3 mm was the corresponding value in control Group-O. Conclusion: ONSD evaluation is a simple, quick, safe, readily available, reliable, cost effective, noninvasive, potential standard of care for screening and monitoring of patients undergoing robotic surgery in ST position.

  4. Volume and expansivity changes of micelle formation measured by pressure perturbation calorimetry.

    Science.gov (United States)

    Fan, Helen Y; Nazari, Mozhgan; Chowdhury, Saria; Heerklotz, Heiko

    2011-03-01

    We present the application of pressure perturbation calorimetry (PPC) as a new method for the volumetric characterization of the micelle formation of surfactants. The evaluation is realized by a global fit of PPC curves at different surfactant concentration ranging, if possible, from below to far above the CMC. It is based on the knowledge of the temperature dependence of the CMC, which can for example be characterized by isothermal titration calorimetry. We demonstrate the new approach for decyl-β-maltopyranoside (DM). It shows a strong volume increase upon micelle formation of 16 ± 2.5 mL/mol (+4%) at 25 °C, and changes with temperature by -0.1 mL/(mol K). The apparent molar expansivity (E(S)) decreases upon micelle formation from 0.44 to 0.31 mL/(mol K) at 25 °C. Surprisingly, the temperature dependence of the expansivity of DM in solution (as compared with that of maltose) does not agree with the principal behavior described for polar (E(S)(T) decreasing) and hydrophobic (E(S)(T) increasing) solutes or moieties before. The results are discussed in terms of changes in hydration of the molecules and internal packing of the micelles and compared with the volumetric effects of transitions of proteins, DNA, lipids, and polymers.

  5. Entropy Production and the Pressure-Volume Curve of the Lung

    Directory of Open Access Journals (Sweden)

    Cláudio Lucas Oliveira

    2016-03-01

    Full Text Available We investigate analytically the production of entropy during a breathing cycle in healthy and diseased lungs. First, we calculate entropy production in healthy lungs by applying the laws of thermodynamics to the well-known transpulmonary pressure-volume (P-V curves of the lung under the assumption that lung tissue behaves as an entropy spring-like rubber. The bulk modulus, $B$, of the lung is also derived from these calculations. Second, we extend this approach to elastic recoil disorders of the lung such as occur in pulmonary fibrosis and emphysema. These diseases are characterized by particular alterations in the P-V relationship. For example, in fibrotic lungs B increases monotonically with disease progression, while in emphysema the opposite occurs. These diseases can thus be mimicked simply by making appropriate adjustments to the parameters of the P-V curve. Using Clausius's formalism, we show that entropy production, Delta_S, is related to the hysteresis area, Delta_A, enclosed by the P-V curve during a breathing cycle, namely, Delta_S = Delta_A/T, where T is the body temperature. Although Delta_A is highly dependent on the disease, such formula applies to healthy as well as diseased lungs, regardless of the disease stage. Finally, we use ansatzs to predict analytically the entropy produced by the fibrotic and emphysematous lungs.

  6. Entropy Production and the Pressure-Volume Curve of the Lung

    CERN Document Server

    Oliveira, Cláudio L N; Bates, Jason H T; Andrade, José S; Suki, Béla

    2015-01-01

    We investigate analytically the production of entropy during a breathing cycle in healthy and diseased lungs. First, we calculate entropy production in healthy lungs by applying the laws of thermodynamics to the well-known transpulmonary pressure-volume ($P-V$) curves of the lung under the assumption that lung tissue behaves as an entropy spring-like rubber. The bulk modulus, $B$, of the lung is also derived from these calculations. Second, we extend this approach to elastic recoil disorders of the lung such as occur in pulmonary fibrosis and emphysema. These diseases are characterized by particular alterations in the $P-V$ relationship. For example, in fibrotic lungs $B$ increases monotonically with disease progression, while in emphysema the opposite occurs. These diseases can thus be mimicked simply by making appropriate adjustments to the parameters of the $P-V$ curve. Using Clausius's formalism, we show that entropy production, $\\Delta S$, is related to the hysteresis area, $\\Delta A$, enclosed by the $P...

  7. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position

    Science.gov (United States)

    2014-01-01

    Background The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. Methods 70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared. Results There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 ± 3 to 32 ± 6 and 27 ± 3 to 33 ± 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p < 0.001). The head-down tilt further increased cuff pressure from 33 ± 5 to 35 ± 5 cmH2O (p < 0.001). There six patients undergoing colorectal tumor resection (18.8%) and eight patients undergoing cholecystecomy (21.1%) had a total increase of cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery. Conclusions An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position. PMID:25210501

  8. Evolution of peptidoglycan biosynthesis under the selective pressure of antibiotics in Gram-positive bacteria.

    Science.gov (United States)

    Mainardi, Jean-Luc; Villet, Régis; Bugg, Timothy D; Mayer, Claudine; Arthur, Michel

    2008-03-01

    Acquisition of resistance to the two classes of antibiotics therapeutically used against Gram-positive bacteria, the glycopeptides and the beta-lactams, has revealed an unexpected flexibility in the peptidoglycan assembly pathway. Glycopeptides select for diversification of the fifth position of stem pentapeptides because replacement of D-Ala by D-lactate or D-Ser at this position prevents binding of the drugs to peptidoglycan precursors. The substitution is generally well tolerated by the classical D,D-transpeptidases belonging to the penicillin-binding protein family, except by low-affinity enzymes. Total elimination of the fifth residue by a D,D-carboxypeptidase requires a novel cross-linking enzyme able to process the resulting tetrapeptide stems. This enzyme, an L,D-transpeptidase, confers cross-resistance to beta-lactams and glycopeptides. Diversification of the side chain of the precursors, presumably in response to the selective pressure of peptidoglycan endopeptidases, is controlled by aminoacyl transferases of the Fem family that redirect specific aminoacyl-tRNAs from translation to peptidoglycan synthesis. Diversification of the side chains has been accompanied by a parallel divergent evolution of the substrate specificity of the L,D-transpeptidases, in contrast to the D,D-transpeptidases, which display an unexpected broad specificity. This review focuses on the role of antibiotics in selecting or counter-selecting diversification of the structure of peptidoglycan precursors and their mode of polymerization.

  9. Effects of diluents on soot surface temperature and volume fraction in diluted ethylene diffusion flames at pressure

    KAUST Repository

    Kailasanathan, Ranjith Kumar Abhinavam

    2014-05-20

    Soot surface temperature and volume fraction are measured in ethylene/air coflowing laminar diffusion flames at high pressures, diluted with one of four diluents (argon, helium, nitrogen, and carbon dioxide) using a two-color technique. Both temperature and soot measurements presented are line-of-sight averages. The results aid in understanding the kinetic and thermodynamic behavior of the soot formation and oxidation chemistry with changes in diluents, ultimately leading to possible methods of reducing soot emission from practical combustion hardware. The diluted fuel and coflow exit velocities (top-hat profiles) were matched at all pressures to minimize shear effects. In addition to the velocity-matched flow rates, the mass fluxes were held constant for all pressures. Addition of a diluent has a pronounced effect on both the soot surface temperature and volume fraction, with the helium diluted flame yielding the maximum and carbon dioxide diluted flame yielding minimum soot surface temperature and volume fraction. At low pressures, peak soot volume fraction exists at the tip of the flame, and with an increase in pressure, the location shifts lower to the wings of the flame. Due to the very high diffusivity of helium, significantly higher temperature and volume fraction are measured and explained. Carbon dioxide has the most dramatic soot suppression effect. By comparing the soot yield with previously measured soot precursor concentrations in the same flame, it is clear that the lower soot yield is a result of enhanced oxidation rates rather than a reduction in precursor formation. Copyright © 2014 Taylor & Francis Group, LLC.

  10. Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial

    Science.gov (United States)

    Jaju, Rishabh; Jaju, Pooja Bihani; Dubey, Mamta; Mohammad, Sadik; Bhargava, AK

    2017-01-01

    Background and Aims: Although volume controlled ventilation (VCV) has been the traditional mode of ventilation in robotic surgery, recently pressure controlled ventilation (PCV) has been used more frequently. However, evidence on whether PCV is superior to VCV is still lacking. We intended to compare the effects of VCV and PCV on respiratory mechanics and haemodynamic in patients undergoing robotic surgeries in steep Trendelenburg position. Methods: This prospective, randomized trial was conducted on sixty patients between 20 and 70 years belonging to the American Society of Anesthesiologist Physical Status I–II. Patients were randomly assigned to VCV group (n = 30), where VCV mode was maintained through anaesthesia, or the PCV group (n = 30), where ventilation mode was changed to PCV after the establishment of 40° Trendelenburg position and pneumoperitoneum. Respiratory (peak and mean airway pressure [APpeak, APmean], dynamic lung compliance [Cdyn] and arterial blood gas analysis) and haemodynamics variables (heart rate, mean blood pressure [MBP] central venous pressure) were measured at baseline (T1), post-Trendelenburg position at 60 min (T2), 120 min (T3) and after resuming supine position (T4). Results: Demographic profile, haemodynamic variables, oxygen saturation and minute ventilation (MV) were comparable between two groups. Despite similar values of APmean, APpeak was significantly higher in VCV group at T2 and T3 as compared to PCV group (P < 0.001). Cdyn and PaCO2 were also better in PCV group than in VCV group (P < 0.001 and 0.045, respectively). Conclusion: PCV should be preferred in robotic pelvic surgeries as it offers lower airway pressures, greater Cdyn and a better-preserved ventilation-perfusion matching for the same levels of MV. PMID:28216699

  11. Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial

    Directory of Open Access Journals (Sweden)

    Rishabh Jaju

    2017-01-01

    Full Text Available Background and Aims: Although volume controlled ventilation (VCV has been the traditional mode of ventilation in robotic surgery, recently pressure controlled ventilation (PCV has been used more frequently. However, evidence on whether PCV is superior to VCV is still lacking. We intended to compare the effects of VCV and PCV on respiratory mechanics and haemodynamic in patients undergoing robotic surgeries in steep Trendelenburg position. Methods: This prospective, randomized trial was conducted on sixty patients between 20 and 70 years belonging to the American Society of Anesthesiologist Physical Status I–II. Patients were randomly assigned to VCV group (n = 30, where VCV mode was maintained through anaesthesia, or the PCV group (n = 30, where ventilation mode was changed to PCV after the establishment of 40° Trendelenburg position and pneumoperitoneum. Respiratory (peak and mean airway pressure [APpeak, APmean], dynamic lung compliance [Cdyn] and arterial blood gas analysis and haemodynamics variables (heart rate, mean blood pressure [MBP] central venous pressure were measured at baseline (T1, post-Trendelenburg position at 60 min (T2, 120 min (T3 and after resuming supine position (T4. Results: Demographic profile, haemodynamic variables, oxygen saturation and minute ventilation (MV were comparable between two groups. Despite similar values of APmean,APpeakwas significantly higher in VCV group at T2 and T3 as compared to PCV group (P < 0.001. Cdynand PaCO2were also better in PCV group than in VCV group (P < 0.001 and 0.045, respectively. Conclusion: PCV should be preferred in robotic pelvic surgeries as it offers lower airway pressures, greater Cdynand a better-preserved ventilation-perfusion matching for the same levels of MV.

  12. Influence of Positive End-Expiratory Pressure on Myocardial Strain Assessed by Speckle Tracking Echocardiography in Mechanically Ventilated Patients

    Directory of Open Access Journals (Sweden)

    Federico Franchi

    2013-01-01

    Full Text Available Purpose. The effects of mechanical ventilation (MV on speckle tracking echocardiography- (STE-derived variables are not elucidated. The aim of the study was to evaluate the effects of positive end-expiratory pressure (PEEP ventilation on 4-chamber longitudinal strain (LS analysis by STE. Methods. We studied 20 patients admitted to a mixed intensive care unit who required intubation for MV and PEEP titration due to hypoxia. STE was performed at three times: (T1 PEEP = 5 cmH2O; (T2 PEEP = 10 cmH2O; and (T3 PEEP = 15 cmH2O. STE analysis was performed offline using a dedicated software (XStrain MyLab 70 Xvision, Esaote. Results. Left peak atrial-longitudinal strain (LS was significantly reduced from T1 to T2 and from T2 to T3 (. Right peak atrial-LS and right ventricular-LS showed a significant reduction only at T3 (. Left ventricular-LS did not change significantly during titration of PEEP. Cardiac chambers’ volumes showed a significant reduction at higher levels of PEEP (. Conclusions. We demonstrated for the first time that incremental PEEP affects myocardial strain values obtained with STE in intubated critically ill patients. Whenever performing STE in mechanically ventilated patients, care must be taken when PEEP is higher than 10 cmH2O to avoid misinterpreting data and making erroneous decisions.

  13. The NOFLO trial: low-flow nasal prongs therapy in weaning nasal continuous positive airway pressure in preterm infants.

    LENUS (Irish Health Repository)

    O'Donnell, Sinéad M

    2013-07-01

    To determine if low-flow nasal prongs therapy with room air, compared with no treatment, facilitates weaning from nasal continuous positive airway pressure (NCPAP) in very low birth weight (VLBW, birth weight <1500 g) infants.

  14. Nocturnal noninvasive positive pressure ventilation in stable COPD : A systematic review and individual patient data meta-analysis

    NARCIS (Netherlands)

    Struik, F. M.; Lacasse, Y.; Goldstein, R. S.; Kerstjens, H. A. M.; Wijkstra, P. J.

    2014-01-01

    Introduction: The effects of nocturnal noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) remain controversial. Methods: The Cochrane Airways group Register of Trials, MEDLINE, EMBASE and CINAHL were searched up to August 2012. Indi

  15. Evaluation of lower body positive pressure supported treadmill training for children with cerebral palsy.

    Science.gov (United States)

    Kurz, Max J; Corr, Brad; Stuberg, Wayne; Volkman, Kathleen G; Smith, Nina

    2011-01-01

    To examine the feasibility of using lower body positive pressure supported (LBPPS) treadmill training to improve the walking abilities, balance and lower extremity strength of children with cerebral palsy (CP). Nine children with CP (GMFCS II-IV) participated in LBPPS treadmill training 2 days per week for 6 weeks. Pre and post training measures of preferred walking speed, spatiotemporal kinematics, lower extremity strength, and the BESTest were used to assess potential improvements from LBPPS treadmill training. LBPPS treadmill training resulted in significantly faster walking speed, less time in double support, improved overall balance, and strength of the lower extremity antigravity musculature. It is feasible to use LBPPS treadmill training to improve the walking performance, balance, and strength of children with CP.

  16. A Novel High-Order, Entropy Stable, 3D AMR MHD Solver with Guaranteed Positive Pressure

    CERN Document Server

    Derigs, Dominik; Gassner, Gregor J; Walch, Stefanie

    2016-01-01

    We describe a high-order numerical magnetohydrodynamics (MHD) solver built upon a novel non-linear entropy stable numerical flux function that supports eight travelling wave solutions. By construction the solver conserves mass, momentum, and energy and is entropy stable. The method is designed to treat the divergence-free constraint on the magnetic field in a similar fashion to a hyperbolic divergence cleaning technique. The solver described herein is especially well-suited for flows involving strong discontinuities. Furthermore, we present a new formulation to guarantee positivity of the pressure. We present the underlying theory and implementation of the new solver into the multi-physics, multi-scale adaptive mesh refinement (AMR) simulation code $\\texttt{FLASH}$ (http://flash.uchicago.edu). The accuracy, robustness and computational efficiency is demonstrated with a number of tests, including comparisons to available MHD implementations in $\\texttt{FLASH}$.

  17. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy

    DEFF Research Database (Denmark)

    Lamberts, M.; Nielsen, O. W.; Lip, G. Y. H.

    2014-01-01

    BACKGROUND: The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously. METHODS: Using nationwide databases, the entire Danish population was followed from 2000 until 2011. First......-time sleep apnoea diagnoses and use of CPAP therapy were determined. Incidence rate ratios (IRRs) of ischaemic stroke and myocardial infarction (MI) were analysed using Poisson regression models. RESULTS: Amongst 4.5 million individuals included in the study, 33 274 developed sleep apnoea (mean age 53, 79......% men) of whom 44% received persistent CPAP therapy. Median time to initiation of CPAP therapy was 88 days (interquartile range 34-346). Patients with sleep apnoea had more comorbidities compared to the general population. Crude rates of MI and ischaemic stroke were increased for sleep apnoea patients...

  18. Role of Positive Selection Pressure on the Evolution of H5N1 Hemagglutinin

    Institute of Scientific and Technical Information of China (English)

    Venkata R.S.K. Duwuri; Bhargavi Duvvuri; Wilfred R. Cuff; Gillian E. Wu; Jianhong Wu

    2009-01-01

    The surface glycoprotein hemagglutinin (HA) helps the influenza A virus to evade the host immune system by antigenic variation and is a major driving force for viral evolution. In this study, the selection pressure on HA of H5N1 influenza A virus was analyzed using bioinformatics algorithms. Most of the identified positive selection (PS) sites were found to be within or adjacent to epitope sites. Some of the identified PS sites are consistent with previous experimental studies, providing further support to the biological significance of our findings. The highest frequency of PS sites was observed in recent strains isolated during 2005-2007. Phylogenetic analysis was also conducted on HA sequences from various hosts. Viral drift is almost similar in both avian and human species with a progressive trend over the years. Our study reports new mutations in functional regions of HA that might provide markers for vaccine design or can be used to predict isolates of pandemic potential.

  19. Graded exposure therapy for addressing claustrophobic reactions to continuous positive airway pressure: a case series report.

    Science.gov (United States)

    Means, Melanie K; Edinger, Jack D

    2007-01-01

    Continuous positive airway pressure (CPAP) is a safe, effective treatment for obstructive sleep apnea, and yet many patients develop claustrophobic reactions to the CPAP nasal mask and cannot tolerate this treatment. We examined the efficacy of a graded in-vivo exposure therapy for enhancing CPAP adherence using a retrospective, case series design. Objective CPAP adherence data were obtained on clinical patients who attended 1 or more sessions of exposure therapy with a behavioral sleep psychologist. Compared to pre-treatment, patients used CPAP significantly longer after exposure therapy. No predictors of treatment response were identified. CPAP exposure therapy may be beneficial in some cases; however, further research is needed to determine types of patients most likely to benefit from this therapy.

  20. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure

    DEFF Research Database (Denmark)

    Bakke, Skule A; Bøtker, Morten Thingemann; Riddervold, Ingunn S;

    2014-01-01

    Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are frequently used inhospital for treating respiratory failure, especially in treatment of acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Early initiation of treatment...... is important for success and introduction already in the prehospital setting may be beneficial. Our goal was to assess the evidence for an effect of prehospital CPAP or NIV as a supplement to standard medical treatment alone on the following outcome measures; mortality, hospital length of stay, intensive care...... examine prehospital CPAP. Of these, only one small, randomized controlled trial shows a reduced mortality rate and a reduced intubation rate with supplemental CPAP. The other three studies have neutral findings, but in two of these a trend toward lower intubation rate is found. The effect of supplemental...

  1. A novel high-order, entropy stable, 3D AMR MHD solver with guaranteed positive pressure

    Science.gov (United States)

    Derigs, Dominik; Winters, Andrew R.; Gassner, Gregor J.; Walch, Stefanie

    2016-07-01

    We describe a high-order numerical magnetohydrodynamics (MHD) solver built upon a novel non-linear entropy stable numerical flux function that supports eight travelling wave solutions. By construction the solver conserves mass, momentum, and energy and is entropy stable. The method is designed to treat the divergence-free constraint on the magnetic field in a similar fashion to a hyperbolic divergence cleaning technique. The solver described herein is especially well-suited for flows involving strong discontinuities. Furthermore, we present a new formulation to guarantee positivity of the pressure. We present the underlying theory and implementation of the new solver into the multi-physics, multi-scale adaptive mesh refinement (AMR) simulation code FLASH (http://flash.uchicago.edu)

  2. PLAYING WITH POSITIVE FEEDBACK: EXTERNAL PRESSURE-TRIGGERING OF A STAR-FORMING DISK GALAXY

    Energy Technology Data Exchange (ETDEWEB)

    Bieri, Rebekka; Dubois, Yohan; Silk, Joseph; Mamon, Gary A., E-mail: bieri@iap.fr [Institut d’Astrophysique de Paris (UMR 7095: CNRS and UPMC—Sorbonne Universités), 98 bis bd Arago, F-75014 Paris (France)

    2015-10-20

    In massive galaxies, the currently favored method for quenching star formation is via active galactic nuclei (AGN) feedback, which ejects gas from the galaxy using a central supermassive black hole. At high redshifts however, explanation of the huge rates of star formation often found in galaxies containing AGNs may require a more vigorous mode of star formation than is attainable by simply enriching the gas content of galaxies in the usual gravitationally driven mode that is associated with the nearby universe. Using idealized hydrodynamical simulations, we show that AGN-pressure-driven star formation potentially provides the positive feedback that may be required to generate the accelerated star formation rates observed in the distant universe.

  3. Analysis of Difference in Center-of-Pressure Positions Between Experts and Novices During Asymmetric Lifting

    Science.gov (United States)

    Yamada, Kenji; Kido, Michiko; Okada, Shima; Nomura, Taishin; Ohno, Yuko

    2016-01-01

    Although numerous studies have analyzed the relationship between manual material handling (MMH) and the forces acting on the lumbar spine, the difference in the MMH between experts and novices through the analysis of measured data has not been well studied. The purpose of this paper was to analyze the difference in the MMH positions between ten skilled experts working at a freight transport company (Group 1) and five unskilled novices without any experience (Group 2) during asymmetric lifting. All the human subjects performed asymmetric lifting experiments with closed eyes; the experiments involved moving loads (6 and 18 kg) to the left side. Time series data of the vertical ground reaction force were measured, using a Wii Balance Board, and then, the center-of-pressure (CoP) trajectories were calculated. The balance board was used for the measurement, because it was reliable, inexpensive, and portable and provided good repeatability even on rough surfaces, and all the information pertaining to the load and worker under various conditions was captured without any omissions. Under the 18 kg load condition, the CoP positions for Group 2 were located on the same side during left asymmetric lifting; however, those for Group 1 were located on the opposite side during left asymmetric lifting (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$P measurement results, we inferred that the difference in the CoP positions between the two different groups could be attributed to the difference in the hip positions. Most skilled experts position their hips in such a way that their CoP trajectories move toward the opposite side during left asymmetric lifting. Although the skillful characteristics of experts may be responsible for the lightening of the burden on the waist during asymmetric

  4. Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Macario Camacho

    2015-01-01

    Full Text Available Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies, apnea-hypopnea index (seventeen studies, and neck circumference (eleven studies were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted.

  5. A position-sensitive neutron spectrometer/dosimeter based on pressurized superheated drop (bubble) detectors

    Science.gov (United States)

    d'Errico, F.; Nath, R.; Holland, S. K.; Lamba, M.; Patz, S.; Rivard, M. J.

    2002-01-01

    A position-sensitive, superheated emulsion chamber (SEC) is introduced for three-dimensional (3D) spectrometry and dosimetry of fast neutrons. The detector is based on a fine suspension of octafluorocyclobutane droplets emulsified in a tissue-equivalent gel. This gel is highly viscous and immobilizes the bubbles at the location of their formation. At an operating temperature of 35°C, the droplets are moderately superheated and their evaporation is nucleated by the densely ionizing products of fast neutron interactions, with no response to sparsely ionizing radiations. Thus, when a neutron emitter such as a 252Cf brachytherapy source is inserted in the SEC, a bubble distribution forms around the source and makes the neutron field visible. The SEC is operated at different externally applied pressures that correspond to different response thresholds. These responses form a virtually orthogonal matrix which is suitable for spectrometry and allows the use of effective few channel unfolding procedures, yielding the spatial dependence of absorbed dose and neutron energy spectra in-tissue. Bubble spatial distributions in the chamber can be determined through optical tomography or magnetic resonance imaging (MRI). A 3D, steady-state MRI method has proven particularly effective for this purpose. After the imaging, the SEC can be pressurized above the halocarbon vapor tension in order to recondense the bubbles to the liquid phase. Within a few minutes, the device is annealed and ready to be used again for repeated measurements improving the bubble counting statistics.

  6. Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

    Science.gov (United States)

    Camacho, Macario; Riaz, Muhammad; Tahoori, Armin; Certal, Victor; Kushida, Clete A.

