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Biomedical subjects

D M Eckmann

Publications and source records attributed to D M Eckmann.

15 recordsLinked to original sources
PubMed2001

Cerebral gas embolism absorption during hyperbaric therapy: theory.

Cerebral gas embolism is a serious consequence of diving. It is associated with decompression sickness and is assumed to cause severe neurological dysfunction. A mathematical model previously developed to calculate embolism absorption time based on in vivo bubble geometry is used in which various conditions of hyperbaric therapy are considered. Effects of varying external pressure and inert gas concentrations in the breathing mixtures, according to US Navy and Royal Navy diving treatment tables, are predicted. Recompression alone is calculated to reduce absorption times of a 50-nl bubble by up to 98% over the untreated case. Lowering the inhaled inert gas concentration from 67.5% to 50% reduces absorption time by 37% at a given pressure. Bubbles formed after diving and decompression with He are calculated to absorb up to 73% faster than bubbles created after diving and decompression with air, regardless of the recompression gas breathed. This model is a useful alternative to impractical clinical trials in assessing which initial step in hyperbaric therapy is most effective in eliminating cerebral gas embolisms should they occur.

Absorption↗
PubMed2000

Gas embolism.

Explore the source record for details and available documents.

Biomechanical Phenomena↗
PubMed2000

Transtracheal oxygen delivery.

Tracheal insufflation of oxygen has at least three major uses for chronic oxygen supplementation through a percutaneous catheter, it is an adjunctive measure to enhance gas exchange during mechanical ventilation, and it provides an emergency therapy for oxygen delivery with upper airway obstruction. In this article the mechanisms of gas exchange and techniques of oxygen delivery are described for each of these major uses.

Airway Obstruction↗
PubMed2000

Hematocrit, volume expander, temperature, and shear rate effects on blood viscosity.

UNLABELLED: Our goal was to determine and predict the effects of temperature, shear rate, hematocrit, and different volume expanders on blood viscosity in conditions mimicking deep hypothermia for cardiac operations. Blood was obtained from six healthy adults. Dilutions were prepared to hematocrits of 35%, 30%, 22.5%, and 15% using plasma, 0.9% NaCl, 5% human albumin, and 6% hydroxyethyl starch. Viscosity was measured over a range of shear rates (4.5-450 s(-1)) and temperature (0 degrees -37 degrees C). A parametric expression for predicting blood viscosity based on the study variables was developed, and its agreement with measured values tested. Viscosity was higher at low shear rates and low temperatures, especially at temperatures less than 15 degrees C (P: < 0.016 for all conditions in comparison with 37 degrees C). Decreasing hematocrit, especially to less than 22.5%, decreased viscosity. Hemodilution with albumin or 0.9% NaCl decreased blood viscosity more than hemodilution with plasma or 6% hydroxyethyl starch (P: < 0.01 for all cases). The derived mathematical model for viscosity as a function of temperature, hematocrit, shear rate, and diluent predicted viscosity values that correlated well with the measured values in experimental samples (r(2) > 0.92, P: < 0.001). IMPLICATIONS: A theoretical model for blood viscosity predicted independent effects of temperature, shear rate, and hemodilution on viscosity over a wide range of physiologic conditions, including thermal extremes of deep hypothermia in an experimental setting. Moderate hemodilution to a hematocrit of 22% decreased blood viscosity by 30%-50% at a blood temperature of 15 degrees C, suggesting the potential to improve microcirculatory perfusion during deep hypothermia.

Adult↗
PubMed2000

Ventilatory support by tracheal gas insufflation and chest vibration during bronchoconstriction.

OBJECTIVE: To determine whether chest wall vibration with tracheal gas insufflation during bronchoconstriction maintains gas exchange at lower airway and intrathoracic pressures than those that occur during positive pressure ventilation. DESIGN: Prospective study. SETTING: Experimental laboratory. SUBJECTS: Six anesthetized, paralyzed mongrel dogs (mean weight, 24.7+/-3.8 kg). INTERVENTIONS: Dogs were ventilated by two methods: mechanical ventilation (7 breaths/min, 25 mL/kg tidal volume); and tracheal oxygen insufflation at 0.15 L x kg(-1) x min(-1) delivered with external chest wall vibration (29 Hz, 2 mm amplitude) of the dependent hemithorax. Bronchoconstriction was induced by methacholine infusion adjusted to double and quadruple the baseline airway resistance. Proximal mean airway pressure was kept equal for both modes of ventilation. MEASUREMENTS AND MAIN RESULTS: Airway pressure and flow, esophageal pressure, hemodynamic variables (cardiac output, systemic and pulmonary arterial pressures, pulmonary artery occlusion pressure) and gas exchange variables (PaO2, PaCO2, pH, shunt fraction, VO2) were measured. Peak airway pressure was lower (p < .05) with insufflation and vibration than with mechanical ventilation by 83.6% at baseline resistance, by 76.9% at twice baseline resistance, and by 76.8% at four times baseline resistance. Peak esophageal pressure was lower (p < .05) during insufflation with vibration by 68.5% at baseline resistance, by 87.5% at twice baseline resistance, and by 107% at four times baseline resistance. During insufflation with vibration, mild hypercapnia (PaCO2 58+/-3 torr (7.7+/-0.4 kPa) and pH 7.28+/-0.02) developed with moderate bronchoconstriction; more profound respiratory acidosis (PaCO2 137+/-41 torr (18.2+/-5.5 kPa) and pH 6.87+/-0.11) developed with severe bronchoconstriction. CONCLUSIONS: Tracheal gas insufflation with chest vibration supports gas exchange with permissive hypercapnia only during moderate, not severe, bronchoconstriction. Gas exchange was achieved at lower airway and intrathoracic pressures than those that developed during mechanical ventilation. The alveolar hypoventilation that occurred during insufflation with vibration indicates impaired CO2 elimination and suggests increased resistance to CO2 transport. This ventilation technique may confer therapeutic advantages over mechanical ventilation in the treatment of asthma.

