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Biomedical subjects

B Jonson

Publications and source records attributed to B Jonson.

At least 91 records · Page 5Linked to original sources
PubMed1989

Measurement of ventilation and respiratory mechanics during continuous positive airway pressure (CPAP) treatment in infants.

A new method has been evaluated for measuring ventilation and lung mechanics in spontaneously breathing infants by means of a face chamber. Airway flow is measured with a pneumotachograph inserted between the face chamber and a stable pressure source. Oesophageal pressure is measured via a water-filled oesophageal catheter. The method is suitable for use in conjunction with continuous positive airway pressure (CPAP) treatment in neonatal intensive care. A flat frequency response curve up to 15 Hz for the two measuring systems (i.e., airway flow and oesophageal pressure), and a time shift between the two respective signals of less than 2 msec are prerequisites for correct evaluation of respiratory mechanics. In preterm infants with chest distortion, the inhomogeneity of pleural pressure affects the significance of resistance and compliance values, as calculated from oesophageal pressure. Supra-diaphragmatic pressure variations reflect the resistive and elastic load on the diaphragm exerted by the lungs and thorax. Thus, oesophageal pressure is still useful in studies of respiratory mechanics in preterm infants.

Apnea↗
PubMed1989

Lung function eight years after neonatal ventilation.

Forty children who had had artificial ventilation during the neonatal period were studied at the age of 8-10 years with spirometry, the nitrogen washout test, bicycle exercise test, pulse oximetry, electrocardiogram, vectorcardiogram, and chest radiography. The median gestational age at birth was 29 weeks, and the median birth weight was 1310 g. Hyaline membrane disease was the indication for neonatal ventilation in 25 children. Bronchopulmonary dysplasia was diagnosed from radiographs in 11 infants (27%). Airway obstruction was observed in 10 of 11 children who had had bronchopulmonary dysplasia and in nine of 29 children who had not. After inhalation of terbutaline, the forced expiratory volume in one second (FEV1) was significantly increased. General hyperinflation was found in 16 of 17 children with abnormal chest radiographs (eight who had had bronchopulmonary dysplasia and nine who had not). Functional residual capacity was significantly higher in children with abnormal radiographs. Each child had a normal maximum working capacity and a normal electrocardiogram, and all but two had normal vectorcardiograms. Oxygen saturation at maximum work load decreased significantly in both groups of children. The risk of future respiratory problems calls for further follow up of lung function and chest radiography.

Electrocardiography↗
PubMed1989

Viscoelastic behavior of lung and chest wall in dogs determined by flow interruption.

Pulmonary and chest wall mechanics were studied in six anesthetized paralyzed dogs, by use of the technique of rapid airway occlusion during constant flow inflation. Analysis of the pressure changes after flow interruption allowed us to partition the overall resistance of the lung (Rl) and chest wall (Rw) and total respiratory system (Rrs) into two components, one (Rinit) reflecting in the lung airway resistance (Raw), the other (delta R) reflecting primarily the viscoelastic properties of the pulmonary and chest wall tissues. The effects of varying inspiratory flow and inflation volume were interpreted in terms of frequency dependence of resistance, by using a spring-and-dashpot model previously proposed and substantiated by Bates et al. (Proc. 9th Annu. Conf. IEEE Med. Biol. Soc., 1987, vol. 3, p. 1802-1803). We observed that 1) Raw and Rw,init were nearly equal and small relative to Rl and Rw (both were unaffected by flow); 2) Rrs,init decreased slightly with increasing volume; 3) both delta Rl and delta Rw decreased with increasing flow and increased with increasing lung volume. These changes were manifestations of frequency dependence of delta R, as it is predicted by the model; 4) Rrs, Rl, and Rw followed the same trends as delta R. These results corroborate data previously reported in the literature with the use of different techniques to measure airways and pulmonary tissue resistances and confirm that the use of Rl to assess bronchial reactivity is problematic. The interrupter techniques provides a convenient way to obtain Raw values, as well as analogs of lung and chest wall tissue resistances in intact dogs.

Airway Resistance↗
PubMed1989

Diagnosis of pulmonary embolism based upon alveolar dead space analysis.