    2015-01-01

    Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP) devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s) development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI) and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies), apnea-hypopnea index (seventeen studies), and neck circumference (eleven studies) were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted. PMID:26294977

  7. Two-Dimensional Electron Density Measurement of Positive Streamer Discharge in Atmospheric-Pressure Air

    Science.gov (United States)

    Inada, Yuki; Ono, Ryo; Kumada, Akiko; Hidaka, Kunihiko; Maeyama, Mitsuaki

    2016-09-01

    The electron density of streamer discharges propagating in atmospheric-pressure air is crucially important for systematic understanding of the production mechanisms of reactive species utilized in wide ranging applications such as medical treatment, plasma-assisted ignition and combustion, ozone production and environmental pollutant processing. However, electron density measurement during the propagation of the atmospheric-pressure streamers is extremely difficult by using the conventional localized type measurement systems due to the streamer initiation jitters and the irreproducibility in the discharge paths. In order to overcome the difficulties, single-shot two-dimensional electron density measurement was conducted by using a Shack-Hartmann type laser wavefront sensor. The Shack-Hartmann sensor with a temporal resolution of 2 ns was applied to pulsed positive streamer discharges generated in an air gap between pin-to-plate electrodes. The electron density a few ns after the streamer initiation was 7*1021m-3 and uniformly distributed along the streamer channel. The electron density and its distribution profile were compared with a previous study simulating similar streamers, demonstrating good agreement. This work was supported in part by JKA and its promotion funds from KEIRIN RACE. The authors like to thank Mr. Kazuaki Ogura and Mr. Kaiho Aono of The University of Tokyo for their support during this work.

  8. A position-sensitive neutron spectrometer/dosimeter based on pressurized superheated drop (bubble) detectors

    Energy Technology Data Exchange (ETDEWEB)

    D' Errico, F. E-mail: francesco.derrico@yale.edu; Nath, R.; Holland, S.K.; Lamba, M.; Patz, S.; Rivard, M.J

    2002-01-01

    A position-sensitive, superheated emulsion chamber (SEC) is introduced for three-dimensional (3D) spectrometry and dosimetry of fast neutrons. The detector is based on a fine suspension of octafluorocyclobutane droplets emulsified in a tissue-equivalent gel. This gel is highly viscous and immobilizes the bubbles at the location of their formation. At an operating temperature of 35 deg.C, the droplets are moderately superheated and their evaporation is nucleated by the densely ionizing products of fast neutron interactions, with no response to sparsely ionizing radiations. Thus, when a neutron emitter such as a {sup 252}Cf brachytherapy source is inserted in the SEC, a bubble distribution forms around the source and makes the neutron field visible. The SEC is operated at different externally applied pressures that correspond to different response thresholds. These responses form a virtually orthogonal matrix which is suitable for spectrometry and allows the use of effective few channel unfolding procedures, yielding the spatial dependence of absorbed dose and neutron energy spectra in-tissue. Bubble spatial distributions in the chamber can be determined through optical tomography or magnetic resonance imaging (MRI). A 3D, steady-state MRI method has proven particularly effective for this purpose. After the imaging, the SEC can be pressurized above the halocarbon vapor tension in order to recondense the bubbles to the liquid phase. Within a few minutes, the device is annealed and ready to be used again for repeated measurements improving the bubble counting statistics.

  9. Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants.

    Science.gov (United States)

    Xie, Li-Hua

    2014-01-01

    Continuous positive airway pressure (CPAP) with nasal devices (nCPAP) is widely used in the respiratory management of newborns. The present study aimed to compare the incidence of nasal trauma secondary to nasal continuous positive airway pressure (nCPAP) protected with or without hydrocolloid dressing in preterm infants. This prospective controlled study was performed in the neonatal intensive care unit (NICU) of the Children's Hospital of Hunan Province from March 1, 2010 to June 31, 2010. A total of 65 infants, 46 males and 19 females, were recruited in this study. Their average gestational age was 32.6 weeks (range 28-37 weeks). The infants were randomly divided into clinical trial group (group A, n=33) and control group (group B, n=32). Paraffin oil was smeared around the nostrils before inserting prongs in group B; the infants in group A were covered on the infant's nostrils surface with hydrocolloid dressing (hydrocolloid dressing, 1.8 mm thick, 90029T, 3M Company, Minnesota, USA) with a size of 2-3 cm cutting two holes adapted to the nose and nostrils. The nostrils of those infants were inspected daily during nCPAP support until they were weaned off nCPAP. Nine infants (2 in group A and 7 in group B) developed nasal injury during nCPAP support. The Chi-square test revealed that there was a statistically significant difference (P=0.01) in the incidence of nasal injury between groups A and B. The study demonstrated that hydrocolloid dressing significantly decreased the incidence and the severity of nasal injury.

  10. Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial.

    Science.gov (United States)

    Wheeler, Natalie C; Wing, Jeffrey J; O'Brien, Louise M; Hughes, Rebecca; Jacobs, Teresa; Claflin, Edward; Chervin, Ronald D; Brown, Devin L

    2016-09-15

    Obstructive sleep apnea (OSA) is common after stroke and predicts poor outcomes. Continuous positive airway pressure (CPAP) treats OSA but is generally poorly tolerated by stroke patients. We assessed whether nasal expiratory positive airway pressure (EPAP), an alternative to CPAP, may be an effective option after acute stroke. We conducted a randomized, controlled, two-period crossover study in which each acute ischemic stroke patient received 1 night of EPAP and 1 night without EPAP while OSA was monitored with a validated device, the Watch-PAT 200. Linear repeated- measures analyses were conducted. Sample size calculations indicated that 18 subjects would be required to detect a 10-point or larger average reduction in the apnea-hypopnea index (AHI, the primary outcome), with use of EPAP, with power ≥ 80% and α = 0.05. Among the 19 subjects who completed the protocol, nasal EPAP treatment was associated with a nonsignificant absolute difference in AHI of -5.73 events/h in the primary analysis (p = 0.183, 95% confidence interval -14.4, 2.97) and a nonsignificant absolute difference in AHI of -5.43 events/h in the subgroup of patients who used nasal EPAP for ≥ 3 h (p = 0.314, 95% confidence interval -16.6, 5.76). This study suggests that EPAP is not an effective alternative to CPAP in acute stroke patients with OSA. Further work is needed to identify other more effective alternatives. ClinicalTrials.gov, ID: NCT01703663. © 2016 American Academy of Sleep Medicine.

  11. Repeated thermo-sterilisation further affects the reliability of positive end-expiratory pressure valves.

    Science.gov (United States)

    Hartung, Julia Christine; Schmölzer, Georg; Schmalisch, Gerd; Roehr, Charles Christoph

    2013-09-01

    Positive end-expiratory pressure (PEEP) valves are used together with self-inflating bags (SIB) to provide a preset PEEP during manual ventilation. It has recently been shown that these valves deliver highly variable levels of PEEP. We hypothesised that material fatigue due to repeated thermo-sterilisation (TS) may contribute to varying reliability of PEEP valves. In a laboratory study 10 new PEEP valves were tested before and after 10, 20 and 30 cycles of routine TS (7 min at 134°C) by using a neonatal lung model (compliance 0.2 mL/kPa). Settings were positive inflation pressure = 20 and 40 cm H(2)O, PEEP = 5 and 10 cm H(2)O, respiratory rate = 40 and 60/min, flow = 8l/min. PEEP was recorded using a respiratory function monitor. Before TS, a mean (standard deviation) PEEP of 4.0 (0.9) and 7.7 (1.0) cm H(2)O was delivered by the 10 valves when the PEEP was set to 5 and 10 cm H(2)O, respectively. One new valve only delivered 2.0 (0.0) and 5.0 (0.0) cm H(2)O when the PEEP was adjusted to 5 and 10 cm H(2)O, respectively. Four of the 10 investigated valves showed significant variations in PEEP (coefficient of variation >10%) throughout the autoclaving process. One valve completely lost its function after the 20th TS. Common defects were tears in the softer materials or displacement of the rubber seal. Six of the 10 valves continued to provide PEEP in spite of repeated TS. The reliability of PEEP valves is affected by repeated TS. Multi-use PEEP valves should be tested for reliable PEEP provision following TS. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  12. European Society of Hypertension position paper on ambulatory blood pressure monitoring.

    Science.gov (United States)

    O'Brien, Eoin; Parati, Gianfranco; Stergiou, George; Asmar, Roland; Beilin, Laurie; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing

    2013-09-01

    Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.

  13. Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVE: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10: individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10: individuals who received positive end-expiratory pressure of 10 cm H2O throughout the surgical procedure; and G-control (n = 20: not received any preoperative or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery. RESULTS: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

  14. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement.

    Science.gov (United States)

    Minonishi, Toshiyuki; Kinoshita, Hiroyuki; Hirayama, Michiko; Kawahito, Shinji; Azma, Toshiharu; Hatakeyama, Noboru; Fujiwara, Yoshihiro

    2013-02-01

    To determine whether the supine-to-prone position change displaced the endotracheal tube (ETT) and, if so, whether the displacement related to this change modified ETT cuff pressure. Prospective study. Operating room of a university hospital. 132 intubated, adult, ASA physical status 1, 2, and 3 patients undergoing lumbar spine surgery. After induction of anesthesia, each patient's trachea was intubated. The insertion depth of each ETT was 23 cm for men and 21 cm for women at the upper incisors. In the supine position and after the supine-to-prone position change with the head rotated to the right, the length from the carina to ETT tip and ETT cuff pressure were measured. After the supine-to-prone position change, 91.7% patients had ETT tube displacement. Of these, 48% of patients' ETT moved ≥ 10 mm, whereas 86.3% of patients had changes in tube cuff pressure. There was a slight but significant correlation between ETT movement and change in cuff pressure. Depending on the position change, ETT cuff pressure decreased and the ETT tended to withdraw. After the supine-to-prone position change, patients had ETT tube displacement. Such ETT movement may be accompanied by a decrease in cuff pressure. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Combination of pedCAT® for 3D Imaging in Standing Position With Pedography Shows No Statistical Correlation of Bone Position With Force/Pressure Distribution.

    Science.gov (United States)

    Richter, Martinus; Zech, Stefan; Hahn, Sarah; Naef, Issam; Merschin, David

    2016-01-01

    pedCAT(®) (CurveBeam, Warrington, PA) is a technology for 3-dimensional (3D) imaging with full weightbearing that has been proved to exactly visualize the 3D bone position. For the present study, a customized pedography sensor (Pliance; Novel, Munich, Germany) was inserted into the pedCAT(®). The aim of our study was to analyze the correlation of the bone position and force/pressure distribution. A prospective consecutive study of 50 patients was performed, starting July 28, 2014. All patients underwent a pedCAT(®) scan and simultaneous pedography with full weightbearing in the standing position. The following parameters were measured on the pedCAT(®) image for the right foot by 3 different investigators 3 times: lateral talo-first metatarsal angle, calcaneal pitch angle, and minimum height of the fifth metatarsal base, second to fifth metatarsal heads, and medial sesamoid. From the pedography data, the following parameters were defined using the standardized software algorithm: midfoot contact area, maximum force of midfoot, maximum force of midfoot lateral, maximum force of entire foot, and maximum pressure of first to fifth metatarsal. The values of the corresponding pedCAT(®) and pedographic parameters were correlated (Pearson). The intra- and interobserver reliability of the pedCAT(®) measurements were sufficient (analysis of variance, p > .8 for each, power >0.8). No sufficient correlation was found between the pedCAT(®) and pedographic parameters (r -0.38).3D bone position did not correlate with the force and pressure distribution under the foot sole during simultaneous pedCAT(®) scanning and pedography. Thus, the bone positions measured with pedCAT(®) do not allow conclusions about the force and pressure distribution. However, the static pedographic parameters also do not allow conclusions about the 3D bone position.one position and force/pressure distribution are important parameters for diagnostics, planning, and follow-up examinations in foot

  16. Arterial pressure allows monitoring the changes in cardiac output induced by volume expansion but not by norepinephrine.

    Science.gov (United States)

    Monnet, Xavier; Letierce, Alexia; Hamzaoui, Olfa; Chemla, Denis; Anguel, Nadia; Osman, David; Richard, Christian; Teboul, Jean-Louis

    2011-06-01

    To evaluate to which extent the systemic arterial pulse pressure could be used as a surrogate of cardiac output for assessing the effects of a fluid challenge and of norepinephrine. Observational study. Medical intensive care unit. Patients with an acute circulatory failure who received a fluid challenge (228 patients, group 1) or in whom norepinephrine was introduced or increased (145 patients, group 2). We measured the systolic, diastolic, and mean arterial pressure, pulse pressure, and the transpulmonary thermodilution cardiac output before and after the therapeutic interventions. In group 1, the fluid challenge significantly increased cardiac output by 24% ± 25%. It significantly increased cardiac output by ≥15% (+35% ± 27%) in 142 patients ("responders"). The fluid-induced changes in cardiac output were correlated with the changes in pulse pressure (r = .56, p arterial pressure (r = .55, p arterial pressure (r = .37, p arterial pressure (r = .52, p pressure were significantly related to changes in stroke volume (multiple r = .52) and to age (r = .12). A fluid-induced increase in pulse pressure of ≥17% allowed detecting a fluid-induced increase in cardiac output of ≥15% with a sensitivity of 65[56-72]% and a specificity of 85[76-92]%. The area under the receiver operating characteristic curves for the fluid-induced changes in mean arterial pressure and in diastolic arterial pressure was significantly lower than for pulse pressure. In group 2, the introduction/increase of norepinephrine significantly increased cardiac output by 14% ± 18%. The changes in cardiac output induced by the introduction/increase in the dose of norepinephrine were correlated with the changes in pulse pressure and systolic arterial pressure (r = .21 and .29, respectively, p = .001) but to a significantly lesser extent than in group 1. Pulse pressure and systolic arterial pressure could be used for detecting the fluid-induced changes in cardiac output, in spite of a significant

  17. Pulsed positive discharges in air at moderate pressures near a dielectric rod

    Science.gov (United States)

    Dubinova, A.; Trienekens, D.; Ebert, U.; Nijdam, S.; Christen, T.

    2016-10-01

    We study pulsed positive discharges in air in a cylindrically symmetric setup with an electrode needle close (about 1 mm) above the top of a dielectric cylindrical rod of 4 mm in diameter mounted at its bottom on a grounded plate electrode. We present ICCD (intensified charge-coupled device) pictures and evaluations of experiments as well as simulations with a fluid discharge model; the simulations use cylindrical symmetry. In the experiments, there is an initial inception cloud phase, where the cylindrical symmetry is maintained, and later a streamer phase, where it is broken spontaneously. At 75-150 mbar, discharges with cylindrical symmetry are not attracted to the dielectric rod, but move away from it. The dielectric rod plays the sole role of an obstacle that shades (in the context of photoionization) a cone-shaped part of the inception cloud; the cone size is determined by the geometry of the setup. The material properties of the dielectric rod, such as its dielectric permittivity and the efficiency of the photon induced secondary electron emission do not have a noticeable effect. This is due to the abundance of photoionization in air, which supplies a positive discharge with free electrons and allows it to propagate along the electric field lines. Using some simple field calculations, we show that field enhancement due to dielectric polarization does not play a significant role in our geometry as long as the discharge maintains its cylindrical symmetry. The field component towards the rod is insufficiently enhanced to cause the discharge to move towards the rod. Any additional electrons produced by the dielectric surface do not influence this discharge morphology. This interpretation is supported by both experiments and simulations. At higher pressures (400-600 mbar) or for larger gaps between the needle and the dielectric rod, the inception cloud reaches its maximal radius within the gap between needle and rod and destabilizes there. In those cases

  18. Parmelia sulcata lichen transplants positioning towards wind direction (Part I): precipitation volumes, total element deposition and lichen element content

    NARCIS (Netherlands)

    Marques, A.P.; Freitas, M.C.; Wolterbeek, H. Th.; Verburg, T.

    2009-01-01

    Parmelia sulcata transplants were used in three different exposure systems, focused on three different influxes: free influx, horizontal influx and vertical influx. The total element deposition and the precipitation volumes were found to be positively correlated for Fe and Ni only. The element conte

  19. Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure

    Directory of Open Access Journals (Sweden)

    Marjory Fernanda Bussoni

    2014-01-01

    Full Text Available OBJECTIVE: The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear. METHODS: This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fraction <0.50 who were in functional classes I-III according to the New York Heart Association criteria. Twenty-three patients were assigned to continuous positive airway pressure therapy (10 cmH2O, while 20 patients received placebo with null pressure for 30 minutes. All patients underwent a 6-minute walk test (6MWT and Doppler echocardiography before and immediately after intervention. Clinicaltrials.gov: NCT01088854. RESULTS: The groups had similar clinical and echocardiographic baseline variables. Variation in the diastolic function index (e′ after intervention was associated with differences in the distance walked in both groups. However, in the continuous positive airway pressure group, this difference was greater (continuous positive airway pressure group: Δ6MWT = 9.44+16.05×Δe′, p = 0.002; sham group: Δ6MWT = 7.49+5.38×Δe′; p = 0.015. There was a statistically significant interaction between e′ index variation and continuous positive airway pressure for the improvement of functional capacity (p = 0.020. CONCLUSIONS: Continuous positive airway pressure does not acurately change the echocardiographic indexes of left ventricle systolic or diastolic function in patients with compensated systolic heart failure. However, 30-minute continuous positive airway pressure therapy appears to have an effect on left ventricular diastolic function by increasing functional capacity.

  20. Cerebral hemodynamics in patients with obstructive sleep apnea syndrome monitored with near-infrared spectroscopy (NIRS) during positive airways pressure (CPAP) therapy: a pilot study

    Science.gov (United States)

    Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Fritschi, Ursula; Lehner, Isabella; Qi, Ming; Khatami, Ramin

    2014-03-01

    In obstructive sleep apnea syndrome (OSA) the periodic reduction or cessation of breathing due to narrowing or occlusion of the upper airway during sleep leads to daytime symptoms and increased cardiovascular risk, including stroke. The higher risk of stroke is related to the impairment in cerebral vascular autoregulation. Continuous positive airways pressure (CPAP) therapy at night is the most effective treatment for OSA. However, there is no suitable bedside monitoring method evaluating the treatment efficacy of CPAP therapy, especially to monitor the recovery of cerebral hemodynamics. NIRS is ideally suited for non-invasive monitoring the cerebral hemodynamics during sleep. In this study, we will for first time assess dynamic changes of cerebral hemodynamics during nocturnal CPAP therapy in 3 patients with OSA using NIRS. We found periodic oscillations in HbO2, HHb, tissue oxygenation index (TOI) and blood volume associated with periodic apnea events without CPAP in all OSA patients. These oscillations were gradually attenuated and finally eliminated with the stepwise increments of CPAP pressures. The oscillations were totally eliminated in blood volume earlier than in other hemodynamic parameters. These results suggested that 1) the cerebral hemodynamic oscillations induced by OSA events can effectively be attenuated by CPAP therapy, and 2) blood flow and blood volume recovered first during CPAP therapy, followed by the recovery of oxygen consumption. Our study suggested that NIRS is a useful tool to evaluate the efficacy of CPAP therapy in patients with OSA bedside and in real time.

  1. High-order accurate finite-volume formulations for the pressure gradient force in layered ocean models

    Science.gov (United States)

    Engwirda, Darren; Kelley, Maxwell; Marshall, John

    2017-08-01

    Discretisation of the horizontal pressure gradient force in layered ocean models is a challenging task, with non-trivial interactions between the thermodynamics of the fluid and the geometry of the layers often leading to numerical difficulties. We present two new finite-volume schemes for the pressure gradient operator designed to address these issues. In each case, the horizontal acceleration is computed as an integration of the contact pressure force that acts along the perimeter of an associated momentum control-volume. A pair of new schemes are developed by exploring different control-volume geometries. Non-linearities in the underlying equation-of-state definitions and thermodynamic profiles are treated using a high-order accurate numerical integration framework, designed to preserve hydrostatic balance in a non-linear manner. Numerical experiments show that the new methods achieve high levels of consistency, maintaining hydrostatic and thermobaric equilibrium in the presence of strongly-sloping layer geometries, non-linear equations-of-state and non-uniform vertical stratification profiles. These results suggest that the new pressure gradient formulations may be appropriate for general circulation models that employ hybrid vertical coordinates and/or terrain-following representations.

  2. Cardiac energetics: from E(max) to pressure-volume area.

    Science.gov (United States)

    Suga, Hiroyuki

    2003-08-01

    1. To celebrate this Festschrift for Professor Colin Gibbs, as an invited speaker, I would like to review briefly my 35 year research career in cardiac physiology. 2. My career started in the late 1960s in Tokyo with my serendipitous discovery of Emax (ventricular end-systolic maximum elastance) as a load-independent contractility index based on the time-varying elastance (E(t)) model of the ventricle. Professor K Sagawa at the Johns Hopkins University, USA, whom I joined in 1971, encouraged me to go further. 3. The next serendipitous event in my career was the discovery of ventricular pressure-volume area (PVA) as a measure of total mechanical energy of ventricular contraction in the late 1970s. The PVA concept was theoretically deducible from the E(t) and Emax concept and correlated surprisingly well with ventricular O2 consumption (Vo2). 4. Professor Gibbs' intuitive recognition of the significance of PVA in myocardial energetics in the 1980-1990s greatly encouraged me thereafter. The third serendipitous event in my career occurred in the mid 1990s and was my discovery of a novel integrative analysis method to assess the total amount of Ca2+ recruited in each excitation-contraction coupling from the decay rate of postextrasystolic potentiation, taking advantage of the Emax-PVA-Vo2 framework. 5. I am now hoping to experience one more serendipitous experience by developing an integrative analysis method of cross-bridge cycling in a beating heart using the Emax and PVA concepts.

  3. Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?

    Science.gov (United States)

    Whitney, Augusta; O'Toole, Robert V; Hui, Emily; Sciadini, Marcus F; Pollak, Andrew N; Manson, Theodore T; Eglseder, W Andrew; Andersen, Romney C; Lebrun, Christopher; Doro, Christopher; Nascone, Jason W

    2014-02-01

    Intracompartmental pressure measurements are frequently used in the diagnosis of compartment syndrome, particularly in patients with equivocal or limited physical examination findings. Little clinical work has been done to validate the clinical use of intracompartmental pressures or identify associated false-positive rates. We hypothesized that diagnosis of compartment syndrome based on one-time pressure measurements alone is associated with a high false-positive rate. Forty-eight consecutive patients with tibial shaft fractures who were not suspected of having compartment syndrome based on physical examinations were prospectively enrolled. Pressure measurements were obtained in all four compartments at a single point in time immediately after induction of anesthesia using a pressure-monitoring device. Preoperative and intraoperative blood pressure measurements were recorded. The same standardized examination was performed by the attending surgeon preoperatively, postoperatively, and during clinical follow-up for 6 months to assess clinical evidence of acute or late compartment syndrome. No clinical evidence of compartment syndrome was observed postoperatively or during follow-up until 6 months after injury. Using the accepted criteria of delta P of 30 mm Hg from preoperative diastolic blood pressure, 35% of cases (n = 16; 95% confidence interval, 21.5-48.5%) met criteria for compartment syndrome. Raising the threshold to delta P of 20 mm Hg reduced the false-positive rate to 24% (n = 11; 95% confidence interval, 11.1-34.9%). Twenty-two percent (n = 10; 95% confidence interval, 9.5-32.5%) exceeded absolute pressure of 45 mm Hg. A 35% false-positive rate was found for the diagnosis of compartment syndrome in patients with tibial shaft fractures who were not thought to have compartment syndrome by using currently accepted criteria for diagnosis based solely on one-time compartment pressure measurements. Our data suggest that reliance on one-time intracompartmental

  4. Clinical assessment of auto-positive end-expiratory pressure by diaphragmatic electrical activity during pressure support and neurally adjusted ventilatory assist.

    Science.gov (United States)

    Bellani, Giacomo; Coppadoro, Andrea; Patroniti, Nicolò; Turella, Marta; Arrigoni Marocco, Stefano; Grasselli, Giacomo; Mauri, Tommaso; Pesenti, Antonio

    2014-09-01

    Auto-positive end-expiratory pressure (auto-PEEP) may substantially increase the inspiratory effort during assisted mechanical ventilation. Purpose of this study was to assess whether the electrical activity of the diaphragm (EAdi) signal can be reliably used to estimate auto-PEEP in patients undergoing pressure support ventilation and neurally adjusted ventilatory assist (NAVA) and whether NAVA was beneficial in comparison with pressure support ventilation in patients affected by auto-PEEP. In 10 patients with a clinical suspicion of auto-PEEP, the authors simultaneously recorded EAdi, airway, esophageal pressure, and flow during pressure support and NAVA, whereas external PEEP was increased from 2 to 14 cm H2O. Tracings were analyzed to measure apparent "dynamic" auto-PEEP (decrease in esophageal pressure to generate inspiratory flow), auto-EAdi (EAdi value at the onset of inspiratory flow), and IDEAdi (inspiratory delay between the onset of EAdi and the inspiratory flow). The pressure necessary to overcome auto-PEEP, auto-EAdi, and IDEAdi was significantly lower in NAVA as compared with pressure support ventilation, decreased with increase in external PEEP, although the effect of external PEEP was less pronounced in NAVA. Both auto-EAdi and IDEAdi were tightly correlated with auto-PEEP (r = 0.94 and r = 0.75, respectively). In the presence of auto-PEEP at lower external PEEP levels, NAVA was characterized by a characteristic shape of the airway pressure. In patients with auto-PEEP, NAVA, compared with pressure support ventilation, led to a decrease in the pressure necessary to overcome auto-PEEP, which could be reliably monitored by the electrical activity of the diaphragm before inspiratory flow onset (auto-EAdi).

