[Effects of positive pressure respiration and controlled respiration on blood circulation: experimental research].
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By exploiting the rapid, direct electrochemistry of horse heart cytochrome c at a modified gold electrode it has been possible to couple the electrode reaction with respiration in rat liver mitochondria and in protoplasts of Paracoccus denitrificans, but not in protoplasts from E. coli. Oxidation of endogenous and exogenous sources of reducing equivalents via cytochrome c is also observed.
With the objective to test the effect of intermittent and short term rest in respiratory muscles in patients with COPD and maintained hypercapnia we have studied 34 patients in a stable condition: 23 were part of the study group (Group I) and 11 were the control group (Group II). After a complete functional basal study, patients in Group I were treated with intermittent rest of their respiratory muscles, through a negative pressure external respirator--shield type--during three consecutive days. We got, in this study group, a significative improvement in the maximum inspiratory pressure measured at residual volume (PI max RV), which went from 66.6 +/- 15.9 to 71.2 +/- 15.2 (p < 0.005), as well as a lowering, also significative, of partial pressure of CO2 in arterial blood (PaCO2) and in expired air (EFCO2), which went from 55.2 +/- 7.2 to 52.3 +/- 3 (p < 0.0002) and 3.3 +/- 0.5 to 3.1 +/- 0.5 (p < 0.01), respectively. Maximum inspiratory pressure measured to functional residual capacity (PI max FRC) experienced an increase in the limit of statistical signification. Rest of the parameters did not significantly change. These results back the hypothesis that in stabilized COPD with CO2 retention, a chronic fatigue of respiratory muscles could exist, and that intermittent rest of these muscles could mean an hypercapnia diminution, due to the improvement in the function of respiratory muscles.
Alarm systems of ventilators enhance detection of possible critical events during artificial ventilation. Due to their significance, in some countries the alarm detection of ventilators is regulated by federal law. Up to now, no recommendations for the adjustment of alarm limits exist and only a few detailed investigations of the accuracy of alarm detection are available. METHODS. The response of four commercially available ventilators (Servoventilator 900C, Siemens, Inc.; Bennett 7200a, Hoyer, Inc.; Veolar, Hamilton, Inc.; EVITA, Dräger, Inc.) to critical events during artificial ventilation of a test lung were evaluated. We measured the alarm time (the time between event creation and alarm response) of ten different simulated critical events including disconnection, differentisized leaks, failure of the gas supply, and obstruction at different places in the artificial airway. DISCUSSION. All respirators were able to recognise severe critical situations such as hose disconnection, failure of gas supply, and total airway obstruction within a short time (< 15 s). The recognition of small airway leaks was more difficult for the ventilators even when the alarm thresholds were close. The alarm detection of the EVITA (software 10.0 or less) under conditions of partial airway obstruction may be a source of risk for the patient as the machine continued supplying inspiration with pressure-limited ventilation even when the pressure threshold was reached.
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