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Biomedical subjects

A Versprille

Publications and source records attributed to A Versprille.

At least 55 records · Page 3Linked to original sources
PubMed1990

Negative effect of insufflation on cardiac output and pulmonary blood volume.

In 14 anaesthetized young pigs the changes in pulmonary blood flow and pulmonary blood volume (Qp) during mechanical ventilation were quantified. Ventilation was performed at 10 cycles per min and tidal volume (VT) was adjusted to an arterial PCO2 of about 40 mmHg (5.3 kPa). In 4 animals, 7 ventilatory cycles with an inspiratory pause (IP) of 7.2 s but different tidal volumes were inserted at intervals of 5 min to determine the decrease in Qp (delta Qp) from the differences between right ventricular (Qs,rv) and left ventricular (Qs,lv) stroke volume, and to relate delta Qp to VT. We measured pressure in the aorta (Pao), central veins (Pcv), right and left ventricles (Prv, Plv) pericardium (Pit), and trachea (PT). Blood flow was measured electromagnetically (EM) in the pulmonary artery (Q'pa) and aorta (Q'ao). Stroke volumes were derived from the EM-flow curves. In the other 10 experiments, Qs,lv was derived from the aortic pulse contour. Beat-to-beat analyses of Qs,rv and Qs,lv and blood pressures during the normal ventilatory cycles and those with an IP revealed the following: 1) The end-expiratory RV output and LV output were constant and were defined as baseline values. 2) The accumulated decrease in Qs,rv during insufflation caused a mean deficit in cardiac output of 10.3 +/- 3.2% (s.d.), n = 135; the same was found for Qs,lv, indicating the pulse contour as a useful method to estimate the variations in cardiac output during a ventilatory cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

A computerized respiratory system including test functions of lung and circulation.

The design of a microcomputer-controlled ventilator for automatic performance of lung function and circulatory tests has been described. It incorporates the characteristics of normal mechanical ventilation and also allows one to perform a multitude of test procedures for lung function and circulatory studies in paralyzed animals. The major components of the setup are a pump assembly with solenoid valves to direct gas flow, an electromechanical servo system, and a MS-DOS microcomputer system. The pump assembly has been constructed as a relatively simple device. Great versatility is created by the use of a microcomputer for the control of the ventilator. The software can be easily adapted to several other types of experimental studies. Besides the keyboard input the ventilator can be controlled by a remote computer system. This allows one to run an experimental protocol automatically and to use it in closed-loop servo ventilation. The flexibility in the choice of the respiratory parameters makes the ventilator suitable for lung function and circulatory studies during artificial ventilation. The ventilator has been successfully used in different animal studies during the last 6 yr.

Animals↗
PubMed1988

Exercise responses in patients with an enzyme deficiency in the mitochondrial respiratory chain.

Responses to exercise were obtained in six patients with a biochemically diagnosed enzyme deficiency at the level of NADH-CoQ reductase. The responses were compared with those of a control group, consisting of fourteen patients with inexplicable dyspnoea or muscle pain during exercise, for which no firm diagnosis could be established and of which the exercise responses were in the normal range. Metabolic, ventilatory and cardiological variables such as oxygen uptake (VO2), minute ventilation (VE), respiratory exchange ratio (R), heart rate (HR) and difference in blood lactate or base-excess (BE) between rest and maximal workload were measured during cycle ergometry from samples obtained in the last minutes of four minute periods, in which the load increased stepwise by 30 W per four minutes. The threshold of lactate metabolism (Tlact) was assumed to be equal to the threshold determined both by the VO2 at which the VE versus VO2 response started to deviate from a straight line and the ventilatory equivalent for oxygen (VE/VO2) showed a minimum (Tvent), Tvent was estimated from the mean of these values, obtained by linear and parabolic regression analysis respectively. In the patient group, mean values for symptom limited maximal VO2 (VO2,max,sl; % of VO2,max,ref), Tvent (% of VO2,max,ref) and R at maximal workload were 43, 17 and 1.23 against 85, 47 and 1.06 for the same variables in the control group, respectively. The differences were highly significant (p less than 0.001; p less than 0.005 for mean R difference). Mean maximal HR and mean change in blood lactate or BE were not significantly different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Suppression of spontaneous breathing during high-frequency jet ventilation. Separate effects of lung volume and jet frequency.

