Biomedical subjects

D Navajas

Publications and source records attributed to D Navajas.

At least 55 records · Page 3Linked to original sources

PubMed1998

Flow-dependent positive airway pressure to maintain airway patency in sleep apnea-hypopnea syndrome.

Airway obstruction in patients with sleep apnea-hypopnea syndrome (SAHS) is due to increased critical pressure (Pcrit) of the upper airway. The ideal nasal pressure (Pn) to maintain airway patency should consist of the constant term to account for Pcrit and a term (Rn . V) proportional to flow (V) to account for the dynamic pressure drop through nasal resistance (R n). Continuous positive airway pressure (CPAP) applied to avoid flow limitation results in a Pn greater than required over most of the breathing cycle. The aim was to assess a flow-dependent positive airway pressure (FDPAP) based on adapting Pn to the instantaneous flow: Pn = P0 + k . V. FDPAP was tested on collapsible airway models and its applicability was assessed in nine patients with SAHS during sleep. In models, FDPAP prevented flow limitation with lower mean P n and work of breathing than CPAP. In patients FDPAP allowed the patients to breathe normally with a mean Pn (6.6 +/- 1.2 cm H2O) systematically and significantly (p < 0.05, paired t test) lower than when applying CPAP (9.1 +/- 1.2 cm H2O). The results found in models and in patients suggest that adapting the applied nasal pressure to the instantaneous breathing flow may be of potential practical interest in SAHS.

Adult↗

PubMed1998

Accuracy of thermistors and thermocouples as flow-measuring devices for detecting hypopnoeas.

The aim of this work was to assess the accuracy of thermistors/thermocouples as devices for detecting hypopnoeas in sleep studies. Conventional thermistor/thermocouples were studied with a respiratory model allowing the simulation of inspiratory (22 degrees C) and expiratory (37 degrees C) flows. The thermistor signal (V'th) was compared with a pneumotachograph (V'th): 1) for sinusoidal and square-wave airflows (+/-0.05 to +/-0.8 L.s(-1), 10-20 breaths.min(-1) (bpm)); 2) when changing the distance from the thermistor to the nose (0-20 mm); and 3) when doubling the section of the nostrils. The thermistor was strongly nonlinear and flow reductions (hypopnoeas) were underestimated: a 50% reduction in V' (+/-0.5 L.s(-1), 15 bpm, sinusoidal) resulted in only an 18% reduction in V'th. V'th depended considerably on the airflow pattern: for V'=+/-0.5 L.s(-1), V'th increased by 100% from sinusoidal (20 bpm) to square-wave (10 bpm). For V'=+/-0.5 L.s(-1), 15 bpm, sinusoidal flow, V'th increased by 79% when the distance thermistor-nose varied from 20-0 mm, and V'th decreased by 37% when doubling the nose section. We concluded that thermistor/thermocouples are inaccurate flow-measuring devices when used at the airflow conditions typical of sleep studies. Their use for quantifying hypopnoeas may lead to considerable underdetection of these respiratory events.

Evaluation Studies as Topic↗

PubMed1998

Nasal prongs in the detection of sleep-related disordered breathing in the sleep apnoea/hypopnoea syndrome.

Conventional systems to monitor oronasal flow in sleep studies have traditionally relied on a thermistor signal. Our study was designed to verify whether nasal prongs (NP) connected to a pressure transducer could improve respiratory events detection in patients with sleep apnoea/hypopnoea syndrome (SAHS) compared to traditional systems. Sleep episodes from a 2 h conventional polysomnographic record plus NP signal obtained at random from eight patients (age: mean(+/-SD) 53(+/-12) yrs; body mass index (BMI): 29(+/-6) kg x m(-2); apnoea/hypopnoea index (AHI): 27(+/-20) events x h(-1)) were identified and used for analysis. An abnormal change in the pattern of any of the respiratory or neurological variables occurring during the observation period was defined as an episode. Each episode was registered and scored with concomitant scoring of the remaining variables. According to the episode definition three different profiles were established: 1) periods of reduction of ventilation in either variable without an arousal or cyclical desaturation, named nonpathological episode (NPE); 2) an idiopathic or nonrespiratory arousal (IA); and 3) a true respiratory event (TRE) defined as reduction or absence of flow demonstrated by either thermistor, thoraco-abdominal bands or NP accompanied by cyclical desaturation and/or arousal. For each TRE, its detection by thermistor, thoraco-abdominal bands or NP was established. A total of 877 sleep episodes were observed (42 NPE, 30 IA and 805 TRE). When compared to single or combined thermistor and bands approach, NP had the highest respiratory events detection rate, 779 (96.8%) versus 673 events (83.6%), respectively. Detection of respiratory-related arousals was also improved by NP and only 3% could account for mouth breathing respiration. It is concluded that nasal prongs improve the detection of respiratory events in patients with sleep respiratory disorders.