Animals↗
PubMed1999

Theoretical and experimental intravascular gas embolism absorption dynamics.

Multifocal cerebrovascular gas embolism occurs frequently during cardiopulmonary bypass and is thought to cause postoperative neurological dysfunction in large numbers of patients. We developed a mathematical model to predict the absorption time of intravascular gas embolism, accounting for the bubble geometry observed in vivo. We modeled bubbles as cylinders with hemispherical end caps and solved the resulting governing gas transport equations numerically. We validated the model using data obtained from video-microscopy measurements of bubbles in the intact cremaster microcirculation of anesthetized male Wistar rats. The theoretical model with the use of in vivo geometry closely predicted actual absorption times for experimental intravascular gas embolisms and was more accurate than a model based on spherical shape. We computed absorption times for cerebrovascular gas embolism assuming a range of bubble geometries, initial volumes, and parameters relevant to brain blood flow. Results of the simulations demonstrated absorption time maxima and minima based on initial geometry, with several configurations taking as much as 50% longer to be absorbed than would a comparable spherical bubble.

Absorption↗
PubMed1998

Computational analysis of confined jet flow and mass transport in a blind tube.

A computational analysis of confined nonimpinging jet flow in a blind tube is performed as an initial investigation of the underlying fluid and mass transport mechanics of tracheal gas insufflation. A two-dimensional axisymmetric model of a laminar steady jet flow into a concentric blind-end tube is put forth and the governing continuity, momentum, and convection-diffusion equations are solved with a finite element code. The effects of the jet diameter based Reynolds number (Re(j)), the ratio of the jet-to-outer tube diameters (epsilon), and the Schmidt number (Sc) are evaluated with the determined velocity and contaminant concentration fields. The normalized penetration depth of the jet is found to increase linearly with increasing Re(j) for epsilon = O(0.1). For a given epsilon, a ring vortex that develops is observed to be displaced downstream and radially outward from the jet tip for increasing Re(j). The axial shear stress profile along the inside wall of the outer tube possesses regions of fixed shear stress in addition to a local minimum and maximum in the vicinity of the jet tip. Corresponding regions of axial shear stress gradients exist between the fixed shear stress regions and the local extrema. Contaminant concentration gradients develop across the ring vortex indicating the inward diffusion of contaminant into the jet flow. For fixed epsilon and Sc and Re(j) approximately 900, normalized contaminant flow rate is observed to be approximately twice that of simple diffusion. This model predicts modest net axial contaminant transport enhancement due to convection-diffusion interaction in the region of the ring vortex.

Biomechanical Phenomena↗
PubMed1998

Bolus contaminant dispersion in oscillating flow in curved tubes.

The investigation of longitudinal dispersion of tracer substances in unsteady flows has biomechanical application in the study of heat and mass transport within the bronchial airways during normal, abnormal, and artificial pulmonary ventilation. To model the effects of airway curvature on intrapulmonary gas transport, we have measured local gas dispersion in axially uniform helical tubes of slight pitch during volume-cycled oscillatory flow. Following a small argon bolus injection into the flow field, the time-averaged effective diffusion coefficient (Deff/Dmol) for axial transport of the contaminant was evaluated from the time-dependent local argon concentration measured with a mass spectrometer. The value of (Deff/Dmol) is extracted from the curve of concentration versus time by two techniques yielding identical results. Experiments were conducted in two helical coiled tubes (delta = 0.031, lambda = 0.022 or delta = 0.085, lambda = 0.060) over a range of 2 < alpha < 15, 3 < A < 15, where delta is the ratio of tube radius to radius of curvature, lambda is the ratio of pitch height to radius of curvature, alpha is the Womersley parameter or dimensionless frequency, and A is the stroke amplitude or dimensionless tidal volume. Experimental results show that, when compared to transport in straight tubes, the effective diffusivity markedly increases in the presence of axial curvature. Results also compare favorably to mathematical predictions of bolus dispersion in a curved tube over the ranges of frequency and tidal volume studied.