The effect of ventilatory frequency of high-frequency jet ventilation (HFJV) from 1 to 5 Hz, apart from changes in thoracic volume, on spontaneous breathing activity was studied in Yorkshire piglets under pentobarbital anesthesia. The highest PaCO2 at which the animals did not breathe against the ventilator (apnea point) was established either by changing minute volume of ventilation or by adding CO2 to the respiratory gas. The higher the apnea point, the higher the suppression of spontaneous breathing activity was assumed to be. If the apnea point was searched for by changing minute volume a progressive increase of suppression of spontaneous respiratory activity was found at ventilatory rates of 3 Hz or more, concomitantly with a rise in end-expiratory pressure (PEE). In case the tidal volume was kept constant, increase of ventilatory rate resulted in a tremendous increase of lung volume, together with considerably higher levels of PEE. When under these conditions the apnea point was searched for by adding CO2 to the respiratory gas a much higher CO2-drive was needed for spontaneous breathing and therefore a much stronger inhibition of spontaneous breathing was concluded. By placing the animals in a body box in which pressure could be varied, thoracic volume could be kept constant during HFJV. When thoracic volume was kept constant in this way a constant tidal volume at increasing jet frequencies resulted in only a slight increase in suppression of spontaneous breathing. We conclude that the increase in lung volume is a major factor in suppressing central respiratory activity during HFJV. Jet frequency by itself might be an additional suppressive factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

A simple and accurate automated system for continuous long-term metabolic studies during artificial ventilation.

Energy expenditure and the amount of metabolised carbohydrate, protein and lipid can be calculated from the O2 consumption, CO2 production and nitrogen excretion using indirect calorimetry. A low-cost automatic system has been developed suitable for short- and long-term measurements during artificial ventilation, in which the gas analysers were calibrated automatically every 10 min and in which the desired variables were calculated and printed every 5 min. O2 and CO2 concentrations of mixed expired and inspiratory gas, the expired minute volume VE, and patient's rectal temperature, were sampled at regular time intervals and a simple programmable calculator with printer was used for the on-line data analysis. Tests on accuracy, stability, reproducibility and feasibility showed this system to be suitable for clinical application.

Autoanalysis↗
PubMed1987

Extrapolation of thermodilution curves obtained during a pause in artificial ventilation.

The feasibility of three mathematical models to extrapolate the tail of thermodilution curves, when flectures are present in the descending limb, was tested in anesthetized pigs. The models were a local random walk model (LDRW), a log-normal distribution, and a two-compartment model. First, the accuracy of the extrapolation of the tail by each model was tested on two undisturbed curves by taking the truncation at five different points on the descending limb. The extrapolated curve area obtained from each model was compared with total area of the undisturbed curve. Next, dilution curves obtained during inspiratory hold maneuvers and characterized by deflection points were analyzed, taking the truncation just before deflection. The estimates of cardiac output by the models were compared with electromagnetically measured flow in the pulmonary artery. The area of the dilution curve was estimated more accurately when more information on the descending limb was available. The LDRW model and the log-normal distribution were superior to the two-compartment model regarding accuracy of cardiac output estimation and root-mean-square errors of the fit. Both models estimated curve area with an error less than 5% when truncation of the descending limb occurred below 60% of the peak value. In circumstances of mechanical ventilation, where only short periods of constant flow will be present, analyses of dilution curves based on the LDRW model or the log-normal distribution are recommended.