Pulmonary embolism (PE) leads to an abnormal alveolar deadspace that is expired in synchrony with gas from normally perfused alveoli. This feature of PE separates it from pulmonary diseases affecting the airways, which are characterized by nonsynchronous emptying of compartments with an uneven ventilation/perfusion relationship. An analysis of the single breath test (SBT) for CO2, SBT-CO2, focusing on the late tidal expirate, was made in order to evaluate the feasibility to use the SBT-CO2 for the diagnosis of PE. The test was evaluated in 38 patients with suspected PE where pulmonary angiography showed that nine had PE and 29 did not. It was also tested in a reference population consisting of patients with normal lung function, obstructive lung disease and interstitial lung disease. Previously suggested gas exchange measurements for the diagnosis of PE, ie, the physiologic deadspace fraction, VDphys/VT, and the arterial-to-end-tidal CO2 gradient, P(a-E')CO2, were also evaluated in the groups. SBT-CO2 achieved a nearly complete separation between the patients with PE and those without. The other measurements, however, showed a substantial overlap between patients with PE and those with obstructive or interstitial lung disease. The SBT-CO2 is simple and potentially widely available and warrants further study as a routine technique for the diagnosis of PE.

Angiography↗
PubMed1989

Lung mechanics and their relationship to lung volumes in pulmonary sarcoidosis.

Pulmonary sarcoidosis was studied with respect to lung mechanical properties and to the influence of these on lung volumes. Sixty-six patients, with histological support for the diagnosis of sarcoidosis, and radiological signs of pulmonary involvement, i.e., stage II or III, were studied. The static pressure/volume (P/V) curves showed that the static elastic recoil pressure (PelL) tended to be increased at a given percentage of predicted total lung capacity (TLC). Reduction of static lung compliance (CstL) was a typical finding. At maximal inspiration PelL was abnormally low in 20 subjects, including in the main those with recent onset of the disease and older patients. The possibility of a greater inflammatory activity at the site of mechanical receptors in the lungs and airways of these patients is proposed. Pulmonary resistance, measured at a given PelL, was usually increased signifying bronchial involvement. TLC, residual volume (RV) and functional residual capacity (FRC) were lower in current smokers and ex-smokers than in lifelong nonsmokers. This may be due to synergistic effects of the inflammatory processes caused by smoking and sarcoidosis. A reduced vital capacity (VC) mainly reflected a low CstL but also obstruction with increased RV. Forced expiratory volume in one second (FEV1) reflected lung stiffness and obstruction equally. Lung mechanics revealed functional abnormalities which were not obvious from the standard tests, particularly in patients with respiratory symptoms.

Adult↗
PubMed1988

Effects on respiration of CPAP immediately after extubation in the very preterm infant.

The effects of continuous positive airway pressure (CPAP) on pulmonary function during weaning from ventilator treatment were examined immediately after extubation in 17 very preterm infants, who had been ventilator-treated because of hyaline membrane disease (15 infants) and chronic pulmonary insufficiency of prematurity (two infants). Seven infants had bronchopulmonary dysplasia. Median birthweight was 920 g and median gestational age 26 completed weeks. The median duration of ventilator treatment was 10 days. Application of CPAP by means of a face chamber device after endotracheal extubation significantly lowered the frequency of apnea (P = 0.02) and enhanced oxygenation (P = 0.001). The respiratory mechanical indices derived from flow rate and juxta-diaphragmatic esophageal pressure measurements showed a reduced elastic (P = 0.03) and resistive (P = 0.02) load on the diaphragm. Even if the measured values do not accurately represent absolute resistances and compliances, the relative values of end-inspiratory and end-expiratory pressures differed significantly with and without CPAP (P = 0.001 and 0.002, respectively). We found CPAP applied via the face chamber technique immediately after extubation to be beneficial and to facilitate weaning from ventilator treatment in very preterm infants.

Female↗
PubMed1988

Pulmonary clearance of inhaled 99mTc-DTPA: effect of the detergent dioctyl sodium sulfosuccinate in aerosol.

The influence of the detergent dioctyl sodium sulfosuccinate on clearance from the lungs of inhaled technetium-99m-labelled dietylenetriamine pentaacetate (99mTc-DTPA) was studied in twelve rabbits. An aerosol of dioctyl sodium sulfosuccinate or its vehicle alone was administered for 5 min prior to aerosolized 99mTc-DTPA via a bag-in-bottle system. Time-activity curves were obtained from the right lung with a gamma camera. In rabbits given detergent, clearance of 99mTc-DTPA was significantly faster than in rabbits given vehicle alone. No changes were seen in arterial PO2 and compliance. Our data indicates that the transfer of 99mTc-DTPA from alveoli to blood can be accelerated by administration of the detergent dioctyl sodium sulfosuccinate without any dramatic change in surface tension. Clearance of 99mTc-DTPA may be a very sensitive indicator of altered surfactant function.

Administration, Inhalation↗
PubMed1988

Nocturnal asthma: effects of slow-release terbutaline on spirometry and arterial blood-gases.

