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Biomedical subjects

K Rehder

Publications and source records attributed to K Rehder.

At least 109 records · Page 6Linked to original sources
PubMed1979

Measurement of ventilatory reserve as an indicator for early extubation after cardiac operation.

The decision to perform tracheal extubation in 44 patients who underwent cardiac operation was based on an assessment of mental alertness, recovery of muscle strength, hemodynamic stability, and adequacy of pulmonary gas exchange. No patients required reintubation. Concomitant measurements of vital capacity (VC) and maximal inspiratory pressure (PImax) were made before a trial of spontaneous ventilation was commenced, after 45 minutes of spontaneous ventilation, and after tracheal extubation. By generally accepted criteria, these measurements suggested the need for continuing mechanical ventilation in 14 patients at the time mechanical ventilatory support was removed and in eight patients at the time of tracheal extubation. In this study, consideration of measurements of VC and PImax would have led to longer trachael intubation, especially in those patients who were extubated within 10 hours of the completion of anesthesia.

Anesthesia, General↗
PubMed1978

Closing capacity in awake and anesthetized-paralyzed man.

Functional residual capacity (FRC), closing capacity (CC), and (FRC--CC) were determined in 61 supine patients using the 133Xe bolus test. In 28 of the 61 patients measurements were made both while the patients were awake and during anesthesia-paralysis. Both FRC and CC decreased significantly after induction of anesthesia-paralysis. The magnitude of the reduction in CC, but not of FRC, was dependent on the relationship between FRC and CC in the awake state. Patients whose FRC was larger than their CC while awake (group I) showed less decrease in CC than FRC, i.e., (FRC--CC) decreased. By contrast, those patients whose CC was larger than their FRC while awake (group II) showed a greater decrease in CC than in FRC, i.e., (FRC--CC) became less negative. The reduction in CC after induction of anesthesia-paralysis may result from an increased elastic recoil of the lung. The larger reduction in CC in group II patients may have been due to a larger increase in elastic recoil, possibly due to the development of atelactasis.

Adult↗
PubMed1978

Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed prone man.

The intrapulmonary distribution of inspired gas (ventilation/unit lung volume, VI), functional residual capacity (FRC), closing capacity (CC), and the slope of phase III were determined in five awake and five anesthetized-paralyzed volunteers who were in the prone position with the abdomen unsupported. After induction of anesthesia-paralysis, FRC was less in four of five subjects and CC was consistently less. At FRC there was no difference in the vertical gradient of regional lung volumes between the awake and anesthetized-paralyzed prone subjects. Also, there was no difference in VI between the two states. The normalized slope of phase III decreased consistently with induction of anesthesia-paralysis, but the vertical distribution of a 133Xe bolus inhaled from residual volume was not different between the two states. The data of the study are compatible with 1) a pattern of expansion of the respiratory system during anesthesia-paralysis and mechanical ventilation different than that during spontaneous breathing and 2) a more uniform intraregional distribution of inspired gas and/or a different sequence of emptying during anesthesia-paralysis.

Adult↗
PubMed1977

Airway closure.

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Adolescent↗
PubMed1977

Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed man.

Intrapulmonary distribution of ventilation/unit lung volume was studied in 28 volunteers in the sitting, supine, or right lateral decubitus position, either awake or anesthetized-paralyzed and mechanically ventilated. We found significant differences between the awake state and anesthesia-paralysis with mechanical ventilation in 1) intrapulmonary gas distribution, and 2) the vertical gradient of regional functional residual capacities for the subjects in the lateral decubitus position, but not for those in the sitting and supine positions. The effect of increasing the tidal volume on distribution of ventilation was significantly different 1) between the three body positions for a given state, and 2) between the two states for a given body position. The data suggest thoracoabdominal mechanics are different in the three body positions and that anesthesia-paralysis and mechanical ventilation may cause a different pattern of expansion of the respiratory system than spontaneous breathing in the awake state.

Adult↗
PubMed1977

Lung recoil and gas trapping during oxygen breathing at low lung volumes.