Animals↗
PubMed1987

Maximal expiratory and inspiratory flow-volume curves in bilateral vocal-cord paralysis. Changes after surgical treatment and comparison with glottic resistance characteristics.

The maximal expiratory flow-volume (MEFV) and maximal inspiratory flow-volume (MIFV) curve present maximal attainable flows, plotted against the displaced volume at the mouth during a forced expiratory manoeuvre from total lung capacity (TLC) and a subsequent forced inspiratory manoeuvre from residual volume (RV), respectively. Depending on the glottic resistance characteristics, the usual flow limitation may be absent during forced expiration, drastically influencing the form of MEFV curves. During forced inspiration however, the flow remains effort-dependent. We tested this hypothesis by comparing the form of MEFV and MIFV curves, and the glottic resistance characteristics, before and after an endolaryngeal superolateralization of a vocal cord, in 12 patients with bilateral vocal-cord paralysis. Peak expiratory and inspiratory flows were estimated with the aid of the measured glottic resistance characteristics on the assumption that the maximal alveolar pressures were normal during the manoeuvres. The estimated values agreed well with measured values. The form of the MEFV and MIFV curves was also found to be closely linked to the glottic resistance characteristics. It is concluded that the MEFV and MIFV curves are sensitive indicators of flow limitation in patients with upper-airway obstructions.

Adult↗
PubMed1987

Flow limitation in upper-airway obstruction. Theoretical analysis.

During a maximal forced expiration from total lung capacity (TLC) in normal human subjects flow limitation will occur (i.e., the flow will become independent of muscular effort) after the initial part of the expiratory manoeuvre. Flow limitation starts at the flow that causes a pressure drop in the bronchial tree large enough for the generation of a flow-limiting segment. In patients with upper-airway obstruction such as laryngeal obstruction or tracheal stenosis, the upper-airway resistance may keep the flow so low that flow limitation cannot arise. The present theoretical study confirms that glottic resistance does not prevent flow limitation from arising in normal human subjects. On the other hand, the mean glottic resistance characteristics measured for 19 patients with bilateral vocal-cord paralysis were found to be such as to prevent flow limitation. This means that in such patients and also in patients with other types of upper-airway obstruction flow may remain effort-dependent throughout the forced expiratory manoeuvre or in any case during much more of this manoeuvre than normal.

Airway Resistance↗
PubMed1986

Improvement of cardiac output estimation by the thermodilution method during mechanical ventilation.

The reliability of cardiac output estimation by thermodilution during artificial ventilation was studied in anesthetized pigs at the right side of the heart. The estimates exhibited a cyclic modulation related to the ventilation. The amplitude of the modulation was independent of the level of positive end-expiratory pressure, ventilatory pattern and volemic loading of the animals. However, a non-constant phase relation existed between the ventilatory cycle and the modulation. Single observations at a fixed moment in the ventilatory cycle are therefore not appropriate for estimation of mean cardiac output nor for studying its relative changes. The averaging of estimates spread equally over the ventilatory cycle led to a much larger reduction in the deviation of the averages from the mean cardiac output than an averaging procedure of randomly selected estimates. The accuracy of estimation of mean cardiac output by two estimates equally spread in the ventilatory cycle was equal to the accuracy obtained by averaging five randomly selected estimates. Averaging four estimates, equally spread in the cycle, appeared to be the optimal procedure. For 89% of all averages an accuracy of 5% around the mean was obtained and for 99% an accuracy of +/- 10%.

Anesthesia, General↗
PubMed1986

Suppression of spontaneous breathing during high-frequency jet ventilation. Influence of dynamic changes and static levels of lung stretch.