Adult↗

PubMed1998

Forced oscillation technique for the evaluation of severe sleep apnoea/hypopnoea syndrome: a pilot study.

The forced oscillation technique (FOT) is a noninvasive method of potential clinical interest for quantitatively assessing airway mechanics during sleep. We investigated the applicability of FOT as a diagnostic tool for noninvasive assessment of airflow obstruction in patients with sleep apnoea/hypopnoea syndrome (SAHS) during sleep. In seven patients previously diagnosed with severe SAHS (mean+/-SD apnoea/ hypopnoea index (AHI) 67+/-14) we performed a full polysomnography (PSG) together with on-line measurement of respiratory impedance (IZI) using FOT. For each patient we determined: 1) number of respiratory events conventionally detected by full PSG, those obtained by FOT and their degree of concordance; and 2) the characteristics and values of IZI during the respiratory events. FOT was well tolerated and easily applied in conjunction with a conventional sleep setup. The mean number of respiratory events x h(-1) detected by PSG and FOT were 55+/-16 and 58+/-17, respectively, with a strong concordance. IZI increased from a baseline of 11+/-4 to 50+/-20 cmH2O x L(-1) x s during apnoea (mean+/-SD). In all but one patient intermittent increases of IZI occurred immediately before each obstructive apnoea. In four patients, the increases of IZI developed at end-expiration whereas in two others occurred during inspiration. During hypopnoea most of the patients showed decreases of IZI during expiration. In conclusion, forced oscillation technique can be used as a noninvasive and complementary tool for the diagnosis of respiratory events and provides an on-line quantitative approach for continuous monitoring of airflow obstruction during sleep in patients with sleep apnoea/hypopnoea syndrome.

Adult↗

PubMed1998

Respiratory mechanics in ventilated COPD patients: forced oscillation versus occlusion techniques.

The respiratory mechanics of artificially ventilated chronic obstructive pulmonary disease (COPD) patients were investigated by means of the forced oscillation (FOT) and the end-inspiratory airway occlusion (AOT) techniques. FOT was applied to measure respiratory resistance (Rrs) and reactance (Xrs) from 0.25-16 Hz. Maximum (Rmax) and minimum (Rmin) resistances, static elastance (Est) and time constant (T) were computed by AOT. FOT and AOT data were interpreted with models featuring airway wall shunt, tissue viscoelasticity and parallel inhomogeneity. Rrs* and Xrs*, predicted from the AOT data, were computed and compared with Rrs and Xrs measured by FOT. Rrs and Xrs (hPa x s x L(-1)) decreased from 31.2+/-10.3 to 5.9+/-4.6 and increased from -20.3+/-7.1 to -8.0+/-4.4 from 0.25-16 Hz, respectively. Central resistance (Rc) and peripheral resistance (Rp) (in hPa x s x L(-1)), and shunt elastance (Esh) and tissue elastance (Et) (in hPa x L(-1)) were 4.4+/-5.4, 28.4+/-153, 723+/-393 and 31.8+/-10.1, respectively. Rmin, Rmax and Est were 18.4+/-5.9, 28.4+/-12.8 and 18.1+/-4.2 respectively, and T=0.76+/-0.25 s. The frequency dependence of predicted Rrs* and Xrs* differed markedly from that of measured Rrs and Xrs. The use of different models to interpret the measured data suggests that both airway and tissue properties determined the frequency dependence of respiratory resistance and respiratory reactance in ventilated chronic obstructive pulmonary disease patients at the investigated frequencies (0.25-16 Hz).

Airway Resistance↗

PubMed1998

[Neuromuscular disorders in critically ill patients].