Argon↗
PubMed1998

Perfluorocarbon induced alterations in pulmonary mechanics.

Perfluorocarbon (PFC) compounds induce pulmonary hyperinflation and respiratory distress in some animals following intravenous administration. This study was designed to quantify the effects of two PFC emulsions on lung volumes and compliance and to identify the mechanism of pulmonary hyperinflation. New Zealand White rabbits received isotonic saline (3 ml/kg), Fluosol (15 ml/kg) or Oxygent (90% perfluorooctyl-bromide emulsion, 3 ml/kg). After seven days we measured functional residual capacity, vital capacity, lung compliance and thoracic gas volume. Gross and microscopic histologic examination of the lungs was performed. Functional residual capacity after Fluosol administration was 16.0 +/- 4.0 ml/kg, significantly greater than after saline (3.4 +/- 1.0 ml/kg) or Oxygent (4.0 +/- 1.4 ml/kg). Vital capacity was lower with Fluosol (30 +/- 5.0 ml/kg) than after saline (37 +/- 3.0 ml/kg) or Oxygent (37 +/- 2.0 ml/kg). Thoracic gas volume increased from 9 +/- 1.0 ml/kg (saline) to 16 +/- 13 ml/kg (Oxygent) and 33 +/- 7.0 ml/kg (Fluosol). Lung compliance was the same after saline (1.6 +/- 0.5 ml.cm H2O-1.kg-1) and Oxygent (1.5 +/- 0.3 ml.cm H2O-1.kg-1) but lower after Fluosol (0.9 +/- 0.1 ml.cm H2O-1.kg-1). Gross pathology demonstrated foam exudation from airways of animals receiving PFCs and intra-alveolar foam was identified by light microscopy. These results show intra-airway foam formation causes gas trapping and shifts tidal breathing to a less compliant region of the pressure-volume curve.

Animals↗
PubMed1998

Influence of intravenous perfluorocarbon administration on the dynamic behavior of lung surfactant.

Intravenous administration of perfluorocarbon (PFC) compounds can lead to pulmonary hyperinflation and respiratory distress in some mammals. This study was designed to quantify the effects of two PFC emulsions on the dynamic behavior of lung surfactant and to demonstrate that PFC is retained in the liquid lining the lung. New Zealand White rabbits received isotonic saline (3 ml/kg), Fluosol (15 ml/kg) or Oxygent (90% perfluorooctyl-bromide emulsion, 3 ml/kg). After seven days we euthanized the animals and lavaged the lungs. Surface tension-surface area relationships (sigma-A loops) were measured with the lavage fluid placed in a Wilhelmy plate-oscillating bellows apparatus. Loop hysteresis area after Fluosol administration was 334 +/- 92 dyne-cm, significantly greater than after saline (203 +/- 36 dyne-cm) but not Oxygent (274 +/- 66 dyne-cm). Loop hysteresis slope was higher with Oxygent (0.8 +/- 0.4 dyne/cm3) than after saline (0.6 +/- 0.3 dyne/cm3) or Fluosol (0.5 +/- 0.1 dyne/cm3). 282 MHz 19F NMR spectral analysis demonstrates that both PFCs tested appear only in the extracellular fraction of the lavage fluid. These results show that pulmonary elimination of intravascular PFC leads to PFC presence in the liquid lining the airways where it alters surfactant dynamic mechanical behavior.

Animals↗
PubMed1996

Acoustic reflectometry and endotracheal intubation.

To determine whether acoustic reflection measurement of the upper airway can be used to identify tracheas that are difficult to intubate, we conducted a pilot study of adults with a documented history of unexpected failed endotracheal intubation (16 cases) and compared them with 16 controls with previous successful intubation. The two groups were matched by age, sex, height, and weight. Acoustic reflection measurements of airway cross-sectional area versus distance were made at six combinations of body (upright and supine) and neck (flexed, neutral, and extended) positions. Cumulative airway volumes were calculated from the incisors to the glottis, and these were subdivided into oral and pharyngeal volumes. For supine position with the neck extended, all patients who had been successfully intubated had pharyngeal volumes more than 43.4 mL (mean +/- SD, 56.9 +/- 8.3 mL), whereas pharyngeal volumes were less than 37.5 mL in all patients who had a history of unexpected failed intubation (mean +/- SD, 19.7 +/- 10.2 mL; P < 0.05). Using a cutoff of 40.2 mL, acoustic reflection enabled us to distinguish between patients with previous unexpected failed endotracheal intubation and those with previous successful intubation.

