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Biomedical subjects

A Harf

Publications and source records attributed to A Harf.

At least 217 records · Page 12Linked to original sources
PubMed1984

High-frequency ventilation: a review.

As a new mode of assisted ventilation, high-frequency ventilation (HFV) embodies several types of devices, all of which employ tidal volumes much smaller and frequencies much greater than conventional mechanical ventilation (CMV). Due to the smaller swings of airway pressure during HFV, it is thought that some of the drawbacks of CMV may be overcome. Besides the obvious clinical implications, considerable interest has been generated concerning the physiological effects of HFV. In this review, the effects of HFV on gas exchange, lung mechanics, mucociliary transport, cardiovascular function and control of breathing will be examined. Although the role of HFV in the management of different lung diseases is still unclear, it has proved to be both a strong stimulus and a useful tool in the study of physiology.

Animals↗
PubMed1984

Lung mechanics in growing guinea pigs.

Lung mechanics were studied in four groups of guinea pigs: neonatal (1), prepubertal (II), postpubertal (III) and adult (IV). The animals were anesthetized and tracheotomized, and an esophageal catheter was inserted. Functional residual capacity (FRC) was measured by body plethysmography. After curarization, the lungs were inflated to a transpulmonary pressure of 30 cm H2O. The resulting change in volume was added to FRC to obtain the total lung capacity (TLC). Lung compliance (CL) normalized for dry lung weight (CL/LW) was calculated. An exponential function was fitted to the experimental P-V curve and the shape constant k was considered as an index of lung distensibility. During growth TCL (ml) increased with BW (g): TLC = 0.3 BW0.69 (r = 0.96). Two significantly different equations (P less than 0.001) were found between TLC (ml) and LW (g): between I and II, TLC = 32.4 LW1.24 (r = 0.88) and between III and IV, TLC = 22.9 LW0.53 (r = 0.73). An increase in lung distensibility as reflected by a significant increase in both CL/LW and the shape constant k was observed. In neonates and in prepubertal animals CL/LW was equal to 1.53 +/- 0.64 and to 2.38 +/- 0.51 ml/cm H2O/g (mean +/- 1 SD), respectively (P less than 0.01) and k to 0.146 +/- 0.026 and 0.219 +/- 0.035 cm H2O-1 (P less than 0.001). From prepuberty to adulthood no further significant changes were observed. These results showed that even in a species with an advanced maturation at birth, lung mechanics changed with growth.

Aging↗
PubMed1984

Plasma histamine and catecholamines during carbachol-induced bronchoconstriction in normal subjects.

To determine (1) whether changes in plasma histamine occurred during provoked bronchospasm and (2) if so, whether such changes could be related to variations in plasma catecholamines, venous plasma histamine and catecholamines were measured during a dose-response carbachol challenge in eight healthy volunteers. A significant rise in plasma histamine was observed, whereas induced bronchoconstriction was small, 80% +/- 4% of initial specific airway conductance. There was no further increase in plasma histamine, whereas induced bronchoconstriction became more marked (70%, 60%, and 50% of specific airway conductance initial value). Plasma catecholamines did not change throughout the study. We conclude that mast cell degranulation occurs during a carbachol challenge, and that the variations in plasma histamine are not related to changes in plasma catecholamines.

Adult↗
PubMed1984

Ventilation by high-frequency oscillation of thorax or at trachea in rats.

The efficiency of ventilation by high-frequency oscillation (HFO) applied to the thorax (external HFO) has been compared with that of HFO applied through a tracheal cannula (internal HFO) in a group of normal rats. Anesthetized, paralyzed, tracheotomized rats were placed in a whole-body plethysmograph. External HFO was achieved by varying the pressure surrounding the animal by means of a piston pump connected to the body plethysmograph; internal HFO was obtained in the same animals by connecting the pump to the tracheal cannula. Arterial CO2 and O2 partial pressures were measured in blood sampled from a carotid artery and were compared for external and internal HFO applied at 20 Hz with matched tidal volumes of 0.8, 1.4, 1.9, and 2.4 ml/kg. With increasing tidal volume, the mean arterial CO2 partial pressure decreased progressively from 68 to 30 Torr and was identical in the two modes of HFO; no difference was noted for the CO2 elimination or for the arterial O2 partial pressure. These results indicate that, in terms of gas exchange, external and internal HFO are equally efficient in normal rats.

Animals↗
PubMed1984

Alveolar ventilation during high-frequency oscillation: core dead space concept.