INTRODUCTION AND OBJECTIVE: Critically ill patients admitted to the Intensive Care Unit (ICU) often develop neuromuscular disorders. The objective of this study was to diagnose these and determine the causes. MATERIAL AND METHODS: We present a series of 13 critically ill patients who developed weakness or paresia, reduced or absent ROT and normal brain stem reflexes, in whom ENG and EMG studies were done in EESS and II which were considered together with data from general laboratory analysis, radiological and microbiological examinations, medication given and posterior clinical course of the patient. Muscle biopsy was not done in any patient. RESULTS: All the patients were intubated, with signs of sepsis, multiple-organ failure and malnutrition. All had received cortico-steroids and amino-glucosides and 8/13 neuromuscular blockers. Neurophysiological study showed that in all cases there was axon type neuropathy, mainly motor and in the lower limbs. Fifty four percent of the patients died. The neuropathy improved in the others. CONCLUSIONS: Critically ill patients often have axon type neuropathy. In our series, the causes of this were sepsis and multiple organ failure. It is important that this pathology be ruled out in the critically ill patient whom it is difficult to disintubate and/or has generalized muscle weakness.

Adult↗

PubMed1997

Analog circuit for real-time computation of respiratory mechanical impedance in sleep studies.

The aim of this work was to develop a low-cost circuit for real-time analog computation of the respiratory mechanical impedance in sleep studies. The practical performance of the circuit was tested in six patients with obstructive sleep apnea. The impedance signal provided by the analog circuit was compared with the impedance calculated simultaneously with a conventional computerized system. We concluded that the low-cost analog circuit developed could be a useful tool for facilitating the real-time assessment of airway obstruction in routine sleep studies.

Airway Resistance↗

PubMed1997

Evaluation of nasal prongs for estimating nasal flow.

Nasal prongs (NP) connected to a pressure transducer have been suggested as a useful alternative for measuring nasal flow in sleep apnea/hypopnea patients. However, flow measured with NP is expected to be nonlinear. The aim of the present study was to analyze and correct the nonlinearity of nasal flow measurements with NP (VNP). Nasal flow was simultaneously measured with a pneumotachograph (PNT; V) and (NP; VNP) in six healthy subjects during 60 s of breathing at different tidal volumes. Nonlinearity of VNP was assessed by fitting separately, for inspiration and expiration, a Rorher-model equation (VNP x K1 x V + K2 x V2). In addition, we fitted the data to a simpler nonlinear quadratic model (P = K x V2). The main findings were: (1) an excellent fit of the Rorher equation to measured data in all cases; (2) although differences in the Rorher equation coefficients between inspiration and expiration were observed, they were not statistically significant; (3) a substantial intersubject variability was found; and finally, (4) the square root of VNP acceptably fitted the nasal flow data measured by PNT (V) in most cases. We conclude that in order to quantitatively assess nasal flow with NP, data should be corrected for their nonlinear pressure-flow relationships and, that the square root of the flow signal measured with NP is the simplest method of correcting for the observed nonlinearity.

Adult↗

PubMed1997

Inspiratory dynamic obstruction detected by forced oscillation during CPAP. A model study.

Assessment of upper airway mechanics in patients with obstructive sleep apnea/hypopnea (OSA) can be carried out qualitatively from indirect signals (flow pattern, snoring, strain gauges, inductance plethysmography) or quantitatively by means of invasive estimation of esophageal pressure. The forced oscillation technique (FOT) is a noninvasive method of potential interest for quantitatively assessing airway obstruction in the sleeping patient. The aim of this work was to ascertain in a model study whether FOT could provide an index of airway obstruction when applied at the conditions of total and partial occlusions similar to the ones found in patients with OSA. An airway analog closely mimicking upper airway collapsibility was constructed and mechanically characterized by the relationship between its flow, upstream and downstream pressures as well as by means of FOT. We simulated total collapse (apnea), different levels of partial collapse with flow limitation (hypopnea), and release of airway obstruction when the collapsible analog was used as an artificial upper airway in a spontaneously breathing subject submitted to continuous positive airway pressure (CPAP) up to 14 cm H2O.s/L. The results showed that the amplitude of airway impedance measured by FOT was a suitable index to detect obstruction in collapsible segments. We concluded from this realistic model study that FOT could be a valuable tool for quantitatively assessing airway obstruction in patients with OSA treated with CPAP. This noninvasive technique is potentially useful both in studying upper airway mechanics in detail and in automatically monitoring airway obstruction in routine studies.