  5. Volume and structural study of Fe{sub 64}Mn{sub 36} anti-ferromagnetic Invar alloy under high pressure

    Energy Technology Data Exchange (ETDEWEB)

    Matsushita, M., E-mail: matsushita@eng.ehime-u.ac.j [Department of Mechanical Engineering, Graduate School of Science and Engineering, Ehime University, 3-Bunkyocho, Matsuyama 790-0826 (Japan); Nakano, S. [National Institute for Materials Science, Tsukuba, Ibaraki 305-0044 (Japan); Ohfuji, H. [Geodynamics Research Center, Ehime University, 2-Bunkyocho, Matsuyama 790-0826 (Japan); Yamada, I. [Department of Chemistry and Biology, Graduate School of Science and Engineering, Ehime University, 2-Bunkyocho, Matsuyama 790-0826 (Japan); Kikegawa, T. [High Energy Accelerator Research Organization, Tsukuba 305-0801 (Japan)

    2011-03-15

    We have investigated the pressure variation of the volume and structure of an FCC Fe{sub 64}Mn{sub 36} anti-ferromagnetic Invar alloy. The inclination of the pressure-volume (P-V) curve of the FCC structure becomes discontinuous at a pressure of 4 GPa. According to the bulk modulus at zero pressure estimated by the Birch-Murnaghan equation of state, the pressure between 4 and 10 GPa is 33 GPa larger than that at a pressure below 4 GPa. Considering previous experiments on magnetism at high pressure the Neel temperature at 4 GPa almost decreases to room temperature. These results suggest that the increase in the bulk modulus by 33 GPa can be attributed to the pressure-induced magnetic phase transition from anti-ferromagnetism to paramagnetism. Volume at zero pressure was estimated using the Birch-Murnaghan equation of state. The volume of FCC structure in the anti-ferromagnetic state was 1.17% larger than the volume in the paramagnetic state, namely, the spontaneous magnetostriction was 1.17%. Pressure-induced structural transition from FCC to HCP occurs with an increase in the pressure, especially at up to 5 GPa. The value of c/a is 1.62; this value almost corresponds to that of an ideal HCP structure. The bulk modulus of the HCP structure estimated by the Birch-Murnaghan equation of state is larger than that of the FCC structure, and the volume/atom ratio is smaller than that of the FCC structure. - Research highlights: > We have investigated the pressure variation of volume and structure of FCC Fe{sub 64}Mn{sub 36} alloy. > We discovered that the change in inclination of the pressure-volume (P-V) curve of the FCC structure becomes discontinuous at a pressure of 4 GPa. This pressure corresponds to the Neel temperature, which decreases down to room temperature. > Further we estimated bulk modulus and volume at zero pressure using the Birch-Murnaghan equation of state. As a result, we have demonstrated that anti-ferromagnetism has very close relationship with the

  6. Comparison of Magnetic Resonance Imaging and Computed Tomography for Breast Target Volume Delineation in Prone and Supine Positions.

    Science.gov (United States)

    Pogson, Elise M; Delaney, Geoff P; Ahern, Verity; Boxer, Miriam M; Chan, Christine; David, Steven; Dimigen, Marion; Harvey, Jennifer A; Koh, Eng-Siew; Lim, Karen; Papadatos, George; Yap, Mei Ling; Batumalai, Vikneswary; Lazarus, Elizabeth; Dundas, Kylie; Shafiq, Jesmin; Liney, Gary; Moran, Catherine; Metcalfe, Peter; Holloway, Lois

    2016-11-15

    To determine whether T2-weighted MRI improves seroma cavity (SC) and whole breast (WB) interobserver conformity for radiation therapy purposes, compared with the gold standard of CT, both in the prone and supine positions. Eleven observers (2 radiologists and 9 radiation oncologists) delineated SC and WB clinical target volumes (CTVs) on T2-weighted MRI and CT supine and prone scans (4 scans per patient) for 33 patient datasets. Individual observer's volumes were compared using the Dice similarity coefficient, volume overlap index, center of mass shift, and Hausdorff distances. An average cavity visualization score was also determined. Imaging modality did not affect interobserver variation for WB CTVs. Prone WB CTVs were larger in volume and more conformal than supine CTVs (on both MRI and CT). Seroma cavity volumes were larger on CT than on MRI. Seroma cavity volumes proved to be comparable in interobserver conformity in both modalities (volume overlap index of 0.57 (95% Confidence Interval (CI) 0.54-0.60) for CT supine and 0.52 (95% CI 0.48-0.56) for MRI supine, 0.56 (95% CI 0.53-0.59) for CT prone and 0.55 (95% CI 0.51-0.59) for MRI prone); however, after registering modalities together the intermodality variation (Dice similarity coefficient of 0.41 (95% CI 0.36-0.46) for supine and 0.38 (0.34-0.42) for prone) was larger than the interobserver variability for SC, despite the location typically remaining constant. Magnetic resonance imaging interobserver variation was comparable to CT for the WB CTV and SC delineation, in both prone and supine positions. Although the cavity visualization score and interobserver concordance was not significantly higher for MRI than for CT, the SCs were smaller on MRI, potentially owing to clearer SC definition, especially on T2-weighted MR images. Copyright © 2016. Published by Elsevier Inc.

  7. Positive corona discharge in N_2 + CH_4 mixture at atmospheric pressure

    Science.gov (United States)

    Horvath, G.; Skalny, J. D.; Mason, N. J.; Zahoran, M.; Orszagh, J.

    2008-07-01

    Titan is considered as one of the few places in Solar system, where atmospheric and surface conditions could have produced organic molecules as precursors of higher hydrocarbons, nitriles or amino acids. Most of laboratory simulations of Titan's atmosphere were carried out at lower pressures presenting stratospheric conditions but there is poor knowledge about simulated reactions of Titan's troposphere. In our work an experimental investigation of products in positive coaxial corona discharge fed by mixture of N_2 and CH_4 with ratio of N_2:CH_4=98:2 in stationary regime has been made using UV spectroscopy. The measurements have been carried out at pressure of 1 bar and ambient temperature. The discharge reactor used for the treatment of the gas mixture consisted of a brass cylinder with diameter of 16 mm and length of 70 mm. A stainless steel and tungsten wires of diameter of 0.125 mm was centred inside the metal cylinder and was connected to the high voltage power supply. Coaxial corona discharge was generated by a Glassman high voltage power supply. The mixing ratio of methane and nitrogen was regulated by a MKS flow controllers. The reactor was placed in a Shimadzu VUV spectrometer for the in-situ measurements of absorbance of synthesized compounds. The measurements were focused on the UV analysis of time evolution of C_2H_2 and C_2H_4 concentrations and EMS study of deposited compounds on discharge electrodes (Figure 1). After a certain time a yellow- orange layer was formed on the active discharge electrode causing sparks and forming a dense rose-like spots on the covered electrode surface (Figure 2). Figure 1: EMS study of electrode surface. Figure 2: EMS picture of a treated electrode.

  8. RESEARCH AND MATHEMATICAL MODELING OF TURBULENT BOUNDARY LAYER AT POSITIVE PRESSURE GRADIENT

    Directory of Open Access Journals (Sweden)

    Vitaliy Mamchuk

    2016-06-01

    Full Text Available Purpose: Mathematical modeling of complex turbulent near-wall flows, that occur during the flow of airfoils, is impossible without understanding the nature of the flow in boundary layer. From a mathematical point of view, the calculation of such flows, because in practical problems they regarded as turbulent, and the characteristics of turbulence are largely dependent on the geometry of the profile of the longitudinal component of the average velocity of the near-wall flow. Based on this, the purpose of this work is studying and mathematical modeling of turbulent near-wall flows in the interaction with the real streamlined surface, that has certain features, such as the curvature, roughness, etc., as well as the study and research of the influence of the pressure gradient on the empirical coefficients, parameters of the flow, velocity profiles and friction stress. Methods: We performed the calculations using numerical finite-difference marching method with algebraic model of turbulent viscosity coefficient. Results: In this paper we present some results of the numerical study of the effect of the positive pressure gradient on the empirical coefficients of the transition zone and the law of the near-wall and the outer-wall areas. Discussion: Comparison of the calculated results with the experimental data shows that the proposed approaches provide an opportunity to simulate the flow as close as possible to their physical properties. Presented mathematical model for the calculation of turbulent boundary layers and near-wall flows makes it possible to calculate such a complex and valuable from a practical point of view type of the flow as the aerodynamic trail behind the streamlined body.

  9. Non-invasive positive pressure ventilation for acute asthma in children.

    Science.gov (United States)

    Korang, Steven Kwasi; Feinberg, Joshua; Wetterslev, Jørn; Jakobsen, Janus C

    2016-09-30

    Asthma is one of the most common reasons for hospital admission among children and constitutes a significant economic burden. Use of non-invasive positive pressure ventilation (NPPV) in the care of children with acute asthma has increased even though evidence supporting the intervention has been considered weak and clinical guidelines do not recommend the intervention. NPPV might be an effective intervention for acute asthma, but no systematic review has been conducted to assess the effects of NPPV as an add-on therapy to usual care in children with acute asthma. To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children with acute asthma. We identified trials from the Cochrane Airways Group Specialised Register (CAGR). The Register contains trial reports identified through systematic searches of bibliographic databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED and PsycINFO, and by handsearching of respiratory journals and meeting abstracts. We also conducted a search of ClinicalTrials.gov (www.ClinicalTrials.gov) and the WHO trials portal (www.who.int/ictrp/en/). We searched all databases from their inception to February 2016, with no restriction on language of publication. We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children (age process in sufficient detail to complete a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow diagram and 'Characteristics of excluded studies' table. We identified the risk of bias of included studies to reduce the risk of systematic error. We contacted relevant study authors when data were missing. We included two RCTs that randomised 20 participants to NPPV and 20 participants to control. We assessed both studies as having high risk of bias; both trials assessed effects of bilateral positive airway

  10. [Efficacy and safety of non-invasive positive pressure ventilation therapy in acute pulmonary edema].

    Science.gov (United States)

    Sarullo, Filippo Maria; D'Alfonso, Giovanni; Brusca, Ignazio; De Michele, Piero; Taormina, Andrea; Di Pasquale, Pietro; Castello, Antonio

    2004-03-01

    Non-invasive positive pressure ventilation (NIPPV) is an effective treatment for acute respiratory failure in patients with chronic obstructive pulmonary disease. We assessed the efficacy and safety of this therapy in acute cardiogenic pulmonary edema (ACPE). In addition to routine therapy consisting of oxygen, nitrates and diuretics, 60 patients (39 male, 21 female, mean age 72.5 +/- 15.8 years) were started on full mask NIPPV using a Sullivan VPAP II ventilator delivering pressure support 15 cm H2O, PEEP 5 cm H2O, FiO2 100%. Pressure support were titrated to achieve oxygen saturation (SaO2) > 95%. Physiological measurements were obtained in the first 2 h and at 3 h, 4 h, and 10 h. Outcome measures included arterial blood gas (ABG), Borg dyspnea score, vital signs, and need for endotracheal intubation (ETI). Initial mean values on FiO2 100% by non nonrebreather mask: pH 7.11 +/- 0.25, paCO2 67.7 +/- 17.5 mmHg, paO2 71.5 +/- 29.7 mmHg, SaO2 83 +/- 12%, lactate concentrations 4.7 +/- 2.3 mmol/L, Borg score 8.6 +/- 1.3, respiratory rate (RR) 41 +/- 7. At 60 minutes of NIPPV, improvement was statistically significant: pH 7.35 +/- 0.18 (difference 0.24; p < 0.0001), paCO2 43 +/- 13 mmHg (difference 24.7; p < 0.0001), paO2 102 +/- 10 mmHg (difference 30.5; p < 0.0001), SaO2 99 +/- 5% (difference 16; p < 0.0001), lactate concentrations 1.2 +/- 0.8 (difference 3.5; p < 0.0001) Borg score 3.6 +/- 0.9 (difference 5; p < 0.0001), RR 24.6 +/- 5 (difference 17.1; p < 0.0001). NIPPV duration ranged from 40 minutes to 24 hours (median 3 hours, 30 minutes). Fifty-six patients (93.4%) improved allowing cessation of NIPPV. ETI was required in four (6.6%) of 60 patients. There were non complications of NIPPV. In this study of acute cardiogenic pulmonary edema, NIPPV is an effective treatment and may help prevent ETI.

  11. Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Takacs J

    2013-07-01

    Full Text Available Judit Takacs,1 Judy E Anderson,1,3 Jeff RS Leiter,1,2,4 Peter B MacDonald,2,4 Jason D Peeler1,4 1Department of Human Anatomy and Cell Science, 2Department of Surgery, 3Department of Biological Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; 4Pan Am Clinic, Winnipeg, Manitoba, Canada Background: Knee osteoarthritis (OA is the most prevalent medical condition in individuals over the age of 65 years, and is a progressive joint degenerative condition with no known cure. Research suggests that there is a strong relationship between knee pain and loss of physical function. The resulting lifestyle modifications negatively impact not only disease onset and progression but also overall health, work productivity, and quality of life of the affected individual. Purpose: The goal of this investigation was to examine the feasibility of using an emerging technology called lower body positive pressure (LBPP to simulate weight loss and reduce acute knee pain during treadmill walking exercise in overweight individuals with radiographically confirmed symptomatic knee OA. Design: Prospective case series. Methods: Twenty-two overweight individuals with knee OA completed two 20-minute treadmill walking sessions (one full weight bearing and one LBPP supported at a speed of 3.1 mph, 0% incline. Acute knee pain was assessed using a visual analog scale, and the percentage of LBPP support required to minimize knee pain was evaluated every 5 minutes. Knee Osteoarthritis Outcome Scores were used to quantify knee pain and functional status between walking sessions. The order of testing was randomized, with sessions occurring a minimum of 1 week apart. Results: A mean LBPP of 12.4% of body weight provided participants with significant pain relief during walking, and prevented exacerbation of acute knee pain over the duration of the 20-minute exercise session. Patients felt safe and confident walking with LBPP support on the treadmill, and demonstrated no change

  12. Subtleties in the calculation of the pressure and pressure tensor of anisotropic particles from volume-perturbation methods and the apparent asymmetry of the compressive and expansive contributions

    Science.gov (United States)

    Brumby, Paul E.; Haslam, Andrew J.; de Miguel, Enrique; Jackson, George

    2011-01-01

    An efficient and versatile method to calculate the components of the pressure tensor for hard-body fluids of generic shape from the perspective of molecular simulation is presented. After due consideration of all the possible repulsive contributions exerted by molecules upon their surroundings during an anisotropic system expansion, it is observed that such a volume change can, for non-spherical molecules, give rise to configurations where overlaps occur. This feature of anisotropic molecules has to be taken into account rigorously as it can lead to discrepancies in the calculation of tensorial contributions to the pressure. Using the condition of detailed balance as a basis, a perturbation method developed for spherical molecules has been extended so that it is applicable to non-spherical and non-convex molecules. From a series of 'ghost' anisotropic volume perturbations the residual contribution to the components of the pressure tensor may be accurately calculated. Comparisons are made with prior methods and, where relevant, results are evaluated against existing data. For inhomogeneous systems this method provides a particularly convenient route to the calculation of the interfacial tension (surface free energy) from molecular simulations.

  13. Gastric yield pressure and gastric yield volume to assess anti-reflux barrier in a porcine model.

    Science.gov (United States)

    Duarte, Marcos E S; Freitag, Carmen P F; Fornari, Fernando; Kruel, Cleber R P; Sanches, Paulo R S; Thomé, Paulo R O; Callegari-Jacques, Sidia M; Möllerke, Roseli O; Vicente, Yvone A M V A; Goldani, Helena A S; Barros, Sérgio G S

    2013-04-01

    Anti-reflux barrier (ARB) resistance may be useful to test new treatments for gastroesophageal reflux (GER). The ARB has been estimated by increasing gastric yield pressure (GYP) and gastric yield volume (GYV) in animal models but has not been validated. This study aimed to develop an experimental model suitable for assessing the ARB resistance to increasing intragastric pressure and volume and its reproducibility in a seven-day interval. Ten two-month-old female Large-White swine were studied. Intragastric pressure and volume were recorded using a digital system connected to a Foley catheter inserted through gastrostomy into the stomach. GYP and GYV were defined as the gastric pressure and volume able to yield gastric contents into the esophagus detected by esophageal pH. A sudden pH drop below 3 sustained during 5 min was considered diagnostic for gastric yield. Animals were studied again after seven days. On days 0 and 7, there were no significant differences for GYP (mean ± SD = 7.66 ± 3.02 mmHg vs. 7.07 ± 3.54 mmHg, p = .686) and GYV (636.70 ± 216.74 ml vs. 608.30 ± 276.66 ml; p = .299), respectively. Concordance correlation coefficient (ρc) was significant for GYP (ρc = 0.634, 95% CI = 0.141-0.829, p = .006), but not for GYV (ρc = 0.291, 95% CI = -0.118 to 0.774, p = .196). This study demonstrated an experimental model, assessing the ARB resistance. GYP seems to be a more reliable parameter than GYV for assessment of ARB resistance.

  14. Association of Right Ventricular Pressure and Volume Overload with Non-Ischemic Septal Fibrosis on Cardiac Magnetic Resonance

    OpenAIRE

    Jiwon Kim; Medicherla, Chaitanya B.; Ma, Claudia L.; Attila Feher; Nina Kukar; Alexi Geevarghese; Parag Goyal; Evelyn Horn; Devereux, Richard B; Weinsaft, Jonathan W.

    2016-01-01

    Background Non-ischemic fibrosis (NIF) on cardiac magnetic resonance (CMR) has been linked to poor prognosis, but its association with adverse right ventricular (RV) remodeling is unknown. This study examined a broad cohort of patients with RV dysfunction, so as to identify relationships between NIF and RV remodeling indices, including RV pressure load, volume and wall stress. Methods and Results The population comprised patients with RV dysfunction (EF

  15. Relationship of blood pressure variability and heart rate variability with prostatic volume in patients with benign prostatic hyperplasia

    Institute of Scientific and Technical Information of China (English)

    金江丽

    2014-01-01

    Objective To investigate the relationship of blood pressure variability(BPV)and heart rate variability(HRV)with prostatic volume(PV)in patients with benign prostatic hyperplasia(BPH).Methods A total of133 patients admitted to our department between January2011 and April 2013 were analyzed retrospectively.The patients were divided into BPH group and non-BPH group according to the PV value.The ambulatory blood

  16. Irrigation dynamics associated with positive pressure, apical negative pressure and passive ultrasonic irrigations: a computational fluid dynamics analysis.

    Science.gov (United States)

    Chen, José Enrique; Nurbakhsh, Babak; Layton, Gillian; Bussmann, Markus; Kishen, Anil

    2014-08-01

    Complexities in root canal anatomy and surface adherent biofilm structures remain as challenges in endodontic disinfection. The ability of an irrigant to penetrate into the apical region of a canal, along with its interaction with the root canal walls, will aid in endodontic disinfection. The aim of this study was to qualitatively examine the irrigation dynamics of syringe irrigation with different needle tip designs (open-ended and closed-ended), apical negative pressure irrigation with the EndoVac® system, and passive ultrasonic-assisted irrigation, using a computational fluid dynamics model. Syringe-based irrigation with a side-vented needle showed a higher wall shear stress than the open-ended but was localised to a small region of the canal wall. The apical negative pressure mode of irrigation generated the lowest wall shear stress, while the passive-ultrasonic irrigation group showed the highest wall shear stress along with the greatest magnitude of velocity.

  17. Osmosis-induced water uptake by Eurobitum bituminized radioactive waste and pressure development in constant volume conditions

    Science.gov (United States)

    Mariën, A.; Mokni, N.; Valcke, E.; Olivella, S.; Smets, S.; Li, X.

    2013-01-01

    The chemo-hydro-mechanical (CHM) interaction between swelling Eurobitum radioactive bituminized waste (BW) and Boom Clay is investigated to assess the feasibility of geological disposal for the long-term management of this waste. These so-called compatibility studies include laboratory water uptake tests at the Belgian Nuclear Research Center SCK•CEN, and the development of a coupled CHM formulation for Eurobitum by the International Center for Numerical Methods and Engineering (CIMNE, Polytechnical University of Cataluña, Spain). In the water uptake tests, the osmosis-induced swelling, pressure increase and NaNO3 leaching of small cylindrical BW samples (diameter 38 mm, height 10 mm) is studied under constant total stress conditions and nearly constant volume conditions; the actual geological disposal conditions should be intermediate between these extremes. Two nearly constant volume tests were stopped after 1036 and 1555 days to characterize the morphology of the hydrated BW samples and to visualize the hydrated part with microfocus X-ray Computer Tomography (μCT) and Environmental Scanning Electron Microscopy (ESEM). In parallel, a coupled CHM formulation is developed that describes chemically and hydraulically coupled flow processes in porous materials with salt crystals, and that incorporates a porosity dependent membrane efficiency, permeability and diffusivity. When Eurobitum BW is hydrated in (nearly) constant volume conditions, the osmosis-induced water uptake results in an increasing pressure to values that can be (in theory) as high as 42.8 MPa, being the osmotic pressure of a saturated NaNO3 solution. After about four years of hydration in nearly constant volume water uptake tests, pressures up to 20 MPa are measured. During this hydration period only the outer layers with a thickness of 1-2 mm were hydrated (as derived from μCT and ESEM analyses), and only about 10-20% of the initial NaNO3 content was released by the samples. In the studied test

  18. [Pressure Ulcer Caused by Long-term Keeping of the Same Body Position during Epidural Labour Analgesia].

    Science.gov (United States)

    Naruse, Satoshi; Uchizaki, Sakiko; Mimura, Shinichiro; Taniguchi, Mizuki; Akinaga, Chieko; Sato, Shigehito

    2016-06-01

    We report the case of a 34-year-old woman (height: 153 cm, weight : 62.4 kg, non-pregnant weight : 52 kg, uniparous) without underlying diseases who developed pressure ulcer due to keeping a similar body position during long-term epidural delivery. Induction of childbirth was started in gestational week 40, causing reduction of fetal heart rate, which improved after adoption of a right lateral recumbent position. Severe contractions occurred and epidural labour analgesia was started. The fetal heart rate decreased again and induction of childbirth was suspended, but the right lateral recumbent position was maintained. Epidural administration was continued due to persistent contractions. Next morning, induction of childbirth was restarted and birth occurred in approximately 6 hours. The right lateral recumbent position was maintained for approximately 20 hours. At childbirth, a pressure ulcer was present in the intertrochanteric part of the right femur. The causes included insufficient knowledge of medical staff about the risk of pressure ulcer during epidural delivery, and no position change. A decreased sensation and blocked motor nerve caused by epidural anesthesia might have accelerated pressure ulcer development. This case suggests that preventive measures against pressure ulcer are required in epidural anesthesia in pregnant women.

