Y004154 1 1806810 86023810 Maximal inspiratory and expiratory pressures are reduced in hyperinflated, malnourished, young adult male patients with cystic fibrosis. Szeinberg A; England S; Mindorff C; Fraser IM; Levison H Respiratory Physiology, Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada. Am Rev Respir Dis (US), Oct 1985, 132 (4) p766-9, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8601 Subfile: AIM; INDEX MEDICUS We measured maximal inspiratory and expiratory pressures (MIP and MEP, respectively) in 23 male patients with cystic fibrosis (CF), 16 to 35 yr of age (22.1 +/- 3.7), and in a control group of 33 male volunteers, 17 to 39 yr of age (22.5 +/- 6.8), to evaluate the effects of chronic hyperinflation and malnutrition on MIP and MEP in the patients with CF. Routine pulmonary function tests and skeletal muscle indexes, such as the force generated by the adductor pollicis muscle with supramaximal ulnar nerve stimulation at a frequency of 10 Hz as percentage of force at 100 Hz (F10/100) and midarm muscle circumference as a percentage of predicted (MAMC), were also measured in the patients with CF. Severe hyperinflation in this study was defined as a ratio of residual volume to total lung capacity above ?0% and malnutrition as a ratio of actual weight to the ideal weight for the patient' age and height of 90% or less. The severely hyperinflated subgroup of patients with CF had significantly reduced MIP values in comparison with those in the other patients with CF. The malnourished subgroup, which was also severely hyperinflated, differed from the well-nourished one in both skeletal muscle indexes; MAMC was reduced, whereas F10/100 was elevated, and respiratory muscle pressure generation, MIP, and ME were reduced. We conclude that patients with CF who are malnourished and/or severely hyperinflated have reduced maximal respiratory pressures. Tags: Human; Male; Support, Non-U.S. Gov't Desc.: Adolescence; Adult; *Cystic Fibrosis--Complications (CO); Cystic Fibrosis--Physiopathology (PP); *Nutrition Disorders--Complications (CO); Nutrition Disorders--Physiopathology (PP); Pressure; Residual Volume *Respiration; Respiratory Function Tests; Total Lung Capacity Y004154 2 1806644 86023644 Assessing tidal volume and detecting hyperinflation during Venturi jet ventilation for microlaryngeal surgery. Glenski JA; MacKenzie RA; Maragos NE; Southorn PA Dept. of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905. Anesthesiology (US), Nov 1985, 63 (5) p554-7, ISSN 0003-3022 Jrnl Code: 4SG Lang.: ENG. Jrnl Ann.: 8601 Subfile: AIM; INDEX MEDICUS Tags: Human; Support, Non-U.S. Gov't Desc.: Adolescence; Adult; Aged; Airway Obstruction--Physiopathology (PP); Child; Intraoperative Complications; *Larynx--Surgery (SU); Lung--Physiology (PH); *Microsurgery; Middle Age; Pressure; *Respiration; *Respiration, Artificial--Methods (MT); Tidal Volume; Trachea--Physiology (PH) Y004154 3 1780167 85305167 The contributions of rib cage and abdominal displacements to the hyperinflation of acute bronchospasm. Lennox S; Mengeot PM; Martin JG Meakins-Christie Laboratorie, McGill Univ., Montreal, Quebec, Canada. Am Rev Respir Dis (US), Sep 1985, 132 (3) p679-84, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8512 Subfile: AIM; INDEX MEDICUS To quantitate the relative contributions of rib cage and abdomen to the hyperinflation of asthma, we examined chest wall movements during histamine-induced bronchospasm in 7 male asthmatic subjects. A reduction in FEV1 of 28.1 +/- 4.5% (mean +/- 1 SE) was associated with an increase in functional residual capacity (FRC) of 0.99 +/- 0.19 L, as measured by spirometer. Similar increases in FRC (0.91 +/- 0.18 L) were obtained using a DC respiratory inductive plethysmograph (RIP). The absolute error of measurement of delta FRC by RIP, compared with that by the spirometer, was 23.0 +/- 1.9%. The delta FRC by RIP was slightly less than by spirometer, as indicated by a net positive error of 7.2 +/- 7.3%. Increase in the volume of the rib cage, measured by RIP, usually accounted for the major change in FRC (75%). Even though the contribution of rib cage displacement to delta FRC ranged from as little as 30% to as much as 100% of the change in individual subjects, it was correlated with the rib cage contribution to the tidal breath prior to bronchoconstriction. We conclude that the relative contributions of rib cage and abdominal displacements to the volume of hyperinflation during mild to moderate acute induced bronchoconstriction are quite variable, but they can be predicted from the relative contributions of these compartments to tidal breathing prior to bronchoconstriction. Tags: Human; Male; Support, Non-U.S. Gov't Desc.: *Abdomen--Physiopathology (PP); Acute Disease; Adult; Bronchial Spasm--Chemically Induced (CI); *Bronchial Spasm--Physiopathology (PP); Forced Expiratory Volume; Functional Residual Capacity; Histamine; Plethysmography--Methods (MT); Respiration; *Ribs--Physiopathology (PP); Tidal Volume; Time Factors CAS Registry No.: 51-45-6 (Histamine) Y004154 4 1777655 85302655 Can modern therapy influence the prognosis of brain injuries in childhood Klot J Univ. Children's Hospital, Dept. of Paediatric Surgery, Zurich, Switzerland. Z Kinderchir (GERMANY, WEST), Jun 1985, 40 (3) p131-5, ISSN 0174-3082 Jrnl Code: YF2 Lang.: ENG. Jrnl Ann.: 8512 ŠSubfile: INDEX MEDICUS A standard therapy and the outcome following severe head injury in 51 children are presented. The Glasgow-Coma-Scale was used for classification. Initial therapy included intubation, hyperventilation, ICP monitoring, and barbiturate coma. 14 children had a normal ICP recording, 13 showed moderate (-5 mmHg) ICP elevations, and 23 had recurrent ICP elevations above 35 mmHg. Only one patient survived in a vegetative state. Overall mortality was 21%. All but one of the survivors were controlled one year after the accident. School performance, social integration and the Glasgow-Outcome-Scale were controlled for judging the results. 82% of the surviving children were able to visit a normal school. Tags: Female; Human; Male Desc.: Adolescence; Brain Injuries--Classification (CL); *Brain Injuries--Therapy (TH); Child; Child, Preschool; Infant; Intracranial Pressure; Methods; Prognosis Y004154 5 1763240 85288240 A review and critique of the literature on preoxygenation for endotratheal suctioning. Riegel B; Forshee T Scripps Clinic and Research Foundation, San Diego, CA 92123. Heart Lung (US) , Sep 1985, 14 (5) p507-18, ISSN 0147-9563 Jrnl Code: G2V Lang.: ENG. Jrnl Ann.: 8512 Subfile: AIM; INDEX MEDICUS Tags: Human Desc.: Anoxemia--Etiology (ET); *Anoxemia--Prevention and Control (PC); Apnea--Physiopathology (PP); *Intubation, Intratracheal; Nursing Care ; *Oxygen--Administration and Dosage (AD); Oxygen--Blood (BL; Research--Methods (MT); Suction--Adverse Effects (AE); *Suction--Methods (MT) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 6 1758905 85283905 Real-time analysis of the change in arterial oxygen tension during endotracheal suction with a fiberoptic bronchoscope. Arai T; Hatano Y; Komatsu K; Takada T; Miyake C; Harioka T; Reshid K Dept. of Anesthesia, Kyoto Univ. Hospital, Japan. Crit Care Med (US), Oct 1985, 13 (10) p855-8, ISSN 0090-3493 Jrnl Code: DTF Lang.: ENG. Jrnl Ann.: 8512 Subfile: AIM; INDEX MEDICUS An intra-arterial Clark-type polarographic oxygen electrode was used with a fiberoptic bronchoscope for real-time analysis of the PO2 change during 1 min of suction in patients spontaneously breathing oxygen. There was a strong correlation between values obtained from the intra-arterial electrode (PiO2) and those from blood samples (PaO2), before and at the end of suction; the PiO2/PaO2 ratio was close to one. Continuous PiO2 recordings during suction without supplemental oxygen showed little change in the early period of suction, followed by a steep drop continuing even after suction. This drop in PiO2 was partially attenuated by providing oxygen with high-frequency jet ventilation and was almost completely attenuated by the use of a suction adaptor. Changes in the inspired oxygen concentration indicated the importance of keeping this variable constant during suction to prevent hypoxemia. Tags: Female; Human; Male Desc.: Adult; Aged; *Bronchoscopy; Electrodes; Fiber Optics--Instrumentation (IS); Intubation, Intratracheal--Instrumentation (IS); Middle Age; Monitoring, Physiologic; Oxygen--Blood (BL); *Oxygen--Physiology (PH); Partial Pressure; Postoperative Care; POSTOP CARE ; *Respiration; Respiration, Artificial--Instrumentation (IS); *Suction; Suction--Instrumentation (IS); Thoracic Surgery; Time Factors CAS Registry No.: 7782-44-7 (Oxygen) Y004154 7 1750401 85275401 Catecholamine response to chest physiotherapy and endotracheal suctioning in preterm infants. Greisen G; Frederiksen PS; Hertel J; Christensen NJ Dept. of Neonatology, Rigshospitalet, Copenhagen, Denmark. Acta Paediatr Scand (SWEDEN), Jul 1985, 74 (4) p525-9, ISSN 0001-656X Jrnl Code: 1LV Lang.: ENG. Jrnl Ann.: 8511 Subfile: INDEX MEDICUS Adrenaline and noradrenaline was measured just before and just after chest physiotherapy and endotracheal suctioning in 13 preterm, ventilated, newborn infants. Mean aortic blood pressure was also recorded. Eight of the infants received phenobarbitone. Catecholamine levels were five-fold higher in the 5 infants with blood pH less than 7.30 compared to the other 8 infants. After the procedure, both adrenaline and noradrenaline were significantly higher than baseline levels. The adrenaline response to the procedure was a two-fold increase and significantly greater than the noradrenaline response. Analysis of the effects of phenobarbitone treatment and acidosis on catecholamine responses by multiple-linear regression demonstrated that the adrenaline response was reduced by phenobarbitone while the noradrenaline response was unaffected. There were no associations of blood pressure, responses with catecholamine responses, with cidosis or with phenobarbitone treatment. Tags: Human Desc.: Acidosis--Blood (BL); Blood Pressure--Drug Effects (DE); Cerebral Hemorrhage--Prevention and Control (PC); *Epinephrine--Blood (BL) Infant Care; Infant, Newborn; *Infant, Premature; *Intubation, Intratracheal; *Norepinephrine--Blood (BL); *Phenobarbital--Therapeutic Use (TU); *Respiration, Artificial CAS Registry No.: 50-06-? (Phenobarbital); 51-41-2 (Norepinephrine); 51-43-4 (Epinephrine) Y004154 8 1743440 85268440 ŠSevere hypophosphatemia after head injury. Gadisseux P; Sica DA; Ward JD; Becker DP Cliniques Universitaires de Mont Godinne, Yvoir, Belgium. Neurosurgery (US), Jul 1985, 17 (1) p35-40, ISSN 0148-396X Jrnl Code: NZL Lang.: ENG. Jrnl Ann.: 8511 Subfile: INDEX MEDICUS Hypophosphatemia occurs in a variety of clinical conditions. It develops in parallel with phosphate depletion from body losses or more commonly as a sequel to the redistribution of phosphate from the extracellular to the intracellular compartment. Hypophosphatemia is a multisystem disturbance capable of involving the neurological, immunological, and muscular systems, among others. In this report, we describe five patients with severe head injury who developed marked hypophophatemia (less than 1 mg/dl) within 24 hours of hospitalization. This fall in serum phosphate coincided with the induction of respiratory alkalosis consequent to mechanical ventilation. In four of the five patients, as acid-base parameters returned to normal, serum phosphate values rose, in all instances reaching values greater than 2.5 mg/dl. Urinary phosphorus excretion, ordinarily negligible after hypophosphatemia induced by hypocapnia, was still present in Cases 1 and 4 (greater than 600 mg/24 hours). This is unexplained by any of the known hormonal or fluid alterations that accompany head injury. These five patients developed severe, yet transient, hypophosphatemia that resolved upon correction of hyperventilation-induced acid-base abnormalities. We discuss the pathophysiology of this entity and the implications for the head trauma patient. Tags: Female; Human; Male Desc.: Adolescence; Adult; Brain Concussion--Blood (BL); Brain Edema--Blood (BL); *Brain Injuries--Blood (BL); Cerebral Hemorrhage--Blood (BL); Hematoma, Epidural--Blood (BL); Hematoma, Subdural--Blood (BL); Middle Age; *Phosphates--Blood (BL) Y004154 9 1731522 85256522 Therapeutic considerations in respiratory muscle function. Sharp JT Hines V.A. Hospital, IL 60141. Chest (US), Aug 1985, 88 (2 Suppl) p118S-123S, ISSN 0012-3692 Jrnl Code: D1C Contract/Grant No.: Hl-31558 Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8511 Subfile: AIM; INDEX MEDICUS Inspiratory muscle function is impaired in many patients with severe COPD. This functional impairment often leads to hypercapnic respiratory failure via inspiratory muscle fatigue. Factors responsible for this functional impairment are: (1) an excessive mechanical load (high resistance and low compliance) for the inspiratory muscles to overcome; (2) the low, flat configuration of the diaphragm owing to lung hyperinflation; (3) reduced inspiratory muscle blood flow relative to the increased respiratory work requirement; and (4) tachypnea which increases the duty cycle (TI/Ttot) for inspiratory muscles, increases hyperinflation, wastes ventilation, and otherwise causes deterioration of gas exchange. Therapy is directed toward improving inspiratory muscle function and has three strategic goals: (1) to reduce the load imposed on the inspiratory muscles and reduce their mechanical disadvantage; (2) to improve the contractile characteristics of the inspiratory muscles; and (3) if goals 1 and 2 cannot be attained otherwise, to rest the inspiratory muscles using mechanical ventilation. Inspiratory muscle training offers promise as a means of preventing hypercapnic respiratory failure. Available data suggest that some COPD patients benefit from it. To be determined are which patients will benefit from it and which will not, as well as which training regimens are most effective. (25 Refs.) Tags: Animal; Human; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S. Desc.: Airway Resistance; Biomechanics; Diaphragm--Blood Supply (BS); Diaphragm--Metabolism (ME); Diaphragm--Physiopathology (PP); Intercostal Muscles--Blood Supply (BS); Intercostal Muscles--Metabolism (ME); Intercostal Muscles--Physiopathology (PP); Lung Compliance; *Lung Diseases, Obstructive--Physiopathology (PP); Lung Diseases, Obstructive--Therapy (TH); Lung--Physiopathology (PP); Muscle Contraction; Muscles--Blood Supply (BS); Muscles--Metabolism (ME); *Muscles--Physiopathology (PP); Pectoralis Muscles--Blood Supply (BS); Pectoralis Muscles--Metabolism (ME); Pectoralis Muscles--Physiopathology (PP); Physical Therapy; Pulmonary Gas Exchange; Regional Blood Flow; *Respiration Y004154 10 1708911 85233911 The effect of a positive end-expiratory pressure adapter on oxygenation during endotracheal suctioning. Douglas S; Larson EL Univ. of Pennsylvania School of Nursing, Hospital of the Univ. of Pennsylvania, Philadelphia 19104. Heart