Airway Obstruction↗

PubMed1997

A system to generate simultaneous forced oscillation and continuous positive airway pressure.

Assessment of airway obstruction in patients with obstructive sleep apnoea (OSA) subjected to continuous positive airway pressure (CPAP) may be carried out using the forced oscillation technique (FOT). To facilitate routine application of forced oscillation (FO) in sleep studies, our aim was to design a system capable of generating CPAP and applying FOT simultaneously. We constructed a prototype CPAP + FO generator by connecting a specially designed electromagnetic valve in parallel with a conventional blower. The capacity of the prototype to generate forced oscillation (5 Hz +/- 1 hPa) was tested by connecting it to a model simulating spontaneous breathing. The response of the prototype for target CPAPs of 5, 10 and 15 hPa and imposed sinusoidal breathing with peak flow up to 0.75 L x s(-1) was excellent when compared with that reported for commercially available CPAP generators. The applicability of the prototype was tested by applying it to assess airway obstruction in four patients with OSA during sleep. We conclude that the generator designed is able to apply continuous positive airway pressure and forced oscillation simultaneously. The system could be useful for automatic and noninvasive assessment of airway obstruction in patients with obstructive sleep apnoea subjected to continuous positive airway pressure. Future development of the generator may be helpful in implementing a set-up for automatic titration of continuous positive airway pressure.

Airway Resistance↗

PubMed1997

Estimation of random errors in respiratory resistance and reactance measured by the forced oscillation technique.

The forced oscillation technique (FOT) allows the measurement of respiratory resistance (Rrs) and reactance (Xrs) and their associated coherence (gamma2). To avoid unreliable data, it is usual to reject Rrs and Xrs measurements with a gamma2 <0.95. This procedure makes it difficult to obtain acceptable data at the lowest frequencies of interest. The aim of this study was to derive expressions to compute the random error of Rrs and Xrs from gamma2 and the number (N) of data blocks involved in a FOT measurement. To this end, we developed theoretical equations for the variances and covariances of the pressure and flow auto- and cross-spectra used to compute Rrs and Xrs. Random errors of Rrs and Xrs were found to depend on the values of Rrs and Xrs, and to be proportional to ((1-gamma2)/(2 x N x gamma2))1/2. Reliable Rrs and Xrs data can be obtained in measurements with low gamma2 by enlarging the data recording (i.e. N). Therefore, the error equations derived may be useful to extend the frequency band of the forced oscillation technique to frequencies lower than usual, characterized by low coherence.

Airway Resistance↗

PubMed1997

Gas compression artefacts when testing peak expiratory flow meters with mechanically-driven syringes.

Mechanically-driven syringes used to test peak expiratory flow (PEF) meters must produce the American Thoracic Society (ATS) standard waveforms with PEF accuracy of 2%. However, gas compression within the syringe could result in significant PEF inaccuracy when testing high resistance meters. The gas compression artefact was investigated in a mechanical syringe (PWG; MH Custom Design & Mfg L.C., Midvale, Ut, USA) of 13.6 L connected to a standard range mini-Wright PEF meter (Clement Clarke International, Harlow, UK). Scaled versions of the ATS standard waveform No. 24, with peak flows of 750 and 450 L x min(-1), were discharged through the PEF meter from different starting piston positions to vary syringe volume (Vsyr). The PEF recorded by the meter decreased linearly with increasing Vsyr. PEF decreased by 0.31 and 0.27% per litre for the ATS standard waveforms with PEF of 750 and 450 L x min(-1), respectively. The target PEF computed from piston displacement overread the actual PEF delivered into the PEF meter by approximately 4% when Vsyr = 13.6 L. Overreading fell to approximately 1% when Vsyr was reduced to 3.62 L. Therefore, gas compression error in commercially available large mechanical syringes can exceed the 2% inaccuracy limit when testing high resistance portable PEF meters. Measurements can be corrected for gas compression by linearly extrapolating PEF recordings to zero volume.

Artifacts↗

PubMed1996

Assessment of respiratory pressure-volume nonlinearity in rabbits during mechanical ventilation.