If airways are closed at lung volumes less than the closing volume (CV), there should be correlations among 1) the volume of trapped N2 (VTN) during N2-washout performed below CV, 2) the increase in static lung recoil pressure (delta P) while breathing below CV after denitrogenation compared with breathing air (due to absorption atelectasis distal to closed airways), and 3) the CV. Static inspiratory pressure-volume (PV) curves and CV were measured in 18 seated normal volunteers (ages 24-48 yr). Subjects then breathed air for 30 s and O2 for 2.5 min at RV + 0.6 liter (LVB-air), and an inspiratory PV curve and VTN were determined. While still breathing O2, the subjects repeated the 3 min of low-volume breathing (LVB-O2). There was a significant (P less than 0.001) delta P with LVB but no difference between delta P (LVB-air) and delta P (LVB-O2). CV was not related to VTN or to either delta P. VTN was not related to delta P (LVB-O2)--delta P (LVB-air) nor to delta P (LVB-air), but was related to delta P (LVB-O2). Evidence of airway closure could not be demonstrated in all subjects by LVB and when present showed no correlation with CV.

Adult↗
PubMed1977

Improved oxygenation in patients with acute respiratory failure: the prone position.

To assess the potential benefits of the prone position for gas exchange in patients with acute respiratory failure, we turned 6 patients from supine to prone, supporting the upper thorax and pelvis and allowing the abdomen to protrude. Arterial PO2 increased by a mean of 69 mm Hg (range, 2 to 178 mm Hg) at the same tidal volume, same inspired oxygen concentration, and same level of positive end-expiratory pressure. The maneuver made it possible to reduce the inspired oxygen concentration in 4 of the 5 patients who required mechanical ventilation of the lungs and to defer intubation in the patient who was breathing spontaneously. After subsequent turns from supine to prone, arterial PO2 increased by a mean of 35 mm Hg (range, 4 to 110 mm Hg), permitting a decrease in inspired oxygen concentration or positive end-expiratory pressure when prone (4 patients); arterial PO2 decreased in 12 of 14 instances after the patient was turned from prone to supine. No significant change in mean arterial carbon dioxide tension, respiratory frequency, or effective compliance was observed.

Acute Disease↗
PubMed1977

New tests for the detection of obstructive pulmonary disease.

Abnormalities in small airways appear to be important in the evolution of chronic obstructive pulmonary disease. Patients with these pathologic lesions may have normal values for airway resistance and forced expiratory volume in one second. Two new tests, the closing volume (CV) and the dependence of maximal flow on density, are believed to be sensitive to abnormalities in the peripheral airways. The CV test detects an increased nonuniformity of changes in volume of pulmonary units. Reduced dependence of flow on density is believed to result from an increase in the peripheral component of the losses of driving pressure which determine maximal expiratory flow. Both tests differentiate smokers with normal conventional spirometric data from age-matched nonsmokers. Although this evidence suggests that these tests can be used to detect abnormalities in small airways, there is very little pathologic confirmation of this belief. The clinical significance of abnormalities in the results of either of these tests in an otherwise normal person has not yet been determined.

Airway Resistance↗
PubMed1976

Single-breath oxygen tests for individual lungs in awake man.

Single-breath oxygen (SBO2) tests for individual lungs were performed in five healthy awake volunteers. In the supine position, all subjects consistently showed a closing volume (CV) for both lungs. In the lateral position, CV was demonstrated in all analyzable SBO2 tests for the dependent and in 20 of 28 for the nondependent lung. CV consistently occurred in the dependent before it occurred in the nondependent lung (asynchronous onset of CV). After CV had been reached in the nondependent lung, a mean of 77 ml of gas was still expired from the dependent lung. No changes in CV for individual lungs were demonstrated with changes in body position. Expiratory flow limitation consistently occurred first in the dependent lung (asynchronous onset of flow limitation). In the lateral position, at high lung volumes, the dependent lung achieved higher flow rates; later in expiration, the nondependent lung contributed progressively more gas to the total expirate (asynchronous emptying). In general, our findings are consistent with both the "asynchronous flow limitation" and the "airway closure" interpretations of CV. However, some of the results are not consistent with either theory.