  19. Acute Effects of Caffeine on Heart Rate Variability, Blood Pressure and Tidal Volume in Paraplegic and Tetraplegic Compared to Able-Bodied Individuals: A Randomized, Blinded Trial

    Science.gov (United States)

    Flueck, Joelle Leonie; Schaufelberger, Fabienne; Lienert, Martina; Schäfer Olstad, Daniela; Wilhelm, Matthias; Perret, Claudio

    2016-01-01

    Caffeine increases sympathetic nerve activity in healthy individuals. Such modulation of nervous system activity can be tracked by assessing the heart rate variability. This study aimed to investigate the influence of caffeine on time- and frequency-domain heart rate variability parameters, blood pressure and tidal volume in paraplegic and tetraplegic compared to able-bodied participants. Heart rate variability was measured in supine and sitting position pre and post ingestion of either placebo or 6 mg caffeine in 12 able-bodied, 9 paraplegic and 7 tetraplegic participants in a placebo-controlled, randomized and double-blind study design. Metronomic breathing was applied (0.25 Hz) and tidal volume was recorded during heart rate variability assessment. Blood pressure, plasma caffeine and epinephrine concentrations were analyzed pre and post ingestion. Most parameters of heart rate variability did not significantly change post caffeine ingestion compared to placebo. Tidal volume significantly increased post caffeine ingestion in able-bodied (p = 0.021) and paraplegic (p = 0.036) but not in tetraplegic participants (p = 0.34). Systolic and diastolic blood pressure increased significantly post caffeine in able-bodied (systolic: p = 0.003; diastolic: p = 0.021) and tetraplegic (systolic: p = 0.043; diastolic: p = 0.042) but not in paraplegic participants (systolic: p = 0.09; diastolic: p = 0.33). Plasma caffeine concentrations were significantly increased post caffeine ingestion in all three groups of participants (p<0.05). Plasma epinephrine concentrations increased significantly in able-bodied (p = 0.002) and paraplegic (p = 0.032) but not in tetraplegic participants (p = 0.63). The influence of caffeine on the autonomic nervous system seems to depend on the level of lesion and the extent of the impairment. Therefore, tetraplegic participants may be less influenced by caffeine ingestion. Trial Registration ClinicalTrials.gov NCT02083328 PMID:27776149

  20. Effects of continuous positive airway pressure on energy balance regulation: a systematic review

    Science.gov (United States)

    Shechter, Ari

    2016-01-01

    Obesity is both a cause and a possible consequence of obstructive sleep apnoea (OSA), as OSA seems to affect parameters involved in energy balance regulation, including food intake, hormonal regulation of hunger/satiety, energy metabolism and physical activity. It is known that weight loss improves OSA, yet it remains unclear why continuous positive airway pressure (CPAP) often results in weight gain. The goal of this systematic review is to explore if and how CPAP affects the behaviour and/or metabolism involved in regulating energy balance. CPAP appears to correct for a hormonal profile characterised by abnormally high leptin and ghrelin levels in OSA, by reducing the circulating levels of each. This is expected to reduce excess food intake. However, reliable measures of food intake are lacking, and not yet sufficient to make conclusions. Although studies are limited and inconsistent, CPAP may alter energy metabolism, with reports of reductions in resting metabolic rate or sleeping metabolic rate. CPAP appears to not have an appreciable effect on altering physical activity levels. More work is needed to characterise how CPAP affects energy balance regulation. It is clear that promoting CPAP in conjunction with other weight loss approaches should be used to encourage optimal outcomes in OSA patients. PMID:27824596

  1. Use of nasal intermittent positive pressure ventilation to avoid intubation in neonates.

    Science.gov (United States)

    Manzar, Shabih; Nair, Arun K; Pai, Mangalore G; Paul, Jose; Manikoth, Prakash; Georage, Mariam; Al-Khusaiby, Saleh M

    2004-10-01

    Nasal intermittent positive pressure ventilation (NIPPV) has widely been used in neonates to prevent extubation failure and apnea. This pilot study was carried out to look at the early use of NIPPV to avoid intubation. The study was carried out over a period of 3 months from August 2003 to October 2003 at the Royal Hospital, Muscat, Sultanate of Oman. The neonates with clinical signs of moderate to severe respiratory distress were given a trial of early NIPPV based on the avoid-intubation protocol. Inclusion, exclusion and failure criteria with general procedure were made clear to all medical and nursing staff and the protocol was posted in the unit for further time to time referral. A total of 16 neonates met the inclusion criteria for early NIPPV trial. Out of these, 13 (81%) had a successful NIPPV. The mean age of entry was 0.95 hours; however, the mean duration of NIPPV was 23 hours. No NIPPV related complications were noted in the study group. We concluded that NIPPV is an appropriate mode of ventilation in neonates requiring respiratory support. The major advantage of NIPPV is the non-invasive mechanics. It is also less expensive and less labor intensive. Further randomized controlled trials with larger sample size are warranted to confirm our findings.

  2. The effect of continuous positive airway pressure on metabolic variables in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Schlatzer, Christian; Schwarz, Esther I; Kohler, Malcolm

    2014-02-01

    Obstructive sleep apnoea (OSA) is increasingly considered as a risk factor for metabolic disturbances, such as diabetes mellitus or dyslipidaemia. Continuous positive airway pressure (CPAP) therapy, the standard treatment for patients with OSA, may improve various metabolic variables, such as insulin sensitivity, glucose metabolism, lipids, fat distribution and adipokines. Several observational and uncontrolled clinical studies claim an improvement of these metabolic variables through the use of CPAP. However, there is only a limited number of clinical randomised controlled trials (RCTs) evaluating the effect of CPAP on metabolic variables. In this review, we summarise and discuss non-randomised studies and RCTs evaluating the effect of CPAP on metabolic variables in patients with OSA. In summary, the currently available body of evidence does not support a clinically important effect of CPAP treatment on any of the investigated metabolic variables. However, some investigators found small, but statistically significant changes in some metabolic variables, thus beneficial effects of CPAP treatment in selected patient cohorts cannot be excluded. To answer this question, more data from RCTs with well-defined study populations are warranted.

  3. Continuous Positive Airway Pressure Device Time to Procurement in a Disadvantaged Population

    Directory of Open Access Journals (Sweden)

    Lourdes M. DelRosso

    2015-01-01

    Full Text Available Introduction. The management of obstructive sleep apnea (OSA in patients who cannot afford a continuous positive airway pressure (CPAP device is challenging. In this study we compare time to CPAP procurement in three groups of patients diagnosed with OSA: uninsured subsidized by a humanitarian grant (Group 1, uninsured unsubsidized (Group 2, and those with Medicare or Medicaid (Group 3. We evaluate follow-up and adherence in Group 1. We hypothesize that additional factors, rather than just the ability to obtain CPAP, may uniquely affect follow-up and adherence in uninsured patients. Methods. 30 patients were in Groups 1 and 2, respectively. 12 patients were in Group 3. Time of CPAP procurement from OSA diagnosis to CPAP initiation was assessed in all groups. CPAP adherence data was collected for Group 1 patients at 1, 3, 6, and 9 months. Results. There were no significant differences between groups in gender, age, body mass index, or apnea hypopnea index. The mean time to procurement in Group 1 was shorter compared to Group 2 but not significant. Compared to both Group 1 and Group 2, Group 3 patients had significantly shorter times to device procurement. Conclusion. Time to procurement of CPAP was significantly shorter in those with Medicaid/Medicare insurance compared to the uninsured.

  4. Inactivation of Gram-positive biofilms by low-temperature plasma jet at atmospheric pressure

    Science.gov (United States)

    Marchal, F.; Robert, H.; Merbahi, N.; Fontagné-Faucher, C.; Yousfi, M.; Romain, C. E.; Eichwald, O.; Rondel, C.; Gabriel, B.

    2012-08-01

    This work is devoted to the evaluation of the efficiency of a new low-temperature plasma jet driven in ambient air by a dc-corona discharge to inactivate adherent cells and biofilms of Gram-positive bacteria. The selected microorganisms were lactic acid bacteria, a Weissella confusa strain which has the particularity to excrete a polysaccharide polymer (dextran) when sucrose is present. Both adherent cells and biofilms were treated with the low-temperature plasma jet for different exposure times. The antimicrobial efficiency of the plasma was tested against adherent cells and 48 h-old biofilms grown with or without sucrose. Bacterial survival was estimated using both colony-forming unit counts and fluorescence-based assays for bacterial cell viability. The experiments show the ability of the low-temperature plasma jet at atmospheric pressure to inactivate the bacteria. An increased resistance of bacteria embedded within biofilms is clearly observed. The resistance is also significantly higher with biofilm in the presence of sucrose, which indicates that dextran could play a protective role.

  5. Continuous Positive Airway Pressure: Is it a route for infection in those with Obstructive Sleep Apnoea?

    Directory of Open Access Journals (Sweden)

    Liam Mercieca

    Full Text Available Introduction: Continuous positive airway pressure (CPAP is the standard treatment for obstructive sleep apnoea (OSA, with limited data about the prevalence of respiratory infections and microbial colonization in these patients. Objectives: The aim of this study was to determine if CPAP use is associated with respiratory infections and to identify the organisms that colonize or infect these patients. Method: A retrospective, case-controlled study in patients diagnosed with OSA was carried out. 137 patients were recruited and interviewed using a questionnaire. A nasal swab was taken from each patient. Patients using CPAP machines had swabs taken from masks and humidifiers. Results: 66 (48.2% patients received CPAP treatment with 60.6% of them having a heated humidifier. 78.8% were male, with the majority using a full face mask (63.6%. No significant difference was seen in the prevalence of rhinosinusitis, lower respiratory tract infections and hospital admissions for pneumonia between CPAP and non-CPAP treated patients. The presence of a humidifier did not influence the prevalence of infections. Commensal flora was predominantly cultured from nasal swabs from both patient groups. Coagulase Negative Staphylococci and Diphtheroids were the main organisms cultured from masks and humidifiers respectively. Conclusions: This study shows that the use of CPAP, choice of mask and humidifier have no significant impact on the prevalence of infections and micro-organisms isolated. This is very reassuring to the physician prescribing CPAP therapy and users.

  6. Noninvasive Positive Airway Pressure Treatment in Children Less Than 12 Months of Age

    Directory of Open Access Journals (Sweden)

    Adetayo Adeleye

    2016-01-01

    Full Text Available Study Objectives. We identified the associated conditions of patients less than 12 months of age who were referred for polysomnogram (PSG studies. We collated PSG findings and physician interpretation. We determined the correlation between the recommended treatment by the PSG interpreting physician and actual prescribed treatment by the referring or subjects’ physician. We determined adherence with noninvasive positive airway pressure (PAP treatment. Methods. This was a retrospective cohort study. Participants included children less than 12 months of age referred for PSG studies between 2007 and 2012. Results. 92 patients under the age of 12 months were included in the study analysis. Mean (standard deviation, SD age in days at time of the PSG study was 208.5 (101.2. 35 (38% patients had a diagnosis of Trisomy 21. Seven (8% patients had no prior diagnosis. Median (Q1, Q3 apnea hypopnea index (AHI was 22.5 (11.3–37.0. Agreement between the PSG interpreting physician’s recommendation and actual prescribed treatment by the referring or subjects’ physician was 85.9% [95% CI 77.1–91.6]. Mean (SD percentage days with PAP therapy usage more than 4 hours was 25.2% (32. Conclusions. In our experience, despite consistent physician messaging to families, adherence with noninvasive PAP treatment is low.

  7. Effects of nasal continuous positive airway pressure therapy on partners' sexual lives.

    Science.gov (United States)

    Acar, Mustafa; Kaya, Coskun; Catli, Tolgahan; Hancı, Deniz; Bolluk, Ozge; Aydin, Yunus

    2016-01-01

    To assess sexual functioning in male and female partners before and after nasal continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA). Twenty-one male patients with moderate to severe OSA and erectile dysfunction, and their female partner, were recruited into this prospective study. Males diagnosed with OSA were treated with nasal CPAP therapy for 12 weeks. Women were assessed for sexual functioning using the Female Sexual Function Index (FSFI), and for mood status using the Beck Depression Inventory (BDI), before and after their male partner underwent nasal CPAP therapy. Sexual functioning was assessed in men using the International Index of Erectile Function (IIEF), before and after nasal CPAP therapy. After nasal CPAP therapy for OSA in men, IIEF scores were significantly higher than pre-treatment scores. Total pre- and post-treatment IIEF scores (mean ± standard deviation) were 50.28 ± 15.88 and 65.42 ± 7.47, respectively, P sexual functioning in both the male and female partners. Moreover, our findings indicate that improved sexual function in women after their male partner underwent nasal CPAP also had psychological benefits.

  8. Scale-4 Analysis of Pressurized Water Reactor Critical Configurations: Volume 2-Sequoyah Unit 2 Cycle 3

    Energy Technology Data Exchange (ETDEWEB)

    Bowman, S.M.

    1995-01-01

    The requirements of ANSI/ANS 8.1 specify that calculational methods for away-from-reactor criticality safety analyses be validated against experimental measurements. If credit for the negative reactivity of the depleted (or spent) fuel isotopics is desired, it is necessary to benchmark computational methods against spent fuel critical configurations. This report summarizes a portion of the ongoing effort to benchmark away-from-reactor criticality analysis methods using critical configurations from commercial pressurized-water reactors. The analysis methodology selected for all the calculations reported herein is based on the codes and data provided in the SCALE-4 code system. The isotopic densities for the spent fuel assemblies in the critical configurations were calculated using the SAS2H analytical sequence of the SCALE-4 system. The sources of data and the procedures for deriving SAS2H input parameters are described in detail. The SNIKR code module was used to extract the necessary isotopic densities from the SAS2H results and provide the data in the format required by the SCALE criticality analysis modules. The CSASN analytical sequence in SCALE-4 was used to perform resonance processing of the cross sections. The KENO V.a module of SCALE-4 was used to calculate the effective multiplication factor (k{sub eff}) of each case. The SCALE-4 27-group burnup library containing ENDF/B-IV (actinides) and ENDF/B-V (fission products) data was used for all the calculations. This volume of the report documents the SCALE system analysis of three reactor critical configurations for the Sequoyah Unit 2 Cycle 3. This unit and cycle were chosen because of the relevance in spent fuel benchmark applications: (1) the unit had a significantly long downtime of 2.7 years during the middle of cycle (MOC) 3, and (2) the core consisted entirely of burned fuel at the MOC restart. The first benchmark critical calculation was the MOC restart at hot, full-power (HFP) critical conditions. The

  9. Scale-4 Analysis of Pressurized Water Reactor Critical Configurations: Volume 3-Surry Unit 1 Cycle 2

    Energy Technology Data Exchange (ETDEWEB)

    Bowman, S.M.

    1995-01-01

    The requirements of ANSI/ANS 8.1 specify that calculational methods for away-from-reactor criticality safety analyses be validated against experimental measurements. If credit for the negative reactivity of the depleted (or spent) fuel isotopics is desired, it is necessary to benchmark computational methods against spent fuel critical configurations. This report summarizes a portion of the ongoing effort to benchmark away-from-reactor criticality analysis methods using selected critical configurations from commercial pressurized-water reactors. The analysis methodology selected for all the calculations in this report is based on the codes and data provided in the SCALE-4 code system. The isotopic densities for the spent fuel assemblies in the critical configurations were calculated using the SAS2H analytical sequence of the SCALE-4 system. The sources of data and the procedures for deriving SAS2H input parameters are described in detail. The SNIKR code module was used to extract the necessary isotopic densities from the SAS2H results and to provide the data in the format required by the SCALE criticality analysis modules. The CSASN analytical sequence in SCALE-4 was used to perform resonance processing of the cross sections. The KENO V.a module of SCALE-4 was used to calculate the effective multiplication factor (k{sub eff}) of each case. The SCALE-4 27-group burnup library containing ENDF/B-IV (actinides) and ENDF/B-V (fission products) data was used for all the calculations. This volume of the report documents the SCALE system analysis of two reactor critical configurations for Surry Unit 1 Cycle 2. This unit and cycle were chosen for a previous analysis using a different methodology because detailed isotopics from multidimensional reactor calculations were available from the Virginia Power Company. These data permitted a direct comparison of criticality calculations using the utility-calculated isotopics with those using the isotopics generated by the SCALE-4

  10. An objective analysis of the pressure-volume curve in the acute respiratory distress syndrome.

    Science.gov (United States)

    Harris, R S; Hess, D R; Venegas, J G

    2000-02-01

    To assess the interobserver and intraobserver variability in the clinical evaluation of the quasi-static pressure-volume (P-V) curve, we analyzed 24 sets of inflation and deflation P-V curves obtained from patients with ARDS. We used a recently described sigmoidal equation to curve-fit the P-V data sets and objectively define the point of maximum compliance increase of the inflation limb (P(mci, i)) and the true inflection point of the deflation limb (P(inf,d)). These points were compared with graphic determinations of lower Pflex by seven clinicians. The graphic and curve-fitting methods were also compared for their ability to reproduce the same parameter value in data sets with reduced number of data points. The sigmoidal equation fit the P-V data with great accuracy (R(2) = 0.9992). The average of Pflex determinations was found to be correlated with P(mci,i) (R = 0.89) and P(inf,d) (R = 0.76). Individual determinations of Pflex were less correlated with the corresponding objective parameters (R = 0.67 and 0.62, respectively). Pflex + 2 cm H(2)O was a more accurate estimator of P(inf,d) (2 SD = +/-6.05 cm H(2)O) than Pflex was of P(mci,i) (2 SD = +/-8.02 cm H(2)O). There was significant interobserver variability in Pflex, with a maximum difference of 11 cm H(2)O for the same patient (SD = 1.9 cm H(2)O). Clinicians had difficulty reproducing Pflex in smaller data sets with differences as great as 17 cm H(2)O (SD = 2.8 cm H(2)O). In contrast, the curve-fitting method reproduced P(mci,i) with great accuracy in reduced data sets (maximum difference of 1.5 cm H(2)O and SD = 0.3 cm H(2)O). We conclude that Pflex rarely coincided with the point of maximum compliance increase defined by a sigmoid curve-fit with large differences in Pflex seen both among and within observers. Calculating objective parameters such as P(mci,i) or P(inf,d) from curve-fitted P-V data can minimize this large variability.

  11. Technical review of target volume delineation on the posterior fossa tumor: an optimal head and neck position

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sang Min; Lee, Sang Wook; Ahn, Seung Do; Kim, Jong Hoon; Yi, Byong Yong; Ra, Young Shin; Ghim, Thad; Choi, Eun Kyung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2003-03-01

    To explore a 3D conformal radiotherapy technique for a posterior fossa boost, and the potential advantages of a prone position for such radiotherapy, A CT simulator and 3D conformal radiotherapy planning system was used for the posterior fossa boost treatment of a 13-year-old medulloblastoma patient. He was placed in the prone position and immobilized with an aquaplast mask and immobilization mold. CT scans were obtained of the brain from the top of the skull to the lower neck, with IV contrast enhancement. The target volume and normal structures were delineated on each slice, with treatment planning performed using non-coplanar conformal beams. The CT scans, and treatment in the prone position, were performed successfully. In the prone position, the definition of the target volume was made easier due to the well enhanced tentorium. In addition, the posterior fossa was located anteriorly, and with the greater choice of beam arrangements, more accurate treatment planning was possible as the primary beams were not obstructed by the treatment table. A posterior fossa boost, in the prone position, is feasible in cooperating patients, but further evaluation is needed to define the optimal and most comfortable treatment positions.

  12. Relative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery

    NARCIS (Netherlands)

    Breukers, R.B.G.E.; Trof, R.J.; Wilde, de R.; Berg, van den P.A.W.; Twisk, J.W.R.; Jansen, J.H.; Groeneveld, A.B.J.

    2009-01-01

    10% per step. Results: Global ejection fraction was tower and PAOP was higher after VS than CAS. In responding steps after VS (n = 9-14) PACP and volumes increased, white CVP and volumes increased in responding steps (n = 12-19) after CAS. Baseline PAOP was tower in responding steps after VS only.

  13. Pressure-volume-temperature and excess molar volume prediction of amorphous and crystallizable polymer blends by equation of state

    Institute of Scientific and Technical Information of China (English)

    Fakhri Yousefi; Hajir Karimi; Maryam Gomar

    2015-01-01

    In this work the statistical mechanical equation of state was developed for volumetric properties of crystal ine and amorphous polymer blends. The Ihm–Song–Mason equations of state (ISMEOS) based on temperature and density at melting point (Tm andρm) as scaling constants were developed for crystalline polymers such as poly(propylene glycol)+poly(ethylene glycol)-200 (PPG+PEG-200), poly(ethylene glycol) methyl ether-300 (PEGME-350)+PEG-200 and PEGME-350+PEG-600. Furthermore, for amorphous polymer blends con-taining poly(2,6-dimethyl-1,4-phenylene oxide) (PPO)+polystyrene (PS) and PS+poly(vinylmethylether) (PVME), the density and surface tension at glass transition (ρg andγg) were used for estimation of second Virial coefficient. The calculation of second Virial coefficients (B2), effective van der Waals co-volume (b) and correction factor (α) was required for judgment about applicability of this model. The obtained results by ISMEOS for crys-talline and amorphous polymer blends were in good agreement with the experimental data with absolute aver-age deviations of 0.84%and 1.04%, respectively.

  14. Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals

    Science.gov (United States)

    de Albuquerque, Isabella Martins; Cardoso, Dannuey Machado; Masiero, Paulo Ricardo; Paiva, Dulciane Nunes; Resqueti, Vanessa Regiane; Fregonezi, Guilherme Augusto de Freitas; Menna-Barreto, Sérgio Saldanha

    2016-01-01

    ABSTRACT Objective: To evaluate the effects of positive expiratory pressure (PEP) on pulmonary epithelial membrane permeability in healthy subjects. Methods: We evaluated a cohort of 30 healthy subjects (15 males and 15 females) with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10), 15 cmH2O (n = 10), and 20 cmH2O (n = 10). The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. Results: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044), 15 cmH2O (p = 0.044), and 20 cmH2O (p = 0.004)-in comparison with that observed during spontaneous breathing. Conclusions: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects. PMID:28117469

  15. Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals

    Directory of Open Access Journals (Sweden)

    Isabella Martins de Albuquerque

    Full Text Available ABSTRACT Objective: To evaluate the effects of positive expiratory pressure (PEP on pulmonary epithelial membrane permeability in healthy subjects. Methods: We evaluated a cohort of 30 healthy subjects (15 males and 15 females with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10, 15 cmH2O (n = 10, and 20 cmH2O (n = 10. The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. Results: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044, 15 cmH2O (p = 0.044, and 20 cmH2O (p = 0.004-in comparison with that observed during spontaneous breathing. Conclusions: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects.

  16. Impact of Polysomnographic Parameters on Continuous Positive Airway Pressure in Patient with Obstructive Sleep Apnea in 2012

    Directory of Open Access Journals (Sweden)

    Abolfazl Mozafari

    2014-06-01

    Full Text Available Background & objectives : O bstructive sleep apnea is a preventable and prevalent major health hazard with serious health consequences including excessive daytime sleepiness, cognitive disturbances, depression, cardiovascular diseases and hypertension. Obstructive sleep apnea is a disorder affecting 2 to 4% of the adult population. The continuous positive airway pressur e (CPAP i s the most efficacious therapy and is often the first option for these patients. The pressure titration during laboratory polysomnography is required for treatment by CPAP.   Methods: The patients with obstructive sleep apnea requiring continuous positive airway pressure treatment were selected . CPAP titration was done according to American Academy of Sleep Medicine protocol. Comparison among continuous positive airway pressure with polysomnographic parameters was performed and analyzed with Pearson correlation coefficient. For analysis of qualitative parameters, we used chi-square and then checked with SPSS version 18 software.   Results: From 125 patients with obstructive sleep apnea, there were 112 cases with inclusion criteria. Mean age of participants was 55.07 ± 12, male frequency was 59.2%, apnea hypopnea index was 43.62 and mean continuous positive airway pressure was 12.50 . There was significant relationship among the pressure of continuous positive airway pressure with apnea hypopnea index (P=0.028, arousal index (P=0.011, body mass index (P=0.041 and O2 desaturation index (P=0.022, although age was not significantly related.   Conclusion: In accordance to this data, we found out a prediction equation for optimal CPAP in our patients

  17. Choking under the pressure of a positive stereotype: gender identification and self-consciousness moderate men's math test performance.

    Science.gov (United States)

    Tagler, Michael J

    2012-01-01

    Choking under pressure occurs when an individual underperforms due to situational pressure. The present study examined whether being the target of a positive social stereotype regarding math ability causes choking among men. Gender identification and self-consciousness were hypothesized to moderate the effect of math-gender stereotypes on men's math test performance. Men high in self-consciousness but low in gender identification significantly underperformed when exposed to gender-relevant test instructions. No significant effects were found under a gender-irrelevant condition. These findings are discussed in the contexts of research on stereotype threat, stereotype lift, and choking under pressure.

  18. A comparative summary on streamers of positive corona discharges in water and atmospheric pressure gases

    Science.gov (United States)

    Tachibana, Kunihide; Motomura, Hideki

    2015-07-01

    From an intention of summarizing present understandings of positive corona discharges in water and atmospheric pressure gases, we tried to observe streamers in those media by reproducing and complementing previously reported results under a common experimental setup. We used a point-to-plane electrode configuration with different combinations of electrode gap (7 and 19 mm length) and pulsed power sources (0.25 and 2.5 ɛs duration). The general features of streamers were similar and the streamer-to-spark transition was also observed in both the media. However, in the details large differences were observed due to inherent nature of the media. The measured propagation speed of streamers in water of 0.035 × 106 ms-1 was much smaller than the speed in gases (air, N2 and Ar) from 0.4 to 1.1 × 106 ms-1 depending on species. In He the discharge looked glow-like and no streamer was observed. The other characteristics of streamers in gases, such as inception voltage, number of branches and thickness did also depend on the species. The thickness and the length of streamers in water were smaller than those in gases. From the volumetric expansion of a streamer in water after the discharge, the molecular density within the streamer medium was estimated to be rarefied from the density of water by about an order of magnitude in the active discharge phase. We derived also the electron density from the analysis of Stark broadened spectral lines of H and O atoms on the order of 1025 m-3 at the earlier time of the streamer propagation. The analyzed background blackbody radiation, rotational temperature of OH band emission and population density of Cu atomic lines yielded a consistent temperature of the streamer medium between 7000 and 10 000 K. Using the present data with a combination of the analysis of static electric field and previously reported results, we discuss the reason for the relatively low streamer inception voltage in water as compared to the large difference in the

  19. Micro-CT evaluation of the efficacy of hard-tissue removal from the root canal and isthmus area by positive and negative pressure irrigation systems.