The volume dependence of respiratory elastance makes it difficult to recognize actual changes in lung and chest wall elastic properties in artificially ventilated subjects. We have assessed in six anesthetized, tracheotomized, and paralyzed rabbits whether reliable information on the static pressure-volume (PV) curve could be obtained from recordings performed during step variations of the end-expiratory pressure without interrupting mechanical ventilation. Pressure and flow data recorded during 5- and 10-hPa positive-pressure steps were analyzed in the time domain with a nonlinear model featuring a sigmoid PV curve and with a model that, in addition, accounted for tissue viscoelastic properties. The latter fitted the data substantially better. Both models provided reasonably reproducible coefficients, but the PV curves obtained from the 5- and 10-hPa steps were systematically different. When the PV curves were used to predict respiratory effective elastance, the best predictor was the curve derived from the 10-hPa step with the viscoelastic model: unsigned differences averaged 8.6 +/- 11.1, 26.9 +/- 36.4, and 5.5 +/- 5.8% at end-expiratory pressures of 0, 5, and 10 hPa, respectively. This approach provides potentially useful, although not highly accurate, estimates of respiratory effective elastance-volume dependence.

Animals↗

PubMed1996

Effect of expiratory flow limitation on respiratory mechanical impedance: a model study.

Large phasic variations of respiratory mechanical impedance (Zrs) have been observed during induced expiratory flow limitation (EFL) (M. Vassiliou, R. Peslin, C. Saunier, and C. Duvivier. Eur. Respir. J. 9: 779-786, 1996). To clarify the meaning of Zrs during EFL, we have measured from 5 to 30 Hz the input impedance (Zin) of mechanical analogues of the respiratory system, including flow-limiting elements (FLE) made of easily collapsible rubber tubing. The pressures upstream (Pus) and downstream (Pds) from the FLE were controlled and systematically varied. Maximal flow (Vmax) increased linearly with Pus, was close to the value predicted from wave-speed theory, and was obtained for Pus-Pds of 4-6 hPa. The real part of Zin started increasing abruptly with flow (V) > 85% Vmax and either further increased or suddenly decreased in the vicinity of Vmax. The imaginary part of Zin decreased markedly and suddenly above 95% Vmax. Similar variations of Zin during EFL were seen with an analogue that mimicked the changes of airway transmural pressure during breathing. After pressure and V measurements upstream and downstream from the FLE were combined, the latter was analyzed in terms of a serial (Zs) and a shunt (Zp) compartment. Zs was consistent with a large resistance and inertance, and Zp with a mainly elastic element having an elastance close to that of the tube walls. We conclude that Zrs data during EFL mainly reflect the properties of the FLE.

Electric Impedance↗

PubMed1995

T model partition of lung and respiratory system impedances.

The aim of this work was to demonstrate that the three compartments of the lung T network and the chest wall impedance (Zcw) can be identified from input and transfer impedances of the respiratory system if the pleural pressure is recorded during the measurements. The method was tested in six healthy volunteers in the range of 8-32 Hz. The impedances resulting from the decomposition confirm the adequacy of the monoalveolar structure commonly used in healthy subjects. Indeed, the T shunt impedance is well modeled by a purely compliant element, the mean compliance [0.038 +/- 0.081 (SD) l/kPa], which coincides within 9.5 +/- 6.3% of the alveolar gas compressibility derived from thoracic gas volume (0.036 +/- 0.011 l/kPa). The results obtained provide experimental evidence that the alveolar gas compression is predominantly isothermal and that lung tissue impedance is negligible throughout the whole frequency range. The shape of Zcw is consistent with a low compliance-low inertance pathway in parallel with a high compliance-high inertance pathway. We conclude that the proposed method is able to reliably identify the T network featuring the lung and Zcw.

Adult↗

PubMed1995

Lung and respiratory impedance at low frequency during mechanical ventilation in rabbits.