Acoustics↗
PubMed1996

Chest vibration redistributes intra-airway CO2 during tracheal insufflation in ventilatory failure.

OBJECTIVE: To determine if high-frequency external chest wall vibration added to low flow intratracheal fresh gas insufflation alters the intra-airway CO2 distribution and the resistance to CO2 transport from the lungs. DESIGN: Prospective study. SETTING: Experimental laboratory. SUBJECTS: Six adult anesthesized and paralyzed mongrel dogs (mean weight 24.3+/- 4.4 kg). INTERVENTIONS: Dogs were ventilated by three methods: a) intermittent positive pressure ventilation; b) intermittent positive pressure ventilation with tracheal insufflation of fresh gas (FIO2 of 0.4) flowing at 0.15 L/kg/min through a catheter positioned at the carina; and c) intermittent positive pressure ventilation with tracheal insufflation and with external high-frequency chest wall vibration of the dependent hemithorax. MEASUREMENTS AND MAIN RESULTS: We measured arterial blood gas values as an index of global gas exchange, and intrapulmonary airway CO2 concentrations as an index of local gas exchange. Intra-airway CO2 concentrations along the axis of the airways were measured via a sampling catheter. Airway axial concentration profiles were constructed and resistances to gas transport were calculated from the measured data. Vibration increased intraluminal CO2 concentrations from 1.1% to 2.5% mouthward of the insufflation catheter tip. Peak resistance to CO2 transport decreased by 65% during vibration relative to the insufflation-only value. Vibration displaced peak transport resistance from second- to fourth-generation airways. CONCLUSIONS: Global gas exchange improves during ventilation by chest wall vibration with low flow insufflation. Local gas exchange in the central airways is also improved due to increased intraluminal mixing and CO2 elimination. This ventilation technique may confer therapeutic advantages over conventional mechanical ventilation in the treatment of ventilatory failure.

Airway Resistance↗
PubMed1995

Intra-airway CO2 distribution during airway insufflation in ventilatory failure.

Low-flow intratracheal gas insufflation is known to be an effective means of providing partial ventilatory support in respiratory failure. We studied the effects of catheter position on intraluminal CO2 concentration profiles and gas transport resistance during intra-airway insufflation at 0.15 l.kg-1.min-1 in six anesthetized paralyzed mechanically hypoventilated dogs. The two positions of the distal tip of the insufflation catheter were 0.5 cm proximal to and 4.0 cm distal to the carina. Local airway CO2 concentrations were measured via a sampling catheter passed through the tracheobronchial tree. Resistance to gas transport was calculated from the measured data. Arterial PO2 and arterial PCO2 remained constant with carinal and bronchial insufflation. Distal positioning of the insufflation tip resulted in a redistribution of ventilation between the lungs, with the ipsilateral lung being relatively hyperventilated and the contralateral lung being relatively hypoventilated. Intraluminal CO2 concentrations were markedly reduced in the ipsilateral lung compared with the profile in the contralateral lung during fresh gas delivery into the main-stem bronchus. The region of peak transport resistance was found to be in the second-generation airways during carinal insufflation and in the fourth-generation airways with intrabronchial insufflation. We conclude that gas exchange during low-flow insufflation occurs by the same mechanisms responsible for CO2 elimination in constant-flow ventilation. Overall gas exchange is not affected by position of the jet catheter.

Airway Resistance↗
PubMed1995

Intra-airway gas transport during high-frequency chest vibration with tracheal insufflation in dogs.

High-frequency external chest vibration with tracheal insufflation (high-frequency vibration ventilation) has previously been shown to be an effective mode of artificial ventilation in experimental animals. To investigate the intra-airway gas mixing during high-frequency vibration ventilation (frequency 30 Hz, amplitude 0.4 cm), we used an analysis of the single-breath washout curve that gives the vibration-induced mixing coefficient distribution relative to the no-vibration situation. Data from four anesthetized dogs were collected during constant-flow insufflation at six rates (0.05-0.4 l.min-1.kg-1), at three insufflation durations (2, 4, and 7 s), and with the insufflation catheter outlet at three positions (carina, trachea, and a bronchus) while the vibration was on and off. Vibration enhanced intra-airway gas mixing 14.1 +/- 3.9-fold, with the peak of the enhancement distribution located 125 +/- 29 ml from the airway opening and a distribution width of 121 +/- 29 ml. As insufflation flow increased, the position of the peak enhancement shifted toward the alveolar zone and diminished in peak amplitude. Changing the insufflation duration and the catheter position did not affect the intra-airway mixing induced by vibration. External chest vibration causes a substantial increase of intra-airway gas mixing, bringing alveolar gas to central airways. This leads to overall increased pulmonary gas transport when fresh gas is insufflating the tracheal carina area.

Animals↗