    Science.gov (United States)

    Versiani, M A; Alves, F R F; Andrade-Junior, C V; Marceliano-Alves, M F; Provenzano, J C; Rôças, I N; Sousa-Neto, M D; Siqueira, J F

    2016-11-01

    To evaluate the removal of accumulated hard-tissue debris (AHTD) from the root canal system of mandibular molars by positive and negative pressure irrigation systems, using micro-CT imaging analysis. Mandibular molars with a single canal in the distal root and 2 canals connected by an isthmus in the mesial root were matched based on similar morphological dimensions using micro-CT evaluation and assigned to 2 experimental groups (n = 20 mesial and 10 distal canals), according to the irrigation protocol: apical positive (conventional irrigation) or negative (EndoVac system) pressure. Changes in root canal volume and surface area as well as percentage of uninstrumented canal wall surface and accumulated hard-tissue debris (AHTD) after canal preparation were compared statistically using the independent sample t-test and Mann-Whitney U-test, with the significance level set at 5%. Volume, surface area and percentage of static voxels in either mesial or distal root canal systems were not significantly different between groups before or after root canal preparation (P > 0.05). After preparation, AHTD was not observed in the distal canal of both groups. However, in the mesial root canal system, the conventional irrigation group was associated with a significantly higher median percentage of AHTD (11.48%; IQR: 5.9-22.6; range: 1.86-41.98) than the EndoVac group (3.40%; IQR: 1.5-7.3; range: 0.82-12.84) (P < 0.05). Neither irrigation protocol succeeded in rendering the mesial canal system free of AHTD; however, apical negative pressure irrigation resulted in lower levels of AHTD than conventional irrigation. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  20. A comparative study of set up variations and bowel volumes in supine versus prone positions of patients treated with external beam radiation for carcinoma rectum

    Directory of Open Access Journals (Sweden)

    K R Rajeev

    2014-01-01

    Conclusion: The prone position using BB device was more effective in reducing irradiated SB volume in rectal cancer patients. There were no significant variations in the daily set up for patients treated in both supine and prone positions.

  1. AGARD Flight Test Instrumentation Series. Volume 8. Linear and Angular Position Measurement of Aircraft Components

    Science.gov (United States)

    1977-01-01

    levers Arrangements as described above a can be used for the measurement cf the p position of lift dumpers and speed brakes, where the highest sensitivity... Monitoring and recording of the excite- tion voltage during the calibration of position transducers is, in general, very useful. In most cases the

  2. Effects of pressure- or volume-overload hypertrophy on passive stiffness in isolated adult cardiac muscle cells

    Science.gov (United States)

    Kato, S.; Koide, M.; Cooper, G. 4th; Zile, M. R.

    1996-01-01

    It has been hypothesized that the changes in myocardial stiffness induced by chronic hemodynamic overloading are dependent on changes in the passive stiffness of the cardiac muscle cell (cardiocyte). However, no previous studies have examined the passive constitutive properties of cardiocytes isolated from animals with myocardial hypertrophy. Accordingly, changes in relative passive stiffness of cardiocytes isolated from animals with chronic pressure- or volume-overload hypertrophy were determined by examining the effects of anisosmotic stress on cardiocyte size. Anisosmotic stress was produced by altering superfusate osmolarity. Hypertrophied cardiocytes were enzymatically isolated from 16 adult cats with right ventricular (RV) pressure-overload hypertrophy induced by pulmonary artery banding (PAB) and from 6 adult cats with RV volume-overload hypertrophy induced by creating an atrial septal defect (ASD). Left ventricular (LV) cardiocytes from each cat served as nonhypertrophied, normally loaded, same-animal controls. Superfusate osmolarity was decreased from 305 +/- 3 to 135 +/- 5 mosM and increased to 645 +/- 4 mosM. During anisosmotic stress, there were no significant differences between hypertrophied RV and normal LV cardiocytes in pressure overload PAB cats with respect to percent change in cardiocyte area (47 +/- 2% in RV vs. 48 +/- 2% in LV), diameter (46 +/- 3% in RV vs. 48 +/- 2% in LV), or length (2.4 +/- 0.2% in RV vs. 2.0 +/- 0.3% in LV), or sarcomere length (1.5 +/- 0.1% in RV vs. 1.3 +/- 0.3% in LV). Likewise, there were no significant differences in cardiocyte strain between hypertrophied RV and normal LV cardiocytes from ASD cats. In conclusion, chronic pressure-overload hypertrophy and chronic volume-overload hypertrophy did not alter the cardiocyte response to anisosmotic stress. Thus chronic overload hypertrophy did not alter relative passive cardiocyte stiffness.

  3. Effects of pressure- or volume-overload hypertrophy on passive stiffness in isolated adult cardiac muscle cells

    Science.gov (United States)

    Kato, S.; Koide, M.; Cooper, G. 4th; Zile, M. R.

    1996-01-01

    It has been hypothesized that the changes in myocardial stiffness induced by chronic hemodynamic overloading are dependent on changes in the passive stiffness of the cardiac muscle cell (cardiocyte). However, no previous studies have examined the passive constitutive properties of cardiocytes isolated from animals with myocardial hypertrophy. Accordingly, changes in relative passive stiffness of cardiocytes isolated from animals with chronic pressure- or volume-overload hypertrophy were determined by examining the effects of anisosmotic stress on cardiocyte size. Anisosmotic stress was produced by altering superfusate osmolarity. Hypertrophied cardiocytes were enzymatically isolated from 16 adult cats with right ventricular (RV) pressure-overload hypertrophy induced by pulmonary artery banding (PAB) and from 6 adult cats with RV volume-overload hypertrophy induced by creating an atrial septal defect (ASD). Left ventricular (LV) cardiocytes from each cat served as nonhypertrophied, normally loaded, same-animal controls. Superfusate osmolarity was decreased from 305 +/- 3 to 135 +/- 5 mosM and increased to 645 +/- 4 mosM. During anisosmotic stress, there were no significant differences between hypertrophied RV and normal LV cardiocytes in pressure overload PAB cats with respect to percent change in cardiocyte area (47 +/- 2% in RV vs. 48 +/- 2% in LV), diameter (46 +/- 3% in RV vs. 48 +/- 2% in LV), or length (2.4 +/- 0.2% in RV vs. 2.0 +/- 0.3% in LV), or sarcomere length (1.5 +/- 0.1% in RV vs. 1.3 +/- 0.3% in LV). Likewise, there were no significant differences in cardiocyte strain between hypertrophied RV and normal LV cardiocytes from ASD cats. In conclusion, chronic pressure-overload hypertrophy and chronic volume-overload hypertrophy did not alter the cardiocyte response to anisosmotic stress. Thus chronic overload hypertrophy did not alter relative passive cardiocyte stiffness.

  4. Nasal Expiratory Positive Airway Pressure Devices (Provent for OSA: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Muhammad Riaz

    2015-01-01

    Full Text Available Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP devices or Provent as treatment for obstructive sleep apnea (OSA. Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD for apnea-hypopnea index (AHI in 345 patients decreased from 27.32±22.24 to 12.78±16.89 events/hr (relative reduction = 53.2%. Random effects modeling mean difference (MD was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI in 247 patients decreased from 21.2±19.3 to 12.4±14.1 events/hr (relative reduction = 41.5%, p value < 0.00001. Lowest oxygen saturation (LSAT M ± SD improved in 146 patients from 83.2±6.8% to 86.2±11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS M ± SD improved (359 patients from 9.9±5.3 to 7.4±5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent.

  5. Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs.

    Science.gov (United States)

    Bernier, Anne; Catelin, Céline; Ahmed, Mohamed Amine Hadj; Samson, Nathalie; Bonneau, Pauline; Praud, Jean-Paul

    2012-06-01

    Current knowledge suggests that, to be successful, oral feeding in preterm infants should be initiated as soon as possible, often at an age where immature respiration still requires ventilatory support in the form of nasal continuous positive airway pressure (nCPAP). While some neonatologist teams claim great success with initiation of oral feeding in immature infants with nCPAP, others strictly wait for this ventilatory support to be no longer necessary before any attempt at oral feeding, fearing laryngeal penetration and tracheal aspiration. Therefore, the aim of the present study was to provide a first assessment of the effect of various levels of nCPAP on bottle-feeding in a neonatal ovine model, including feeding safety, feeding efficiency, and nutritive swallowing-breathing coordination. Eight lambs born at term were surgically instrumented 48 h after birth to collect recordings of electrical activity of laryngeal constrictor muscle, electrocardiography, and arterial blood gases. Two days after surgery, lambs were bottle-fed under five randomized nCPAP conditions, including without any nCPAP or nasal mask and nCPAP of 0, 4, 7, and 10 cmH(2)O. Results revealed that application of nCPAP in the full-term lamb had no deleterious effect on feeding safety and efficiency or on nutritive swallowing-breathing coordination. The present study provides a first and unique insight on the effect of nCPAP on oral feeding, demonstrating its safety in newborn lambs born at term. These results open the way for further research in preterm lambs to better mimic the problems encountered in neonatology.

  6. Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Riaz, Muhammad; Certal, Victor; Nigam, Gaurav; Abdullatif, Jose; Zaghi, Soroush; Kushida, Clete A.; Camacho, Macario

    2015-01-01

    Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent). PMID:26798519

  7. Improved growth and development in premature infants managed with nasal continuous positive airway pressure.

    Science.gov (United States)

    Flesher, Susan Lee; Domanico, Renee S

    2014-01-01

    Our goal was to assess the association between the use of nasal continuous positive airway pressure (NCPAP) vs. conventional ventilation (CV) in premature infants and its effects on: 1) growth in the NICU and at follow up visits 2) neurodevelopmental outcomes measured by Bayley Infant Neurodevelopmental Screener (BINS) 3) the incidence of retinopathy of prematurity (ROP) and chronic lung disease (CLD). A retrospective chart review of two groups of NICU patients was conducted. The first group was from 1/1999-12/2000 (n = 140) and was managed by CV. The second group (n = 168) was from 1/2003-12/2004 and was managed primarily by NCPAP. Categorical variables were analyzed using Pearson Chi Square. Mean numerical values were analyzed with the student t-test. There was no statistical difference between the groups in regard to 15 demographic and interventional variables. There were significant differences between the two groups in CLD (p < 0.05) and ROP (p < 0.01), mean weight at one month (p < 0.05), 9-12 months (p < 0.01) and 15-18 months (p < 0.01), length at 4-6 months (p < 0.05), 9-12 months (p < 0.05), 15-18 months (p < 0.01), and 2 years (p = .05), and in BINS scores at 9-12 months (p < 0.01) and 15-18 months (p < 0.01). Managing babies with NCPAP therapy when compared with CV, significantly increased the weight at one month which was sustained at the 9-12 month and 15-18 month visits, increased length at all follow up visits, increased BINS scores at the 9-12 month and 15-18 month visits, and decreased the incidence of ROP and CLD.

  8. Accuracy of Positive Airway Pressure Device—Measured Apneas and Hypopneas: Role in Treatment Followup

    Directory of Open Access Journals (Sweden)

    Carl Stepnowsky

    2013-01-01

    Full Text Available Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP devices in the home environment. Although clinicians’ treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. “PAP efficacy” studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO, which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI was 14.2 ± 11.8 (median: 11.7; range: 3.9–46.3 and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2–39.3. Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring.

  9. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study

    Science.gov (United States)

    2014-01-01

    Background Continuous positive airway pressure (CPAP) is commonly used to relieve respiratory distress in infants with bronchiolitis, but has mostly been studied in an intensive care setting. Our prime aim was to evaluate the feasibility of CPAP for infants with bronchiolitis in a general paediatric ward, and secondary to assess capillary PCO2 (cPCO2) levels before and during treatment. Methods From May 1st 2008 to April 30th 2012, infants with bronchiolitis at Stavanger University Hospital were treated with CPAP in a general paediatric ward, but could be referred to an intensive care unit (ICU) when needed, according to in-house guidelines. Levels of cPCO2 were prospectively registered before the start of CPAP and at approximately 4, 12, 24 and 48 hours of treatment as long as CPAP was given. We had a continuous updating program for the nurses and physicians caring for the infants with CPAP. The study was population based. Results 672 infants (3.4%) were hospitalized with bronchiolitis. CPAP was initiated in 53 infants (0.3%; 7.9% of infants with bronchiolitis), and was well tolerated in all but three infants. 46 infants were included in the study, the majority of these (n = 33) were treated in the general ward only. These infants had lower cPCO2 before treatment (8.0; 7.7, 8.6)(median; quartiles) than those treated at the ICU (n = 13) (9.3;8.5, 9.9) (p bronchiolitis may be feasible in a general paediatric ward, providing sufficient staffing and training, and the possibility of referral to an ICU when needed. PMID:24886569

  10. Effect of continuous positive airway pressure treatment on pulmonary artery pressure in patients with isolated obstructive sleep apnea: a meta-analysis.

    Science.gov (United States)

    Imran, Tasnim F; Ghazipura, Marya; Liu, Spencer; Hossain, Tanzib; Ashtyani, Hormoz; Kim, Bernard; Michael Gaziano, J; Djoussé, Luc

    2016-09-01

    Pulmonary hypertension (PH) can occur in patients with obstructive sleep apnea (OSA) in the absence of cardiac or lung disease. Data on the development and severity of PH, and the effect of continuous positive airway pressure (CPAP) therapy on pulmonary artery (PA) pressures in these patients have been inconsistent in the literature. We sought to determine whether CPAP therapy affects PA pressures in patients with isolated OSA in this meta-analysis. We searched PubMed, Medline, EMBASE and other databases from January 1980 to August 2015. Studies of patients with OSA, defined as an apnea-hypopnea index >10 events/h, and PH, defined as PA pressure >25 mmHg were included. Two reviewers independently extracted data and assessed risk of bias. A total of 222 patients from seven studies (341.53 person-years) had reported PA pressures before and after treatment with CPAP therapy. 77 % of participants were men, with a mean age of 52.5 years, a mean apnea-hypopnea index of 58 events/h, and mean PA pressure of 39.3 ± 6.3 mmHg. CPAP treatment duration ranged from 3 to 70 months. Using fixed effects meta-analysis, CPAP therapy was associated with a decrease in PA pressure of 13.3 mmHg (95 % CI 12.7-14.0) in our study population. This meta-analysis found that CPAP therapy is associated with a significantly lower PA pressure in patients with isolated OSA and PH.

  11. Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    GUO Feng-mei; DING Jing-jing; SU Xin; XU Hui-ying; SHI Yi

    2008-01-01

    Background It is still controversial as to the implementation of higher positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS).This study was conducted to compare the lower and higher PEEP in patients with ARDS ventilated with low tidal volume,to investigate the relationship between the recruited lung volume by higher PEEP and relevant independent variables and to provide a bedside estimate of the percentage of potentially recruitable lung by higher PEEP.Methods Twenty-four patients with ARDS were studied.A lung recruiting maneuver was performed,then each patient was ventilated with PEEP of 8 cmH2O for 4 hours and subsequently with PEEP of 16 cmH2O for 4 hours.At the end of each PEEP level period,gas exchange,hemodynamic data,lung mechanics,stress index "b" of the dynamic pressure-time curve,intrinsic PEEP and recruited volume by PEEP were measured.Results Fourteen patients were recruiters whose alveolar recruited volumes induced by PEEP 16 cmH2O were (425±65) ml and 10 patients were non-recruiters.Compared with the PEEP 8 cmH2O period,after the application of the PEEP 16 cmH2O,the PaO2/FiO2 ratio and static lung compliance both remained unchanged in non-recruiters,whereas they increased significantly in recruiters.Changes in PaO2/FiO2 and static lung compliance after PEEP increase were independently associated with the alveolar recruitment.Analyzing the relationship between recruiting maneuver (RM)-induced change in end-expiratory lung volume and the alveolar recruitment induced by PEEP,we found a notable correlation.Conclusions The results of this study indicated that the potential for alveolar recruitment might vary among the ARDS population and the higher PEEP levels should be limited to recruiters.Improving in PaO2/FiO2,static lung compliance after PEEP increase and the shape of the pressure-time curve could be helpful for PEEP application.

  12. Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects.

    Science.gov (United States)

    Kim, Hee Yeong; Choi, Jae Moon; Lee, Yong-Hun; Lee, Sukyung; Yoo, Hwanhee; Gwak, Mijeung

    2016-05-01

    Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery.In this prospective study, the CSA of the right IJV was assessed using ultrasound in 47 anesthetized pediatric patients with simple congenital heart defects. The baseline CSA was obtained in response to a supine position with no PEEP and compared with 5 different randomly ordered maneuvers, that is, a PEEP of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a 10° Trendelenburg position. Hemodynamic variables, including blood pressure and heart rate, maximum and minimum diameters, and CSA, were measured.All maneuvers increased the CSA of the right IJV with respect to the control condition. In the supine position, the CSA was increased by 9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment.The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects.

  13. Excess Molar Volumes and Viscosities for Binary Mixtures of 1-Alkoxypropan-2-ols with 1-Butanol,and 2-Butanol at 298.15 K and Atmospheric Pressure

    Institute of Scientific and Technical Information of China (English)

    PAL Amalendu; GABA Rekha

    2007-01-01

    Excess molar volumes VEm and kinematic viscosities v have been measured as a function of composition for binary mixtures of propylene glycol monomethyl ether (1-methoxy-2-propanol),MeOCH2CH(OH)Me,propylene glycol monoethyl ether (1-ethoxy-2-propanol), EtOCH2CH(OH)Me,propylene glycol monopropyl ether (1-propoxy-2-propanol), PrOCH2CH(OH)Me, propylene glycol monobutyl ether (1-butoxy-2-propanol),BuOCH2CH(OH)Me,and propylene glycol tert-butyl ether (1-tert-butoxy-2-propanol),t-BuOCH2CH(OH)Me with 1-butanol,and 2-butanol,at 298.15 K and atmospheric pressure.The excess molar volumes are negative across the entire range of composition for all the systems with 1-butanol,and positive for the systems 2-butanol+1-methoxy-2-propanol,and +1-propoxy-2-propanol,negative for the systems 2-butanol+1-butoxy-2-propanol,and change sign for the systems 2-butanol+1-ethoxy-2-propanol,and +1-tert-butoxy-2-propanol.From the experimental data,the deviation in dynamic viscosity η from Σxiηi has been calculated.Both excess molar volumes and viscosity deviations have been correlated using a Redlich-Kister type polynomial equation by the method of least-squares for the estimation of the binary coefficients and the standard errors.

  14. The effect of blood volume loss on cardiovascular response to lower body negative pressure using a mathematical model

    Science.gov (United States)

    Karam, E. H.; Srinivasan, R. S.; Charles, J. B.; Fortney, S. M.

    1994-01-01

    Different mathematical models of varying complexity have been proposed in recent years to study the cardiovascular (CV) system. However, only a few of them specifically address the response to lower body negative pressure (LBNP), a stress that can be applied in weightlessness to predict changes in orthostatic tolerance. Also, the simulated results produced by these models agree only partially with experimental observations. In contrast, the model proposed by Melchior et al., and modified by Karam et al. is a simple representation of the CV system capable of accurately reproducing observed LBNP responses up to presyncopal levels. There are significant changes in LBNP response due to a loss of blood volume and other alterations that occur in weightlessness and related one-g conditions such as bedrest. A few days of bedrest can cause up to 15% blood volume loss (BVL), with consequent decreases in both stroke volume and cardiac output, and increases in heart rate, mean arterial pressure, and total peripheral resistance. These changes are more pronounced at higher levels of LBNP. This paper presents the results of a simulation study using our CV model to examine the effect of BVL on LBNP response.

  15. A Feasibility Study of Pressure Retarded Osmosis Power Generation System based on Measuring Permeation Volume using Reverse Osmosis Membrane

    Science.gov (United States)

    Enomoto, Hiroshi; Fujitsuka, Masashi; Hasegawa, Tomoyasu; Kuwada, Masatoshi; Tanioka, Akihiko; Minagawa, Mie

    Pressure Retarded Osmosis (PRO) power generation system is a hydroelectric power system which utilize permeation flow through a semi-permeable membrane. Permeation flow is generated by potential energy of salinity difference between sea water and fresh water. As membrane cost is expensive, permeation performance of membrane must be higher to realize PRO system. We have investigated Reverse Osmosis (RO) membrane products as semi-permeable membrane and measured permeation volume of a few products. Generation power by membrane area calculated from permeation volume is about 0.62W/m2. But by our improvements (more salt water volume, spacer of fresh water channel with a function of discharging concentrated salinity, extra low pressure type of membrane, washing support layer of membrane when generation power reduces to half), generation power may be 2.43W/m2. Then power system cost is about 4.1 million yen/kW. In addition, if support layer of membrane makes thinner and PRO system is applied to the equipment that pumping power on another purpose is avairable (wastewater treatment plant located at the seaside, thermal and nuclear power plant or sea water desalination plant), generation power may be more. By these improvements PRO system may be able to realize at the cost close to photovoltaic power system.

  16. The effect of blood volume loss on cardiovascular response to lower body negative pressure using a mathematical model

    Science.gov (United States)

    Karam, E. H.; Srinivasan, R. S.; Charles, J. B.; Fortney, S. M.

    1994-01-01

    Different mathematical models of varying complexity have been proposed in recent years to study the cardiovascular (CV) system. However, only a few of them specifically address the response to lower body negative pressure (LBNP), a stress that can be applied in weightlessness to predict changes in orthostatic tolerance. Also, the simulated results produced by these models agree only partially with experimental observations. In contrast, the model proposed by Melchior et al., and modified by Karam et al. is a simple representation of the CV system capable of accurately reproducing observed LBNP responses up to presyncopal levels. There are significant changes in LBNP response due to a loss of blood volume and other alterations that occur in weightlessness and related one-g conditions such as bedrest. A few days of bedrest can cause up to 15% blood volume loss (BVL), with consequent decreases in both stroke volume and cardiac output, and increases in heart rate, mean arterial pressure, and total peripheral resistance. These changes are more pronounced at higher levels of LBNP. This paper presents the results of a simulation study using our CV model to examine the effect of BVL on LBNP response.

  17. A two-step finite volume method to discretize heterogeneous and anisotropic pressure equation on general grids

    Science.gov (United States)

    Zhang, Wenjuan; Al Kobaisi, Mohammed

    2017-10-01

    A novel Two-Step cell-centered Finite Volume Method (TSFVM) is developed in this work to discretize the heterogeneous and anisotropic pressure equation on triangular and quadrilateral grids in 2D and hexahedral and tetrahedral grids in 3D. Physical properties such as permeability and porosity are piece-wise constant on each grid cell. In the first step, the Galerkin Finite Element Method (FEM) is utilized to compute pressure solutions at all cell vertices. In the second step, pressure values at cell vertices are used to derive continuous two-point flux stencils for cell faces. Mass conservation equations are then written for each cell to obtain a system of linear equations that can be solved for pressure at cell centers. Extensive numerical experiments are carried out to test the performance of our TSFVM. In particular, we compare TSFVM with the classical Multipoint Flux Approximation (MPFA-O) method as well as a more recently developed MPFA method with full pressure support called enhanced MPFA (eMPFA). The results show that the TSFVM compares well with eMPFA for challenging test cases for which MPFA-O breaks down. Specifically, and as a significant step forward, our TSFVM is quite robust for challenging problems involving heterogeneous and highly anisotropic permeability tensors when both MPFA-O and eMPFA suffer from unphysical oscillations. Finally, the numerical convergence study demonstrates that TSFVM has comparable convergence behavior to MPFA-O method for both homogeneous and discontinuous permeability fields.