We have tested in eight rabbits the feasibility of measuring respiratory (Zrs) and lung (ZL) impedances in the low-frequency domain, including below the breathing frequency (fb), during conventional mechanical ventilation (CMV). The animals were tracheotomized and ventilated with a tidal volume (VT) of 20 ml at a fb of 1 Hz. The excitation signal was provided by a flow generator connected in parallel with the ventilator; it included six components ranging from 0.45 to 14.8 Hz, which met the neither-sum-nor-difference criterion of B. Suki and K. Lutchen (IEEE Trans. Biomed. Eng. 39: 1142-1151, 1992) to minimize the influence of nonlinearities. Zrs and ZL were also measured at the same mean lung volume and with the same excitation signal both during apnea and when the ventilator signal was replaced by a sine wave with the same VT and fb (SMV). The real parts (Re) of both Zrs and ZL, as well as the effective elastances, were significantly larger during apnea than during CMV and SMV over the whole frequency range. Re(Zrs) and Re(ZL) were similar during CMV and SMV above fb but they were lower during CMV at 0.45 Hz. The latter difference seems to be related to the presence of harmonics of fb and of additional frequency components due to pulse amplitude modulation. We conclude that, because of nonlinearities, it is feasible to measure Zrs and ZL during CMV only at and above fb.

Animals↗

PubMed1995

Dynamic viscoelastic nonlinearity of lung parenchymal tissue.

To investigate the contribution of nonlinear tissue viscoelasticity to the dynamic behavior of lung, time and frequency responses of isolated parenchymal strips of degassed dog lungs were investigated. The strips were subjected to loading and unloading stretch steps for 60 s and to sinusoidal oscillations (0.03-3 Hz) of different stretch amplitudes (delta lambda = 0.05, 0.1, and 0.2) and at different operating stresses (T(o) = 0.5, 1, and 2 kPa). Elastance (E) increased linearly with the logarithm of frequency (approximately 10% per frequency decade), and resistance (R) decreased hyperbolically with frequency. Both E and R varied little with delta lambda but they increased proportionally with T(o). Hysteresivity (eta = R x 2 pi x frequency/E) ranged from 0.07 to 0.10. In agreement with the frequency response, the magnitude of the unit step response increased with T(o) and was higher when loading than when unloading, and the stress relaxation ratio (approximately 0.10) did not vary greatly with T(o) or with delta lambda. The time and frequency behavior of the strips were interpreted in terms of the quasilinear viscoelastic model of Navajas et al. (J. Appl. Physiol. 73:2681-2692, 1992). The model explains most of the dependencies of step and oscillatory responses on the measurement conditions, in particular the proportional dependence of E and R on T(o). According to the model, about two-thirds of energy dissipated during oscillation arises from tissue viscoelasticity. The remaining dissipated energy could be accounted for by plasticity. Thus the effect of nonlinear elasticity on the dynamic behavior of lung tissue can be empirically described by a simple quasilinear model characterized by only two parameters.

Animals↗

PubMed1995

Dynamic elastance and tissue resistance of isolated liquid-filled rat lungs.

The effect of the surface forces of the alveolar air-liquid interface on the dynamic behavior of lung tissue was investigated in five isolated liquid-filled rat lungs. The lungs were subjected to 0.04-Hz sinusoidal oscillation (1.5-ml tidal volume) at lung volume (VL) levels ranging from volume at zero pressure (V0) + 4 ml to V0 + 10 ml. Oscillations were performed at each VL after inflation of the lungs from V0. Alveolar pressure (PA) was measured with an alveolar capsule attached to the visceral pleura. Dynamic elastance (Edyn), tissue resistance (Rti), and hysteresivity [eta = Rti omega/Edyn, where omega is angular frequency (2 pi x frequency)] were computed from PA and VL changes. Edyn was 59.6 +/- 4.3 Pa/ml at V0 + 4 ml and varied little up to V0 + 7 ml. Thereafter, Edyn increased markedly with VL, reaching 102 +/- 16 Pa/ml at V0 + 10 ml. No significant difference was found between elastance computed from PA and that computed from pressure recorded at the airway opening. Rti was 35.2 +/- 3.6 Pa.s.ml-1 and exhibited a VL dependence similar to that of Edyn. As a result, eta was 0.16 and did not vary significantly in the explored VL range. We conclude that PA can be reliably measured in the liquid-filled lung by means of alveolar capsules. In the liquid-filled lung, Edyn was smaller than and eta was similar to values reported for air-filled lungs. Hence, surface tension accounts for a considerable part of elastance and Rti of the air-filled lung within the volume range of normal breathing.

Animals↗