Biomedical subjects

Abraham Noordergraaf

Publications and source records attributed to Abraham Noordergraaf.

6 recordsLinked to original sources

PubMed2006

The quality of chest compressions by trained personnel: the effect of feedback, via the CPREzy, in a randomized controlled trial using a manikin model.

Even after training, the ability to perform effective cardiac compressions has been found to be poor and to decrease rapidly. We assessed this ability with and without a non-invasive feedback device, the CPREzy, during a 270s CPR session in an unannounced, single-blinded manikin study using 224 hospital employees and staff chosen at random and using a non-cross over design. The two groups self-assessed their knowledge and skills as adequate. However, the control group (N=111) had significantly more difficulty in delivering chest compressions deeper than 4 cm (25 versus 1 candidate in the CPREzy group), P=0.0001. The control group compressed ineffectively in 36% (+/-41%) of all compressions as opposed to 6+/-13% in the CPREzy group (N=112, P=0.0001). If compressions were effective initially, the time until >50% of compressions were less than 4 cm deep was 75+/-81s in the control group versus 194+/-87 s in the CPREzy group (P=0.0001 [-180 to -57.5]). After a few seconds of training in its use, our candidates used the CPREzy effectively. Against the background knowledge that estimation of compression depth by the rescuer or other team members is difficult, and that performing effective compressions is the cornerstone of any resuscitation attempt, our data suggests that a feedback device such as the CPREzy should be used consistently during resuscitation.

Adult↗

PubMed2006

Resolving the hemodynamic inverse problem.

The "hemodynamic inverse problem" is the determination of arterial system properties from pressures and flows measured at the entrance of an arterial system. Conventionally, investigators fit reduced arterial system models to data, and the resulting model parameters represent putative arterial properties. However, no unique solution to the inverse problem exists-an infinite number of arterial system topologies result in the same input impedance (Zin) and, therefore, the same pressure and flow. Nevertheless, there are exceptions to this theoretical limitation; total peripheral resistance (Rtot), total arterial compliance (Ctot), and characteristic impedance (ZO) can be uniquely determined from input pressure and flow. Zin is determined completely by Ctot and Rtot at low frequencies, Zo at high frequencies, and arterial topology and reflection effects at intermediate frequencies. We present a novel method to determine the relative contribution of Zo, Ctot, Rtot and arterial topology/reflection to Zin without assuming a particular reduced model. This method is tested with a large-scale distributed model of the arterial system, and is applied to illustrative cases of measured pressure and flow. This work, thus, lays the theoretical foundation for determining the arterial properties responsible for increased pulse pressure with age and various arterial system pathologies.

Animals↗

PubMed2005

The arterial system pressure-volume loop.

Although the ventricular P-V loop has become a popular tool to characterize aspects of the performance of the heart, an arterial system P-V loop has not yet been described. In principle, the volume stored in the arterial system (V) could be calculated by integrating the difference between inflow and outflow. In practice, however, flow out of the innumerable arterioles cannot be measured directly. To overcome this obstacle, it has been shown that outflow can be approximated by input pressure divided by total peripheral resistance. Recently, the classical Windkessel model was generalized with the concept of apparent arterial compliance (C(app)), the transfer function relating pressure and volume expressed in the frequency domain. The arterial system P-V loop serves as a time-domain representation of C(app). This simple technique provides the first known characterization of an arterial system P-V loop.

Animals↗

PubMed2004

Efficacy and safety in patients on a resuscitator, Oxylator EM-100, in comparison with a bag-valve device.

The purpose of this study was to compare the Oxylator EM-100, a ventilator with a fixed flow and working pressure of 25 to 50 cm H(2)O, with a bag-valve device with respect to safety, efficiency, and efficacy when used by professionals. We conducted a prospective, controlled, caregiver-blind single center study. Induction was followed by ventilation with a bag-valve device oxylator in manual and automatic modes. Steps were repeated under hypnosis, after muscle relaxation with mask, and with an endotracheal tube. Forty patients, aged 48.8 +/- 13.5 years weighing 50 to 111 kg were studied. Airway management was consistently better with the bag-valve (P <.0001). Normocapnia was maintained with the bag-valve in 88%, oxylator (manual) in 73%, but only 14% of cases in automatic mode with tidal volumes of 1200 mL and more. This device was associated with the potential for rapid hyperventilation in patients when used by professionals. Simplicity of airway management was not improved.

Adult↗

PubMed2002

Arterial pulse wave reflection as feedback.

Traditionally, input impedance (Z(in)) has been used to characterize the global dynamic properties of an arterial system independent of properties of the heart. Defined as the relationship of pressure and flow at the entrance of an arterial system, it describes the ability of an arterial system to dynamically impede blood flow. Recently, a new description has been developed that also characterizes the arterial system independent of properties of the heart. Apparent arterial compliance (C(app)) is defined as the dynamic relationship of input pressure and volume stored in an arterial system, and describes the ability of the arterial system to dynamically store blood. Both Z(in) and C(app) are influenced by pulse wave propagation and reflection. However, the functional form of Capp lends itself to describing the arterial system in terms of negative feedback. Pulse wave reflection decreases the pulsatile volume stored (gain) at low frequencies, but increases the range of frequencies (bandwidth) in which the pulsatile volume is determined by total arterial compliance. This paper illustrates, by simple analytical formula, large-scale arterial system modeling, and direct analysis of data, how this conceptualization of reflection offers a new means to interpret changes in arterial system dynamics resulting from changes in arterial compliance.

Animals↗

PubMed2002

A paradigm for quantifying ventricular contraction.

The left ventricle may be described as a time, volume and flow dependent pressure generator. First, isovolumic pressure is measured at various end-diastolic volumes. Next, pressure is adjusted to account for small changes accompanying ejection, denoted the ejection effect. The resulting analytical function can describe pressure generation and ventricular outflow of the ventricle under a wide range of contractile and vascular conditions. This paradigm is unique in separating isovolumic from ejecting ventricular properties, as well as ventricular from vascular conditions.

Humans↗