Lung (US), Jul 1985, 14 (4) p396-400, ISSN 0147-9563 Jrnl Code: G2V Lang.: ENG. Jrnl Ann.: 8510 Subfile: AIM; INDEX MEDICUS Tags: Female; Human; Male Desc.: Adult; Aged; Intubation, Intratracheal--Instrumentation (IS) ; Intubation, Intratraheal--Methods (MT); Middle Age; *Oxygen--Blood (BL) *Positive Pressure Respiration--Instrumentation (IS); Positive Pressure Respiration--Methods (MT); *Respiration, Artificial--Instrumentation (S); Respiration, Artificial--Methods (MT); Suction--Instrumentation (IS); *Suction--Methods (MT) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 11 1708908 85233908 Hyperinflation, hyperventilation, and hyperoxygenation before tracheal suctioning in children requiring long-term respiratory care. Feaster SC; West C; Ferketich S School of Nursing, Univ. of California San Francisco. Heart Lung (US) , Jul 1985, 14 (4) p379-84, ISSN 0147-9563 Jrnl Code: G2V Lang.: ENG. Jrnl Ann.: 8510 ŠSubfile: AIM; INDEX MEDICUS The findings reported failed to support a best method of pretreating subjects before tracheal suctioning to minimize oxygen desaturation. Conversely, all method prevented significant desaturation. No subject's desaturation readings dropped during the study to such a point that they did not subsequently recover after 30 seconds and return to baseline by the end of the 20 minutes. Several subjects has the high 70s to low 80s as reported during CTP. After recovery from CTP ( in mot cases a 30-second time period), no clinically significant desaturation was noted from the 30-second time period to the end of the study. The results could not be reproduced when the trials were repeated on four subjects. If oxygenation is questionable, these children should be monitored noninvasively to prevent serious desaturation in an already compromised patient. Tags: Comparative Study; Female; Human; Male Desc.: Bronchopulmonary Dysplasia--Blood (BL); Bronchopulmonary Dysplasia--Physiopathology (PP); Brochopulmonary Dysplasia--Therapy (TH); Child, Preschool; Chronic Disease; Hyperventilation--Blood (BL); *Hyperventilation--Physiopathology (PP); Infant; Intubation, Intratracheal Muscular Diseases--Congenital (CN); Muscular Diseases--Therapy (TH); *Oxygen--Blood (BL); *Respiration, Artificial--Methods (MT); *Suction--Methods (MT) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 12 1701932 85226932 Ventilatory support for pulmonary failure of the head trauma patient. Hemmer M Dept. of Anesthesiology and Surgical Intensive Care, Centre Hospitalier de Luxembourg. Bull Eur Physiopathol Respir (ENGLAND) , May-Jun 1985, 21 (3) p287-93, ISSN 0395-3890 Jrnl Code: BGX Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8510 Subfile: INDEX MEDICUS Severe head trauma patients frequently develop pulmonary failure. The aetiology of this respiratory distress may be central (neurogenic pulmonary oedema, delayed neurogenic pulmonary dysfunction, abnormal respiratory patterns) or peripheral, due to chest trauma, multiple trauma or lung infection. Hypoxia and hypercarbia alter cerebral haemodynamics, increase intracranial pressure and cause secondary deterioration of neurological function. Ventilatory support is of utmost importance in supportive care of head trauma patients. Continuous mechanical ventilation and intermittent mandatory ventilation are most frequently employed. Hyperventilation is used to lower intracranial pressure and positive end-expiratory pressure (PEEP) is applied in lung disorders characterized by interstitial oedema and alveolar collapse. The effects of PEEP on cerebral perfusion pressure and on intracranial pressure depend on the interaction of pulmonary compliance, cerebral pressure/volume relationship and cerebral vascular autoregulation. High levels of EEP may be deleterious in patients with altered cerebral autoregulation. High frequency ventilation theoretically has less influence on intrathoracic pressures and on cerebral haemodynamics but has not been shown superior in the respiratory support of severe head trauma patients. (78 Refs.) Tags: Animal; Human Desc.: Anoxia--Etiology (ET); Blood Pressure; Brain Injuries--Complications (CO); Brain Injuries--Physiopathology (PP); Brain Injuries--Therapy (TH); Brain--Blood Supply (BS); Central Nervous System--Physiopathology (PP); *Head Injuries--Complications (CO); Head Injuries--Physiopathology (PP); Hypertension, Pulmonary--Etiology (ET); Intracranial Pressure; Lung Compliance; Lung--Blood Supply (BS); Positive ressure Respiration; Pulmonary Edema--Etiology (ET); Pulmonary Gas Exchange; *Respiration, Artificial--Methods (MT); Respiratory Insufficiency--Etiology (ET); Respiratory Insufficiency--Physiopathology (PP); *Respiratory Insufficiency--Therapy (TH); Vascular Resistance; Ventilation-Perfusion Ratio Y004154 13 1698407 85223407 Inspiratory force reserve of the respiratory muscles in children with chronic obstructive pulmonary disease. Gultier C; Boule M; Tournier G; Girard F Laboratory of Physiology, Hopital Antoine Beclere, Clamart, France. Am Rev Respir Dis (US), Jun 1985, 131 (?) p811-5, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8509 Subfile: AIM; INDEX MEDICUS The purpose of this study was to evaluate inspiratory muscle force reserve in children with chronic obstructive pulmonary disease (COPD). In 15 hyperinflated (FRC/TLC, 65 +/- 0.7%) children, maximal mouth inspiratory static pressure (PImax) at FRC, mouth occlusion pressure (P0.1), tidal volume (VT), inspiratory time (TI), and total duration of the respiratory cycle (Ttot) were all measured. It was found that PImax at FRC was reduced compared with predicted values. However, after lung volume correction, PImax was in the normal range, and P0.1 was higher, TI was shorter, and Ti/Ttot was lower than predicted. The estimated mean inspiratory pressure for breathing at rest (PI) was significantly higher than predicted and was related to total pulmonary resistance (r = 0.74, p less than 0.001). The fraction of PImax developed by the respiratory muscles for breathing at rest (PI/PImax) significantly increased. The higher the PI/PImax ratio, the more the TI/Ttot ratio decreased (r = -0.64, p = 0.01). At rest, our subjects had to develop a mean inspiratory power (W) of as much as 48% (range, 30 to 76%) of the critical W above which fatigue occurs. Thus, even minimal increases in breathing load might expose children with COPD to respiratory muscle fatigue and to respiratory failure. Tags: Comparative Study; Female; Human; Male Desc.: Adolescence; Child; Functional Residual Capacity; *Lung Diseases, Obstructive--Physiopathology (PP); *Muscles--Physiopathology (PP) ; *Respiration; Respiratory Function Tests; *Respiratory System--Physiopathology (PP); Rest; Risk; Tidal Volume; Time Factors; Total Lung Capacity Y004154 14 1669477 85194477 [Special artificial respiration procedures and intracranial pressure. Animal experiment studies, development and use of a new pressure measuring technic, clinical aspects] Spezielle Beatmungsverfahren und intrakranieller Druck. Tierexperimentelle Untersuchungen, Entwicklung und Anwendung eines neuen Druckmessprinzips, Klinik. Schedl R II. Universitatsklinik fur Unfallchirurgie, Wien. Wien Klin Wochenschr [Suppl] (AUSTRIA), 1985, 157 p1-22, ISSN 0300-5178 Jrnl Code: XOR Lang.: GERMAN Summary Languages: ENG. Doc. Type: English Abstract Jrnl Ann.: 8508 Subfile: INDEX MEDICUS We investigated the influence of Forced Diffusion Ventilation (FDV), a special form of High Frequency Ventilation (HFV), on elevated intracranial pressure (ICP) in 5 dogs. Elevation of ICP as standardized by inflation of an epidural balloon. A typical finding with FDV is a reduced intrapleural pressure and therefore one could expect a better cerebrovenous drainage influencing ICP. Nevertheless, we found no changes in mean ICP under conditions of FDV compared with IPPV. Respirator synchronous fluctuations of ICP, cisternal cerebrospinal fluid pressure and intrapleural pressure were drastically reduced with FDV. This phenomenon has been already reported by other groups as a typical effect of HFV with rates of 100/min. One can speculate, that this immediate impact of HFV on ICP-curves might be of some advantage in patients with critically reduced intracranial compliance requiring long-term artificial ventilation, because peaks and amplitudes of ICP are reduced. Our clinical experience with High Frequency Pulsation (HFP) includes 11 patients with severe brain trauma. In clinical routine this method of HFV is more facile to applicate than FDV, because there is no need of a special endotracheal tobe and sufficient CO2-elimination is not strongly dependent on precise position of the tube. But HFP, as FDV, includes all advantages of respiratory systems, that are open against atmosphere (coughing and simultaneous breathing, without drastically increasing airway pressure, suction during respiration, etc.). However, we could find no special advantages or disadvantages in ICP-course during long-term application of HFP (up to 10 days). Because application of HFV is dependent on special technical equipment, we investigated in patients the influence of respiratory frequency, tidal volume and inspiratory flow on ICP-fluctuations using conventional ventilators. ICP was recorded by a new, self constructed pneumatic epidural pressure sensor. Ventilator-related ICP-fluctuations were found to be markedly reduced at frequencies of 20/min and usually eliminated at 30/min. We found an exponential correlation between ICP-fluctuations and respiratory frequency and there was no correlation between tidal volume and ICP. Central venous pressure amplitudes were found to be in linear correlation with respiratory frequency and tidal volumes as well. The amplitude of respiratory ICP-fluctuations seems to be more d ependent on duration of expiratory time. As our findings demonstrated art Tags: Animal; Female; Human; Male Desc.: Adult; *Brain Injuries--Therapy (TH); Carbon Dioxide--Blood (BL); Dogs; Hemodynamics; *Intracranial Pressure; Manometry--Instrumentation (IS); Oxygen--Blood (BL); *Respiration, Artificial--Methods (MT) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 15 1659884 85184884 ŠFactors affecting intracranial pressure: a descriptive study. Boortz-Marx R Univ. Hospital, Division of Neurosurgery, London, Ontario, Canada. J Neurosurg Nurs (US), Apr 1985, 17 (2) p89-94, ISSN 0047-2603 Jrnl Code: JD7 Lang.: ENG. Jrnl Ann.: 8508 Subfile: INDEX MEDICUS This study examined the effects of 365 occurrences on the intracranial pressure (ICP) of four patients with severe head injuries and a Glasgow Coma Score below five. The occurrences were in: 1) health care activities, 2) patient-initiated activities, and 3) environmental stimuli. The health care activities that increased intracranial pressure were suctioning, turning, and flexion of the head; decreases were realized by elevating the head of the bed and repositioning the patient. The patient-initiated activities that increased intracranial pressures were flexion of extremities, rotation of the neck, and coughing. In contrast to previous reports, environmental stimuli did not affect intracranial pressure and bathing increased it. Recommendations for nursing care include: turning patients more slowly to less acute angles; proper head/neck positioning; and more direct psychosocial interactions with families of patients who have low Glasgow Coma Scores. Tags: Female; Human; Male Desc.: Adult; Child; *Coma--Physiopathology (PP); Cough--Physiopathology (PP); Environment; *Head Injuries--Physiopathology (PP); *Intracranial Pressure; Middle Age; Movement; Nursing Care; *Physical Stimulation; Posture Y004154 16 1632271 85157271 Effect of expiratory loading on glottic dimensions in humans. Branatisano TP; Dodd DS; Collett PW; Engel LA Thoracic Medicine Unit, Westmead Hospital, Sydney, New South Wales, Australia. J Appl Physiol (US), Feb 1985, 58 (2) p605-11, ISSN 8750-7587 Jrnl Code: HEG Lang.: ENG. Jrnl Ann.: 8507 Subfile: INDEX MEDICUS We examined the effects of external mechanical loading on glottic dimensions in 13 normal subjects. When flow-resistive loads of 7, 27, and 48 cmH2O X l-1 X s, measured at 0.2 l/s, were applied during expiration, glottic width at the mid-tidal volume point in expiration (dge) was 2.3 +/- 12, 37.9 +/- 7.5, and 38.3 +/- 89% (means +/- SE) less than the control dge, respectively. Simultaneously, mouth pressure (Pm) increased by 2.5 +/- 4, 3.0 +/- 0.4, and 4.6 +/- 0.6 cmH2O, respectively. When subjects were switched from a resistance to a positive end-expiratory pressure at comparable values of Pm, both dge and expiratory flow returned to control values, whereas the level of hyperinflation remained constant. Glottic width during inspiration (unloaded) did not change on any of the resistive loads. There was a slight inverse relationship between the ratio of expiratory to inspiratory glottic width and the ratio of expiratory to inspiratory duration. Our results show noncompensatory glottic narrowing when subjects breathe against an expiratory resistance and suggest that the glottic dimensions are influenced by the time course of lung emptying during expiration. We speculate that the glottic constriction is related to the increased activity of expiratory medullary neurons during loaded expiration and, by increasing the internal impedance of the respiratory system, may have a stabilizing function. Tags: Human; Support, Non-U.S. Gov't Desc.: Adult; Airway Resistance; Glottis--Anatomy and Histology (AH); *Glottis--Physiology (PH); Lung Volume Measurements; Positive Pressure Respiration; *Respiration; Respiratory Airflow; Tidal Volume; Time Factors Y004154 17 1632236 85157236 Laryngeal constriction in normal humans during experimentally induced bronchoconstriction. England SJ; Ho V; Zamel N Dept. of Respiratory Physiology, Hospital for Sick Children, Toronto, Ontario, Canada. J Appl Physiol (US), Feb 1985, 58 (2) p352-6, ISSN 8750-7587 Jrnl Code: HEG Lang.: ENG. Jrnl Ann.: 8507 Subfile: INDEX MEDICUS Changes in the size of the glottis with bronchoconstruction were assessed in six normal subjects following inhalation of histamine or methacholine. Measurements were made during both tidal breathing and panting at 2-3 Hz. The midexpiratory size of the glottis was decreased by a mean of 8% during brochoconstriction compared with control during tidal breathing. Changes in midinspiratory size were inconsistent. During panting, the glottic size was unchanged from inspiration to expiration but decreased in 7 of 15 studies during bronchoconstriction. The decreases in expiratory size of the glottis during quiet breathing would lead to an elevated laryngeal resistance coupled with an increased lower airway resistance. Although this seems to be a paradoxical laryngeal response, it may contribute to maintaining hyperinflation during bronchoconstriction, thereby effectively enlarging the lower airways. