Measurement of exhaled nitric oxide in humans and animals.
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OBJECTIVE: Tracheal gas insufflation (TGI) reduces PaCO(2) by flushing the tracheal and mechanical deadspace, and may have its maximum benefit when TGI gas is unopposed by significant expiratory gas flow. Thus, limiting TGI to the late expiratory period may diminish tracheal exposure to TGI gas while preserving the efficacy of TGI. This study examined the gas exchange consequences of such late-expiratory TGI. DESIGN AND SETTING: Randomized controlled trial, animal study. MATERIALS: Eleven pigs. INTERVENTIONS: After stable lung injury was established using oleic acid 11 pigs were ventilated using a standardized lung protective strategy. Phasic expiratory TGI was applied for 30 min stages during the last 20%, 40%, 60%, and 100% of expiration in random sequence. PaCO(2) was continuously measured via an indwelling blood gas analysis system. MEASUREMENTS AND RESULTS: PaCO(2) at baseline was 86.1+/-4.7 mmHg, and decreased progressively with increasing TGI duration of 20%, 40%, and 60%, but not 100%, of expiration (PaCO(2)=75.7+/-5.2, 68.8+/-3.6, 65.1+/-5.3 and 65.2+/-5.2 mmHg, respectively). For all stages the reduction in PaCO(2) relative to baseline was significant. Trends of increasing PaO(2) and airway pressure with increasing TGI duration were noted and most likely associated with a TGI-induced increase in lung volume. CONCLUSIONS: Under these conditions confining TGI to the final 60% of expiration achieved effective PaCO(2) reduction, not significantly different from panexpiratory TGI, while limiting exposure of the trachea to TGI gas, and reducing the potential for TGI-induced hyperinflation. These findings suggest that TGI is most effectively applied in a phasic manner in late expiration, with its duration titrated to effect.
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UNLABELLED: It is important to measure the rate of haemolysis in patients with sickle cell disease (SCD) to identify aplastic crises and indirectly assess the rate of vaso-occlusion and sequestration. The aim of this study was to assess whether end-tidal carbon monoxide (ETCOc) levels in children with sickle cell disease (SCD) could be measured reproducibly, reflected haemolysis and whether they were elevated compared to those of similarly aged, ethnic matched children without SCD (controls). ETCOc levels were measured non-invasively in 87 SCD children (age range 2.3-17.6 years) and 26 age and ethnic origin matched healthy controls using an electro-chemical sensor. The within- and between- occasion reproducibilities were assessed in ten and 15 SCD children respectively. ETCOc levels of 15 SCD children undergoing regular transfusions were related to carboxyhaemoglobin, haemoglobin and bilirubin levels. The within and between occasions' mean intrasubject coefficients of reproducibility were 5% and 18% respectively. Positive correlations were found between the ETCOc and carboxyhaemoglobin ( P =0.007) and bilirubin ( P =0.02) levels, and a significant negative correlation between the ETCOc and haemoglobin ( P =0.0002) levels. The mean and SD ETCOc levels of the SCD children (4.9 ppm; SD 1.7 ppm) were significantly higher than that of the controls (mean 1.3 ppm; SD 0.4 ppm) (difference between means 3.60; 95% C.I. 2.93-4.28; P <0.0001). CONCLUSION: These results suggest that measurement of end-tidal carbon monoxide levels is a reliable and useful method to monitor haemolysis in children with sickle cell disease.
In this study, dry season radon flux densities and radon fluxes have been determined at the rehabilitated Nabarlek uranium mine in northern Australia using conventional charcoal canisters. Environmental background levels amounted to 31+/- 15 milli Becquerel per m(2) per second (mBq m(-2) s(-1)). Radon flux densities within the fenced rehabilitated mine area showed large variations with a maximum of 6500 mBq m(-2) s(-1) at an area south of the former pit characterised by a disequilibrium between (226)Ra and (238)U. Radon flux densities were also high above the areas of the former pit (mean 971 mBq m(-2) s(-1)) and waste rock dump (mean 335 mBq m(-2) s(-1)). The lower limit for the total pre-mining radon flux from the fenced area (140 ha) was estimated to 214 kBq s(-1), post-mining radon flux amounted to 174 kBq s(-1). Our study highlights that the results of radon flux studies are vitally dependant on the selection of individual survey points. We suggest the use of a randomised system for both the selection of survey points and the placement of charcoal canisters at each survey point, to avoid over estimation of radon flux densities. It is also important to emphasize the significance of having reliable pre-mining radiological data available to assess the success of rehabilitation of a uranium mine site.
Changes in expired nitric oxide (NO) occur in airway inflammation and have proved to be important in the monitoring of inflammatory disease processes such as asthma. We set out to develop a novel hand-held NO-analyzer with a performance comparable to the present more costly and complex chemiluminescence instruments. The new device is based on a specially designed electrochemical sensor, where we have developed a novel sampling and analysis technology, compensating for the relatively slow response properties of the electrochemical sensor technique. A Lowest Detection Limit in NO-analysis from reference gas tests of less than 3 ppb and a response time of 15 seconds together with an average precision in human breath measurements of 1.4 ppb were obtained. We also show an agreement with the existing 'gold standard' FENO measurement technique, within 0.5 ppb in a group of 19 subjects together with a high linearity and accuracy compared to reference gases. The new analyzer enables affordable monitoring of inflammatory airway diseases in research and routine clinical practice.
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Low molecular mass hydrocarbons, particularly ethane and pentane, have been measured in expired air of man. The air is collected into 5-10 l polyamide bags. After removal of water vapour and CO2, the hydrocarbons are concentrated on a silicagel column kept at 0 degree C. The column desorption is carried out at 290 degrees C, and the gases are analysed by gas chromatography. A slight but statistically significant increased pentane production was detected in cirrhotic patients.
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A pilot study to test methods of estimating personal exposures to toxic substances and corresponding body burdens was carried out between July and December 1980. Individual exposures to about a dozen volatile organic compounds in air and drinking water were measured for nine volunteers in Bayonne and Elizabeth, New Jersey, and for three volunteers in Research Triangle Park, North Carolina during three 3-day visits over the 6-month period. Breath samples were also collected from all subjects on each visit. Composite food samples were collected in each locality. Sampling and analytical methods for air, water, food, and breath were evaluated and found generally capable of detecting concentrations as low as 1 microgram/m3 in air and breath, and 1 ng/g in water and food. About 230 personal air samples, 170 drinking water samples, 66 breath samples, and 4 food samples (16 composites) were analyzed for the target chemicals. Ten compounds were present in air and eight were transmitted mainly through that medium. The two target trihalomethanes (chloroform and bromodichloromethane) were predominantly transmitted through water and beverages. Food appeared to be a minor route of exposure, except possibly for trichloroethylene in margarine. Seven compounds were present in more than half of the breath samples. Diurnal and seasonal variations were noted in air and water concentrations of some compounds, with summer levels generally higher. For some chemicals, weekday air exposures were significantly higher than weekend exposures. Some, but not all, of the potentially occupationally exposed individuals had significantly higher workplace exposures to several chemicals. Distributions of air exposures were closer to log normal than normal for most chemicals. Several chemicals were highly correlated with each other in personal air samples, indicating possible common sources of exposure.