To assess the role of direct alveolar ventilation during high-frequency ventilation, we studied convective gas mixing during high-frequency oscillation with tidal volumes close to the dead space volume in a simple physical model. A main conduit representing a large airway was connected with a rigid sphere (V = 77, 517, and 1,719 cm3) by a small circular tube (d = 0.3 and 0.5 cm; L = 5, 10, and 20 cm). The efficiency of sinusoidal oscillations (f = 5, 20, and 40 Hz) applied at one end of the main conduit was assessed from the washout of a CO2 mixture from the sphere; to flush CO2 from the main fluid line, a constant flow of air was used. The decay in CO2 concentration measured in the sphere was exponential and therefore characterized by a measured time constant (tau m). Taking the small tube volume as the ventilatory dead space (VD), an effective tidal volume (VT*) was computed from tau m and compared with the tidal volume (VT) obtained separately from the pressure variation in the sphere. The discrepancy between these two tidal volumes has been found to be uniquely dependent on the ratio VT/VD within the range of VT/VD studied (0.5-2.2). For VT/VD less than 1.2, VT* was larger than VT, indicating that the conventional concept of alveolar ventilation does not apply. From the partition of the oscillatory flow in the small tube into two regions, the core and the unsteady boundary layer, we theoretically computed the proportions of the sinusoidal flow (or tidal volume) and the dead space for each region.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Redistribution of pulmonary blood flow induced by positive end-expiratory pressure and dopamine infusion in acute respiratory failure.

The mechanism by which mechanical ventilation (MV) with positive end-expiratory pressure (PEEP) improves hypoxemia in patients with acute respiratory failure (ARF) is unclear, and may be attributed in part to a decrease in cardiac output inducing by itself a reduction of the shunt. Using the multiple inert gas elimination technique we evaluated the effects of PEEP on ventilation-perfusion (VA/Q) distribution in 8 patients while cardiac output was maintained at control value by means of a dopamine infusion. In each patient, evaluation was performed during MV without PEEP (control) then with PEEP (17 +/- 2 cm H2O) and dopamine. After application of PEEP, PaO2, PvO2, and oxygen transport (TO2) increased significantly, whereas venous admixture decreased from 37.5 +/- 5 to 17 +/- 2% (p less than 0.01). Comparison of VA/Q distribution during PEEP and zero end-expiratory pressure documented a redistribution of pulmonary blood flow; the shunt decreased markedly from 30 +/- 4 to 13 +/- 2% (p less than 0.001), whereas the fraction of cardiac output distributed to "normal" VA/Q ratio units (0.1 to 10) increased from 62 to 78.5% (p less than 0.001). Dead space increased slightly with PEEP, from 44 to 49% (p less than 0.01) of total ventilation. The pattern of ventilation distribution was essentially unaltered; specifically, no additional high VA/Q mode was observed during PEEP. It is concluded that cardiac output maintenance with dopamine infusion during PEEP does not suppress the beneficial effects of PEEP on gas exchange, but induces a redistribution of pulmonary blood toward the main VA/Q ratio.

Acute Disease↗
PubMed1984

Lung mechanics in rachitic rats.

Lung mechanics was studied at 50 days of age in 7 rachitic rats born from mothers deprived of vitamin D. They were compared with 7 control rats raised in the same conditions but fed a diet supplemented with vitamin D. The animals were anesthetized, tracheotomized, and paralyzed. Quasi-static pressure-volume curves of the respiratory system and of the lungs were obtained. Body weight of the rachitic rats was within the range of the control rats, but dry lung weight (LW) was significantly lower (p less than 0.01). Lung volumes in absolute terms and when normalized for LW were significantly lower than in the control rats. Chest wall compliance (Ccw) of the rachitic rats was within the range of values of the control rats, except for 2 animals with an infinite Ccw. Analysis of the pressure-volume curves of the lungs of the rachitic rats compared with those in the control animals showed a significant decrease in lung compliance (CL) and in CL/LW (p less than 0.01), indicating a decrease in lung distensibility. The more severe the rickets (according to microradiographic criteria of the tibia), the lower the CL/LW. It is speculated that decrease in lung distensibility may be related to abnormal lung growth caused by disturbed alveolar formation and lung connective tissue development. These abnormalities could be due to vitamin D deficiency acting on the growing lung, as on the growing bones, by a mechanism involving proteoglycans.