Conditions which suppress spontaneous breathing activity during high-frequency jet ventilation (HFJV) were analysed in Yorkshire piglets under pentobarbital anesthesia. The highest PaCO2 at which the animals did not breathe against the ventilator (apnea point) was established during different patterns of ventilation, either by changing the minute volume or by adding CO2 to the inspiratory gas. Arterial oxygen tension was maintained throughout the study above 80 mm Hg. An elevation of ventilatory rate increased the apnea point, suggesting a progressive suppression of spontaneous breathing. This suppression did not depend on the amount of lung stretch during insufflation, because at higher rates lower tidal volumes were used. Suppression also appeared to be independent of insufflatory flow, i.e. the velocity of lung stretch. At higher frequencies end-expiratory airway pressure (PEE) increased and there appeared to be a positive relationship between the apnea point and PEE. In a separate series this positive relationship between the apnea point and PEE was confirmed. A hysteresis effect in this relationship, however, suggests that other than jet frequency, lung volume rather than positive end-expiratory pressure (PEEP) is a major determinant of suppression of spontaneous breathing activity during HFJV.

Animals↗
PubMed1986

Random walk type models for indicator-dilution studies: comparison of a local density random walk and a first passage times distribution.

The relative merits of the local density random walk and the first passage times distributions were compared with respect to their practical applicability in cardiovascular research and clinical practice. Open indicator-dilution curves of varying shape were used, and reference values for area and mean transit times were calculated numerically. Curves not perturbed by recirculation were obtained in two different ways. Thermodilution curves were obtained in an animal model at the left and the right side of the heart respectively and conductivity curves with 0.5% NaCl solution as indicator were obtained in a hydrodynamic circulation model. The fits of the two types of distribution were equally accurate for the more symmetrical curves; for very skewed curves the local density random walk fit proved to be more accurate. This result could be related to the greater difference in shape between the first passage times and local density random walk distribution for a large degree of asymmetry. For this reason the local density random walk distribution for fitting indicator-dilution curves was used in a variety of other experimental conditions.

Animals↗
PubMed1986

A simplified procedure for exponential fitting of pressure-volume curves of normal and diseased lungs.

Exponential fitting of mammalian pressure-volume curves requires least squares approaches, using computer facilities. We have developed a simplified fit procedure which can be performed by hand or by a small pocket calculator. First the asymptotic value of the volume axis, Vm, is estimated from a series of volume data at equal pressure-intervals. Subsequently, the 'pressure constant' (comparable with a time constant) and the intersection of the curve with the pressure axis (Po) are determined graphically. A comparison of the fit parameters with those obtained from a non-linear least squares procedure, performed on a medium-size computer, yielded an accuracy sufficient for practical purposes. We conclude that the simplified fit procedure may be a valuable tool for a quick and accurate interpretation of mammalian pressure-volume curves in pulmonary function routine.

Biometry↗
PubMed1985

Mean systemic filling pressure as a characteristic pressure for venous return.

Guyton's theory on venous return, implying a linear relationship between blood flow and central venous pressure, was tested in an intact circulation after thoracotomy and airtight chest closure. In eleven Yorkshire pigs (approx. 10 kg) we measured flow in the pulmonary artery and aorta and pressure in the central veins and aorta during pentobarbital anesthesia and mechanical ventilation. To change central venous pressure different lung volumes were randomly applied at intervals of 5 min in a series of inspiratory hold procedures of 7.2 s. During these short periods hemodynamic steady state circumstances were met without involvement of cardiovascular control mechanisms. We confirmed the linear relationship between venous return and central venous pressure and derived mean systemic filling pressure from the regression equation. Mean systemic filling pressure was on average 10.5 +/- 2.3 (SD) mm Hg. The time dependent changes during the inspiratory hold procedure showed that the increase in central venous pressure was the primarily dependent variable, followed by a decrease in venous return and right ventricular output. After a delay of 2-4 heart beats also a decrease in left ventricular output and aortic pressure occurred. Subsequently, the lower venous return during inspiratory hold was mainly sustained by the lower aortic pressure, but nevertheless fulfilled the linear relationship mentioned above. For analysis of flow and pressure changes in the systemic circulation during changes of central venous pressure a tube of constant flow resistance was used as a conceptual mode.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