  18. X-ray diffraction and electroresistance measurements under high pressure and temperature using a large-volume cell

    Energy Technology Data Exchange (ETDEWEB)

    Principi, E; Minicucci, M [CNISM, CNR-INFM SOFT and Dipartimento di Fisica Universita degli Studi di Camerino via Madonna delle Carceri 62032, Camerino (Italy); Di Cicco, A

    2008-07-15

    In this communication we report about original experimental techniques for in-house x-ray diffraction and electrical resistance measurements under high-temperature and high pressure conditions, using large volume cells in the opposite anvil recessed geometry. The high-pressure devices we are currently using are a compact Paris-Edinburgh (PE) V5 150 Tons press and a 50 Tons standard hydraulic press, coupled usually with WC anvils and 10 mm or 7 mm boron-epoxy or pyrophyllite biconical gaskets for x-ray diffraction and resistance measurements respectively. Limiting pressures, using such a non-toroidal sample assembly and WC anvils, are about 10 GPa on samples of large sizes (10-20 mm{sup 3}). Samples can be heated using an hollow graphite cylinder as a crucible reaching temperatures as high as 2300 K, while the temperature can be measured up to 1300 K by using a K-type thermocouple. The highly automated setup developed for resistance measurements is described in details. In particular, we present electroresistance measurements of Bi melting under pressure and measurements of the Ge and LiF EOS (equation of state) at high temperature and pressure obtained using x-ray diffraction showing the sensitivity of the techniques. The relevance of these experiments to the exploitation of the potential of equipments available at synchrotron radiation facilities is emphasized.

  19. AGARD Flight Test Instrumentation Series. Volume 11. Pressure and Flow Measurement

    Science.gov (United States)

    1980-07-01

    PdgPt-Pa pression qc,Pd dynamischer qc impact pressure pressure dynamique Druck 1 24 q 7k:v kinetic - pression q kinetischer q dynamic...number of parallel transducers may have to be used. To save weight and cost, up to 48 pressures of up to 200 bar press- ure scanners (scanivalves...control is accomplished following "ATLAS"-requirement5 by means of a scanner unit, giving access to designated test pins on the computer’s main

  20. Comparing intra-abdominal pressures in different body positions via a urinary catheter and nasogastric tube: a pilot study.

    Science.gov (United States)

    Rooban, Nirooshan; Regli, Adrian; Davis, Wendy A; De Keulenaer, Bart L

    2012-07-05

    Intra-abdominal pressure (IAP) is most commonly measured via the bladder with the patient in the supine position. In the ICU, patients are nursed with the head of the bed elevated at 30° (HOB30) to reduce the risk of ventilator-associated pneumonia. This study investigated whether gastric pressure at HOB30 can be used as a surrogate measure of IAP via the bladder in the supine position. A prospective observational study was conducted in a single-centre intensive care unit. A total of 20 patients were included. IAP was recorded simultaneously via the bladder catheter (bladder pressure, IBP) and via nasogastric tube (gastric pressures, IGP) in the supine and HOB30 position. Each patient had three sets of IAP measurements performed at least 4 h apart. In the supine position, mean IBP was 12.3 ± 4.5 mmHg compared to IGP of 11.8 ± 4.7 mmHg. The bias between the two groups was 0.5 and precision of 3.7 (LA, -6.8 to 7.5 mmHg). At 30 degrees, mean IBP was 15.8 ± 4.9 mmHg compared to IGP of 13.1 ± 6.1 mmHg. The bias between both groups was 2.7 with a precision of 5.5 (LA, -8.0 to 13.5). Comparing IBP in the supine position with IGP at 30° showed a bias of -0.8 and precision of 5.6 (LA, -10.1 to 11.6 mmHg). IAP measured via a nasogastric tube was less influenced by changing the body position from supine to HOB30 than was bladder pressure.

  1. Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome.

    Science.gov (United States)

    Carneiro, Gláucia; Togeiro, Sônia Maria; Hayashi, Lílian F; Ribeiro-Filho, Fernando Flexa; Ribeiro, Artur Beltrame; Tufik, Sérgio; Zanella, Maria Teresa

    2008-08-01

    Obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular events. Sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis activation may be the mechanism of this relationship. The aim of this study was to evaluate HPA axis and ambulatory blood pressure monitoring in obese men with and without OSAS and to determine whether nasal continuous positive airway pressure therapy (nCPAP) influenced responses. Twenty-four-hour ambulatory blood pressure monitoring and overnight cortisol suppression test with 0.25 mg of dexamethasone were performed in 16 obese men with OSAS and 13 obese men controls. Nine men with severe apnea were reevaluated 3 mo after nCPAP therapy. Body mass index and blood pressure of OSAS patients and obese controls were similar. In OSAS patients, the percentage of fall in systolic blood pressure at night (P = 0.027) and salivary cortisol suppression postdexamethasone (P = 0.038) were lower, whereas heart rate (P = 0.022) was higher compared with obese controls. After nCPAP therapy, patients showed a reduction in heart rate (P = 0.036) and a greater cortisol suppression after dexamethasone (P = 0.001). No difference in arterial blood pressure (P = 0.183) was observed after 3 mo of nCPAP therapy. Improvement in cortisol suppression was positively correlated with an improvement in apnea-hypopnea index during nCPAP therapy (r = 0.799, P = 0.010). In conclusion, men with OSAS present increased postdexamethasone cortisol levels and heart rate, which were recovered by nCPAP.

  2. A direct method for determining complete positive and negative capillary pressure curves for reservoir rock using the centrifuge

    Energy Technology Data Exchange (ETDEWEB)

    Spinler, E.A.; Baldwin, B.A. [Phillips Petroleum Co., Bartlesville, OK (United States)

    1997-08-01

    A method is being developed for direct experimental determination of capillary pressure curves from saturation distributions produced during centrifuging fluids in a rock plug. A free water level is positioned along the length of the plugs to enable simultaneous determination of both positive and negative capillary pressures. Octadecane as the oil phase is solidified by temperature reduction while centrifuging to prevent fluid redistribution upon removal from the centrifuge. The water saturation is then measured via magnetic resonance imaging. The saturation profile within the plug and the calculation of pressures for each point of the saturation profile allows for a complete capillary pressure curve to be determined from one experiment. Centrifuging under oil with a free water level into a 100 percent water saturated plug results in the development of a primary drainage capillary pressure curve. Centrifuging similarly at an initial water saturation in the plug results in the development of an imbibition capillary pressure curve. Examples of these measurements are presented for Berea sandstone and chalk rocks.

  3. The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Camacho, Macario; Riaz, Muhammad; Capasso, Robson; Ruoff, Chad M.; Guilleminault, Christian; Kushida, Clete A.; Certal, Victor

    2015-01-01

    Background: The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined. Study Objectives: To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therapeutic CPAP device pressures and use in adults with obstructive sleep apnea. Methods: MEDLINE, Scopus, Web of Science, and The Cochrane Library were searched through July 15, 2014. The MOOSE consensus statement and PRISMA statement were followed. Results: Eighteen studies (279 patients) reported CPAP data after isolated nasal surgery. Seven studies (82 patients) reported preoperative and postoperative mean therapeutic CPAP device pressures and standard deviations, which reduced from 11.6 ± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled random effects analysis demonstrated a statistically significant pressure reduction, with a mean difference of −2.66 cwp (95% confidence intervals, −3.65 to −1.67); P < 0.00001. Eleven studies (153 patients) described subjective, self-reported data for CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients) who were not using CPAP prior to nasal surgery subsequently accepted, adhered to, or tolerated it after nasal surgery. Objective, device meter-based hours of use increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (< 6 mo of follow-up). Conclusion: Isolated nasal surgery in patients with obstructive sleep apnea and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients. Citation: Camacho M, Riaz M, Capasso R, Ruoff CM, Guilleminault C, Kushida CA, Certal V. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment

  4. Gel pillow designed specifically for obstructive sleep apnea treatment with continuous positive airway pressure.

    Science.gov (United States)

    Salvaggio, Adriana; Lo Bue, Anna; Isidoro, Serena Iacono; Romano, Salvatore; Marrone, Oreste; Insalaco, Giuseppe

    2016-01-01

    To determine whether the use of a gel pillow with side cutouts designed to accommodate a continuous positive airway pressure (CPAP) mask and reduce head temperature improves the efficacy of and adherence to auto-CPAP therapy. Twenty-three consecutive CPAP-naïve patients with obstructive sleep apnea were enrolled in the study. Patients were given an auto-CPAP machine with an appropriate CPAP mask and were instructed to use CPAP for 15 nights. They were instructed to sleep with their own pillow (the control pillow) from nights 1 to 5 and with either a foam pillow or a gel pillow, both of which had side cutouts, for 5 consecutive nights each, in random order. After night 15, auto-CPAP machine data were downloaded and patients rated their satisfaction with each pillow on a visual analog scale. Twenty-two patients completed the protocol. The pressures administered, residual apnea-hypopnea index, air leaks, and mean duration of CPAP use did not differ among the periods during which each pillow was used. Patients were significantly more satisfied with the gel pillow than with the control pillow and the foam pillow (p = 0.022 and p = 0.004, respectively), their level of satisfaction with the gel pillow correlating significantly with excessive daytime sleepiness (r2 = 0.19; p = 0.0443). Among obstructive sleep apnea patients treated with nasal CPAP, the use of a gel pillow with side cutouts appears to have no impact on treatment effectiveness. Nevertheless, such patients seem to prefer a gel pillow over other types of pillows. Determinar se o uso de um travesseiro de gel com recortes laterais para acomodar a máscara de continuous positive airway pressure (CPAP, pressão positiva contínua nas vias aéreas) e diminuir a temperatura em torno da cabeça melhora a eficácia do tratamento com auto-CPAP e a adesão dos pacientes ao tratamento. Foram incluídos no estudo 23 pacientes consecutivos com apneia obstrutiva do sono que nunca haviam recebido tratamento com CPAP. Os

  5. Influence that oscillating positive expiratory pressure using predetermined expiratory pressures has on the viscosity and transportability of sputum in patients with bronchiectasis.

    Science.gov (United States)

    Ramos, Ercy Mara Cipulo; Ramos, Dionei; Iyomasa, Daniela Mizusaki; Moreira, Graciane Laender; Melegati, Kátia Cristina Teixeira; Vanderlei, Luiz Carlos Marques; Jardim, José Roberto; Oliveira, Adriana Siqueira de

    2009-12-01

    To determine the effectiveness of oscillating positive expiratory pressure (OPEP) using predetermined expiratory pressures on the viscosity and transportability of sputum in patients with bronchiectasis. The study involved 15 stable patients with bronchiectasis (7 males; mean age = 53 +/- 16 years), submitted to two consecutive OPEP interventions, with a 24-h interval between the two, using positive expiratory pressures set at 15 cmH2O (P15) and 25 cmH2O (P25). The protocol consisted of a voluntary cough; another voluntary cough 20 min later, designated time zero (T0); a 10-min rest period; and two 10-min series (S1 and S2, using OPEP at P15 and P25 in both), with a 10-min interval between the two. The viscosity and transportability of sputum were evaluated by viscometry, relative transport velocity on frog palate, transport in a simulated cough machine and contact angle. Sputum samples were collected at T0, after S1 and after S2. Specific statistical tests were performed depending on the type of data distribution. In comparison with the values obtained at T0, sputum viscosity decreased significantly after S1 at P15 and after S2 at P25. There were no significant differences among all of the samples in terms of transportability. The fact that sputum viscosity decreased whether OPEP was performed at P15 or at P25 suggests that there is no need to generate high expiratory pressure to achieve the desired result.

  6. Safety and Effectiveness of Bubble Continuous Positive Airway Pressure in Neonates With Respiratory Distress and Its Failure Factors

    Directory of Open Access Journals (Sweden)

    Ajay Sethi

    2015-09-01

    Conclusion: Bubble Continuous Positive Airway Pressure is safe, efficacious and easy to use in preterm and term neonates with mild to moderate respiratory distress. The major failure factors in our study were sepsis, recurrent apnea, and shock. The survival rate in our study was 60%. [Natl J Med Res 2015; 5(3.000: 202-206

  7. Nebulized hypertonic saline via positive expiratory pressure versus via jet nebulizer in patients with severe cystic fibrosis.

    LENUS (Irish Health Repository)

    O'Connell, Oisin J

    2011-06-01

    Nebulized hypertonic saline is a highly effective therapy for patients with cystic fibrosis (CF), yet 10% of patients are intolerant of hypertonic saline administered via jet nebulizer. Positive expiratory pressure (PEP) nebulizers splint open the airways and offers a more controlled rate of nebulization.

  8. Oral Appliance Versus Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome : A 2-Year Follow-up

    NARCIS (Netherlands)

    Doff, Michiel H. J.; Hoekema, Aarnoud; Wijkstra, Peter J.; van der Hoeven, Johannes H.; Slater, James J. R. Huddleston; de Bont, Lambert G. M.; Stegenga, Boudewijn

    2013-01-01

    Study Objectives: Oral appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of oral appliance therapy and

  9. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    LENUS (Irish Health Repository)

    McCaul, Conán

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

  10. Improvement of lung mechanics by exogenous surfactant: effect of prior application of high positive end-expiratory pressure

    NARCIS (Netherlands)

    A. Hartog (Anneke); D.A.M.P.J. Gommers (Diederik); J.J. Haitsma (Jack); B.F. Lachmann (Burkhard)

    2000-01-01

    textabstractThe use of a ventilation strategy with high positive end-expiratory pressure (PEEP) that is intended to recruit collapsed alveoli and to prevent recurrent collapse can reduce alveolar protein influx in experimental acute lung injury (ALI). This could affect

  11. Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

    Directory of Open Access Journals (Sweden)

    MCY Tan

    2008-01-01

    Full Text Available BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs. Continuous positive airway pressure (CPAP, which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.

  12. Maxillomandibular Advancement Surgery as Alternative to Continuous Positive Airway Pressure in Morbidly Severe Obstructive Sleep Apnea : A Case Report

    NARCIS (Netherlands)

    Doff, Michiel H. J.; Jansma, Johan; Schepers, Rutger H.; Hoekema, Aamoud

    2013-01-01

    Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder, characterized by disrupted snoring and repetitive upper airway obstructions. Oral appliance therapy is an effective alternative to continuous positive airway pressure (CPAP) and is especially effective in mild and moderat

  13. Continuous positive airway pressure breathing increases cranial spread of sensory blockade after cervicothoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Eerd, M.J. van; Seventer, R. van; Gielen, M.J.M.; Giele, J.L.P.; Scheffer, G.J.

    2007-01-01

    BACKGROUND: Continuous positive airway pressure (CPAP) increases the caudad spread of sensory blockade after low-thoracic epidural injection of lidocaine. We hypothesized that CPAP would increase cephalad spread of blockade after cervicothoracic epidural injection. METHODS: Twenty patients with an e

  14. Simulated driving in obstructive sleep apnoea-hypopnoea : effects of oral appliances and continuous positive airway pressure

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stegenga, Boudewijn; Bakker, Marije; Brouwer, Wiebo H.; de Bont, Lambert G. M.; Wijkstra, Peter J.; van der Hoeven, Johannes H.

    2007-01-01

    Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients. Although continuous positive airway pressure (CPAP) generally improves simulated driving performance, the effects of oral-appliance (OA) therapy are unknown. The aims of this

  15. Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure

    NARCIS (Netherlands)

    Dieperink, Willem; Weelink, E. E. M.; van der Horst, I. C. C.; de Vos, R.; Jaarsma, T.; Aarts, L. P. H. J.; Zijlstra, F.; Nijsten, M. W. N.

    Background: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by

  16. Effect of glenohumeral position on contact pressure between the capsulolabral complex and the glenoid in free ALPSA and Bankart lesions.

    Science.gov (United States)

    Kim, DooSup; Chung, HoeJeong; Yi, Chang-Ho; Yoon, Yeo-Seung; Son, Jongsang; Kim, Youngho; On, Myoung-Gi; Yang, JaeHyung

    2016-02-01

    Anterior shoulder dislocation is a common injury, but the optimal management of dislocation remains controversial. We hypothesized that reducing the shoulder in externally rotated position would aid the reduction in capsulolabral lesions. Thus, in this study, contact pressure between the capsulolabral lesion and the glenoid in free ALPSA and Bankart lesions was measured using a cadaver model. In 10 specimens, the humerus was externally rotated by abduction on the coronal plane to measure the contact pressure between the capsulolabral complex and glenoid in free ALPSA and Bankart lesions using a Tekscan pressure system. Stability of the joint was confirmed using the Vicon motion analysis system. In the normal shoulder joint, the peak pressure between the subscapularis muscle and the anterior capsule according to the location of the glenohumeral joint decreased to 83.4 ± 21.2 kPa in the 0° abduction and -30° external rotation positions and showed a 300.7 ± 42.9 kPa peak value in the 60° abduction and 60° external rotation positions. In both free ALPSA and Bankart lesions, the lowest pressure between the labral lesion and the glenoid was measured at 0° abduction and -30° external rotation, and the highest pressure was recorded at 60° external rotation and 60° abduction. The contact pressure between the capsulolabral complex and the glenoid significantly increased when the abduction and external rotation angles were increased. Based on our results, the conservative management in free ALPSA lesions would respond better than Bankart lesions. YWMR-12-0-038.

  17. Tyre Volume and Pressure Effects on Impact Attenuation during Mountain Bike Riding

    Directory of Open Access Journals (Sweden)

    Paul W. Macdermid

    2015-01-01

    Full Text Available Exposure to impacts and vibrations has been shown to be detrimental to cross country mountain bike performance and health. Therefore, any strategy aimed at attenuating such exposure is useful to participants and/or industry. The purpose of this study was to assess the influence of tyre size and tyre inflation pressure on exposure to impacts. Participants completed nine trials of a technical section (controlled for initial speed and route taken including nine separate conditions involving three tyre sizes and three tyre inflation pressures normalised per tyre. Performance was determined by time to negotiate the technical section while triaxial accelerometers recorded accelerations (128 Hz to quantify impact exposure and the subsequent effects on soft tissue response. Increases in tyre size within the range used improved performance P<0.0001 while changes to tyre inflation pressure had no effect P=0.6870 on performance. Larger tyre sizes and lower tyre inflation pressures significantly P<0.0001 reduced exposure to impacts which could be augmented or negated due to an interaction between tyre size and inflation pressure P<0.0001. It is recommended that mountain bikers use larger tyres, inflated to the moderate pressures used within this study, in order to increase performance and reduce the risk of overuse injuries.

  18. Finite element modeling for predicting the contact pressure between a foam mattress and the human body in a supine position.

    Science.gov (United States)

    Lee, Wookjin; Won, Byeong Hee; Cho, Seong Wook

    2017-01-01

    In this paper, we generated finite element (FE) models to predict the contact pressure between a foam mattress and the human body in a supine position. Twenty-year-old males were used for three-dimensional scanning to produce the FE human models, which was composed of skin and muscle tissue. A linear elastic isotropic material model was used for the skin, and the Mooney-Rivlin model was used for the muscle tissue because it can effectively represent the nonlinear behavior of muscle. The contact pressure between the human model and the mattress was predicted by numerical simulation. The human models were validated by comparing the body pressure distribution obtained from the same human subject when he was lying on two different mattress types. The experimental results showed that the slope of the lower part of the mattress caused a decrease in the contact pressure at the heels, and the effect of bone structure was most pronounced in the scapula. After inserting a simple structure to function as the scapula, the contact pressure predicted by the FE human models was consistent with the experimental body pressure distribution for all body parts. These results suggest that the models proposed in this paper will be useful to researchers and designers of products related to the prevention of pressure ulcers.

  19. Turn down the volume or change the channel? Emotional effects of detached versus positive reappraisal.

    Science.gov (United States)

    Shiota, Michelle N; Levenson, Robert W

    2012-09-01

    Cognitive reappraisal, or changing one's interpretation of an event in order to alter the emotional response to it, is thought to be a healthy and an effective emotion regulation strategy. Although researchers recognize several distinct varieties of reappraisal, few studies have explicitly compared the effects of multiple reappraisal strategies on emotional responding. The present study compares the effects of detached and positive reappraisal on thought content, subjective emotional experience, physiological reactivity, and facial expressions of emotion while viewing film clips evoking sadness and disgust. Although both forms of reappraisal reduced overall emotional responding to unpleasant stimuli, the effects of detached reappraisal were stronger in this regard, and positive reappraisal was more likely to maintain subjective experience and facial expression of stimulus-appropriate positive emotions. The two reappraisal strategies also produced somewhat different profiles of physiological responding. Differences between detached and positive reappraisal with respect to subjective experience and facial expression were more pronounced among men than women; the reverse was true for differences with respect to physiological responding. Beyond these effects on individual emotion response systems, detached and positive reappraisal also had somewhat different effects on coherence in change across response systems. Implications for our understanding of emotion regulation processes, and for emotion theory more broadly, are discussed.

  20. Turn Down the Volume or Change the Channel?: Emotional Effects of Detached Versus Positive Reappraisal

    Science.gov (United States)

    Shiota, Michelle N.; Levenson, Robert W.

    2013-01-01

    Cognitive reappraisal, or changing one’s interpretation of an event in order to alter the emotional response to it, is thought to be a healthy and effective emotion regulation strategy. Although researchers recognize several distinct varieties of reappraisal, few studies have explicitly compared the effects of multiple reappraisal strategies on emotional responding. The present study compares the effects of detached and positive reappraisal on thought content, subjective emotional experience, physiological reactivity, and facial expressions of emotion while viewing film clips evoking sadness and disgust. While both forms of reappraisal reduced overall emotional responding to unpleasant stimuli, the effects of detached reappraisal were stronger in this regard, and positive reappraisal was more likely to maintain subjective experience and facial expression of stimulus-appropriate positive emotions. The two reappraisal strategies also produced somewhat different profiles of physiological responding. Differences between detached and positive reappraisal with respect to subjective experience and facial expression were more pronounced among men than women; the reverse was true for differences with respect to physiological responding. Beyond these effects on individual emotion response systems, detached and positive reappraisal also had somewhat different effects on coherence in change across response systems. Implications for our understanding of emotion regulation processes, and for emotion theory more broadly, are discussed. PMID:22746676

  1. Stroke volume variation compared with pulse pressure variation and cardiac index changes for prediction of fluid responsiveness in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Randa Aly Soliman

    2015-04-01

    Conclusions: Baseline stroke volume variation ⩾8.15% predicted fluid responsiveness in mechanically ventilated patients with acute circulatory failure. The study also confirmed the ability of pulse pressure variation to predict fluid responsiveness.

  2. Effect of Inhalational Anesthetics and Positive-pressure Ventilation on Ultrasound Assessment of the Great Vessels: A Prospective Study at a Children's Hospital.

    Science.gov (United States)

    Lin, Elaina E; Chen, Aaron E; Panebianco, Nova; Conlon, Thomas; Ju, Na Rae; Carlson, Dustin; Kopenitz, Jason; Nishisaki, Akira

    2016-04-01

    Bedside ultrasound has emerged as a rapid, noninvasive tool for assessment and monitoring of fluid status in children. The inferior vena cava (IVC) varies in size with changes in blood volume and intrathoracic pressure, but the magnitude of change to the IVC with inhalational anesthetic and positive-pressure ventilation (PPV) is unknown. Prospective observational study of 24 healthy children aged 1 to 12 yr scheduled for elective surgery. Ultrasound images of the IVC and aorta were recorded at five time points: awake; spontaneous ventilation with sevoflurane by mask; intubated with peak inspiratory pressure/positive end-expiratory pressure of 15/0, 20/5, and 25/10 cm H2O. A blinded investigator measured IVC/aorta ratios (IVC/Ao) and changes in IVC diameter due to respiratory variation (IVC-RV) from the recorded videos. Inhalational anesthetic decreased IVC/Ao (1.1 ± 0.3 vs. 0.6 ± 0.2; P 0.99). The initiation of PPV increased IVC/Ao (0.64 ± 0.21 vs. 1.16 ± 0.27; P 0.99 for both). Addition of inhalational anesthetic affects IVC/Ao but not IVC-RV, and significant changes in IVC/Ao and IVC-RV occur with initiation of PPV in healthy children. Clinicians should be aware of these expected vascular changes when managing patients. Establishing these IVC parameters will enable future studies to better evaluate these measurements as tools for diagnosing hypovolemia or predicting fluid responsiveness.

  3. Modification of the Steel Surface Treated by a Volume Discharge Plasma in Nitrogen at Atmospheric Pressure

    Science.gov (United States)

    Erofeev, M. V.; Shulepov, M. A.; Ivanov, Yu. F.; Oskomov, K. V.; Tarasenko, V. F.

    2016-03-01

    Effect of volume discharge plasma initiated by an avalanche electron beam on the composition, structure, and properties of the surface steel layer is investigated. Voltage pulses with incident wave amplitude up to 30 kV, full width at half maximum of about 4 ns, and wave front of about 2.5 ns were applied to the gap with an inhomogeneous electric field. Changes indicating the hardening effect of the volume discharge initiated by an avalanche electron beam are revealed in St3-grade steel specimens treated by the discharge of this type.