Animals↗
PubMed1984

Total respiratory pressure-volume curves in the adult respiratory distress syndrome.

To assess the value of measuring compliance in the adult respiratory distress syndrome, sequential pressure-volume curves were obtained in 19 patients with this syndrome. Analysis of the pressure-volume curves allowed separation of the patients into the following four groups: (1) group 1 (n = 6), normal compliance measured during deflation, little hysteresis, and no inflection in the ascending limb of the pressure-volume tracing; (2) group 2 (n = 8), normal compliance during deflation, increased hysteresis, and presence of an inflection; (3) group 3 (n = 10), decreased compliance during deflation, marked hysteresis, and presence of an inflection; and (4) group 4 (n = 10), reduced compliance during deflation, no increased hysteresis, and no inflection. These patterns were correlated with the stage of the adult respiratory distress syndrome and to the pattern of the chest x-ray film. Group 2 corresponds to the initial stage of the syndrome and to pure alveolar opacities on the chest x-ray film. Group 3 is seen later in the course of the syndrome and corresponds to mixed alveolar and interstitial opacities. Group 4 corresponds to patients with end-stage adult respiratory distress syndrome (two weeks) and a predominant interstitial pattern on the chest x-ray film. Group 1 corresponds to a nearly normal chest x-ray film and to recovery.

Adolescent↗
PubMed1984

Computation of ventilation-perfusion ratio with Kr-81m in pulmonary embolism.

Diagnostic difficulties occur in pulmonary embolism (PE) during visual analysis of ventilation-perfusion images in matched defects or in chronic obstructive lung disease (COPD). In 44 patients with angiographically confirmed PE and in 40 patients with COPD, the regional ventilation-perfusion ratios (V/Q) were therefore computed using krypton-81m for each perfusion defect, and were displayed in a functional image. In patients with PE and mismatched defects, a high V/Q (1.96) was observed. A V/Q greater than 1.25 was also found in nine of 11 patients having PE and indeterminate studies (studies with perfusion abnormalities matched by radiographic abnormalities). COPD was characterized by matched defects and low V/Q. The percentage of patients correctly classified as having PE or COPD increased from 56% when considering the match or mismatched character to 88% when based on a V/Q of 1.25 in the region of the perfusion defect. This quantitative analysis, therefore, seems useful in classifying patients with scintigraphic suspicion of PE.

Adult↗
PubMed1983

Mechanical ventilation with superimposed high frequency oscillation in the normal rat.

The gas exchange efficacy of high frequency oscillations superimposed on conventional mechanical ventilation (CMV-HFO) was assessed in 24 normal rats. These animals were anesthetized, paralyzed, tracheotomized and placed in a body box in order to measure the magnitude of the CMV tidal volume and that of the superimposed oscillations. The frequency of oscillations was 20 Hz and the mechanical ventilator delivered a tidal volume of 5 ml/kg at a rate of 50 min-1 which corresponded to a slight alveolar hypoventilation. Four groups of animals were studied with two magnitudes of oscillation (0.75 and 1.25 ml/kg) and with two different volumes of instrumental dead space. Blood gases were measured during CMV-HFO and during CMV alone from blood samples taken from a carotid artery. There were no significant differences in arterial PCO2 during these two modes of ventilation except a decrease in the group with large amplitude oscillations and a small dead space in which the oscillations alone could ensure quasi-normal gas exchange. By contrast in 20 out of 24 animals there was a decrease of alveolar - arterial oxygen difference with CMV-HFO even in the case of small oscillations and a large dead space. These results suggest that VA/Q homogeneity is improved by interregional and/or intraregional redistribution of ventilation due to the high frequency oscillations superimposed on conventional mechanical ventilation.

Animals↗
PubMed1983

A new device for measurement of pulmonary pressure-volume curves in patients on mechanical ventilation.

Measurement of total (lung plus chest wall) pulmonary compliance is routinely obtained in mechanically ventilated patients by dividing the tidal volume (VT) by the airway pressure (Paw) gradient from end-inspiration to end-expiration. In order to obtain the pressure-volume (P-V) tracing during inspiration, we developed a method using a continuous and slow (1.7 L/min) oxygen inflow. When gas flow is kept constant, changes in lung volume are proportional to time and do not require direct measurement. In 22 patients, P-V curves traced using the continuous-flow method were identical to those obtained from the syringe method. The advantages of the inflow method are simplicity, reproducibility, and better visualization of the initial part of P-V curve.