The effect of terbutaline, in a slow-release preparation, on spirometry and arterial blood-gases, was studied in fourteen patients with nocturnal asthma. The patients were treated with either 15 mg of slow-release terbutaline or placebo given as a single dose at 10 pm for eight days in a double-blind crossover trial. The patients were studied in the hospital for one night at the end of each treatment period. During active treatment the patients had a significantly higher FEV1 and PaO2 compared with placebo. Tolerance to the high single dose was good and none of the patients discontinued treatment because of side-effects. In patients with nocturnal asthma treatment with a high dose of slow-release terbutaline given as a single dose in the evening appears to be effective.

Asthma↗
PubMed1987

Measurement of lung volume by sulfur hexafluoride washout during spontaneous and controlled ventilation: further development of a method.

An open circuit tracer gas washout method for measurement of lung volume in patients during anesthesia and intensive care is described and tested. The method employs a device for dispensing the tracer gas, sulfur hexafluoride (SF6), a fast SF6 analyzer, a pneumotachograph, and a computer. The dispensing device delivers SF6 into the airway in proportion to instantaneous inspiratory flow so that inspiratory SF6 concentration is held constant, usually at about 0.5%, regardless of the inspiratory flow pattern. The amount of SF6 present in the lungs at the end of a washin is calculated during washout from signals representing expired SF6 concentration and expired flow. From this, lung volume is derived. Accurate and reproducible results were obtained in lung model tests during ventilation with air, N2O in O2, and halothane in O2. Functional residual capacity (FRC) was measured both with SF6 washout and nitrogen washout in five mechanically ventilated patients. This gave the regression equation: FRCSF6 = 10 ml + 1.04 x FRCN2, r = 0.99. A similar close agreement was observed for total lung capacity (TLC) and residual volume (RV) measurements in eight healthy, spontaneously breathing subjects: TLCSF6 = 91 ml + 1.01 x TLCN2, r = 0.99; RVSF6 = -32 ml + 0.97 x RVN2, r = 0.95. Comparison with body plethysmography in eight healthy, sitting subjects gave the regression equation: FRCSF6 = 180 ml + 0.96 x FRCbox, r = 0.99. The median (range) for the coefficient of variation at duplicate determinations in 10 anesthetized, paralyzed, and mechanically ventilated adults was 3.0% (0.2-6.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Endotracheal administration of surfactant in very low birth weight infants with respiratory distress syndrome.

This study was designed to evaluate whether the ventilatory maneuvers associated with surfactant replacement would, per se, influence oxygenation in newborn infants with severe respiratory distress syndrome. Eight patients (700 to 1400 g), all requiring mechanical ventilation with fraction of inspired oxygen greater than 0.6, were included in the trial; four were randomized to receive surfactant, and the others served as controls. Porcine surfactant (2 ml/kg; phospholipid concentration, 100 mg/ml) was instilled via a naso-endotracheal tube at end-expiration and dispersed into the lungs during a period of standardized "sighing" mediated by the ventilator: two prolonged ventilatory cycles (10 sec each) with an inspiration/expiration ratio of 4:1, followed by a 6-min ventilation with a frequency of 60 breath/min and an inspiration/expiration ratio of 4:1. Control babies received no surfactant but were otherwise subjected to the same ventilatory maneuvers. Surfactant-treated infants showed a rapid increase in transcutaneous oxygen associated with improved lung aeration in chest x-rays; the response was transient in three babies and persistent in one. No improvement was observed in control babies. We conclude that the beneficial effect of surfactant replacement cannot be attributed to the ventilatory maneuvers associated with the instillation procedure.

Critical Care↗
PubMed1987

Sex- and age-related normal limits for the QRS complex in vectorcardiography.

In order to provide reference values for vectorcardiography (VCG), which are relevant with regard to sex, age and available computer technology. VCG from a normal material were studied. VCG according to Frank were recorded in 159 men and 193 women, healthy and randomly selected from a defined caucasian urban population. The technique used includes noise reduction by averaging and a spatial algorithm for QRS delineation. The results are given separately for men and women and for young and old subjects. Significant differences between these groups were found to be common and of potential importance for interpretation of VCG. Discrepancies between our results and other reports on normal ranges can be explained by both different techniques used and different composition of the material studied. On the basis of our data normal limits for a number of measurements, commonly used in diagnostic criteria for myocardial infarction and ventricular hypertrophy are reported.

Adult↗
PubMed1987

Long-term effects of physical exercise on working capacity and pulmonary function in cystic fibrosis.