  4. Added sugars in the diet are positively associated with diastolic blood pressure and triglycerides in children.

    Science.gov (United States)

    Kell, Kenneth P; Cardel, Michelle I; Bohan Brown, Michelle M; Fernández, José R

    2014-07-01

    Hypertension and dyslipidemia have traditionally been associated with dietary sodium and fat intakes, respectively; however, they have recently been associated with the consumption of added sugars in adults and older adolescents, but there is no clear indication of how early in the life span this association manifests. This study explored the cross-sectional association between added sugar (sugars not naturally occurring in foods) consumption in children, blood pressure (BP), and fasting blood lipids [triglycerides and total, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol]. BP, blood lipids, and dietary intakes were obtained in a multiethnic pediatric sample aged 7-12 y of 122 European American (EA), 106 African American (AA), 84 Hispanic American (HA), and 8 mixed-race children participating in the Admixture Mapping of Ethnic and Racial Insulin Complex Outcomes (AMERICO) study-a cross-sectional study conducted in the Birmingham, AL, metro area investigating the effects of racial-ethnic differences on metabolic and health outcomes. Multiple regression analyses were performed to evaluate the relations of added sugars and sodium intakes with BP and of added sugars and dietary fat intakes with blood lipids. Models were controlled for sex, race-ethnicity, socioeconomic status, Tanner pubertal status, percentage body fat, physical activity, and total energy intake. Added sugars were positively associated with diastolic BP (P = 0.0462, β = 0.0206) and serum triglycerides (P = 0.0206, β = 0.1090). Sodium was not significantly associated with either measure of BP nor was dietary fat with blood lipids. HA children had higher triglycerides but lower added sugar consumption than did either the AA or EA children. The AA participants had higher BP and HDL but lower triglycerides than did either the EA or HA children. These data suggest that increased consumption of added sugars may be associated with adverse cardiovascular health factors in children

  5. LIQUID-LIQUID PHASE EQUILIBRIUM OF POLYMER SOLUTIONS AND POLYMER BLENDS UNDER POSITIVE AND NEGATIVE PRESSURE

    Institute of Scientific and Technical Information of China (English)

    Attila R.Imre

    2003-01-01

    In this paper we would like to give a brief review about the extensibility of the liquid-liquid locus into the negative pressure region. Negative pressure states are hardly explored; most researchers believe that the pressure scale ends at p = 0.We would like to show that this is not true, thep = 0 point is not a special point for liquids, it can be "easily" crossed. We are going to give a few example, where the extension of liquid-liquid locus for polymer blends and solutions below p = 0 gives us some interesting results, like the merging of UCST and LCST branches in weakly interacting polymer solutions or the reason why most UCST blends exhibit pressure induced immiscibility. Also, we will see what happens with the immiscibility island of aqueous polymer solutions when - reaching the critical molar mass - it "disappears".

  6. Preliminary investigation of an ultrasound method for estimating pressure changes in deep-positioned vessels

    Science.gov (United States)

    Olesen, Jacob Bjerring; Villagomez-Hoyos, Carlos Armando; Traberg, Marie Sand; Chee, Adrian J. Y.; Yiu, Billy Y. S.; Ho, Chung Kit; Yu, Alfred C. H.; Jensen, Jørgen Arendt

    2016-04-01

    This paper presents a method for measuring pressure changes in deep-tissue vessels using vector velocity ultrasound data. The large penetration depth is ensured by acquiring data using a low frequency phased array transducer. Vascular pressure changes are then calculated from 2-D angle-independent vector velocity fields using a model based on the Navier-Stokes equations. Experimental scans are performed on a fabricated flow phantom having a constriction of 36% at a depth of 100 mm. Scans are carried out using a phased array transducer connected to the experimental scanner, SARUS. 2-D fields of angle-independent vector velocities are acquired using directional synthetic aperture vector flow imaging. The obtained results are evaluated by comparison to a 3-D numerical simulation model with equivalent geometry as the designed phantom. The study showed pressure drops across the constricted phantom varying from -40 Pa to 15 Pa with a standard deviation of 32%, and a bias of 25% found relative to the peak simulated pressure drop. This preliminary study shows that pressure can be estimated non-invasively to a depth that enables cardiac scans, and thereby, the possibility of detecting the pressure drops across the mitral valve.

  7. Reduced defense of central blood volume during acute lower body negative pressure-induced hypovolemic circulatory stress in aging women.

    Science.gov (United States)

    Lindenberger, Marcus; Länne, Toste

    2012-06-01

    Elderly humans are more vulnerable to trauma and hemorrhage than young and elderly men and respond with decreased defense of central blood volume during acute experimental hypovolemia induced by lower body negative pressure (LBNP). However, these defense mechanisms have not been evaluated in elderly women. The aim of this study was to determine the effectiveness of compensatory responses to defend central blood volume during experimental hypovolemia in elderly and young women. Cardiovascular responses in 34 women, 12 elderly (66 ± 1 years) and 22 young women (23 ± 0.4 years), were studied during experimental hypovolemia induced by LBNP of 11 to 44 mmHg. Air plethysmography was used to assess the capacitance response (redistribution of peripheral venous blood to the central circulation) as well as net capillary fluid transfer from tissue to blood in the arm. Lower body negative pressure seemed to create comparable hypovolemia measured as total calf volume increase in elderly and young women. Heart rate increased less in elderly women (LBNP of 44 mmHg: 20 ± 2 vs. 37 ± 4%; P < 0.01) but with similar (%) increase in forearm vascular resistance. Mobilization of capacitance blood from the peripheral circulation was both slower and decreased by ∼60% in elderly women (P < 0.001), and net capillary fluid absorption from surrounding tissues was reduced by ∼40% (P < 0.01, LBNP of 44 mmHg). Elderly women responded with less increase in heart rate but with equal forearm vascular resistance (%) response during LBNP. Furthermore, the compensatory capacitance response was both slower and substantially decreased, and net capillary fluid absorption considerably reduced, collectively indicating less efficiency to defend central blood volume in elderly than in young women.

  8. Left ventricular pressure-volume relationships during normal growth and development in the adult rat--studies in 8- and 50-week-old male Wistar rats.

    Science.gov (United States)

    Bal, M P; de Vries, W B; van der Leij, F R; van Oosterhout, M F M; Baan, J; van der Wall, E E; van Bel, F; Steendijk, P

    2005-11-01

    Left ventricular (LV) pressure-volume relations provide relatively load-independent indexes of systolic and diastolic LV function, but few data are available on pressure-volume relations during growth and development in the normal adult heart. Furthermore, to quantify intrinsic ventricular function the indexes should be normalized for heart weight. However, in many studies the indexes are reported in absolute terms, or body weight-correction is used as a surrogate for heart weight-correction. We determined pressure-volume relations in young (8-week-old, n = 13) and middle-aged (50-week-old, n = 19) male Wistar rats in relation to their heart and body weights. The animals were anaesthetized and a 2F pressure-conductance catheter was introduced into the LV to measure pressure-volume relations. Heart and body weights were significantly higher in the 50-week-old rats, whereas the heart-to-body weight ratio was significantly lower (2.74 +/- 0.32 vs. 4.41 +/- 0.37 mg g(-1), P pressure-volume relation (E(ES)), the dP/dt(MAX) vs. end-diastolic volume relation (S-dP), and the preload recruitable stroke work relation (PRSW), normalized for heart weight, was slightly decreased in the 50-week-old rats (S-dP: -6%, P pressure-volume indexes showed improved systolic function and significantly depressed diastolic function. Intrinsic systolic function slightly decreases from the juvenile to the middle-aged period in normal male Wistar rats. Furthermore, correction of pressure-volume indexes for body weight is not an adequate surrogate for heart weight-correction in these animals.

  9. A Single Session of Low-Volume High-Intensity Interval Exercise Reduces Ambulatory Blood Pressure in Normotensive Men.

    Science.gov (United States)

    Dantas, Teresa C B; Farias Junior, Luiz F; Frazão, Danniel T; Silva, Paulo H M; Sousa Junior, Altieres E; Costa, Ingrid B B; Ritti-Dias, Raphael M; Forjaz, Cláudia L M; Duhamel, Todd A; Costa, Eduardo C

    2017-08-01

    Dantas, TCB, Farias Junior, LF, Frazão, DT, Silva, PHM, Sousa Junior, AE, Costa, IBB, Ritti-Dias, RM, Forjaz, CLM, Duhamel, TA, and Costa, EC. A single session of low-volume high-intensity interval exercise reduces ambulatory blood pressure in normotensive men. J Strength Cond Res 31(8): 2263-2269, 2017-The magnitude and duration of postexercise hypotension (PEH) may provide valuable information on the efficacy of an exercise approach to blood pressure (BP) control. We investigated the acute effect of a time-efficient high-intensity interval exercise (HIIE) on ambulatory BP. Twenty-one normotensive men (23.6 ± 3.6 years) completed 2 experimental sessions in a randomized order: (a) control (no exercise) and (b) low-volume HIIE: 10 × 1 minute at 100% of maximal treadmill velocity interspersed with 1 minute of recovery. After each experimental session, an ambulatory BP monitoring was initiated. Paired sample t-test was used to compare BP averages for awake, asleep, and 20-hour periods between the control and the low-volume HIIE sessions. A 2-way repeated measures analysis of variance was used to analyze hourly BP after both experimental sessions. Blood pressure averages during the awake (systolic: 118 ± 6 vs. 122 ± 6 mm Hg; diastolic: 65 ± 7 vs. 67 ± 7 mm Hg) and 20-hour (systolic: 115 ± 7 vs. 118 ± 6 mm Hg; diastolic: 62 ± 7 vs. 64 ± 7 mm Hg) periods were lower after the low-volume HIIE compared with the control (p ≤ 0.05). Systolic and diastolic PEH presented medium (Cohen's d = 0.50-0.67) and small (Cohen's d = 0.29) effect sizes, respectively. Systolic PEH occurred in a greater magnitude during the first 5 hours (3-5 mm Hg). No changes were found in asleep BP (p > 0.05). In conclusion, a single session of low-volume HIIE reduced ambulatory BP in normotensive men. The PEH occurred mainly in systolic BP during the first 5 hours postexercise.

  10. Guide To Fighting Positions, Obstacles, And Revetments - Air Force Handbook 10-222, Volume 14

    Science.gov (United States)

    2006-05-31

    and should provide a minimum 2-foot wide crest at the top of the wall. Constructing the wall requires formwork and equipment to mix the soil-cement...hardened position, which is reinforced against direct- and indirect-fire. Tunnels and trenches may be constructed to connect with other fighting

  11. Continuous stroke volume estimation from aortic pressure using zero dimensional cardiovascular model: proof of concept study from porcine experiments.

    Directory of Open Access Journals (Sweden)

    Shun Kamoi

    Full Text Available Accurate, continuous, left ventricular stroke volume (SV measurements can convey large amounts of information about patient hemodynamic status and response to therapy. However, direct measurements are highly invasive in clinical practice, and current procedures for estimating SV require specialized devices and significant approximation.This study investigates the accuracy of a three element Windkessel model combined with an aortic pressure waveform to estimate SV. Aortic pressure is separated into two components capturing; 1 resistance and compliance, 2 characteristic impedance. This separation provides model-element relationships enabling SV to be estimated while requiring only one of the three element values to be known or estimated. Beat-to-beat SV estimation was performed using population-representative optimal values for each model element. This method was validated using measured SV data from porcine experiments (N = 3 female Pietrain pigs, 29-37 kg in which both ventricular volume and aortic pressure waveforms were measured simultaneously.The median difference between measured SV from left ventricle (LV output and estimated SV was 0.6 ml with a 90% range (5th-95th percentile -12.4 ml-14.3 ml. During periods when changes in SV were induced, cross correlations in between estimated and measured SV were above R = 0.65 for all cases.The method presented demonstrates that the magnitude and trends of SV can be accurately estimated from pressure waveforms alone, without the need for identification of complex physiological metrics where strength of correlations may vary significantly from patient to patient.

  12. Novel experimental design for high pressure-high temperature electrical resistance measurements in a "Paris-Edinburgh" large volume press

    Science.gov (United States)

    Matityahu, Shlomi; Emuna, Moran; Yahel, Eyal; Makov, Guy; Greenberg, Yaron

    2015-04-01

    We present a novel experimental design for high sensitivity measurements of the electrical resistance of samples at high pressures (0-6 GPa) and high temperatures (300-1000 K) in a "Paris-Edinburgh" type large volume press. Uniquely, the electrical measurements are carried out directly on a small sample, thus greatly increasing the sensitivity of the measurement. The sensitivity to even minor changes in electrical resistance can be used to clearly identify phase transitions in material samples. Electrical resistance measurements are relatively simple and rapid to execute and the efficacy of the present experimental design is demonstrated by measuring the electrical resistance of Pb, Sn, and Bi across a wide domain of temperature-pressure phase space and employing it to identify the loci of phase transitions. Based on these results, the phase diagrams of these elements are reconstructed to high accuracy and found to be in excellent agreement with previous studies. In particular, by mapping the locations of several well-studied reference points in the phase diagram of Sn and Bi, it is demonstrated that a standard calibration exists for the temperature and pressure, thus eliminating the need for direct or indirect temperature and pressure measurements. The present technique will allow simple and accurate mapping of phase diagrams under extreme conditions and may be of particular importance in advancing studies of liquid state anomalies.

  13. Plasma sE-selectin level is positively correlated with neutrophil count and diastolic blood pressure in Japanese men.

    Science.gov (United States)

    Mochizuki, Kazuki; Inoue, Seiya; Miyauchi, Rie; Misaki, Yasumi; Shimada, Masaya; Kasezawa, Nobuhiko; Tohyama, Kazushige; Goda, Toshinao

    2013-01-01

    Increased levels of circulating soluble type of E-selectin (sE-selectin), neutrophil counts and blood pressure are associated with the development of cardiovascular diseases (CVD). In this study, we conducted a cross-sectional study of men who participated in health check-ups, and selected those who were not diagnosed with or being treated for metabolic diseases such as diabetes, hypertension and lipid abnormality according to the health check-ups. We measured their basic clinical parameters including blood pressure and neutrophil count, plasma sE-selectin concentration and lifestyle factors, and assessed their interrelations by multivariate linear regression (MLR) analysis. A total of 351 subjects aged 47.5±8.41 (range, 30-64) y were recruited. Significantly correlated with sE-selectin concentration were neutrophil count, diastolic blood pressure (DBP), and systolic blood pressure (SBP) (Pearson's correlation coefficient, 0.194, 0.220 and 0.175, respectively). MLR analysis showed that sE-selectin concentration was independently positively related with DBP and neutrophil count, whereas neutrophil count was positively associated with sE-selectin concentration but not DBP. DBP, but not SBP, was independently positively correlated with sE-selectin concentration but not neutrophil count. These results indicate that circulating sE-selectin concentration may be a biomarker for indicating subsequent development of metabolic diseases, in particular CVD, from a healthy state.

  14. Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients

    Science.gov (United States)

    Krakow, Barry; McIver, Natalia D; Ulibarri, Victor A; Nadorff, Michael R

    2017-01-01

    Purpose Emerging evidence shows that positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) in chronic insomnia patients (proposed “complex insomnia” disorder) leads to substantial decreases in insomnia severity. Although continuous PAP (CPAP) is the pressure mode most widely researched, intolerance to fixed pressurized air is rarely investigated or described in comorbidity patients. This retrospective study examined dual pressure, autoadjusting PAP modes in chronic, complex insomnia disorder patients. Patients and methods Chronic insomnia disorder patients (mean [SD] insomnia severity index [ISI] =19.11 [3.34]) objectively diagnosed with OSA or UARS and using either autobilevel PAP device or adaptive servoventilation (ASV) device after failing CPAP therapy (frequently due to intolerance to pressurized air, poor outcomes, or emergence of CSA) were divided into PAP users (≥20 h/wk) and partial users (insomnia patients, PAP users (n=246) averaged 6.10 (1.78) nightly hours and 42.71 (12.48) weekly hours and partial users (n=56) averaged 1.67 (0.76) nightly hours and 11.70 (5.31) weekly hours. For mean (SD) decreases in total ISI scores, a significant (group × time) interaction was observed (F[1,300]=13.566; Pinsomnia symptoms (r=−0.256, PInsomnia severity significantly decreased in patients using autoadjusting PAP devices, but the study design restricts interpretation to an association. Future research must elucidate the interaction between insomnia and OSA/UARS as well as the adverse influence of pressure intolerance on PAP adaptation in complex insomnia patients. Randomized controlled studies must determine whether advanced PAP modes provide benefits over standard CPAP modes in these comorbidity patients. PMID:28331381

  15. Review: artifical ventilation with positive end-expiratory pressure (PEEP). Historical background, terminology and patho-physiology.

    Science.gov (United States)

    Stokke, D B

    1976-09-01

    CPPV (continuous positive pressure ventilation) is obviously superior to IPPV (intermittent positive pressure ventilation) for the treatment of patients with acute respiratory insufficiency (ARI) and results within a few minutes in a considerable increase in the oxygen transport. The principle is to add a positive end-expiratory plateau (PEEP) to IPPV, with a subsequent increase in FRC (functional residual capacity) resulting in re-opening in first and foremost the declive alveolae, which can then once again take part in the gas exchange and possibly re-commence the disrupted surfactant production. In this manner the ventilation/perfusion ratio in the diseases lungs is normalized and the intrapulmonary shunting of venous blood (Qs/Qt) will decrease. At the same time the dead space ventilation fraction (VD/VT) normalizes and the compliance of the lungs (CL) increases. The PEEP value, which results in a maximum oxygen transport, and the lowest dead space fraction, also appears to result in the greatest total static compliance (CT) and the greatest increase in mixed venous oxygen tension (PVO2); this value can be termed "optimal PEEP". The greater the FRC is, with an airway pressure = atmospheric pressure, the lower the PEEP value required in order to obtain maximum oxygen transport. If the optimal PEEP value is exceeded the oxygen transport will fall because of a falling Qt (cardiac output) due to a reduction in venous return. CT and PVO2 will fall and VD/VT will increase. Increasing hyperinflation of the alveolae will result in a rising danger of alveolar rupture. The critical use of CPPV treatment means that the lungs may be safeguarded against high oxygen percents. The mortality of newborn infants with RDS (respiratory distress syndrome) has fallen considerably after the general introduction of CPPV and CPAP (continuous positive airway pressures). The same appears to be the case with adults suffering from ARI (acute respiratory insufficiency).

  16. Medical device-related hospital-acquired pressure ulcers: development of an evidence-based position statement.

    Science.gov (United States)

    Pittman, Joyce; Beeson, Terrie; Kitterman, Jessica; Lancaster, Shelley; Shelly, Anita

    2015-01-01

    Hospital-acquired pressure ulcers (HAPUs) are a problem in the acute care setting causing pain, loss of function, infection, extended hospital stay, and increased costs. In spite of best practice strategies, occurrences of pressure ulcers continue. Many of these HAPUs are related to a medical device. Correct assessment and reporting of device-related HAPUs were identified as an important issue in our organization. Following the Iowa Model for Evidence-Based Practice to Promote Quality Care, a task force was created, a thorough review of current evidence and clinical practice recommendations was performed, and a definition for medical device-related HAPU and an evidence-based position statement were developed. Content of the statement was reviewed by experts and appropriate revisions were made. This position statement provides guidance and structure to accurately identify and report device-related HAPU across our 18 healthcare facilities. Through the intentional focus on pressure ulcer prevention and evidence-based practice in our organization and the use of this position statement, identification and reporting of device-related HAPUs have improved with a decrease in overall HAPU rates of 33% from 2011 and 2012. This article describes the development and implementation of this device-related HAPU position statement within our organization.

  17. The impact of arm position and pulse pressure on the validation of a wrist-cuff blood pressure measurement device in a high risk population

    Directory of Open Access Journals (Sweden)

    Ali Reza Khoshdel

    2010-03-01

    Full Text Available Ali Reza Khoshdel1,2, Shane Carney2, Alastair Gillies21Faculty of Medicine, Aja University of Medical Science, Tehran, Iran; 2John Hunter Hospital, Faculty of Health, The University of Newcastle, Newcastle, NS W, AustraliaAbstract: Despite the increasing popularity of blood pressure (BP wrist monitors for self-BP measurement at home, device validation and the effect of arm position remains an issue. This study focused on the validation of the Omron HEM-609 wrist BP device, including an evaluation of the impact of arm position and pulse pressure on BP measurement validation. Fifty patients at high risk for cardiovascular disease were selected (age 65 ± 10 years. Each patient had two measurements with a mercury sphygmomanometer and three measurements with the wrist BP device (wrist at the heart level while the horizontal arm supported [HORIZONTAL], hand supported on the opposite shoulder [SHOULDER], and elbow placed on a desk [DESK], in random order. The achieved systolic BP (SBP and diastolic BP (DBP wrist-cuff readings were compared to the mercury device and the frequencies of the readings within 5, 10, and 15 mmHg of the gold standard were computed and compared with the British Hypertension Society (BHS and Association for the Advancement of Medical Instrumentation (AAMI protocols. The results showed while SBP readings with HORIZONTAL and SHOULDER positions were significantly different from the mercury device (mean difference = 7.1 and 13.3 mmHg, respectively; P < 0.05, the DESK position created the closest reading to mercury (mean difference = 3.8, P > 0.1. Approximately 71% of SBP readings with the DESK position were within ±10 mmHg, whereas it was 62.5% and 34% for HORIZONTAL and SHOULDER positions, respectively. Wrist DBP attained category D with BHS criteria with all three arm positions. Bland–Altman plots illustrated that the wrist monitor systematically underestimated SBP and DBP values. However a reading adjustment of 5 and 10 mm

  18. The equivalence between volume averaging and method of planes definitions of the pressure tensor at a plane

    Science.gov (United States)

    Heyes, D. M.; Smith, E. R.; Dini, D.; Zaki, T. A.

    2011-07-01

    It is shown analytically that the method of planes (MOP) [Todd, Evans, and Daivis, Phys. Rev. E 52, 1627 (1995)] and volume averaging (VA) [Cormier, Rickman, and Delph, J. Appl. Phys. 89, 99 (2001), 10.1063/1.1328406] formulas for the local pressure tensor, Pα, y(y), where α ≡ x, y, or z, are mathematically identical. In the case of VA, the sampling volume is taken to be an infinitely thin parallelepiped, with an infinite lateral extent. This limit is shown to yield the MOP expression. The treatment is extended to include the condition of mechanical equilibrium resulting from an imposed force field. This analytical development is followed by numerical simulations. The equivalence of these two methods is demonstrated in the context of non-equilibrium molecular dynamics (NEMD) simulations of boundary-driven shear flow. A wall of tethered atoms is constrained to impose a normal load and a velocity profile on the entrained central layer. The VA formula can be used to compute all components of Pαβ(y), which offers an advantage in calculating, for example, Pxx(y) for nano-scale pressure-driven flows in the x-direction, where deviations from the classical Poiseuille flow solution can occur.

  19. Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals.

    Science.gov (United States)

    Albuquerque, Isabella Martins de; Cardoso, Dannuey Machado; Masiero, Paulo Ricardo; Paiva, Dulciane Nunes; Resqueti, Vanessa Regiane; Fregonezi, Guilherme Augusto de Freitas; Menna-Barreto, Sérgio Saldanha

    2016-01-01

    To evaluate the effects of positive expiratory pressure (PEP) on pulmonary epithelial membrane permeability in healthy subjects. We evaluated a cohort of 30 healthy subjects (15 males and 15 females) with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10), 15 cmH2O (n = 10), and 20 cmH2O (n = 10). The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044), 15 cmH2O (p = 0.044), and 20 cmH2O (p = 0.004)-in comparison with that observed during spontaneous breathing. Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects. Avaliar os efeitos da pressão expiratória positiva (PEP) na permeabilidade da membrana epitelial pulmonar em indivíduos saudáveis. Foi avaliada uma coorte de 30 indivíduos saudáveis (15 homens e 15 mulheres), com média de idade de 28,3 ± 5,4 anos, média da relação VEF1/CVF de 0,89 ± 0,14 e média de VEF1 de 98,5 ± 13,1% do previsto. Os indivíduos foram submetidos a cintilografia pulmonar por inalação de radioaerossol de ácido dietilenotriaminopentacético marcado com tecnécio-99m (99mTc-DTPA em inglês) em dois estágios: durante respiração espontânea e durante respiração com uma máscara de PEP de 10 cmH2O (n = 10), 15 cmH2O (n = 10) ou 20 cmH2O (n = 10). O 99mTc-DTPA foi nebulizado por 3 min, e sua depuração foi registrada por cintilografia por um

  20. Energy concentration and positional stability of sonoluminescent bubbles in sulfuric acid for different static pressures.