Humans↗
PubMed1982

A comparative study of the cardiorespiratory effects of continuous positive airway pressure breathing and continuous positive pressure ventilation in acute respiratory failure.

Positive end expiratory pressure (PEEP) produces cardiopulmonary effects whether administered by controlled positive pressure ventilation (CPPV) or continuous positive airway pressure (CPAP). In eight patients with acute respiratory failure, the effects of 20 cm PEEP administered via CPPV and CPAP were compared. An esophageal balloon was used to calculate the transmural vascular pressures. The control values under mechanical ventilation with no PEEP (IPPV) for PaO2 and QS/QT (FiO2 being 1.0) were respectively 132 +/- 15 mmHg and 31 +/- 3%; CPPV gave a PaO2 of 369 +/- 27 mmHg and QS/QT fo 14 +/- 1.6%, CPAP 365 +/- 18 mmHg and 18 +/- 1.3% respectively. The two different modes of ventilation (CPPV and CPAP) gave identical blood gas improvement through the same level of end expiratory transpulmonary pressure despite marked differences between absolute mean airway and esophageal pressures. Conversely, hemodynamic tolerance was very different from one technique to the other: CPPV depressed cardiac index from 3.4 +/- 0.3 to 2.4 +/- 0.2 1/min/m2 as well as decreasing transmural filling pressures, suggesting a reduction in venous return. Conversely, filling pressures maintained at control values during CPAP and cardiac indexes were unchanged.

Acute Disease↗
PubMed1982

Role of surface tension and tissue in rat lung stress relaxation.

When the volume of the lung is maintained constant after an initial change of volume, stress relaxation (SR) occurs as a slow decay of transpulmonary pressure (PTP). In order to define which structure in the lung is responsible for SR a multiple exponential fitting of the PTP variation has been made. Excised rat lungs were placed in a fluid-filled box with trachea connected to atmosphere and submitted to stepwise changes of volume. Single volume steps (0.2 ml) were performed for lungs filled with either air or saline and the variations of PTP were monitored until steady state was reached. An exponential model (time constant = 6.5 +/- 0.4 (SD) and 92 +/- 6 s) described adequately the SR for air-filled lungs (n = 6) whereas only one exponential (time constant = 6.7 +/- 1.3 s) was required for saline-filled lungs. Multiple volume step experiments were also performed in air-filled lungs to obtain pressure volume loops. These hysteresis loops have been adequately simulated by use of the exponential model. It can be concluded that (1) lung tissue and air-liquid interface are both responsible for the SR with, respectively, short and long time constants and (2) the same relaxation function is able to describe both stress relaxation and static hysteresis in such experimental conditions.

Animals↗
PubMed1982

[Assessment of acute respiratory failure: shunt versus alveolar arterial oxygen difference].

Information provided by computation of shunt and alveolar arterial oxygen differences have been compared in 58 episodes of acute respiratory failure. In order to demonstrate the role of hemodynamic factors on pulmonary gas exchange, we compared blood gas measurements made in 29 patients with a high cardiac output and a reduced arteriovenous oxygen difference [C(a--v-)O2 less than 3.5 ml], with 33 measurements corresponding to a low cardiac output and a widened C(a--v-)O2 (greater than 6.5 ml). When the data was pooled together, the same P(A--a)O2 corresponded to many different shunt values, depending on the level of mixed venous oxygenation (PV-O2). QS/Qtot and P(A--a)O2 were quasi linearly correlated only when they corresponded to patients with the same C(a--v-)O2. For the same value of shunt, the PaO2 was always raised when the PV-O2 was raised. As far as pulmonary gas exchange is concerned, shunt calculation in acute respiratory failure is preferable to P(A--a)O2, especially when some hemodynamic disturbance is present.

Acute Disease↗
PubMed1982

Improved method in the computer determination of plethysmographic thoracic gas volume.

To improve the computer determination of thoracic gas volume (TGV), two new approaches were worked out. 1) A new program was designed, which overcomes the difficulties encountered in the time recognition of the panting maneuver and rules out the artifacts. Such a procedure is based on the data analysis in the pressure-volume time derivatives plane. 2) A hyperbolic fitting of the signals recorded during the panting maneuver was introduced. This last procedure, lying on Boyle's law, has proved to be useful in case of large mouth pressure changes. In fact the error induced by the conventional linear fitting may reach 500 ml (9% of the TGV value).

Computers↗