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; Airway Resistance; Bronchial Provocation Tests; BP TESTS; *Bronchial Spasm--Chemically Induced (CI); Bronchial Spasm--Physiopathology (PP); Forced Expiratory Volume; Glottis--Physiopathology (PP); Histamine--Diagnostic Use (DU); *Laryngismus--Etiology (ET); Laryngismus--Physiopathology (PP); Methacholine Compounds--Diagnostic Use (DU); METHACHOLINE CPDS--Diagnostic Use (DU); Vital Capacity CAS Registry No.: 1-45-6 (Histamine); 55-92-5 (acetyl-beta-methylcholine) Y004154 18 1621078 85146078 Fatal meconium aspiration syndrome occurring despite airway management considered appropriate. Davis RO; Philips JB 3d; Harris B Jr; Wilson ER; Huddleston JF Dept. of Obstetrics and Gynecology, Univ. of Alabama, Birmingham. Am J Obstet Gynecol (US), Mar 15 1985, 151 (6) p731-6, ISSN 0002-9378 Jrnl Code: 3NI Lang.: ENG. Jrnl Ann.: 8506 ŠSubfile: AIM; INDEX MEDICUS A combined obstetric-pediatric approach to tracheal toilet is said to prevent serious cases of the potentially fatal meconium aspiration syndrome. After delivery of the head a DeLee trap is used to suction the oropharynx and nasopharynx. Immediately following delivery, endotracheal suction is performed in an effort to remove any remaining meconium-stained amniotic fluid. Although routinely using this approach, we continue to have occasional cases of fatal meconium aspiration syndrome. Therefore, we reviewed the outcome of infants born through meconium-stained fluid. During a 5-year period, 1420 (15%) of 9299 live-born infants had meconium-stained fluid. Thirty (2.1%) of these 1420 developed meconium aspiration syndrome and 12 (40%) died; eight received a postmortem examination. Four had unequivocal evidence of meconium aspiration, two had large numbers of intra-alveolar squamous cells, and two had no evidence of aspiration. We conclude that aggressive airway management during and immediately after delivery does not always prevent fatal meconium aspiration syndrome. Tags: Human Desc.: Amniotic Fluid--Cytology (CY); Atelectasis--Complications (CO); Delivery--Methods (MT); Infant, Newborn; *Intubation, Intratracheal; Lung--Pathology (PA); *Meconium; Meconium--Cytology (CY); Persistent Fetal Circulation Syndrome--Complications (CO); PFC SYNDROME--Complications (CO) *Pneumonia, Aspiration--Etiology (ET); Pneumonia, Aspiration--Mortality (MO); Pneumonia, Aspiration--Prevention and Control (PC); Retrospective Studies; Suction Y004154 19 1620213 85145213 Epidural monitoring of the intracranial pressure in severe head injury characterized by non-localizing motor response. Nordby HK; Gunnerod N Dept. of Neurosurgery, Ullev.ANG.al Univ. Hospital, Oslo, Norway. Acta Neurochir (Wien) (AUSTRIA), 1985, 74 (1-2) p2-6, ISSN 0001-6268 Jrnl Code: 19C Lang.: ENG. Jrnl Ann.: 8506 Subfile: INDEX MEDICUS Recent studies on prognostic variables and the intensive care of head injuries enabled us to select 64 patients and administer a standard treatment protocol to prevent secondary brain injury. All the patients were in coma with a flexor motor pattern as the best response between 6 and 24 hours after the accident and/or decompressive surgery. Continuous epidural intracranial pressure (ICP) monitoring was used in all patients to control the effect of positioning, analgetics, hyperventilation and osmotherapy. None of the patients with a normal initial ICP (15 mm Hg or less) developed an ICP increase leading to brain tamponade. A subsequent further rise to 40 mm Hg signified a very high risk of progression towards brain tamponade. The majority of the patients (71%) with a maximum ICP increase of less than 40 mm Hg had an acceptable recovery. After 6-12 months, the outcome in this series of patients was 48% with a good/moderate recovery, 14% with severe deficits and 38% dead/vegetative. Tags: Human Desc.: Brain Concussion--Diagnosis (DI); Brain Death; Brain Edema--Diagnosis (DI); *Brain Injuries--Diagnosis (DI); Brain Injuries--Therapy (TH); Coma--Diagnosis (DI); Combined Modality Therapy; Epidural Space; Hydrocephalus--Diagnosis (DI); *Intracranial Pressure; *Muscle Contraction; Neurologic Examination--Methods (MT); Prognosis; Tomography, X-Ray Computed; CT XRAY Y004154 20 1600777 85125777 Histamine-induced asthma in children: effects on the ventilation-perfusion relationship. Hedlin G; Freyschuss U; Hedenstierna G Dept. of Pediatrics, Huddinge Hospital, Karolinska Institute, Sweden. Clin Physiol (ENGLAND), Feb 1985, 5 (1) p19-34, ISSN 0144-5979 Jrnl Code: DKG Lang.: ENG. Jrnl Ann.: 8506 Subfile: INDEX MEDICUS Asthma was provoked by histamine inhalation in five children in order to study the hypoxaemia that might ensue and the underlying ventilation-perfusion (A/Q) mismatching. The distribution of the VA/Q ratios was measured by a multiple inert gas technique before the provocation, during the asthmatic attack and after salbutamol inhalation All children displayed a unimodal distribution of ventilation and perfusion under baseline conditions. During asthma they all developed a bimodal distribution, one mode lying within normal VA/Q regions but with increased perfusion to regions with VA/Q ratios of 0.1-1, which correlated with the observed hypoxaemia; the other mode was centered on a VA/Q ratio of approximately 10 and the magnitude of this mode correlated with FEV1 in percent of the predicted value. Salbutamol improved the VA/Q distribution and restored the blood gases to normal. We hypothesize that histamine-induced asthma causes a state of hyperinflation which compromises regional ventilation and blood flow, resulting in a VA/Q mismatching with one normal and one high VA/Q mode, and hypoxaemia. Tags: Comparative Study; Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adolescence; Albuterol--Therapeutic Use (TU); Arteries; *Asthma--Chemically Induced (CI); Asthma--Drug Therapy (DT); Asthma--Physiopathology (PP); Bronchial Provocation Tests; BP TESTS; Carbon Dioxide--Blood (BL); Cardiac Output--Drug Effects (DE); Child; *Histamine--Pharmacodynamics (PD); Oxygen--Blood (BL); Partial Pressure; Pulmonary Gas Exchange--Drug Effects (DE); Respiratory Airflow--Drug Effects (DE); *Ventilation-Perfusion Ratio; Ventilation-Perfusion Ratio--Drug Effects (DE) CAS Registry No.: 18559-94-9 (Albuterol); 51-45-6 (Histamine); 7782-44-7 (Oxygen) Y004154 21 1595312 85120312 The effects of acute bronchoconstriction on respiratory activity in patients with chronic obstructive pulmonary disease. Oliven A; Cherniack NS; Deal EC; Kelsen SG Dept. of Medicine, Case Western Reserve Univ., Cleveland, Ohio. Am Rev Respir Dis (US), Feb 1985, 131 (2) p236-41, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8505 Subfile: AIM; INDEX MEDICUS Attacks of acute airway obstruction often complicate the course of chronic obstructive pulmonary disease (COPD). In asthmatic subjects, bronchospasm triggers an increase in respiratory drive, which results in hyperventilation and hypocapnia. In the present study, we assessed the effects of acute bronchoconstriction induced by aerosolized methacholine on breathing and lung mechanics in 12 patients with stable COPD. Even low doses of methacholine markedly increased airway resistance and caused hyperinflation and decreased inspiratory muscle performance in the patients. Increasing airway obstruction produced a progressive rise in PCO2 despite an increase in minute ventilation. Breathing frequency and average inspiratory flow were greater, but tidal volume decreased because of shortening of the inspiratory duration. The magnitude of CO2 retention during acute bronchoconstriction was inversely related to the changes in tidal volume and inspiratory time (p less than 0.01 for each). In subjects with COPD, the occlusion pressure response to progressive hypercapnil failed to increase during bronchoconstriction. These results show that patients with COPD retain CO2 during acutely increasing airway obstruction induced by bronchoconstriction partly because of a rapid shallow breathing pattern that reduces alveolar ventilation. Tags: Human Desc.: Aged; Airway Resistance; Bronchial Provocation Tests; BP TESTS; *Bronchial Spasm--Chemically Induced (CI); Bronchial Spasm--Complications (CO); Bronchial Spasm--Physiopathoogy (PP); Carbon Dioxide--Physiology (PH); Hyperventilation--Etiology (ET); Lung Compliance Lung Diseases, Obstructive--Complications (CO); *Lung Diseases, Obstructive--Physiopathology (PP); *Methacholine Compounds--Diagnostic Use (DU); *METHACHOLINE CPDS--Diagnostic Use (DU); Middle Age; Pulmonary Gas Exchange; *Respiration; Tidal Volume; Ventilation-Perfusion Ratio CAS Registry No.: 55-92-5 (acetyl-beta-methylcholine) Y004154 22 1593879 85118879 Bronchial compression by a patent ductus arteriosus associated with pulmonary atresia. Markowitz RI; Fahey JT; Hellenbrand WE; Kopf GS; Rothstein P ŠDept. of Diagnostic Radiology, Yale Univ. School of Medicine, New Haven, CT. AJR (US), Mar 1985, 144 (3) p535-40, ISSN 0361-803X Jrnl Code: 3AE Lang.: ENG. Jrnl Ann.: 8505 Subfile: AIM; INDEX MEDICUS Two infants with pulmonary atresia are presented, wherein a large, vertically oriented patent ductus arteriosus, acting as the only source of pulmonary blood supply, compressed the left bronchus, causing significant respiratory distress. Hyperinflation of the left lung was the clue to this circumstance. After bronchographic confirmation, surgical repair was accomplished by placement of aortopulmonary shunts and division of the patent ductus. Other causes of airway compression in congenital heart disease are briefly reviewed. The embryology of the ductus arteriosus is discussed, emphasizing its anatomic configuration and physiologic role in pulmonary atresia. Tags: Case Report; Human; Male Desc.: *Airway Obstruction--Etiology (ET); Aortography; *Bronchi; Constriction, Pathologic--Diagnosis (DI); *Ductus Arteriosus, Patent-Complications (CO); Ductus Arteriosus, Patent--Radiography (RA); Ductus Arteriosus, Patent--Surgery (SU); Heart Catheterization; Infant, Newborn; *Pulmonary Valve--Abnormalities (AB) Y004154 23 1579303 85104303 The effects of oxygen and hyperinflation on arterial oxygen tension after endotracheal suctioning. Goodnough SK School of Nursing, Univ. of California, San Francisco. Heart Lung (US) , Jan 1985, 14 (1) p1-7, ISSN 0147-9563 Jrnl Code: G2V Lang.: ENG. Jrnl Ann.: 8505 Subfile: AIM; INDEX MEDICUS The effects of hyperinflation and increasing the FIO2 to 1.0 on PaO2 after endotracheal suctioning were examined in 28 patients after cardiac surgery. The changes in PaO2 immediately after and at 5and 10-minutes after suctioning were compared with control values. Hyperinflation at the patient's baseline FIO2 produced a mean decrease in PaO2 of 18 mm Hg immediately after suctioning in over 75% of the sample. Preoxygenation with an increase in the ventilator FIO2 to 1.0 produced a mean increase in PaO2 of 48 mm Hg in 75% of the sample. Delivering preoxygenation by hyperinflation provided greater protection for all patients with a mean increase in PaO2 of 100 mm Hg. No statistically significant differences existed between the 5- and 10-minute PaO2 value and the control PaO2 values for any of the procedures. Experimental hyperinflation was aborted in two patients who experienced significant hypotension in association with the hyperinflation. The hypotension was transient, with arterial blood pressure immediately returning to baseline values on termination of the experimental hyperinflation. In conclusion, 100% oxygen administered by hyperinflation for 1 minute before and after endotracheal suctioning protects patients after cardiac surgery from a fall in PaO2. Because hyperinflation can cause alterations in arterial blood pressure and heart rate, these vital signs should be visually monitored during the endotracheal suctioning procedure. Tags: Human; Support, Non-U.S. Gov't Desc.: Adult; Aged; *Anoxemia--Etiology (ET); Anoxemia--Prevention and Control (PC); Blood Pressure; Heart Rate; *Intubation, Intratracheal--Adverse Effects (AE); Middle Age; Oxygen--Administration and Dosage (AD); *Oxygen--Blood (BL); Partial Pressure; Respiratory Therapy--Methods (MT); *Suction--Adverse Effects (AE) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 24 1579302 85104302 Endotracheal tube suctioning/manual hyperventilation procedure on patients with severe closed head injuries [letter] Clochesy JM Heart Lung (US) , Jan 1985, 14 (1) p107, ISSN 0147-9563 Jrnl Code: G2V Lang.: ENG. Jrnl Ann.: 8505 Subfile: AIM; INDEX MEDICUS Tags: Human Desc.: *Head Injuries--Physiopathology (PP); *Intracranial Pressure ; Oxygen Inhalation Therapy; Suction--Adverse Effects (AE) Y004154 25 1574750 85099750 Pulmonary artery constriction produces a greater right ventricular dynamic afterload than lung microvascular injury in the open chest dog. Calvin JE Jr; Baer RW; Glantz SA Cardiovascular Research Institute, Univ. of California, San Francisco. Circ Res (US) , Jan 1985, 56 (1) p40-56, ISSN 0009-7330 Jrnl Code: DAJ Contract/Grant No.: HL-25869; HL-01792 Lang.: ENG. Jrnl Ann.: 8505 Subfile: INDEX MEDICUS Investigators model noncardiogenic pulmonary hypertension by constricting the pulmonary artery to increase right ventricular afterload. To investigate this model's validity, we compared the right ventricular afterload, quantified as pulmonary input impedance, created by constricting the pulmonary artery and by inducing a pulmonary microvascular injury (with glass beads infused into the pulmonary circulation). The pulmonary injury constriction produced a different right ventricular afterload than the microvascular injury. The constriction increased both the input resistance and the characteristic impedance. Microvascular injury increased only input resistance. Physiological levels of lung inflation did not influence pulmonary impedance, but lung hyperinflation increased input resistance both before and while constricting the pulmonary artery or after producing microvascular injury. Total right ventricular power output and stroke work were unchanged during each vascular intervention. Pulmonary artery constriction did not affect power output distribution, whereas microvascular injury decreased oscillatory power and its relative contribution to total power. Lung hyperinflation dramatically reduced right ventricular power and left ventricular stroke work. These effects appeared mediated by right venticular afterload increase uncompensated for by right ventricular preload increase. These observations help explain the hemodynamic consequences of acute pulmonary hypertension and the effects of lung hyperinflation with positive end-expiratory pressure respiration in such patients. Tags: Animal; Support, U.S. Gov't, P.H.S. Desc.: Constriction Dogs; *Heart--Physiopathology (PP); Hypertension, Pulmonary--Etiology (ET); *Hypertension, Pulmonary--Physiopa-tholoy (PP); Lung Compliance; Lung--Blood Supply (BS); Microcirculation; Myocardial Contraction; Positive Pressure Respiration; *Pulmonary Artery--Physiopathology (PP); *Pulmonary Circulation; Stroke Volume; Tidal Volume; Vascular Resistance Y004154 26 1566068 85091068 Late cataclysmic hemorrhage from the innominate artery after tracheostomy. ŠHafez A; Couraud L; Velly JF; Bruneteau A Dept. of Thoracic