    Science.gov (United States)

    Rosselló, Juan Manuel; Dellavale, Damián; Bonetto, Fabián José

    2013-09-01

    In this study we report several experimental and numerical results on the influence of static pressure (P_{0}) over the main parameters in single bubble sonoluminescence (SBSL), using a sulfuric acid aqueous solution (SA) with low concentrations of argon gas dissolved. Bifrequency driving was used in the experiments to enhance spatial stability of the bubbles. The experimental results were compared with simulations provided by a numerical code that models the radial dynamics of the bubbles. The results showed that an increase on the static pressure of the system shifts the Bjerknes instability threshold, allowing the bubble to access higher acoustic pressures (P_{Ac}^{}). Furthermore, a decrease in the measured ambient radius R_{0} and the calculated relative gas concentration c_{∞}/c_{0} were observed. A notorious increment in the bubble collapse violence and energy focusing for P_{0} above 1 bar was achieved. These were mainly indicated by the growth of the bubble expansion ratio (R_{max}/R_{0}), the bubble mechanical energy density, and the maximum bubble wall velocity dR/dt. In agreement with the previous statement, the maximum temperature during the bubble collapse predicted by the model is augmented as well. The use of different harmonics in the ultrasound pressure field regarding energy focusing is also discussed. Finally, we analyzed the stability regions of the R_{0}-P_{Ac}^{} parameter space via numerical predictions for P_{0} above the measured, identifying the shape instabilities as the main limiting agent to obtain further energy concentration in SA systems at high static pressures.

  1. The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients

    Directory of Open Access Journals (Sweden)

    J.O.C. Auler Jr.

    2000-01-01

    Full Text Available We prospectively evaluated the effects of positive end-expiratory pressure (PEEP on the respiratory mechanical properties and hemodynamics of 10 postoperative adult cardiac patients undergoing mechanical ventilation while still anesthetized and paralyzed. The respiratory mechanics was evaluated by the inflation inspiratory occlusion method and hemodynamics by conventional methods. Each patient was randomized to a different level of PEEP (5, 10 and 15 cmH2O, while zero end-expiratory pressure (ZEEP was established as control. PEEP of 15-min duration was applied at 20-min intervals. The frequency dependence of resistance and the viscoelastic properties and elastance of the respiratory system were evaluated together with hemodynamic and respiratory indexes. We observed a significant decrease in total airway resistance (13.12 ± 0.79 cmH2O l-1 s-1 at ZEEP, 11.94 ± 0.55 cmH2O l-1 s-1 (P<0.0197 at 5 cmH2O of PEEP, 11.42 ± 0.71 cmH2O l-1 s-1 (P<0.0255 at 10 cmH2O of PEEP, and 10.32 ± 0.57 cmH2O l-1 s-1 (P<0.0002 at 15 cmH2O of PEEP. The elastance (Ers; cmH2O/l was not significantly modified by PEEP from zero (23.49 ± 1.21 to 5 cmH2O (21.89 ± 0.70. However, a significant decrease (P<0.0003 at 10 cmH2O PEEP (18.86 ± 1.13, as well as (P<0.0001 at 15 cmH2O (18.41 ± 0.82 was observed after PEEP application. Volume dependence of viscoelastic properties showed a slight but not significant tendency to increase with PEEP. The significant decreases in cardiac index (l min-1 m-2 due to PEEP increments (3.90 ± 0.22 at ZEEP, 3.43 ± 0.17 (P<0.0260 at 5 cmH2O of PEEP, 3.31 ± 0.22 (P<0.0260 at 10 cmH2O of PEEP, and 3.10 ± 0.22 (P<0.0113 at 15 cmH2O of PEEP were compensated for by an increase in arterial oxygen content owing to shunt fraction reduction (% from 22.26 ± 2.28 at ZEEP to 11.66 ± 1.24 at PEEP of 15 cmH2O (P<0.0007. We conclude that increments in PEEP resulted in a reduction of both airway resistance and respiratory elastance. These results

  2. Relation Between Pressure and Volume Unloading During Ramp Testing in Patients Supported with a Continuous-Flow Left Ventricular Assist Device

    DEFF Research Database (Denmark)

    Jung, Mette H; Hassager, Christian; Balling, Louise;

    2015-01-01

    Pulmonary capillary wedge pressure (PCWP) is the key to describing left ventricular (LV) unloading, however, the relation between pressure and the echocardiography-derived surrogate of LV volume (left ventricular end-diastolic diameter (LVEDD)) as a function of pump speed (RPM) in continuous......-flow left ventricular assist device (CF-LVAD) patients is unknown. In this study the pressure-volume relationship as a function of RPM during ramp testing was investigated by simultaneously measuring PCWP by Swan-Ganz catheter and LVEDD by echocardiography. The ramp protocol started at usual pump setting...

  3. Non-Invasive Ultrasonic Diagnosing and Monitoring of Intracranial Pressure/Volume

    Science.gov (United States)

    2001-10-01

    related to cardiovascular parameters. ICP VI, Eds. Miller JD, Teasdale GM, Rowan JO, Galbraith SL, Mendelow AD. Springer-Verlag Berlin Heidelberg, 290...Galbraith AD Mendelow (Springer Berlin Heidelberg) 305-309 43. Hayashi M, Handa Y, Kobayashi H, Kawano H, Ishii H, Hirose S (1991). Plateau-wave...Galbraith SL, Mendelow AD Springer-Verlag Berlin Heidelberg. 151-155 72. Maeda M, Tanaka K, Nishimur S, Matsuura S (1986). Pressure wave-like changes in

  4. How do jet time, pressure and bone volume fraction influence the drilling depth when waterjet drilling in porcine bone?

    Science.gov (United States)

    den Dunnen, Steven; Dankelman, Jenny; Kerkhoffs, Gino M M J; Tuijthof, Gabrielle J M

    2016-09-01

    Using water jets for orthopedic procedures that require bone drilling can be beneficial due to the absence of thermal damage and the always sharp cut. Previously, the influence of the water jet diameter and bone architectural properties on the drilling depth have been determined. To develop water jet instruments that can safely drill in orthopedic surgery, the impact of the two remaining primary factors were determined: the jet time (tjet [s]) and pressure (P [MPa]). To this end, 84 holes were drilled in porcine tali and femora with water jets using Ø 0.4mm nozzle. tjet was varied between 1, 3 and 5s and P between 50 and 70MPa. Drilling depths Lhole (mm), diameters Dhole (mm) and the volume of mineralized bone per unit volume (BV/TV) were determined with microCT scans. A non-linear regression analysis resulted in the predictive equation: Lhole= 0.22 * tjet(0.18) * (1.2-BV/TV) * (P-29) (R(2)=0.904). The established relation between the machine settings and drilling depth allows surgeons to adjust jet time and pressure for the patient׳s BV/TV to drill holes at a predetermined depth. For developers, the relation allows design decisions to be made that influence the dimensions, flexibility and accuracy of water jet instruments. For a pressure of 50MPa, the potential hole depth spread indicated by the 95% confidence interval is drilling can be applied in orthopedic surgery to drill holes in bone with controlled depth.

  5. Numerical simulation of magnetospheric ULF waves excited by positive and negative impulses of solar wind dynamic pressure

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The sources of ultra low frequency (ULF) waves in the magnetosphere are generally believed to be either the external solar wind perturbations or the internal plasma instabilities. When a sudden impulse of the solar wind dynamic pressure impinges on the magnetopause, ULF waves might be excited and thus the solar wind energy is transported into the earth’s magnetosphere. In this paper, we study the ULF waves excited by different kinds of sudden solar wind pressure impulses through an MHD simulation. We primarily focus on the responses of the earth’s magnetosphere to positive/negative impulses of solar wind dynamic pressure, and positive-negative impulse pairs. The simulation results show that the ULF waves excited by positive and negative impulse have the same amplitude and frequency, with 180° difference in phase, if the amplitude and durations of the input impulses are the same. In addition, it is found that field line resonances (FLRs) occur at certain L-shell regions of the earth’s magneto-sphere after the impact of different positive-negative impulse pairs, which appear to be related to the duration of the impulses and the time interval between the sequential impulses. Another result is that the energy from the solar wind could be transported deeper into the inner magnetosphere by an impulse pair than by a single pulse impact. The results presented in this paper could help us to better understand how energy is transported from solar wind to the earth’s magnetosphere via ULF waves. Also, these results provide some new clues to understanding of how energetic particles in the inner magnetosphere response to different kinds of solar wind pressure impulse impacts including inter-planetary shocks.

  6. Endotracheal tube cuff pressures and tube position in critically injured patients on arrival at a referral centre: Avoidable harm?

    Directory of Open Access Journals (Sweden)

    Timothy C. Hardcastle

    2016-03-01

    Conclusion: Most patients, whether intubated on-scene or at hospital have ETT cuff pressures that are excessive, with the potential for ischaemic necrosis of the tracheal mucosa. ETT cuff manometry should be standard of care for all prehospital and in-hospital intubations where the tube will remain in situ for any prolonged period of time. Before inter-facility transfer ETT position should be confirmed radiologically.

  7. Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea

    OpenAIRE

    Melveetil S Sreejit; Venkateswaran Ramkumar

    2015-01-01

    Background and Aims: Induction of general anaesthesia per se as also the use of 100% oxygen during induction of anaesthesia, results in the development of atelectasis in dependent lung regions within minutes of anaesthetic induction. We aimed to assess the effect of application of a continuous positive airway pressure (CPAP) of 5 cm H 2 O during pre-oxygenation and induction of anaesthesia on the period of apnoea before the occurrence of clinically significant desaturation. Methods: In this p...

  8. Long-Term Effects of Continuous Positive Airway Pressure Treatment on Sexuality in Female Patients with Obstructive Sleep Apnea

    OpenAIRE

    Petersen, Marian; Kristensen, Ellids; Berg, Søren; Midgren, Bengt

    2013-01-01

    Introduction Results from a previous study showed that sexuality was negatively affected in females with untreated obstructive sleep apnea (OSA). Data are sparse on the long-term effects of nocturnal continuous positive airway pressure (CPAP) treatment on sexual difficulties and sexual distress in female patients with OSA. Aim The aim of the present study was to investigate the effects after 1 year of CPAP treatment on sexual difficulties, sexual distress, and manifest sexual dysfunction in f...

  9. Study of pressure-volume relationships and higher derivatives of bulk modulus based on generalized equations of state

    Energy Technology Data Exchange (ETDEWEB)

    Kushwah, S.S. [Department of Physics, Rishi Galav College, Morena, 476001 MP (India); Shrivastava, H.C. [Department of Physics, S.M.S. Government Model Science P.G. College, Gwalior, 474001 MP (India)]. E-mail: hcs2050@yahoo.com; Singh, K.S. [Department of Physics, R.B.S. College, Agra, UP (India)

    2007-01-15

    We have generalized the pressure-volume (P-V) relationships using simple polynomial and logarithmic expansions so as to make them consistent with the infinite pressure extrapolation according to the model of Stacey. The formulations are used to evaluate P-V relationships and pressure derivatives of bulk modulus upto third order (K', K'' and K''') for the earth core material taking input parameters based on the seismological data. The results based on the equations of state (EOS) generalized in the present study are found to yield good agreement with the Stacey EOS. The generalized logarithmic EOS due to Poirier and Tarantola deviates substantially from the seismic values for P, K and K'. The generalized Rydberg EOS gives almost identical results with the Birch-Murnaghan third-order EOS. Both of them yield deviations from the seismic data, which are in opposite direction as compared to those found from the generalized Poirier-Tarantola logarithmic EOS.

  10. Lower body positive pressure application with an antigravity suit in acute carotid occlusion.

    Science.gov (United States)

    Berthet, Karine; Lukaszewicz, Anne Claire; Bousser, Marie-Germaine; Payen, Didier

    2010-04-01

    The challenge in acute stroke is still to reperfuse as early as possible the ischemic territory. Since fibrinolytic therapies have a limited window with potential risk of bleeding, having a nonpharmacologic mean to recruit vessels in area surrounding necrosis might be useful. We propose here to use antigravity suit inflated at "venous" pressure levels to shift blood towards thoracic and brain territories. We report two cases of spectacular clinical recovery after acute carotid occlusion.

  11. Lower Body Positive Pressure Application with an Antigravity Suit in Acute Carotid Occlusion

    Directory of Open Access Journals (Sweden)

    Karine Berthet

    2010-01-01

    Full Text Available The challenge in acute stroke is still to reperfuse as early as possible the ischemic territory. Since fibrinolytic therapies have a limited window with potential risk of bleeding, having a nonpharmacologic mean to recruit vessels in area surrounding necrosis might be useful. We propose here to use antigravity suit inflated at “venous” pressure levels to shift blood towards thoracic and brain territories. We report two cases of spectacular clinical recovery after acute carotid occlusion.

  12. Effect of adjuvant nasal continuous positive airway pressure therapy on immune response and organ injury in children with severe pneumonia

    Institute of Scientific and Technical Information of China (English)

    Ni-Na Huang; Yu-Dan Zhang

    2016-01-01

    Objective:To analyze the effect of adjuvant nasal continuous positive airway pressure therapy on immune response and organ injury in children with severe pneumonia.Methods:A total of 90 children with severe pneumonia were randomly divided into observation group and control group (n=45), control group received conventional therapy, observation group accepted regular + adjuvant nasal continuous positive airway pressure therapy, and then differences in immune globulin, Th1/Th2 indexes, blood coagulation indexes, echocardiography parameters and so on were compared between two groups of children.Results:IgG2, IgG3, IgA and IgM content in peripheral blood of observation group were higher than those of control group; Th1/Th2 indexes IL-4 and IFN-γ content in serum as well as IL-4/IFN-γ level were lower than those of control group; blood coagulation indexes PT, TT, APTT and D-D levels were lower than those of control group while FIB and PLT levels were higher than those of control group; echocardiography parameters PVAT and AVAT levels were higher than those of control group while PFVMA level was lower than that of control group.Conclusions: Adjuvant nasal continuous positive airway pressure therapy helps to enhance the immune response and optimize blood coagulation function and cardiac function in children with severe pneumonia.

  13. Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke.

    Science.gov (United States)

    Tsivgoulis, Georgios; Zhang, Yi; Alexandrov, Anne W; Harrigan, Mark R; Sisson, April; Zhao, Limin; Brethour, Mary; Cava, Luis; Balucani, Clotilde; Barlinn, Kristian; Patterson, Damon E; Giannopoulos, Sotirios; DeWolfe, Jennifer; Alexandrov, Andrei V

    2011-04-01

    Hypercapnia can induce intracranial blood-flow steal from ischemic brain tissues, and early initiation of noninvasive ventilator correction (NIVC) may improve cerebral hemodynamics in acute ischemic stroke. We sought to determine safety and tolerability of NIVC initiated on hospital admission without polysomnography study. Consecutive acute ischemic stroke patients were evaluated for the presence of a proximal arterial occlusion, daytime sleepiness, or history of obstructive sleep apnea, and acceptable pulse oximetry readings while awake (96%-100% on 2 to 4 L supplemental oxygen delivered by nasal cannula). NIVC was started on hospital admission as standard of care when considered necessary by treating physicians. NIVC was initiated using bilevel positive airway pressure at 10 cmH(2)O inspiratory positive airway pressure and 5 cmH(2)O expiratory positive airway pressure in combination with 40% fraction of inspired oxygen. All potential adverse events were prospectively documented. Among 356 acute ischemic stroke patients (median NIHSS score, 5; interquartile range, 2-13), 64 cases (18%) received NIVC (median NIHSS score, 12; interquartile range, 6-17). Baseline stroke severity was higher and proximal arterial occlusions were more frequent in NIVC patients compared to the rest (Pacute ischemic stroke patients with proximal arterial occlusion and excessive sleepiness or obstructive sleep apnea, NIVC can be initiated early with good tolerability and a relatively small risk of serious complications.

  14. The effect of positioning devices and pressure therapy on outcome after full-thickness burns of the neck.

    Science.gov (United States)

    Sharp, Patricia A; Dougherty, Mary E; Kagan, Richard J

    2007-01-01

    The postoperative management of full-thickness burns of the neck can be a challenge for burn therapists despite the availability of many treatment modalities to minimize scar hypertrophy and contracture. Interventions include pressure appliances, massage, exercise, and positioning devices. The objective of this study was to identify factors associated with the development of neck contractures and optimal treatment strategies for their prevention. We performed a retrospective chart review of all patients admitted to our pediatric burn center between 1989 and 2003 with acute full-thickness neck burns. Rehabilitation protocols used for each patient were examined. The necessity of a reconstructive procedure was analyzed, as well as time from initial grafting to that procedure. We identified 49 eligible subjects. Patients ranged in age from 0.6 to 14.2 years at the time of injury. The number of factors present which inhibited both positioning and application of pressure to the neck was found to be significantly related to the need for neck reconstruction (P Patients who had tracheostomies had a mean time to neck reconstruction of 20.3 months compared with 43.4 months in patients without tracheostomies (P patients who were discharged with reduced range of motion of the neck required reconstruction compared with fewer than 65% of patients with normal neck range. Delayed pressure and positioning of the neck after skin grafting result in an earlier and more frequent need for neck reconstruction.

  15. Positive end expiratory pressure during one-lung ventilation: Selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation

    Directory of Open Access Journals (Sweden)

    Hoftman Nir

    2011-01-01

    Full Text Available The efficacy of positive end-expiratory pressure (PEEP in treating intraoperative hypoxemia during one-lung ventilation (OLV remains in question given conflicting results of prior studies. This study aims to (1 evaluate the efficacy of PEEP during OLV, (2 assess the utility of preoperative predictors of response to PEEP, and (3 explore optimal intraoperative settings that would maximize the effects of PEEP on oxygenation. Forty-one thoracic surgery patients from a single tertiary care university center were prospectively enrolled in this observational study. After induction of general anesthesia, a double-lumen endotracheal tube was fiberoptically positioned and OLV initiated. Intraoperatively, PEEP = 5 and 10 cmH 2 O were sequentially applied to the ventilated lung during OLV. Arterial oxygenation, cardiovascular performance parameters, and proposed perioperative variables that could predict or enhance response to PEEP were analysed. T-test and c2 tests were utilized for continuous and categorical variables, respectively. Multivariate analyses were carried out using a classification tree model of binary recursive partitioning. PEEP improved arterial oxygenation by ≥20% in 29% of patients (n = 12 and failed to do so in 71% (n = 29; however, no cardiovascular impact was noted. Among the proposed clinical predictors, only intraoperative tidal volume per kilogram differed significantly between responders to PEEP and non-responders (mean 6.6 vs. 5.7 ml/kg, P = 0.013; no preoperative variable predicted response to PEEP. A multivariate analysis did not yield a clinically significant model for predicting PEEP responsiveness. PEEP improved oxygenation in a subset of patients; larger, although still protective tidal volumes favored a positive response to PEEP. No preoperative variables, however, could be identified as reliable predictors for PEEP responders.

  16. Changes in Intraocular Pressure due to Surgical Positioning Studying Potential Risk for Postoperative Vision Loss

    Science.gov (United States)

    2007-01-01

    surgical position on IOP and perfusion to the optic nerve during spine surgery is not known. Moreover, most surgeons and anesthesiologists do not record...needed at some point during surgery, be vigilant to return to less risky positions when appropriate. 3. Consider anesthesiologists recording the...massive blood loss after lumbar spine surgery. Spine 1994;19:468–9. 18. Brown R, Schauble J, Miller N. Anemia and hypotension as contributors to

  17. Ocean Engineering Studies Compiled 1991. Volume 6. Acrylic Windows - Typical Applications in Pressure Housings

    Science.gov (United States)

    1991-01-01

    Nostrand Inc., Princeton, New Jersey, March 1956. 20. Southwest Research Institute, Final Repo .’t SWRI 034090-001, "Finite Element Anlalysis of an... REPO " T .. OI3t ,Any other nun,,.,. that troy be Cl ~re d.1 IC’ D-vRflUJTiON STATEMENT Distribution of this document is unlimited. Naval Undersea...No. 4, 1971. 6. Maison , J. R., and Stachiw, J. D., "Acrylic Pressure Hull for Johnson-Sea-Link Sub- mersible," ASME Paper No. 71-WA/Unt-6. 7. Wilson, E

  18. Licensing assessment of the Candu Pressurized Heavy Water Reactor. Preliminary safety information document. Volume II. [USA

    Energy Technology Data Exchange (ETDEWEB)

    1977-06-01

    ERDA has requested United Engineers and Constructors (UE and C) to evaluate the design of the Canadian natural uranium fueled, heavy water moderated (CANDU) nuclear reactor power plant to assess its conformance with the licensing criteria and guidelines of the U.S. Nuclear Regulatory Commission (USNRC) for light water reactors. This assessment was used to identify cost significant items of nonconformance and to provide a basis for developing a detailed cost estimate for a 1140 MWe, 3-loop Pressurized Heavy Water Reactor (PHWR) located at the Middletown, USA Site.

  19. A positive and entropy-satisfying finite volume scheme for the Baer-Nunziato model

    Science.gov (United States)

    Coquel, Frédéric; Hérard, Jean-Marc; Saleh, Khaled

    2017-02-01

    We present a relaxation scheme for approximating the entropy dissipating weak solutions of the Baer-Nunziato two-phase flow model. This relaxation scheme is straightforwardly obtained as an extension of the relaxation scheme designed in [16] for the isentropic Baer-Nunziato model and consequently inherits its main properties. To our knowledge, this is the only existing scheme for which the approximated phase fractions, phase densities and phase internal energies are proven to remain positive without any restrictive condition other than a classical fully computable CFL condition. For ideal gas and stiffened gas equations of state, real values of the phasic speeds of sound are also proven to be maintained by the numerical scheme. It is also the only scheme for which a discrete entropy inequality is proven, under a CFL condition derived from the natural sub-characteristic condition associated with the relaxation approximation. This last property, which ensures the non-linear stability of the numerical method, is satisfied for any admissible equation of state. We provide a numerical study for the convergence of the approximate solutions towards some exact Riemann solutions. The numerical simulations show that the relaxation scheme compares well with two of the most popular existing schemes available for the Baer-Nunziato model, namely Schwendeman-Wahle-Kapila's Godunov-type scheme [39] and Tokareva-Toro's HLLC scheme [44]. The relaxation scheme also shows a higher precision and a lower computational cost (for comparable accuracy) than a standard numerical scheme used in the nuclear industry, namely Rusanov's scheme. Finally, we assess the good behavior of the scheme when approximating vanishing phase solutions.

  20. Methodologies for localizing loco-regional hypopharyngeal carcinoma recurrences in relation to FDG-PET positive and clinical radiation therapy target volumes

    DEFF Research Database (Denmark)

    Due, Anne Kirkebjerg; Korreman, Stine; Bentzen, Søren M;

    2010-01-01

    Focal methods to determine the source of recurrence are presented, tested for reproducibility and compared to volumetric approaches with respect to the number of recurrences ascribed to the FDG-PET positive and high dose volumes....

  1. Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi-long; YIN Kai-sheng; LI Chong; JIA En-zhi; LI Yan-qun; GAO Zhao-fang

    2007-01-01

    Background Recent research suggested that obstructive sleep apnea syndrome (OSAS) might be independently associated with hypoadiponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes,etc. This study was conducted to investigate the effect of continuous positive airway pressure (CPAP) treatment on changes of both serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients.Methods Twenty-three adult male patients with moderate-to-severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood sampleswere collected and moming mean arterial pressure (MAP) was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay.Results Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment (P>0.05). It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur (P<0.01). Meanwhile, the MAP showed no statistically significant difference among its levels before CPAP, on day 3 and day 7 of CPAP treatment (P>0.05). However, on day 14 of CPAP treatment,a significantly lower MAP than that obtained before treatment was observed (P<0.05).Conclusions CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAS patients.Hypoadiponectinemia might be involved in the pathogenesis of OSAS-mediated hypertension.

  2. Effects of respiratory rate, plateau pressure, and positive end-expiratory pressure on PaO2 oscillations after saline lavage.

    Science.gov (United States)

    Baumgardner, James E; Markstaller, Klaus; Pfeiffer, Birgit; Doebrich, Marcus; Otto, Cynthia M

    2002-12-15

    One of the proposed mechanisms of ventilator-associated lung injury is cyclic recruitment of atelectasis. Collapse of dependent lung regions with every breath should lead to large oscillations in PaO2 as shunt varies throughout the respiratory cycle. We placed a fluorescence-quenching PO2 probe in the brachiocephalic artery of six anesthetized rabbits after saline lavage. Using pressure-controlled ventilation with oxygen, ventilator settings were varied in random order over three levels of