Seven patients with cystic fibrosis aged 6 to 20 were enrolled for 30 months in a daily exercise program. After 12 months conventional chest physiotherapy was withdrawn. Patients with low initial Shwachman scores improved as regards maximal working capacity. Spirometric data and volume of trapped gas indicated opening of closed airways. We suggest that physical exercise in general should be the basis of pulmonary therapy in cystic fibrosis. Other forms of physiotherapy are advisable when hard physical exercise is not feasible.

Adolescent↗
PubMed1987

Relation between lung function, exercise capacity, and exposure to asbestos cement.

A group of 137 male workers with known exposure (mean 20 fibre years per millilitre) to asbestos cement who had symptoms or signs of pulmonary disease was studied together with a reference group of 49 healthy industrial workers with no exposure to asbestos. Lung function measurements were made at rest and during exercise. Evidence of lung fibrosis was found as well as of obstructive airways disease in the exposed group compared with the reference group. Asbestos cement exposure was related to variables reflecting lung fibrosis but not to variables reflecting airflow obstruction. Smoking was related to variables reflecting obstructive lung disease. Exercise capacity was reduced in the exposed workers and was related to smoking and to lung function variables, reflecting obstructive airways disease. There was no significant correlation between exercise capacity and exposure to asbestos cement.

Asbestos↗
PubMed1987

Pulmonary clearance of inhaled 99mTc-DTPA: effects of surfactant depletion by lung lavage.

The influence of surfactant depletion on clearance from the lungs of inhaled technetium-99m-labeled diethylenetriamine pentaacetate (99mTc-DTPA) was studied in rabbits. Surfactant was removed by repeated lung lavage with isotone saline. To minimize structural damage to the lungs, pressure generated insufflation with short expiration was utilized. Aerosolized 99mTc-DTPA was administered via a bag-in-bottle system. Radioactivity was measured with a gamma camera and time-activity curves were obtained over the base of the right lung. Six nonlavaged rabbits served as controls. In six lavaged rabbits clearance of 99mTc-DTPA was significantly faster than in controls. In three rabbits given natural surfactant into the trachea after lung lavage, 99mTc-DTPA was eliminated faster than in controls but slower than in surfactant-depleted animals. The results indicate a role of surfactant on clearance rate of 99mTc-DTPA from rabbit lungs. Measurements of 99mTc-DTPA clearance may be useful in studying the function of the surfactant system in different lung disorders.

Aerosols↗
PubMed1987

Measurement of lung density by x-ray computed tomography. Relation to lung mechanics in workers exposed to asbestos cement.

We measured lung density by means of x-ray computed tomography and lung mechanics in 33 workers exposed to asbestos cement and in 39 normal subjects. The exposed group showed evidence of lung fibrosis with reduced static lung volumes and lung compliance, although only three subjects had signs of interstitial fibrosis at standard chest radiography. Lung density was significantly increased in the exposed workers compared to control subjects, with greater differences between nonsmokers than between smokers. Lung density correlated inversely with static lung volumes. There was no appreciable difference in the regional distribution of lung density between exposed workers and control subjects. We conclude that lung density is often increased in workers with mild asbestosis, even in the presence of a normal chest radiograph. Measurement of lung density may be of value in the evaluation of asbestos-exposed workers for assessment of the extent of parenchymal disease.

Asbestosis↗
PubMed1987

Quantification of regional ventilation in humans using a short-lived radiotracer--theoretical evaluation of the steady-state model.

The accuracy of the steady-state measurement of ventilation by means of a short-lived insoluble inert gas tracer rests with the validity of the steady-state flow equation. This has previously been applied to the qualitative assessment of regional ventilation using krypton-81m, but may potentially be used for the calculation of regional alveolar ventilation per unit alveolar gas volume--(VA/VA)cal--from measurements of the alveolar concentration of the tracer. The steady-state alveolar tracer concentration was calculated for the course of a breathing cycle, using a lung model featuring airways dead space and tidal gas flow. The calculations were made by computer simulations of a lung, characterized by predefined values of parameters describing the lung structure and the mode of ventilation. In the normal lung of supine man at rest (specific alveolar ventilation, ranging from 1.0 to 3.5 min-1) the errors of (VA/VA)cal relative to the predefined true values range from an overestimation by some 3% in the low ventilation regions to an underestimation by 8% in the best ventilated regions. The errors mainly result from ventilation of the airways dead space, which will influence the distribution of tracer in the lung by the transfer of tracer between regions by way of the common dead space and by the decay of tracer during its transport through the bronchial tree.

Humans↗