Surgery, Xavier-Arnozan Hospital, Pessac-Bordeaux, France. Thorac Cardiovasc Surg (GERMANY, WEST), Oct 1984, 32 (5) p315-9, ISSN 0171-6425 Jrnl Code: VR0 Lang.: ENG. Jrnl Ann.: 8504 Subfile: INDEX MEDICUS We report on 12 patients sustaining late cataclysmic hemorrhage as a complication of tracheostomy or endotracheal intubation, resulting from erosion of the innominate artery. Four long-term survivors are reported. A number of surgical techniques was used and up-to-date management is briefly described. Our technique mainly consists of transecting and suturing the innominate artery without prior debridement. Innominate artery blood flow was not reestablished in all patients, thereby avoiding local wound infection and recurrence of hemorrhage. Initial temporary control of bleeding was achieved either by hyperinflation of the cuff of the tracheostomy tube, or finger compression of the innominate artery against the sternal notch. Definite surgical repair of this lesion and reestablishment of innominate artery flow is carried out through complete sternotomy in combination with right cervical extension which is considered the incision of choice by the authors. To prevent this unusual and lethal complication, tracheostomy should not be used without proper indication and technical errors of its performance, such as lacing it lower than the level of third tracheal ring, must be avoided. Tags: Female; Human; Male Desc.: Adolescence; Adult; Aged; *Fistula--Surgery (SU); *Hemorrhage--Surgery (SU); *Innominate Artery--Injuries (IN); Innominate Artery--Surgery (SU); Intubation, Intratracheal--Adverse Effects (AE); Middle Age; Postoperative Complications--Mortality (MO); POSTOP COMPL--Mortality (MO); Recurrence; Suture Technics; *Tracheal Diseases--Surgery (SU); *Tracheotomy--Adverse Effects (AE) Y004154 27 1562636 85087636 Lung distensibility and airway function in asthmatic children. Kraemer R; Geubelle F Dept. of Pediatrics, Univ. of Berne, Switzerland. Pediatr Res (US), Nov 1984, 18 (11) p1154-9, ISSN 0031-3998 Jrnl Code: OWL Lang.: ENG. Jrnl Ann.: 8504 Subfile: INDEX MEDICUS Lung distensibility and airway mechanics were evaluated in 24 asthmatic children and adolescents, ages between 7 and 21 years, by quasi-static pressure-volume curves and by the static recoil-lung conductance relationship. The measurements were obtained by the step-wise inflation technique and the pressure-volume curves were analyzed by a new sigmoid exponential curve-fitting model of the form: VL = Vm + [VM/(1 + be-K . PstL)], where VL is lung volume, PstL is static recoil pressure, VM and Vm are the upper and lower asymptotes, and K and b are shape constants. The shape constant K serves as index for lung distensibility, whereas the slope of theta of the static recoil-lung conductance plot represents the flow-resistive behavior of the airways. The combined evaluation of these two parameters (K and theta) shows that some asthmatic children have a very high lung distensibility and normal airway function, whereas others have nearly normal lung elasticity but grossly reduced airway distensibility. Sigmoid exponential analysis of static pressure-volume curves and an evaluation of the static recoil-lung conductance relationship in asthmatic children enable a distinction of these two types of functional derangements. Increased pulmonary distensibility consistent with an increase of alveolar air space seems to indicate an involvement of tissue elements. In contrast, decreased airway distensibility indicates a defect in the conducting airways. Sympathomimetics not only have a positive effect on airway mechanics, but seem to increase lung distensibility both in patients with hyperinflation and to an even greater degree in patients whose lungs are already too compliant. Tags: Human; Support, Non-U.S. Gov't Desc.: Adolescence; Adult; Airway Resistance; Albuterol--Pharmacodynamics (PD); *Asthma--Physiopathology (PP); *Bronchi--Physiopathology (PP) ; Bronchodilator Agents--Pharmacodynamics (PD); Child; Lung Compliance; Lung Volume Measurements; *Lung--Physiopathology (PP) CAS Registry No.: 18559-94-9 (Albuterol) Y004154 28 1520609 85045609 Handling during neonatal intensive care. Murdoc DR; Darlow BA Dept. of Paediatrics, Christchurch Clinical School of Medicine, Christchurch Hospital, New Zealand. Arch Dis Child (ENGLAND) , Oct 1984, 59 (10) p957-61, ISSN 00039888 Jrnl Code: 6XG Lang.: ENG. Jrnl Ann.: 8502 Subfile: AIM; INDEX MEDICUS The handling received by very low birthweight newborns undergoing intensive care in the first few days of life and the effects of this were studied. Infants were handled an average of 4.3 hours (18%) of the total 24 hour observation time and received a mean 234 handling procedures. Parental handling contributed 35% of the total time but was usually benign except in that it could interfere with the infant's rest. Many procedures were associated with undesirable consequences. Endotracheal suctioning as invariably associated with hypoxaemia and was often carried out more frequently, or took longer, than was optimal. Transcutaneous oxygen monitoring, although considered routine for all intensive care infants, was only carried out for 50% of the observation time and often did not accompany periods of likely intensive handling. Increasing technology in neonatal intensive care often results in increased handling of sick infants. Each new innovation, as well as routine procedures, should be viewed in the light of the continuum of neonatal intensive care events, and handling kept to a minimum. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Anoxemia--Etiology (ET); *Critical Care; *Infant Care; *Infant, Low Birth Weight; *INFANT LBW; Infant, Newborn; *Infant, Premature, Diseases--Therapy (TH); Suction--Adverse Effects (AE); Time Factors Y004154 29 1508818 85033818 The effects of the pneumatic antishock garment on intracranial pressure in man: a prospective study of 12 patients with severe head injury. Gardner SR; Maull KI; Swensson EE; Ward JD Division of Neurosurgery, Medical College of Virginia, Richmond. J Trauma (US) , Oct 1984, 24 (10) p896-900, ISSN 0022-5282 Jrnl Code: KAF Lang.: ENG. Jrnl Ann.: 8502 Subfile: AIM; INDEX MEDICUS Changes in intracranial pressure, mean arterial blood pressure, and cerebral perfusion pressure in response to sequential inflation of the pneumatic antishock garment were monitored in 12 patients with severe head injury and initial intracranial pressure less than 20mm Hg. The small incremental increases in intracranial pressure that occurred with inflation of the pneumatic antishock garment were compensated for by improved hemodynamic stability and eleated mean arterial blood pressure which produced a simultaneous rise in cerebral perfusion pressure. The treatment of hypotension in traumatized patients with head injuries is paramount and sequential slow inflation of the pneumatic antishock garment can be used in such patients without apparent ill effect to the brain when the initial intracranial pressure is 20 mm Hg or below. Further study is needed to determine the safety of the device in head injured patients with elevated intracranial pressures Tags: Human Desciptors: Adolescence; Adult; Blood Pressure; Central Venous Pressure Coma--Etiology (ET); *G Suits; *MAST; *Head Injuries--Physiopathology (PP) Hypotension--Therapy (TH); *Intracranial Pressure; Prospective Studies; Pulmonary Wedge Pressure ŠY004154 30 1503524 85028524 [Endotracheal suction of meconial aniotic fluid] Succion endotraqueal del liquido amniotico meconial. Cervantes FJ; Arreola MA; Martinez Cuellar J Ginecol Obstet Mex (MEXICO), Mar 1984, 52 (323) p69-75, ISSN 0300-9041 Jrnl Code: FQJ Lang.: SPANISH Summary Languages: ENG. Doc. Type: English Abstract Jrnl Ann.: 8502 Subfile: INDEX MEDICUS Tags: Female; Human; Male Desc.: *Amniotic Fluid; Asphyxia Neonatorum--Etiology (ET); *Asphyxia Neonatorum--Prevention and Control (PC); Aspiration; Heart Enlargement--Etiology (ET); Infant, Newborn; *Meconium; *Suction Y004154 31 1495886 85020886 Effects of abdominal and thoracic breathing on breathing pattern components in normal subjects and in patient with chronic obstructive pulmonary disease. Sackner MA; Gonzalez HF; Jenouri G; Rodriguez M Dept. of Medicine, Mount Sinai Medical Center, Miami Beach, Florida. Am Rev Respir Dis (US), Oct 1984, 130 (4) p584-7, ISSN 0003-0805 Jrnl Code: 426 Contract/Grant No.: HL-10622 Lang.: ENG. Jrnl Ann.: 8501 Subfile: AIM; INDEX MEDICUS The purpose of this study was to assess the effect of voluntarily controlled breathing maneuvers on breathing pattern components measured noninvasively with the respiratory inductive plethosmograph. In normal subjects, these maneuvers included predominantly thoracic and abdominal patterns with and without visual reinforcement from video-displayed plots of rib cage versus abdominal loops. In patients with chronic obstructive pulmonary disease (COPD), only predominantly abdominal breathing without and with visual feedback was employed; the latter produced greater abdominal contribution to tidal volume. Voluntarily controlled breathing patterns led to increased minute ventilation (VI) in normal subjects because of variable changes of frequency and tidal volume. This increase in ventilation was achieved despite increased asynchronous and paradoxic motion between rib cage and abdominal excursions that would add to the work of breathing. Patients with COPD had heightened baseline respiratory center dive when compared with that in normal subjects, as evidenced by elevation of VI and mean respiratory flow (VT/TI). In contrast to normal subjects, abdominal breathing produced no change in VI and VT/TI for the group as a whole, but 6 of the 9 patients with COPD had decreases compared with natural breathing. This diminution of respiratory drive in some patients with COPD during voluntary abdominal breathing might relate to limitation of ventilatory response by the increased work of breathing caused by pulmonary hyperinflation, elevated airway resistance, and increased asynchronous and paradoxic motion of the rib cage to the abdominal excursions, and/or the mental activity required to perform the breathing maneuver might be inhibitory to respiratory drive. Tags: Comparative Study; Female; Human; Male; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. Desc.: *Abdomen; Adult; *Lung Diseases, Obstructive--Physiopathology (PP); Middle Age; *Respiration; Respiratory Airflow; *Thorax-Tidal Volume; Time Factors Y004154 32 1493376 85018376 Physiological determinants of a clinically successful method of endotracheal suction. Baun MM West J Nurs Res (US), Spring 1984, 6 (2) p213-28, ISSN 0193-9459 Jrnl Code: XNZ Contract/Grant No.: 1 F04-NU-27, 569 Lang.: ENG. Jrnl Ann.: 8501 Subfile: Nursing Tags: Female; Human; Male; Support, U.S. Gov't, P.H.S. Desc.: Adult; Aged; *Anoxemia--Prevention and Control (PC); Hemodynamics; *Intubation, Intratracheal; Middle Age; Oxygen--Blood (BL); Probability; Respiration; *Respiratory Insufficiency--Physiopathology (PP) Respiratory Insufficiency--Therapy (TH); *Suction CAS Registry No.: 7782-44-7 (Oxygen) Y004154 33 1463423 84303423 The effect of high dose barbiturate decompression after severe head injury. A controlled clinical trial. Nordby HK; Nesbakken R Dept. of Neurosurgery, Ullev.ANG.al Univ. Hospital, Oslo, Norway. Acta Neurochir (Wien) (AUSTRIA), 1984, 72 (3-4) p157-66, ISSN 0001-6268 Jrnl Code: 19C Lang.: ENG. Jrnl Ann.: 8412 Subfile: INDEX MEDICUS Treatment resistant intracranial hypertension after severe head injury has a very high mortality with conventional therapy such as hyperventilation and mannitol infusions. In this report, we describe the use of large doses of thiopental as a means of treating such swelling. From a consecutive series of 107 severe head injuries with a Glasgow Coma Score (GCS) of 6 or below, we selected all patients below 40 years age with a progressive increase in intracranial pressure (ICP) to 40 mm Hg. The first 16 patients (mean age 20 years, mean GCS 4.3) were treated with deep barbiturate coma and hypothermia (32-35 degrees Celsius) until stable lowering of IP was achieved. The next 15 patients received conventional intensive care and were in other respects very similar to the barbiturate group (mean age 26, mean GCS 5.2). After 9-12 months the outcome was classified according to the Glasgow Outcome Scale (GOS). Therapy with barbiturate coma resulted in 6 good/moderate outcomes, 3 severe and 7 dead/vegetative. Conventional treatment resulted in 2 good/moderate outcomes and 13 dead/vegetative. This is a highly significant difference and cannot easily be explained by more severe injuries or complications in the conventional group. Superior control of ICP was achieved by large doses of thiopental and the final outcome was better. Tag: Human; Support, Non-U.S. Gov't ŠDesc.: Adolescence; Adult; Brain Concussion--Complications (CO); Brain Edema--Drug Therapy (DT); *Brain Injuries--Complications (CO); Child Child, Preschool; Clinical Trials; Dose-Response Relationship, Drug; DOSE RESPONSE RELAT DRUG; Hematoma, Subdural--Complications (CO); Intracranial Pressure--Drug Effects (DE); Prognosis; *Pseudotumor Cerebri--Drug Therapy (DT); *Thioental--Therapeutic Use (TU) CAS Registry No.: 76-75-5 (Thiopental) Y004154 34 1456962 84296962 New approach to management of unilateral tension pulmonary interstitial emphysema in premature infants. Swingle HM; Eggert LD; Bucciarelli RL Dept. of Pediatrics, Univ. of Florida, Gainesville. Pediatrics (US) , Sep 1984, 74 (3) p354-7, ISSN 0031-405 Jrnl Code: OXV Lang.: ENG. Jrnl Ann.: 8412 Subfile: AIM; INDEX MEDICUS Conservative management of unilateral tension pulmonary interstitial emphysema is reported. Treatment consisted of (1) positioning the infant on his or her side with the emphysematous lung dependent, (2) minimal chest physiotherapy and endotracheal suctioning, and (3) appropriate ventilator management. Conservative therapy is effective and appears to be afer than selective bronchial intubation or surgical therapy. Tags: Human; Male Desc.: Infant, Newborn; *Infant, Premature, Diseases--Therapy (TH) Intubation, Intratracheal; Physical Therapy; Posture; *Pulmonary Emphysema--Therapy (TH); Respiration, Artificial; Suction Y004154 35 1410024 84250024 Isolation of pathogenic bacteria from the nasopharynx of children with respiratory syncytial virus infection. Predictive value of chest roentgen examination and laboratory tests. Wahlgren H; Erksson M; Mortensson W; Forsgren M; Melen B Dept. of Radiology, St. Goran's Children's Hospital, Stockholm, Sweden. Scand J Infct Dis (SWEDEN) , 1984, 16 (2) p139-43, ISSN 0036-5548 Jrnl Code: UCX Lang.: ENG. Jrnl Ann.: 8410 Subfile: INDEX MEDICUS Potentially pathogenic bacteria were isolated from the nasopharynx in 33/66 hospitalized infants and children with verified respiratory syncytial virus (RSV) infection. The value of chest roentgenograms and blood counts for the prediction of concomitant bacterial infection was evaluated. Abnormal chest roentgenograms were found