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Biomedical subjects

R M Goldring

Publications and source records attributed to R M Goldring.

At least 37 records · Page 2Linked to original sources
PubMed1983

Combined ventilator and bicarbonate strategy in the management of status asthmaticus.

Management of intubated hypercapnic asthmatic patients requires a delicate balance between the control of pH with adequate ventilation and the risk of barotrauma associated with the high pressures that may be required. The present report documents a strategy of mechanical ventilation combined with infusion of large amounts of bicarbonate in three patients with severe status asthmaticus requiring intubation. This strategy reduced peak inflation pressure by decreasing ventilation and maintained a physiologic pH while allowing pCO2 to remain elevated.

Adult↗
PubMed1981

Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Long-term maintenance with noninvasive nocturnal mechanical ventilation.

Described in this study are eight patients with alveolar hypoventilation syndromes who presented with carbon dioxide narcosis and coma. After reversal of severe hypercapnia, all patients were discharged and maintained at home for an average period of 10 years utilizing "noninvasive" nocturnal mechanical ventilation. The use of "noninvasive" mechanical ventilation at home attempted to void the hazards of tracheostomy and the difficulties inherent in continuous daytime use of oxygen. This form of treatment has allowed these patients to continue their previously productive lives. This study represents the first published long-term follow-up regarding this mode of treatment in patients with alveolar hypoventilation.

Adult↗
PubMed1981

Regulation of ventilation in the obstructive sleep apnea syndrome.

The recent recognition of the sleep apnea syndrome has forced a re-evaluation of the mechanism of hypercapnia and disordered respiratory control in obese patients. Thirteen obese patients with sleep apnea were studied in an attempt to relate the pattern of sleep abnormality and awake ventilatory control to the presence of chronic hypercapnia. Patients with hypercapnia and/or hypoxemia had reduced ventilatory responses to hypercapnic and hypoxic stimulation, respectively. The presence of hypercapnia, however, did not separate the patients with respect to type, duration, or frequency of apneas. The degree of awake chemical drives could not be related to the severity of the sleep apnea phenomenon. However, patients with intact ventilatory control demonstrated augmented ventilation after apneas, which may explain their eucapnic state.

Adult↗
PubMed1980

Canopy ventilation monitor for quantitative measurement of ventilation during sleep.

A portable, easily assembled system that allows quantitative monitoring of ventilation in the sleeping human subject is described. It is a modification of the system used by Kinney et al. (Metab. Clin. Exp. 13: 205-211, 1964) and Spencer et al. (J. Appl. Physiol. 33: 523-528, 1972). The system directly measures gas flow without reliance on indirect CO2 or temperature sensors or on chest wall motion. It is comfortable and reflects the tidal volume with an accuracy of 92%. It also allows measurement of oxygen consumption and CO2 production. The gas breathed by the subject can be varied in composition. Two illustrative examples of the use of the system are given: 1) a case of obstructive apnea; and 2) a case in which a drop in arterial oxygen saturation is explained by quantified hypoventilation undetected by a nasal CO2 probe.

Carbon Dioxide↗
PubMed1980

Flow-volume curve contour in COPD: correlation with pulmonary mechanics.

A study was designed to evaluate the diagnostic usefulness as well as the mechanical determinants of the flow-volume contour in chronic obstructive pulmonary disease (COPD). Twenty patients with COPD of varying etiology were divided equally into two groups. Group 1 had an airway collapse pattern (described in the text) designated type 1, and group 2 had a more curvilinear obstructive pattern designated type 2. Pressure, volume, and flow relationships were examined. The results of our studies showed that a type 1 flow-volume contour in a patient with obstructive airways disease suggests a critical combination of central and peripheral airway collapse at high lung volumes with loss of elastic recoil. However, not all patients with loss of recoil will exhibit this contour. Persistence of type 1 contour suggests that there is a component of airway instability which may be irreversible.

Adult↗
PubMed1979

Hermansky-Pudlak syndrome. Pulmonary manifestations of a ceroid storage disorder.

