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PubMed1981

Measurement of respiratory gas exchange during artificial respiration.

This paper reports a new system for the continuous measurements of respiratory gas exchange in ventilated subjects. It involves mixing some of the inspired gas with all of the expired gas and withdrawing the mixture at a constant rate through a dry gas meter that measures the flow. The inspired gas and expired gas mixtures are sampled and O2 and CO2 concentrations measured with a paramagnetic gas analyzer and a capnograph, respectively, to an accuracy of 0.01%. Evidence is presented to confirm the necessary stability and sensitivity of these instruments. It is possible to use the system with high inspired O2 concentrations, with ventilators where there is incomplete separation of inspired and expired gas, and in the presence of intermittent mandatory ventilation, positive end-expiratory pressure, and continuous airway pressure. The system was compared with the N2-dilution method and with the collection of expired gas in a Douglas bag in dog experiments and with patients in the intensive therapy unit. Excellent correlation between these methods was found in all circumstances.

Air Pressure↗
PubMed1992

Effects of corticotropin-releasing hormone on the postoperative course of elderly patients under long-term artificial respiration.

In both human and animal studies a stimulatory effect of corticotropin-releasing hormone (CRH) on respiration and on cognitive parameters has been demonstrated. Our own studies employing human CRH (hCRH) iv in healthy volunteers and different groups of patients have shown hCRH to be a safe drug. We prospectively studied the clinical effects of a standardized dose of 100 micrograms hCRH iv in 12 elderly patients following major abdominal surgery who remained comatose and were under prolonged respirator therapy over a mean period of 37 days. Cardio-respiratory parameters, blood gas values, plasma cortisol and catecholamines were evaluated before and 30 min following hCRH injection. Furthermore, vigilance was tested using a score system. Ventilation was markedly enhanced following hCRH injection while the cardiovascular parameters were only moderately affected. Vigilance was augmented in all subjects and improved impressively in five patients. The changes were of great benefit for the patients treated and supported their respirator weaning procedures and mobilization training.

Abdomen↗
PubMedDate not supplied

[Optimization of artificial respiration parameters in patients with acute pulmonary parenchymal damage syndrome].

The relationship between the mean pressure in the trachea, generated in mechanical ventilation of the lungs (Ptr.m), and normal arterial oxygenation is linear in ventilated patients with severe bilateral acute parenchymatous damage to the lungs. Under conditions of mechanical ventilation of the lungs (MVL) with regulated volume, constant end-expiratory pressure (PEEP) and inspiratory pause (eIP) are effective methods for regulating Ptr.m. However, the efficacy of regulating Ptr.m by PEEP and IF for each clinical case is different. The algorithm of using PEEP and IF for optimizing the respiratory pattern in this category of patients is not clear, too. The results indicate that optimization of MVL with controlled volume should be started with selecting the optimal level of PEEP for each patient. The level of Ptr.m should not be increased immediately at by of prolonging eIP, because the probability of compromising the hemodynamics is higher in such a case than the probability of improving blood oxygenation. Only after selecting the optimal PEEP is it permissible to try to improve arterial oxygenation by prolonging xx, because under such conditions the efficacy of prolonged inspiration is notably increased. Our data indicate that eIP no higher than 30% of the respiratory cycle (inspiration/expiration = 1.5/1) is the optimal. A further increase of eIP gives rise to a tendency towards decrease of arterial oxygenation and oxygen transport to tissues.

Acute Disease↗
PubMedDate not supplied

[Doppler ultrasound monitoring of cerebral circulation during neonatal intensive care with special reference to artificial respiration].

BACKGROUND: Doppler sonographic data from routine cerebral ultrasonic examination of mechanically ventilated premature neonates were analyzed in order to find out which intensive care influence factors take effect on the cerebral circulation. It was to be demonstrated if Doppler sonographic results are changed by current intensive medical influences especially mechanically ventilation. PATIENTS AND METHODS: In 24 premature neonates (mean gestational age 29.6 +/- 4 weeks, mean birth weight 1367 +/- 660 g) treated with mechanical ventilation for IRDS cerebral blood flow parameters were assessed by pulsed Doppler sonography. A single Doppler sonographic investigation was performed during the first week of life (median: day 5). Doppler flow velocity waveforms were obtained, and resistance index (RI) and pulsatility index (PI) values were calculated from the anterior cerebral arteries (ACA) as well as from the internal carotid artery (ACI). Oscillometrically measured blood pressure, pH, pCO2, and parameters of mechanical ventilation were registered. RESULTS: Besides the well established influence of pCO2 and blood pressure parameters of mechanical ventilation PEEP and time of inspiration have an influence on cerebral blood flow. CONCLUSIONS: Our results demonstrate the impact of mechanical ventilation on cerebral blood flow and therefore indicate the necessity of Doppler sonographic monitoring during mechanical ventilation. To our knowledge this is the first report about the influence of mechanical ventilation on cerebral blood flow in neonates.

Blood Flow Velocity↗