in 89% whether pathogenic bacteria were present or not. The most common finding was general hyperinflation of the lungs, with or without infiltrates. This occurred more frequently in the group with isolated RSV infection. Fever, leucocytosis and an elevated ESR were found during the illness in more than half the cases. These findings were more frequent in children who harboured potential pathogenic bacteria, though the difference was not significant. For optimal evaluation of a case all available information about it should be taken into consideration. Tags: Human Desc.: Bacterial Infections--Diagnosis (DI); Bacterial Infections--Microbiology (MI); Bacterial Infections--Radiagraphy (RA); Child, Preschool; Haemophilus Influenzae--Isolation and Purification (IP); Infant; *Nasopharynx--Microbiology (MI); *Paramyxovirus Infections--Microbiology (MI); Respiratory Syncytial Viruses; Respiratory Tract Infections--Diagnosis (DI); *Respiratory Tract Infections--Microbiology (MI); Respiratory Tract Infections--Radiography (RA); Retrospective Studies ; Staphylococucs aureus--Isolation and Purification (IP); STAPH AUREUS--Isolation and Purification (IP); Streptococcus pneumoniae--Isolation and Purification (IP); STREP PNEUMONIAE--Isolation and Purification (IP) ; Streptococcus Pyogenes--Isolation and Purification (IP); STREP PYOGENES--Isolation and Purification (IP) Y004154 36 1406165 84246165 Effect of neurointensive care upon outcome following severe head injuries in childhood--a preliminary report. Kaiser G; Pfenninger J Dept. of Pediatric Surgery, Universit Children's Hospital, Inselspital Bern, Switzerland. Neuropediatrics (GERMANY, WEST), May 1984, 15 (2) p68-75, ISSN 0174304X Jrnl Code: NZA Lang.: ENG. Jrnl Ann.: 8410 Subfile: INDEX MEDICUS From March 1978 till August 1981 neurointensive care was applied to 24 children with severe head injuries (Glasgow Coma Scale less than or equal to 7, mean 5 +/- 1) corresponding to 7% of a population with head injuries observed during the same period. The neurointensive care included continuous intracranial and arterial pressure monitoring and normalization of intracranial and cerebal perfusion pressure with intubation, hyperventilation, control of body temperature, dexamethason, barbiturates and osmotic agents. The follow-up time is 1.5 to 4.4 year (mean 2.5 years). The results obtained by check-ups every 3-6 months were analyzed as proposed by Lange-Cosack and Tepfer (1973) and used to group the children according to Jennett and Bond (1975). At the end of the follow-up four children were 1-5, twelve 6-14 years old and 3 older. Five patients (= 21) died during the acute stage of head injury. Residual neurological signs were present in 42% of the children depending on the specific topics (cranial nerve deficits, hemiparesis, speech disorders, ataxic syndromes) at most in 1/4 of the cases. Minimal to distinct residual psychoorganic signs were found in 58%, an altered personality being somewhat more frequent than intelligence deficit or psychomotor retardation. Eleven of the twelve school children are back in school of whom are eight in regular and three in special schools. At a mean time of 1.5 years after the accident the EEG was normal in nine cases and displayed a slightly altered background activity and/or slow wave foci in eight and epileptiform foci in two cases.(ABSTRACT TRUNCATED AT 250 WORDS) Tags: Human Desc.: Adolescence; Brain--Radiography (RA); Child; Child, Preschool; *Critical Care; Electroencephalography; EEG; Epilepsy--Etiology (ET); Epilepsy--Physiopathology (PP); Evaluation Studies; Follow-Up Studies ; Head Injuries--Complications (CO); Head Injuries--Psychology (PX); *Head Injuries--Therapy (TH); Infant; Wounds, Nonpenetrating Y004154 37 1401968 84241968 Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. Obrist WD; Langfitt TW; Jaggi JL; Cruz J; Gennarelli TA Division of Neurosurgery, Univ. of Pennsylvania School of Medicine, Philadelphia. J Neurosurg (US), Aug 1984, 61 (2) p241-53, ISSN 0022-3085 Jrnl Code: JD3 Contract/Grant No.: NS 08803 Lang.: ENG. Jrnl Ann.: 8410 ŠSubfile: AIM; INDEX MEDICUS Cerebral blood flow (CBF) measurements were made in 75 adult patients with closed head injuries (mean Glasgow Coma Scale score 6.2) using the xenon-133 intravenous injection method with eight detectors over each hemisphere. All patients were studied acutely within 96 hours of trauma, and repeatedly observed until death or recovery (total of 361 examinations). Arteriojugular venous oxygen differences (AVDO2) were obtained in 55 of the patients, which permitted assessment of the balance between metabolism and blood flow, and provided estimates of cerebral metabolic rate for oxygen (CMRO2). Based on mean regional CBF, the patients were classified into two group: those who exhibited hyperemia on one or more examinations, and those who had a consistently reduced flow during their acute illness. "Hyperemia" was defined as a normal or supernormal CBF in the presence of coma, a definition that was independently confirmed by narrow AVDO2's indicative of "luxury perfusion". During coma, all patients showed a significant depression in CMRO2. Forty-one patients (55%) developed an acute hyperemic with an average duration of 3 days, while 34 patients (45%) consistently had subnormal flows. Although more prevalent in younger patients, hyperemia was found at all age levels (15 to 8? years). There was a highly significant association between hyperemia and the occurrence of intracranial hypertension, defined as an intracranial pressure above 20 mm Hg. Patients with reduced flow showed little or no evidence of global cerebral ischemia, but instead revealed the expected coupling of CBF and metabolism. The CBF responses to hyperventilation were generally preserved, with the hyperemic patients being slightly more reactive. In 10 patients with reduced flow, hyperventilation resulted in wide AVDO2's suggestive of ischemia. Tags: Female; Human; Male; Support, U.S. Gov't, P.H.S. Desc.: Adolescence; Adult; Aged; Brain Injuries--Complications (CO) ; Brain Injuries--Metabolism (ME); *Brain Injuries--Physiopathology (PP); *Cerebrovascular Circulation; Coma--Complications (CO); Coma--Metabolism (ME); *Coma--Physiopathology (PP); Hyperemia--Complications (CO); Hyperemia--Metabolism (ME); Hyperemia--Physiopathology (PP); Middle Age; Oxygen--Metabolism (ME); Pseudotumor Cerebri--Complications (CO); Pseudotumor Cerebri--Metabolism (ME); *Pseudotumor Cerebri--Physiopathology (PP) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 38 1400636 84240636 Metabolic and hemodynanic response to hyperventilation in patients with head injuries. Turner E; Hilfiker O; Braun U; Wienecke W; Rama B Centre for Anaesthesiology, Univ. of Gottingen School of Medicine, FRG. Intensive Care Med (US), 1984, 10 (3) p127-32, ISSN 0342-4642 Jrnl Code: H2J Lang.: ENG. Jrnl Ann.: 8410 Subfile: INDEX MEDICUS The effects of controlled moderate hyperventilation (paCo2 approximately 31 mmHg) on cardiovascular parameters and whole-body-oxygen-uptake (VO2) was studied in 10 patients with head injuries, who were unconscious and artificially ventilated at the time of the investigation. VO2 was measured with the Beckmann Metabolic Measurement Cart and also calculated from cardiac output and arterio-mixed venous oxygen content difference. A mean increase in VO2 (+ 19.6% of control) was observed after 2 h of hyperventilation. Cardiac output remained unchanged. This resulted in a decrease of venous oxygen content and impaired full oxygenation of the blood. Our results indicate that hyperventilation should not be a routine procedure. Close monitoring of arterial and venous blood gases is recommended, when hyperventilation is applied. Tags: Human; Support, Non-U.S. Gov't Desc.: Adult; Brain Injuries--Metabolism (ME); *Brain Injuries--Physiopathology (PP); Heart--Physiopathology (PP); *Hemodynamics Intracranial Pressure; Middle Age; Oxygen Consumption; Oxygen--Physiology (PH); *Respiration, Artificial; Respiratory Function Tests CAS Registry No.: 7782-44-7 (Oxygen) Y004154 39 1399026 84239026 The effects of the endotracheal tube suctioning/manual hyperventilation procedure on patients with severe closed head injuries. Parson LC; Shogan JS School of Nursing, Univ. of Virginia, Charlottesville. Heart Lung (US) , Jul 1984, 3 (4) p372-80, ISSN 0147-9563 Jrnl Code: G2V Lang.: ENG. Jrnl Ann.: 8410 Subfile: AIM; INDEX MEDICUS The findings of this clinical study suggest that the ETTS/MH procedure could be safely performed upon patients with severe closed head injuries whose baseline measurements of MICP were within the range of 0 to 20 mm Hg, provided the CPP was maintained at 50 mm Hg or greater. The advantages of performing the ETTS/MH procedure upon intubated patients far outweigh the possible disadvantages. The removal of pulmonary mucus plugs and secretions, which subsequently prevents hypercarbia and hypoxemia, is very important to the patient's recovery. In most situations, stimulation of the cough reflex through ETTS or even MH can help prevent atelectasis, a frequent pulmonary complication of neurologically depressed patients. Atelectasis can result in hypoxia that may adversely affect the cerebrovascular status. In addition, the results of this study suggest that multiple MHs after the third and subsequent ETTSs should be extended to a longer time interval, perhaps 60 seconds, in order that the physiologic measurements of MABP, MICP, CPP, and HR more closely approach the baseline levels. Also it is suggested that nurses performing the ETTS/MH procedure delay initiation of levels of physiologic function used to assess cerebrovascular status are resched. Tags: Female; Human; Male Desc.: Adolescence; Adult; Aged; Blood Pressure; Cerebrovascular Circulation; Child; Child, Preschool; Coma--Nursing (NU); *Head Injuries--Nursing (NU); Head Injuries--Physiopathology (PP); Heart Rate; Intracranial Pressure; *Intubation, Intratracheal--Nursing (NU); Middle Age ; *Respiratory Therapy--Methods (MT); Suction Y004154 40 1388559 8422859 Relationship of functional residual capacity to static pulmonary mechanics in chronic obstructive pulmonary disease. Yip CK; Epstein H; Godring RM Dept. of Medicine, New York Univ.-Bellevue Medical Center, New York. Am J Med Sci (US), May-Jun 1984, 287 (3) p3-6, ISSN 0002-9629 Jrnl Code: 3L2 Lang.: ENG. Jrnl Ann.: 8409 Subfile: AIM; INDEX MEDICUS Static pulmonary mechanics may not be the sole determinant of the functional residual capacity (FRC) in the chronic obstructive pulmonary diseases (COPD). To assess the relationship of FR~Cr to pulmonary mechanics, pulmonary function tests such as spirometry, lung volumes, maximum expiratory flow volume curves, and single-breath diffusing capacity were related to compliance measurements in 65 patients with stable COPD. Compliance studies were examined over the range of tidal volume and at maximum lung inflation. The results showed that there was a poor correlation between the degree of hyperinflation at FRC and static compliance in the tidal range. However, there was a highly significant correlation between FRC and static lung mechanics at maximum lung inflation, as well as between FRC and diffusing capacity. Thus, in patients with stable COPD, FRC is a useful guide to static recoil properties of the lung as assessed at maximum lung inflation. Lung compliance measurement in tidal range may not reflect this relationship. An increase in FRC remains a useful index of pulmonary emphysema, even in the presence of chronic airway disease. Tags: Female; Human; Male Desc.: Adult; Aged; Biomechanics; *Functional Residual Capacity; *Lung Compliance; *Lung Diseases, Obstructive--Physiopathology (PP); *Lung Volume Measurements; Middle Age; Pulmonary Emphysema--Diagnosis (DI); Respiratory Function Tests Y004154 41 1381601 84221601 Transmission of herpes simplex virus type 1 to a newborn infant during endotracheal suctioning for meconium aspiration. Van Dyke RB; Spector SA Dept. of Pediatrics, Univ. of California, San Diego, La Jolla. Pediatr Infect Dis (US), Mar-Apr 1984, 3 (2) p153-6, ISSN 0277-9730 ŠJrnl Code: PA4 Lang.: ENG. Jrnl Ann.: 8409 Subfile: INDEX MEDICUS Tags: Case Report; Female; Human Desc.: Aspiration; *Cross Infection--Transmission (TM); DNA Restriction Enzymes; DNA, Viral--Analysis (AN); Herpes Simplex--Microbiology (MI); *Herpes Simplex--Transmission (TM); Herpesvirus Hominis--Analysis (AN); Infant, Newborn; *Intubation, Intratracheal; Meconium; *Suction Enzyme No.: EC 3.1.23. (DNA Restriction Enzymes) Y004154 42 1380529 84220529 Streamlining your suctioning techniques. Part 2. Endotracheal suctioning. Fuchs PL Nursing (Horsham) (US), Jun 1984, 14 (6) p46-51, ISSN 0360-4039 Jrnl Code: OA3 Lang.: ENG. Jrnl Ann.: 8409 Subfile: Nursing Tags: Human Desc.: *Nursing Care; Suction--Instrumentation (IS); *Suction--Methods (MT); *Trachea Y004154 43 1378961 84218961 Vasogenic edema with intraparenchymatous expanding mass lesions: a theory on its pathophysiology and mode of action of hyperventilation and corticosteroids. Casanova MF Johns Hopkins Univ., Neuropathology Laboratory, Baltimore, Maryland. Med Hypotheses (CANADA) , Apr 1984, 13 (4) p439-50, ISSN 0306-9877 Jrnl Code: M0M Lang.: ENG. Jrnl Ann.: 8409 Subfile: INDEX MEDICUS Vasogenic edema with expanding mass brain lesions is hypothesized to be due to an increased intracapillary pressure. The latter may be due to preferential occlusion of the venous system by the growth of the lesion but endothelila proliferation and biogenic amines may also play a part. Endocytosis appears to be a mechanical response to the increased intraluminal pressure. This is a poorly selective process which can explain the proteinaceous nature of vasogenic edema. Sterois may act by forming hydrophobic bonds in the endothelial cell membrane and making it more difficult for any membrane fission to occur. Hyperventilation can be of use in vasogenic edema by decreasing intracranial pressure, providing better oxygenation and also by diminishing the capillary head pressure. Tags: Animal; Human Desc.: *Adrenal Cortex Hormones--Pharmacodynamics (PD); *Brain Edema--Physiopathology (PP); Brain Injuries--Physiopathology (PP); Brain Neoplasms--Physiopathology (PP); *Capillary Permeability; Capillary Permeability--Drug Effects (DE); Carbon Dioxide--Blood (BL); Endocytosis--Drug Effects (DE); *Hyperventilation--Physiopathology (PP); Intracranial Pressure--Drug Effects (DE) Y004154 44 1371889 84211889 Breathing pattern during induced bronchoconstriction. Chadha TS; Schneider AW; Birch S; Jenouri G; Sackner MA Dept. of Medicine, Mount Sinai Medical Center, Miami Beach, Florida. J Appl Physiol (US), Apr 1984, 56 (4) p1053-9, ISSN 0161-756 Jrnl Code: HAL Contract/Grant No.: HL-10622 Lang.: ENG. Jrnl Ann.: 8409 Subfile: INDEX MEDICUS The breathing patterns of normal subjects monitored with respiratory inductive plethysmography were investigated after mild increases in respiratory resistance provoked by aerosolized methacholine during natural breathing and while breathing on a mouthpiece to a pneumotachograph. First, during natural breathing, comparisons of inspiratory ventilation (VI), tidal volume (VT), frequency (f), inspiratory time (TI), fractional inspiratory time (TI/TT), and mean inspiratory flow (VT/TI) were made before and after aerosolized buffered saline and methacholine in a dose that reduced specific airway conductance (sGaw) by 35% (PD35). There was a significant increase in VT/TI and VI after methacholine, whereas VT, f, TI, and TI/TT were not consistently modified by saline or methacholine. Pretreatment with bronchodilators prevented changes in respiratory resistance (Rrs) as well as in breathing pattern after PD35 methacholine. On another day, Rrs, end-expiratory lung volume level, and breathing pattern during natural breathing were monitored after administration of predetermined doses of methacholine that reduced sGaw by 25% (PD25), PD35, and 55% (PD55). Increases in VT/TI and end-expiratory lung volume level paralleled the increases in Rrs after each dose of methacoline but not with saline control. VI increased along with Rrs at the PD25 and PD35 doses but plateaued at the PD55 dose while Rrs continued to rise. There were no changes in breathing pattern in subjects who breathed on a mouthpiece to a pneumotachograph after PD55 methacholine. Thus alterations of the breathing pattern due to mild-to-moderate degrees of bronchoconstriction are characterized by progressive rises of mean inspiratory flow (an index of respiratory center drive) and end-expiratory lung volume level (a measure of pulmonary hyperinflation), but VI plateaus at the more severe degree of bronchoconstriction.