Adult↗
PubMed1976

Effect of posture on the single-breath oxygen test in normal subjects.

The effect of posture on phase III (alveolar nitrogen plateau) and phase IV (closing capacity) of the single-breath oxygen test was examined in 10 normal people. In part 1 of the study, subjects inspired and expired in the standing, supine, prone, and right lateral decubitus positions; there was no effect of posture on phase IV but slopes of phase III were higher when subjects were in the supine and lateral positions. In part 2, subjects inspired in the standing position and expired in one of the recumbent positions. Phase IV occurred infrequently except in the prone position (6 of 10 subj); slopes of phase III in part 2 were not consistently altered by changing posture. It is difficult to explain the failure of posture to alter phase IV solely on a model requiring a linear gradient of pleural pressure. The slope of phase III appears to depend more on the emptying patterns of small regions with widely varying volume-to-ventilation ratios than on gravity-dependent sequences of emptying. Finally, the data suggest a considerable similarity between the upright and prone positions in terms of lung filling and emptying.

Adult↗
PubMed1975

Lung volumes and closing capacity with continuous positive airway pressure.

Total lung capacity, vital capacity, residual volume, and functional residual capacity were determined by body plethysmography and the single-breath oxygen (SBO2) test was performed at 0, 5, and 11 cm H20 continuous positive airway pressure in healthy, awake, seated, spontaneously breathing subjects. Mean values for the absolute lung volume at which phase IV of the SBO2 test begins (closing capacity) did not change significantly with continous positive airway pressure at 5 or 11 cm H2O. Mean total lung capacity, functional residual capacity, and residual volume increased significantly, and the mean closing volume, the lung volume above residual volume at which phase IV begins, decreased significantly with 11 cm H20 continuous positive airway pressure; differences at 5 cm H20 were not significant. The slope of the alveolar nitrogen plateau (phase III) obtained during the SBO-2 test did not change with continuous positive airway pressure.

Adult↗
PubMed1975

Positive airway pressure and vertical transpulmonary pressure gradient in man.

Static transpulmonary pressure (Pao-Pes) and the vertical gradient of transpulmonary pressure were determined in five sitting conscious normal subjects at mean airway pressures of 0 (ambient), 11, and 21 cmH2O. All subjects exhibited a nonuniform transpulmonary pressure gradient down the esophagus. The vertical pressure gradient was consistently larger in the lower (8-20cm below esophageal artifact) than in the middle region (0-8cm) of the esophagus. The gradient was not significantly altered by continuous positive airway pressure (11 and 21 cmH2O) or by changes in lung volume (60, 70, and 80% of total lung capacity (TLC)). Continuous positive airway pressure also did not result in a consistent change of the overall static pressure-volume curve of the lung. There was a small but statistically significant increase in TLC with each increase in airway pressure.

Biomechanical Phenomena↗
PubMed1975

General anesthesia and the lung.

In this review, an attempt has been made to select, evaluate, and interpret the pertinent literature relative to general anesthesia and the lung. Concepts of intrapulmonary gas exchange and respiratory system mechanics were synthesized, emphasizing the importance of changes in intrapulmonary gas distribution that are induced by general anesthesia and exploring the possible underlying mechanisms of these changes. The area of control mechanisms and the effects of anesthesia on respiratory regulation were not discussed, nor was the distribution of pulmonary blood flow examined. The following general conclusions can be reached: (1) impaired gas exchange occurs during general anesthesia, with both impaired oxygenation and CO2 elimination; (2) increased venous admixture and increased alveolar dead space impair gas exchange; (3) the distribution of ventilation is changed during general anesthesia, and this change is related to a decrease in FRC in the recumbent positions and to altered chest-wall mechanics. Numerous questions regarding the effect of anesthesia on the lung remain unanswered. The close relationship between advances in pulmonary physiology and the pulmonary effects of anesthetic actions is increasingly apparent, as is the importance of this knowledge in applying mechanical ventilation and end-expiratory pressure to patients with pulmonary disease.

Airway Resistance↗