The Hermansky-Pudlak syndrome is a form of oculocutaneous albinism, characterized by a qualitative platelet defect and deposition of ceroid-like material throughout the reticuloendothelial system. During a 16 month period five patients with Hermansky-Pudlak syndrome presented with symptoms, chest films and pulmonary function studies consistent with restrictive pulmonary disease. In two patients, lung biopsies revealed diffuse interstitial fibrosis. However, light and electron microscopy demonstrated ceroid-like material within alveolar macrophages. In addition, two patients presented with inflammatory bowel disease with deposition of ceroid-like material in the colon. This disorder appears to be more common than is currently recognized and should be considered in the differential diagnosis of diffuse interstitial pulmonary disease and inflammatory bowel disease. A relationship between the deposition of ceroid-like material and pulmonary fibrosis is discussed in light of recent research concerning inflammatory processes. In view of the serious pulmonary, gastrointestinal and hematologic consequences of this syndrome, there is a need for genetic counseling of these patients.

Adult↗
PubMed1976

Role of circulatory congestion in the cardiorespiratory failure of obesity.

The role of circulatory congestion in the cardiorespiratory dysfunction of massive obesity was investigated in 18 patients. They were hypervolemic and had increased cardiac outputs proportionate to their weight. The average resting left ventricular filling pressure was within the upper limits of normal, but it increased to abnormally high levels with increased venous return of passive leg raising, and further during exercise. The elevations in pressure were associated with high resting central blood volumes which increased significantly with exertion. These findings are consistent with reduced distensibility of the central circulation in these congested patients. Weight reduction was accompanied by a decrease in central blood volumes and restoration of a normal left ventricular response in three of four patients and a return toward normal in one. The improvement in ventricular function with relief of edema and dyspnea. In 14 patients with normal or only minimal alveolar hypoventilation, there were no significant transpulmonary diastolic pressure gradients despite a marked increase in left ventricular end-diastolic pressures. One patient, after regaining weight, subsequently had an abnormal gas exchange and an increased pulmonary vascular resistance. He and two others with severe alveolar hypoventilation demonstrated cor pulmonale on a background of left ventricular dysfunction and congestion of the circulation. Two other patients, the least obese of the group, had hypoventilation and cor pulmonale with normal left ventricular pressures. Hypervolemia and a hyperdynamic state are common features of the obese patients. High cardiac output is maintained despite marked circulatory congestion which may result in generalized anasarca and increased ventricular filling pressures. This clinical syndrome may be present in obese patients without intrinsic heart disease and may be reversible with weight reduction. The central circulatory congestion may contribute to the development of the alveolar hypoventilation syndrome in certain obese patients.

Adult↗
PubMed1976

Techniques for measuring the responsiveness of the ventilatory apparatus in man in disease.

More complete understanding of the disturbances in the regulation of ventilation in disease must await techniques which can estimate the neural output of the respiratory centers and also the neural inputs. Some of these techniques, such as diaphragmatic electromyography, offer the prospect of clinical usefulness even now and newer techniques, such as mouth occlusion pressure, are promising but have just begun to be evaluated in disease. Despite the limited ability of current techniques to clearly distinguish abnormal central nervous system function of ventilatory control from peripheral mechanical limitations to ventilation, a useful interpretation of clinical tests of ventilatory responsiveness may be gained by an awareness of the many physiologic and pathogenetic factors which are interposed by disease. These factors may reinforce or diminish both stimuli and response. In chronic disease states, these modifying factors must be identified and evaluated for their role in altered ventilatory responsiveness. Frequently, therapeutic measures can induce substantial effects on these modifying factors, whereas primary disturbances of central nervous system function may be difficult to alter. For the above reasons, tests of ventilatory responsiveness which provide information focussed only on the normality or abnormality of responsiveness to CO2 breathing from measurement of minute ventilation and alveolar PCO2 in an unsteady state, as in the CO2 rebreathing test, may, in a patient, require the addition of tests which allow more complete evaluation of these modifying factors. The state of arterial blood gases, hydrogen ion concentration, bicarbonate concentration, pulmonary function, ventilatory response to exercise, as well as understanding of the state of body temperature, catecholamine secretion, the functional state of the muscles of ventilation, as well as the resistances to ventilation are all a necessary part of the evaluation.

Airway Obstruction↗