(ABSTRACT TRUNCATED AT 250 WORDS) Tags: Comparative Study; Female; Human; Male; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. Desc.: Adult; Aerosols; Bronchial Spasm--Chemically Induced (CI); *Bronchial Spasm--Physiopathology (PP); Methacholine Compounds; METHACHOLINE CPDS; Orciprenaline--Pharmacodynamics (PD); Oxygen--Blood (BL) ; Plethysmography--Methods (MT); *Respiration; Tidal Volume; Time Factors CAS Registry No.: 55-92-5 (acetyl-beta-methylcholine); 586-06-1 (Orciprenaline); 7782-44-7 (Oxygen) Y004154 45 1356999 84196999 Abnormalities of chest wall motion in patients with chronic airflow obstruction. Gilmartin JJ; Gibson GJ Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne. ŠThorax (ENGLAND), Apr 1984, 39 (4) p264-71, ISSN 0040-6376 Jrnl Cod: VQW Lang.: ENG. Jrnl Ann.: 8408 Subfile: INDEX MEDICUS Forty patients with severe chronic stable airflow obstruction and hyperinflation were studied to assess patterns of abnormal chest wall motion and their frequency. Dimensional changes were measured during tidal breathing, four pairs of magnetometers being used to record anteroposterior diameters of ribcage and abdomen and two lateral diameters of the ribcage. Chest wall movements were qualitatively normal in only five patients. Three main types of abnormality were found and 13 subjects had two or more abnormal patterns Lateral ribcage paradox was present in 31 of the 40 patients and was recognised clinically in all except one. Inspiratory indrawing of the lower sternum was recorded in 12 patients, paradoxical inspiratory motion of the abdomen was present in four patients and in six there was a biphasic expiratory pattern of abdominal movement. Analysis of variance showed no significant group differences in severity of airflow obstruction or hyperinflation between the patients with qualitatively normal motion and those with different types of abnormal motion. Relationships between the tidal displacement of each dimension and severity of airflow obstruction and hyperinflation were examined. In general, patients with more severe hyperinflation showed less abdominal movement and those with severe airflow obstruction had less lateral expansion of the ribcage, but the correlations were weak. It is concluded that abnormal motion of the chest wall is very common in patients with airflow obstruction and hyperinflation, that clinical recognition of abnormal motion other than lateral ribcage paradox is easily overlooked, and that quantitative relationships between abnormal motion and disease severity are weak. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Abdomen--Physiopathology (PP); Adult; Aged; Forced Expiratory Volume; *Lung Diseases, Obstructive--Physiopathology (PP); Magnetics; Middle Age Movement; Posture; Respiration; *Thorax-Physiopathology (PP); Total Lung Capacity; Vital Capacity Y004154 46 1341880 84181880 Reduced functional residual capacity and severe head injury [letter] Ibanez J; Raurich JM Chest (US), May 1984, 85 (5) p715-6, ISSN 0012-3692 Jrnl Code: D1C Lang.: ENG. Jrnl Ann.: 8408 Subfile: AIM; INDEX MEDICUS Tags: Human Desc.: Adolescence; Adult; *Functional Residual Capacity; *Head Injuries--Physiopathology (PP); *Lung Volume Measurements; Middle Age; Oxygen--Blood (BL); Posture CAS Registry No.: 7782-44-7 (Oxygen) Y004154 47 1341872 84181872 Bronchiolitis in rheumatoid arthritis. Lahdensuo A; Mattila J; Vilppula A Chest , May 1984, 85 (5) p705-8, ISSN 0012-3692 Jrnl Code: D1C Lang.: ENG. Jrnl Ann.: 8408 Subfile: AIM; INDEX MEDICUS Bronchiolitis in association with rheumatoid arthritis has been reported, to our knowledge, in 18 patients to date. In some cases use of penicillamine has been strongly associated with the development of bronchiolitis. Most of the reported cases are described as having marked irreversible airways obstruction and hyperinflation. We describe a patient with rheumatoid arthritis whose respiratory tract symptoms began during gold therapy. Physiologic studies showed marked lung hyperinflation without pathologic findings in forced dry spirometric study. On open lung biopsy a mild degree of granulomatous bronchiolitis was found. Immunofluorescent microscopy showed IgM- and IgG-containing plasma cells in the bronchiolar walls. Tags: Case Report; Female; Human Desc.: Adult; *Arthritis, Rheumatoid--Complications (CO); Arthritis, Rheumatoid--Drug Therapy (DT); *Bronchitis--Etiology (ET); Bronchitis--Immunology (IM); Bronchitis--Pathology (PA); Gold--Therapeutic Use (TU); IgG-Analysis (AN); IgM--Analysis (AN); Respiratory Function Tests CAS Registry No.: 7440-57-5 (Gold) Y004154 48 1331403 84171403 The effect of hyperinflation on lung elasticity in healthy subjects. Hillman DR; Finucane KE Dept. of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, Australia. Respir Physiol (NETHERLANDS), Dec 1983, 54 (?) p295-305, ISSN 0034-5687 Jrnl Code: R88 Lang.: ENG. Jrnl Ann.: 8407 Subfile: INDEX MEDICUS In acute severe asthma, lung distensibility may increase. To determine whether hyperinflation alone can increase lung distensibilit acutely total lung capacity (TLC) and static volume-pressure (VP) properties were measured in six healthy subjects after quiet breathing, and two periods of hyperinflation of 20-60 min, with negative pressure assistance at the chest wall (NPA) in one period and positive airways pressure assistance (PPA) in the other In five subjects there was no change with NPA; with PPA lung volume at a static transpulmonary pressure of 10 cm H2O (VL 10) increased by 0.3 L (P less than 0.01) and K, the shape constant of an exponential function fited to the deflation VP curve, increased (P less than 0.001) without a change in TLC. In Subject 6, with both NPA and PPA, VL 10 increased by 1.3 L (P less than 0.001). K increased P less than 0.001 with NPA; P less than 0.0 with PPA) and TLC increased (P less than 0.001 with NPA; P less than 0.01 with PPA); volume hysteresis was unchanged. The small increase of lung distensibility in five subjects after PPA we attribute to decreased pulmonary blood volume; in Subject 6 the changes with hyperinflation suggest decreased tissue forces. We conclude that hyperinflation can cause an acute increase in lung distensibility in some individuals. The variable response between subjects parallels that seen in asthma. Tags: Comparative Study; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; Asthma--Physiopathology (PP); Lung Compliance; Lung Volume Measurements; *Lung--Psysiology (PH); Lung--Physiopathology (PP); Plothysmography; Positive Pressure Respiration; Pressure; *Respiration; Total Lung Capacity Y004154 49 1321512 84161512 Lung compliance changes on high-frequency ventilation in normal dogs. Weinmann GG; Simon BA; Mitzner W Dept. of Environmental Health Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland. J Appl Physiol (US), Feb 1984, 56 (2) p506-12, ŠISSN 0161-7567 Jrnl Code: HAL Contract/Grant No.: HL-26532; GM-07309 Lang.: ENG. Jrnl Ann.: 8407 Subfile: INDEX MEDICUS To test the hypothesis that high-frequency ventilation (HFV) promotes lung stability we compared the temporal course of dynamic lung compliance changes after two inflations on HFV with those occurring on conventional mechanical ventilation (CMV) at two different lung volumes, specifically with and without 5 cmH2O positive end-expiratory pressure (PEEP). In our first set of experiments we ventilated six anesthetized paralyzed dogs first with CMV, then with HFV, then again with CMV using tidal volumes of 15 ml/kg at rates of 16-18 times/min for CMV and less than 90 ml and a rate of 15 Hz for HFV. I our second set of experiment, we ventilated six dogs for 4 h, the 1st h with CMV at 0 cmH2O end-expiratory pressure, the 2nd h with CMV with 5 cmH2O PEEP, the 3rd h with HFV at the same mean pleural pressure, and the 4th h again with CMV with 5 cmH2O PEEP. We found the decreases in dynamic compliance with time following hyperinflations were similar on HFV and CMV (P greater than 0.5) at both lung volumes. With the lower lung volume the initial dynamic compliance following hyperinflation also tended to fall progressively from one hour to the next despite the inflations. However, with PEEP the initial dynamic compliance over successive hours tended to rise from one hour to the next. We found that changes in dynamic compliance were not necessarily reflected in the venous admixture or alveolar to arterial O2 partial pressure gradients. We thus conclude that lung stability in normal dogs is not improved during HFV, and blood gases cannot be used to predict compliance changes. Tags: Animal; Comparative Study; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. Desc.: Dogs; *Lung Compliance; Lung Volume Measurements; Positive Pressure Respiration; *Respiration, Artificial; Tidal Volume; Time Factors Y004154 50 1317909 84157909 Physiologic correlate of airway collapse in chronic airflow obstruction. Healy F; Wilson AF; Fairshter RD Dept. of Medicine, Univ. of California, Irvine Medical Center, Orange. Chest (US), Apr 1984, 85 (4) p476-81, ISSN 0012-3692 Jrnl Code: D1C Contract/Grant No.: HL0529-01 Lang.: ENG. Jrnl Ann.: 8407 Subfile: AIM; INDEX MEDICUS Forty percent of 89 patients with chronic airflow obstruction (CAO) demonstrated maximum expiration flow-volume (MEFV) patterns consistent with sudden collapse or marked narrowing of large central airways. In contrast, 43 percent of the CAO patients demonstrated a curvilinear (C) pattern; the remainder (17 percent) were intermediate. Volume displacement plethysmography indicated that the airway collapse (AC) pattern was influenced by, but was not solely, a gas compression artifact. Airway collapse patients had more obstruction and hyperinflation than C patients and also had decreased diffusing capacity, absence of density dependence, reduced lung recoil, and no effort dependence of airflow. Bronchodilaton administration in AC patients typically produced large reduction of residual volume and increase of vital capacity, with a smaller increase of airflow. These data suggest that AC patients have significant, partially reversible peripheral airways obstruction plus emphysema. Possible determinants of AC include reduced central airway support, increased peripheral resistance, loss of lung recoil, and increased pleural pressures during forced expiration. The MEFV contour appears to evolve from normal to curvilinear to the AC pattern as the severity of airflow obstruction worsens. Tags: Female; Human; Male; Support, U.S. Gov't, P.H.S. Desc.: Aged; Bronchodilator Agents-Therapeutic Use (TU); Forced Expiratory Volume; Lung Compliance; Lung Diseases, Obstructive--Drug Therapy (DT); *Lung Diseases, Obstructive--Physiopathology (PP); Methacholine Compounds--Pharmacodynamics (PD); METHACHOLINE CPDS--Pharmacodynamics (PD); Middle Age; Pulmonary Diffusing Capacity; Pulmonary Wedge Pressure; Respiratory Function Tests Y004154 51 1312067 84152067 Hyperinflation [editorial] Macklem PT Am Rev Respir Dis (US), Jan 1984, 129 (1) p1-2, ISSN 00030805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8406 Subfile: AIM; INDEX MEDICUS Tags: Animal; Human Desc.: Dogs; Lung Volume Measurements; *Lung--Physiopathology (PP) Muscles--Physiopathology (PP); *Respiration Disorders--Physiopathology (PP) ; *Respiration; Respiratory Airflow Y004154 52 1304151 84144151 Cerebrovascular status of severe closed head injured patients following passive position changes. Parsons LC; Wilson M School of Medicine, Univ. of Virginia, Charlottesville. Nurs Res (US), Mar-Apr 1984, 33 (2) p68-75, ISSN 0029-6562 Jrnl Code: O9K Lang.: ENG. Jrnl Ann.: 8406 Subfile: AIM; INDEX MEDICUS Nursing care of the severe closed head injured patient has two primary goals: (1) the prevention of secondary brain injury associated with intracranial hypertension, and (2) the prevention of complications associated with immobility. This study examined the effects of six body position changes, performed as part of routine nursing care interventions, on the cerebrovascular status of 18 severely head injured patients. These changes included turning and positioning in bed, head rotation, range of motion exercises, and raising and lowering of the head of the bed. All subjects had baseline mean intracranial pressures of less than or equal to 15 mm/Hg, and cerebral perfusion pressures of greater than or equal to 50 mm/Hg. Over 200 observations of the effects of position changes on heart rate (HR), mean arterial blood pressure (MABP), mean intracranial pressure (MICP), and cerebral perfusion pressure (CPP) were recorded and analyzed. With the exception of the intervention raising the head of the bed, all position changes produced increases in HR, MABP, MICP, and CPP. Typically, the physiologic changes were transient and showed recovery toward baseline values in one-minute postintervention measurements. The results of this study suggest that passive position changes may be performed safely upon severe closed head injured patients with baseline MICPs less than or equal to 15 mm/Hg, provide CPPs are maintained above 50 mm/Hg throughout each position change and provided multiple fractures do not preclude these position changes. Tags: Female; Human; Male Desc.: Adolescence; Adult; Blood Pressure; Cerebrovascular Circulation; Child; Child, Preschool; *Head Injuries--Nursing (NU); Head Injuries--Physiopathology (PP); Heart Rate; Intracranial Pressure; Middle Age; *Posture Y004154 53 1295074 84135074 Cumulative effects of three sequential endotracheal suctioning episodes in the dog model. Baun MM; Flones MJ Nursing Research Center, College of Nursing, Univ. of Nebraska, Omaha. ŠHeart Lung (US) , Mar 1984, 13 (2) p148-54, ISSN 0147-9563 Jrnl Code: G2V Contract/Grant No.: R01NU00694 Lang.: ENG. Jrnl Ann.: 8406 Subfile: AIM; INDEX MEDICUS Tags: Animal; Female; Support, U.S. Gov't, P.H.S. Desc.: Anoxemia--Etiology (ET); Anoxemia--Prevention and Control (PC); Dogs; *Intubation, Intratracheal; Oxygen--Administration and Dosage (AD); *Oxygen--Blood (BL); Respiration, Artificial--Methods (MT); *Suction--Adverse Effects (AE); Tidal Volume CAS Registry No.: 7782-4-7 (Oxygen) Y004154 54 1267740 84107740 Predicting risk of pneumothorax in needle biopsy of the lung. Poe RH; Kallay MC; Wicks CM; Odoroff CL Pulmonary Disease Unit, Highland Hospital, Rochester, New York. Chest (US), Feb 1984, 85 (2) p232-5, ISSN 0012-3692 Jrnl Code: D1C Lang.: ENG. Jrnl Ann.: 8405 Subfile: AIM; INDEX MEDICUS We prospectively studied results of 103 consecutive transthoracic needle biopsies of lung lesions suspicious for malignancy to determine if lesion size, depth within the lung, hyperinflation, second needle passes, or 100 percent oxygen breathing influenced the incidence of pneumothorax. Thirty-eight patients (37 percent) developed pneumothorax. Ten (10 percent) required tube thoracostomy for re-expansion. Five of the ten requiring the chest tube had clinically severe obstructive lung disease. In all patients, greater depth (D) in centimeters of needle penetration significantly increased the probability (p) of pneumothorax (p much less than .001) and can be estimated by the equation: (formula see text) the estimated probability of pneumothorax is 13 percent at 1 cm, 49 percent at 4 cm, and 86 percent at 7 cm. An increase in total lung capacity above predicted added additional risk of pneumothorax (p less than .02). Oxygen breathing did not significantly reduce the incidence of pneumothorax, but may reduce size by increasing the rate of reabsorption. The other factors had little influence. We conclude that the more central location of the lesion and pre-existing lung hyperinflation determine the risk of pneumothorax. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; Aged; *Biopsy, Needle--Adverse Effects (AE); Lung Neoplasms--Complications (CO); Lung Neoplasms--Diagnosis (DI); Lung Neoplasms--Pathology (PA); Lung Volume Measurements; *Lung--Pathology (PA) Lung--Radiography (RA); Middle Age; Pneumothorax--Etiology (ET); *Pneumothorax--Occurrence (OC); Prognosis; Prospective Studies; Risk Y004154 55 1243372 84083372 Prolonged hyperventilation and intracranial pressure. Havill JH Intensive Therapy Unit, Waikato Hospital, Hamilton, New Zealand. Crit Care Med (US), Jan 1984, 12 (1) p72-4, ISSN 0090-3493 Jrnl Code: DTF Lang.: ENG. Jrnl Ann.: 8404 Subfile: AIM; INDEX MEDICUS The effects of a CO2 changes on intracranial pressure (ICP) often remain even after prolonged hyperventilation. Two representative cases are described where PaCO2 rises were directly related to serious rises in ICP after 4, 6, and 14 days of hyperventilation. This is common in head injuries and suggests that where hyperventilation is used to reduce ICP in the presence of brain swelling, withdrawal of the technique should be cautious. Tags: Case Report; Female; Human; Male Desc.: Adolescence; Blood Pressure; Carbon Dioxide--Blood (BL); Child; *Critical Care; *Head Injuries--Therapy (TH); *Intermittent Positive Pressure Ventilation; *Intracranial Pressure; *Positive Pressure Respiration; Time Factors Y004154 56 1238796 84078796 Controlled hyperventilation [letter] Levy DE Arch Intern Med (US), Dec 1983, 13 (12) p2342-3, ISSN 0003-9926 Jrnl Code: 7FS Lang.: ENG. Jrnl Ann.: 8403 Subfile: AIM; INDEX MEDICUS Tags: Animal; Human Desc.: *Brain Injuries--Therapy (TH); Cerebrovascular Circulation; *Intracranial Pressure; *Respiration, Artificial--Methods (MT) Y004154 57 1237980 8407798 The effects of chronic hyperinflation, nutritional status, and posture on respiratory muscle strength in cystic fibrosis. O'Neill S; Leahy F; Pasterkamp H; Tal A Division of Respirology, Univ. of Manitoba, Winnipeg, Canada. ŠAm Rev Respir Dis (US), Dec 1983, 128 (6) p1051-4, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8403 Subfile: AIM; INDEX MEDICUS We measured maximal static inspiratory and expiratory pressures (PImax and PEmax) in 25 patients with cystic fibrosis (CF) and 80 normal control subjects to determine whether chronic hyperinflation and malnutrition reduce PImax and PImax/PEmax, respectively. In addition, we examined the effect of posture on pressures generated. We used a diminution in PEmax as an index of a malnutrition effect on pressures generated. The patients with CF, although significantly hyperinflated (ratio of residual volume to total lung capacity, 0.49), generated PImax values similar to those of the control subjects (p greater than 0.05). Despite evidence of malnutrition (mean body mass percentile, 78%) the PEmax values of patients with CF and those of control subjects were comparable (p greater than 0.05). There was no postural effect on pressures generated in the normal subjects or the CF group as a whole. We conclude that respiratory muscle strength is normal or supranormal in C, despite chronic hyperinflation and malnutrition. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adolescence; Adult; Child; Cystic Fibrosis--Complications (CO); *Cystic Fibrosis--Physiopathology (PP); Forced Expiratory Volume; *Muscles--Physiopathology (PP); *Nutrition Disorders--Complications (CO); Posture; Pressure; Residual Volume; *Respiration; *Respiratory Airflow; Total Lung Capacity Y004154 58 1187716 84027716 Effect of positive end-expiratory pressure on breathing patterns of normal subjects and intubated patients with respiratory failure. Tobin MJ; Jenouri G; Birch S; Lind B; Gonzalez H; Ahmed T; Sackner MA Division of Pulmonary Diseases, Mount Sinai Medical Center, Miami Beach, FL. Crit Care Med (US), Nov 1983, 11 (11) p859-67, ISSN 0090-3493 Jrnl Code: DTF Contract/Grant No.: HL 10622 Lang.: ENG. Jrnl Ann.: 8402 Subfile: AIM; INDEX MEDICUS The aims of this study included assessment of accuracy of respiratory inductive plethysmography when pulmonary hyperinflation was induced by application of PEEP, and examination of breathing patterns of normal subjects, intubated patients requiring mechanical ventilation and intubated patients immediately before extubation during application of PEEP by demand valve and high gas flow reservoir bag systems. Validation of tidal volume (VT) and end-expiratory level measured with respiratory inductive plethysmography to simultaneous spirometry (SP) was achieved with PEEP levels up to 12.5 cm H2O in 7 normals. In 17 intubated patients, almost all VT values measured with respiratory inductive plethysmography fell within +/- 10% of SP even with 2 to 3 changes of body posture. In normal subjects, increasing levels of PEEP from the demand valve system produced nonprogressive rises of VT and mean inspiratory flow, falls of frequency and fractional inspiratory time (TI/TTOT), and no changes of minute ventilation (Vmin) nor mean expiratory flow. PEEP from the high gas flow reservoir bag system produced nonprogressive rises of VT and rib cage (RC) contribution to VT, and rises of Vmin and mean inspiratory and expiratory flows between 10.0 and 12.5 cm H2O of PEEP. Intubated patients requiring intermittent mandatory ventilation (IMV) had a rapid, shallow breathing pattern unaltered by PEEP levels delivered by either system up to 12.5 cm H2O despite increases of end-expiratory level. Intubated patients who were about to be extubated breathed with patterns closer to ambulatory normal subjects with the exception of their elevated RC contribution to VT.(ABSTRACT TRUNCATED AT 250 WORDS) Tags: Female; Human; Male; Support, U.S. Gov't, P.H.S. Desc.: Adult; Aged; Evaluation Studies; Middle Age; Monitoring, Physiologic; Plethysmography; *Positive Pressure Respiration; *Respiration Respiratory Function Tests; *Respiratory Insufficiency--Therapy (TH) Y004154 59 1182640 84022640 Respiratory problems 2 years after acute bronchiolitis in infancy. Henry RL; Hodges IG; Milner AD; Stokes GM Univ. Dept. of Child Health, Univ. Hospital, Queen's Medical Centre, Nottingham. Arch Dis Child (ENGLAND) , Sep 1983, 58 (9) p713-6, ISSN 0003-9888 Jrnl Code: 6XG Lang.: ENG. Jrnl Ann.: 8401 Subfile: AIM; INDEX MEDICUS We assessed the clinical progress of 55 children 2 years after admission to hospital with acute bronchiolitis and performed lung function tests on 40. During the 2 year follow up period 75% of the children had wheezed, 36% had 2 or more lower respiratory symptoms lasting more than 2 weeks, 33% had more than 100 days of lower respiratory symptoms, and 13% were readmitted to hospital with acute respiratory disease. In addition 60% of the children were hyperinflated on lung function tests. Many of the children with hyperinflation at the 2 year assessment had not been hyperinflated 1 year earlier, suggesting variable airways obstruction. Reversibility of airways obstruction was also assessed by response to nebulise salbutamol. Nine children had a fall greater than 15% in airways resistance after salbutamol and these children had the highest baseline airways resistances. Airways resistance was higher in the children with a family history of atopy. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Acute Disease; Airway Resistance; *Bronchiolitis, Viral--Complications (CO); Cough--Etiology (ET); Follow-Up Studies; Infant Lung Volume Measurements; Lung--Physiopathology (PP); Paramyxovirus Infections--Complications (CO); Respiratory Sounds--Etiology (ET); Respiratory Syncytial Viruses; *Respiratory Tract Diseases--Etiology (ET) Y004154 60 1182087 84022087 Changes in the glottic aperture during bronchial asthma Collett PW; Brancatisano T; Engel LA Thoracic Medicine Unit, Westmead Hospital, Sydney, Australia. Am Rev Respir Dis (US), Oct 1983, 128 (4) p719-23, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8401 Subfile: AIM; INDEX MEDICUS We measured the cross-sectional area of the glottis in 12 asymptomatic asthmatic subjects before and after bronchoconstriction (BC) induced by histamine or ultrasonically nebulized water aerosol. The glottis was visualized using a fiberoptic bronchoscope attached to a video camera and tape recorder onto which flow and volume were simultaneously recorded. During induced asthma, measurements of forced expiratory flow fell to 36 +/- 3% (mean +/- SE) of control. Glottic area at mid-expiration (Age) fell from 75 +/- 14 mm2 by 45 +/- 8% (p less than 0.005). In some subjects, expiratory constriction of the supraglottic portion of the larynx and pharynx as also noted. Five subjects showed mild constriction (13 to 32%) of the glottis during inspiration. The administration of 10 cm H2O of continuous positive airway pressure (CPAP) during the induced asthma temporarily abolished expiratory constriction of the glottis and supraglottic structures; Age increased from 45 +/- 15 to 79 +/- 11 mm2 (p less than 0.01). The constriction returned when CPAP was stopped. After reversal of BC by salbutamol Age returned to values similar to those before BC. Although the mechanism for the expiratory glottic constriction is not known, it may be related to the different pattern of respiratory muscle activity seen in asthma. We speculate that the glottic constriction may contribute to hyperinflation by slowing expiratory flow and/or allowing a reduction in the persistent inspiratory muscle activity during expiration. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; *Asthma--Physiopathology (PP); Bronchoscopy; Forced Expiratory Flow Rates; Forced Expiratory Volume; *Glottis--Physiopathology (PP); Middle Age; Respiration Y004154 61 1169964 84009964 Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. ŠCardoso ER; Rowan JO; Galbraith S Dept. of Neurosurgery, Southern General Hospital, Glasgow, Scotland. J Neurosurg (US), Nov 1983, 59 (5) p817-21, ISSN 0022-3085 Jrnl Code: JD3 Lang.: ENG. Jrnl Ann.: 8401 Subfile: AIM; INDEX MEDICUS The configuration of the intracranial pressure (ICP) pulse wave represents a complex sum of various components. Amplitude variations of an isolated component might reflect changes in a specific intracranial structure. Fifteen awake patients suffering from hydrocephalus, benign intracranial hypertension, or head injury underwent ICP monitoring through a ventricular catheter and were subjected to three standardized maneuvers to alter the intracranial dynamics: head elevation, voluntary hyperventilation, and cerebrospinal fluid (CSF) withdrawal. A 12 degrees head elevation and fractionated CSF withdrawal caused a mild ICP drop and a proportionate amplitude reduction of all the wave components. Voluntary hyperventilation caused a comparable fall in ICP, and a disproportionate reduction in the amplitude of the wave components, especially the P2 component. It is postulated that the decrease in amplitude of the P2 component reflects the reduction of the cerebral bulk caused by hyperventilation. Head elevation and CSF withdrawal caused a decrease of global ICP but no specific changes in any intracranial structure, and consequently the configuration of the pulse wave remained unchanged. The establishment of relationships between anatomical substrate and particular wave components is promising since potentially it could be useful for monitoring conditions such as vasoparalysis, impaired cerebrovascular reactivity, and cerebral edema. Tags: Human Desc.: *Brain Injuries--Physiopathology (PP); *Cerebrospinal Fluid Hematoma--Physiopathology (PP); Hydrocephalus--Physiopathology (PP); Hypoventilation--Physiopathology (PP); *Intracranial Pressure; Posture; Pseudotumor Cerebri--Physiopathology (PP) Y004154 62 1167691 84007691 A model of inspiratory muscle mechanics. Macklem PT; Macklem DM; De Troyer A Meakins-Christie Laboratories, McGill Univ. Clinic, Royal Victoria Hospital, Montreal, Quebec, Canada. J Appl Physiol (US), Aug 1983, 55 (2) p547-57, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8401 Subfile: INDEX MEDICUS We have previously shown that the costal and crural parts of the diaphragm have different actions on the rib cage (RC) and that the tension developed in one part is not transmitted perfectly to the other. Thus the diaphragm can be modeled pneumatically or electrically as two generators or pumps in series between the lung and abdomen. As such, the force developed by diaphragmatic contraction is the sum of the forces developed in each part, whereas the volume displaced is the same for each part and equal to the total volume displaced. The costal part of the diaphragm is in series with the intercostal and accessory (IA) muscles between the lung and RC, whereas the crural part is in parallel. The volume displaced by simultaneous contraction of the crural part and IA is the sum of volumes displaced by each part. The action of pleural and abdominal pressure [acting through the area of apposition (Aap) of the diaphragm to RC] can be modelled as a summing junction between IA and RC. With hyperinflation the costal part acts more and more in parallel with both IA and the crural part, whereas Aap diminishes, so that the ability to develop large forces decreases independently of the muscles' force-length relationships. The model also predicts that the factors determining the length of the costal and crural parts are different. Finally, the parallel and serial arrangement of the inspiratory musculature allows for increases in maximum power, maximum force, and maximum velocity by appropriate recruitment of the various muscle groups. Tags: Comparative Study; Human; Support, Non-U.S. Gov't Desc.: Biomechanics; *Diaphragm--Physiology (PH); *Intercostal Muscles--Physiology (PH); *Models, Biological; Pleura--Physiology (PH); Pressure; *Respiration Y004154 63 1167657 84007657 Vagal feedback with expiratory threshold load under extracorporeal circulation. Jammes Y; Bye PT; Pardy RL; Roussos C Meakins-Christie Laboratories, McGill Univ. Clinic, Royal Victoria Hospital, Montreal, Quebec, Canada. J Appl Physiol (US), Aug 1983, 55 (2) p316-22, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8401 Subfile: INDEX MEDICUS In 11 anesthetized dogs placed under extracorporeal circulation, the vagal feedback was tested by electrical stimulation of the vagus nerves with cold block of their caudal part and by passive lung hyperinflation. The apnaic response to such vagal stimulation progressively disappeared during expiratory threshold load breathing but then returned to control values some minutes after the load was removed. This suppression of the inhibitory response to stimulation of the vagus nerves was usually observed when vagal afferents were intact or blocked by cold. However, it was not observed whether no evoked activity continued in expiratory muscles after the cold block, or after suppression of all proprioceptive muscular afferents after transection of the spinal cord at C6 level. These results strongly suggest that enhancement of proprioceptive inputs to the respiratory centers counteracts the vagally mediated inspiratory "off-switch" mechanisms. Tags: Animal; Support, Non-U.S. Gov't Desc.: Abdominal Wall--Physiology (PH); Afferent Pathways--Physiology (PH); Differential Threshold; Dogs; Electric Stimulation; *Extracorporeal Circulation; Feedback; *Respiration; *Vagus Nerve--Physiology (PH); *Work of Breathing Y004154 64 1151793 83306793 Mechanical load and inspiratory muscle action during induced asthma. Martin JG; Shore SA; Engel LA Meakins-Christie Laboratories, McGill Univ. Clinic, Royal Victoria Hospital, Montreal, Canada. Am Rev Respir Dis (US), Sep 1983, 128 (3) p455-60, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8312 Subfile: AIM; INDEX MEDICUS To examine the relationship between inspiratory mechanical load in asthma and the pattern of respiratory muscle recruitment, we studied lung and chest wall mechanics in 7 asymptomatic asthmatics in whom progressive bronchoconstriction was induced with inhaled aerosolized histamine. A fall in the FEV1 to 49.5 +/- 3.9% of the control value (mean +/- 1 SE) was associated with a 10.7-fold increase in the inspiratory work rate of the inspiratory muscles from 6.7 +/- 1.6 to 71.4 +/- 11.4 Joules/min. Elastic work accounted for 69% of the total work during the control period and 57% at the maximal level of bronchoconstriction studied. The net pressure time product for the inspiratory muscles, measured over 1 min, rose fivefold from 245 +/- 33 cmH2O.s to a maximum of 1, 211 +/- 107 cmH2O.s, indicating a relatively greater increase in the recruitment of the intercostal/accessory muscles of inspiration. The abdominal muscles, which were recruited during bronchoconstriction, relaxed during inspiration, and permitted outward movement of the abdominal wall with progressively smaller net increases in Pga. We concluded that during induced asthma (1) the increase in inspiratory muscle work was largely the result of hyperinflation, (2) the recruitment of the intercostal/accessory muscles exceeded that of the diaphragm, and (3) the combined action of the intercostal/accessory and abdominal muscles favored the diaphragm. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Abdominal Wall--Physiopathology (PP); Adult; *Asthma--Physiopathology (PP); Bronchi--Physiopathology (PP); Diaphragm--Physiopathology (PP); Forced Expiratory Volume; Intercostal Muscles--Physiopathology (PP); Lung Volume Measurements; Middle Age; *Muscles--Physiopathology (PP); *Respiration; Respiratory Airflow Y004154 65 1110273 83265273 ŠMaximal shortening of inspiratory muscles: effect of training. Fanta CH; Leith DE; Brown R Dept. of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. J Appl Physiol (US), Jun 1983, 54 (6) p1618-23, ISSN 0161-7567 Jrnl Code: HAL Contract/Grant No.: HL-19170 Lang.: ENG. Jrnl Ann.: 8311 Subfile: INDEX MEDICUS Normal subjects can increase their vital capacity by appropriate training. We tested whether that change can be achieved by greater maximal shortening of the inspiratory muscles without concomitant increases in peak static inspiratory pressures. Sixteen healthy volunteers participated in the study: eight were randomly assigned to make 20 inhalations to total lung capacity, held for 10 s with the glottis open, each day for 6 wk; the remainder served as nontraining control. Before and after the 6-wk study period, we made multiple determinations of lung volumes and of curves relating lung volume to maximal static inspiratory (and expiratory) pressure. Control subjects had no significant changes from base line in any variable. In the training group, the mean vital capacity increased 200 +/- 74 ml (P less than 0.05) or 3.9 +/- 1.3% (P less than 0.02), without a significant change in residual volume. After training, the mean maximal inspiratory pressure at the airway opening (PI) at a lung volume equal to the base-line total lung capacity was 27 +/- 8 cmH2O in this group (vs. zero before training; P less than 0.02). Values of PI in the mid-vital capacity range did not change. We conclude that in response to appropriate training stimuli inspiratory muscles can contract to shorter minimal lengths, a capacity potentially important in progressive pulmonary hyperinflation. Tags: Comparative Study; Female; Human; Male; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S. Desc.: Adolescence; Adult; *Muscles--Anatomy and Histology (AH); *Physical Education and Training; *PHYS ED; *Respiratory System--Anatomy and Histology (AH); Respiratory System--Physiology (PH); Total Lung Capacity; Vital Capacity Y004154 66 1078831 83233831 Reduced functional residual capacity and abnormal oxygenation in patients with severe head injury. Cooper KR; Boswell PA Pulmonary Division, Medical College of Virginia-Virginia Commonwealth Univ., Richmond. Chest (US), Jul 1983, 84 (1) p29-35, ISSN 0012-3692 Jrnl Code: D1C Contract/Grant No.: NS-12587 Lang.: ENG. Jrnl Ann.: 8310 Subfile: AIM; INDEX MEDICUS Severe head injury often results in hypoxemia, but the pathophysiology of this phenomenon is unclear. We studied 24 patients hospitalized after severe head injury to determine whet~rher the abnormality of oxygen transfer as measured by venous admixture (Qs/Qt) was associated with a reduction in functional residual capacity (FRC) and also what changes in these variables could be induced by positive end-expiratory pressure (PEEP). Mean FRC was 68 percent of the value predicted for the upright position, and mean Qs/t was 0.196. The FRC and Qs/Qt were significantly related so that patients with the lowest FRC had the highest Qs/Qt (p less than 0.001). The FRC was small enough to expect closure of small airways in many of these patients. The addition of 10 cm H2O of PEEP resulted in an increase in RC of 28 percent (+/- 15 percent [SD] of the value predicted for upright posture; Qs/Qt declined by 0.05 (+/- 0.05 [SD] ). Most of these patients had no spontaneous breathing due either to the severity of the brain injury or to the therapeutic hyperventilation and muscular paralysis employed to control intracranial pressure. We conclude that FRC is often reduced in patients hospitalized after severe head injury and that associated abnormalities of ventilation-perfusion matching often lead to an elevated Qs/Qt. Therapy with PEEP in the range of 10 to 15 cm H2O was well tolerated by our patients and can be used safely to reduce Qs/Qt. Tags: Female; Human; Male; Support, U.S. Gov't, P.H.S. Desc.: Adolescence; Adult; Aged; Anoxemia--Etiology (ET); Anoxemia--Therapy (TH); Blood Pressure; Cardiac Output; *Functional Residual Capacity; Head Injuries--Complications (CO); *Head Injuries--Physiopathology (PP); *Lung Volume Measurements; Middle Age; *Oxygen--Physiology (PH); Positive Pressure Respiration; Posture; Pulmonary Gas Exchange; Ventilation-Perfusion Ratio CAS Registry No.: 7782-44-7 (Oxygen) Y004154 67 1024943 83179943 [Acute postembolic pulmonary edema in vagotomized rats] Cedeme pulmonaire aigu post-embolique chez le rat vagotomise. Lagneaux D; Lecomte J Institut Leon Fredericq, Universite de Liege, Belgique. C R Soc Biol (Paris) (FRANCE) , 1982, 176 (6) p876-9, ISSN 0037-9026 Jrnl Code: CA2 Lang.: FRENCH Summary Languages: ENG. Doc. Type: English Abstract Jrnl Ann.: 8308 Subfile: INDEX MEDICUS 1. In the rat, pulmonary embolism induced by intravenous administration of gaseous carbon dioxide increases intrapulmonary water content. When the rat is vagotomized before emboli are produced, an important lung edema is found. 2. Strong respiratory stimulation with lung hyperinflation seem to be the cause of this facilitated alveolar transudation. 3. Mechanical factors operating after pulmonary embolism are those which explain transudation after inhalation of hypercapnic gas mixtures in vagotamized rats. Tags: Animal Desc.: Acute Disease; Disease Models, Animal; *Embolism, Air--Complications (CO); *Pulmonary Edema--Etiology (ET); Rats; *Vagotomy Y004154 68 1022261 83177261 Controlled hyperventilation in patients with intracranial hypertension. Application and management. Heffner JE; Sahn SA Intensive Care Units, Penrose and Penrose Community Hospitals, Colorado Springs, Denver. Arch Intern Med (US), Apr 1983, 143 (4) p765-9, ISSN 0003-9926 Jrnl Code: 7FS Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8307 ŠSubfile: AIM; INDEX MEDICUS When elevated intracranial pressure (ICP) complicates the course of various forms of cerebral edema, the likelihood of survival with full recovery is greatly diminished. Controlled mechanical hyperventilation effectively lowers ICP in some patients by causing cerebral vasoconstriction. Improved survival occurs in patients with elevated ICP from head trauma and intracranial infection treated with hyperventilation; however, no benefit has been demonstrated in patients with increased ICP from strokes or hypoxic brain damage. Proper management of the hyperventilation requires knowledge of basic cerebral circulatory physiology. Arterial Paco2 tensions should be maintained between 25 and 30 mm Hg. Vasoconstrictive effects of hyperventilation diminish after 48 to 72 hours when renal mechanisms compensate for the respiratory alkalosis. When hyperventilation is discontinued, the Paco2 must be gradually returned to normal values, since sudden changes may cause a marked rise in ICP. (65 Refs.) Tags: Human Desc.: Brain Edema--Mortality (MO); *Brain Edema--Therapy (TH); Brain--Blood Supply (BS); Carbon Dioxide--Deficiency (DF); Cerebral Anoxia--Therapy (TH); Cerebrovascular Disorders--Therapy (TH); Electrocardiography; ECG; Encephalitis--Therapy (TH); Head Injuries--Therapy (TH); *Intracranial Pressure; Meningitis--Therapy (TH); *Respiration, Artificial--Method (MT); Time Factors Y004154 69 1021286 83176286 Intensive management of severe head injuries. A scheme of intensive management of severe head injuries. Moss E; Gibson JS; McDowall DG; Gibson RM Dept. of Anaesthesia, Univ. of Leeds. Anaesthesia (ENGLAND), Mar 1983, 38 (3) p214-25, ISSN 0003-2409 Jrnl Code: 4MC Lang.: ENG. Jrnl Ann.: 8307 Subfile: AIM; INDEX MEDICUS Seventy-six severely head-injured patients, 67% of whom had Glasgow Coma scores of five or less on admission, were managed according to a intensive treatment regime which included controlled hyperventilation (under full muscular paralysis), high-dose steroids, dehydrating agents, diuretics and hypnotics (Althesin and thiopentone). Intracranial pressure (ICP) was measured throughout the period of controlled ventilation. Treatment was directed to keeping the mean ICP below 25-30 mmHg and to the prevention of increases in ICP during chest physiotherapy and other noxious stimulation. Six months after injury 46% of patients had died and 4% were vegetative survivors, whilst 43% had made a good recovery or were only moderately disabled. Features associated with worse than average prognosis were: low coma score, pupillary abnormalities, respiratory dysrhythmia and ICP greater than 30 mmHg. Spontaneous hyperventilation was a relatively good initial feature. These results support the employment of intensive care in severely head-injured patients, particularly those with diffuse brain injury. Tags: Comparative Study; Female; Human; Male Desc.: Adolescence; Adult; Aged; Child; Child, Preschool; Coma--Etiology (ET); *Critical Care--Methods (MT); Dexamethasone--Therapeutic Use (TU); Head Injuries--Complications (CO); *Head Injuries--Therapy (TH); Intracranial Pressure; Middle Age; Respiration, Artificial; Time Factors CAS Registry No.: 50-02-2 (Dexamethasone) Y004154 70 1006965 83161965 Treatment and outcome of the severely head injured child. Pfenninger J; Kaiser G; Lutschg J; Sutter M Intensive Care Unit, Univ. Children's Hospital, Inselspital, Berne, Switzerland. Intensive Care Med (US), 1983, 9 (1) p13-6, ISSN 0342-4642 Jrnl Code: H2J Lang.: ENG. Jrnl Ann.: 8307 Subfile: INDEX MEDICUS Twenty-four children (aged 3 months to 14 years) with severe head injuries were treated by means of invasive neurointensive care for normalizing intracranial pressure (ICP) involving hyperventilation, control of body temperature, dexamethasone, barbiturates and continuous intracranial and arterial pressure monitoring. The Glasgow Coma Scale before initiation of treatment was 3-4 in 8, 5-6 in 9 and 7 in 7 patients. Moderately to severely elevated ICP was observed in 20 patients. Seven developed acute and subacute space occupying intracranial hematomas. Nineteen children (79%) survived, most often with good recovery and 5 (21%) died. Severely elevated ICP, presence of severe consumption coagulopathy and loss of components in brain auditor evoked potentials were significantly more frequent in the fatal group. We conclude that the prognosis of the severely head injured child can be improved by prompt resuscitation and aggressive neurointensive care but probably not, however, to the extent postulated in recent literature. Tags: Human Desc.: Adolescence; Body Temperature; Child; Child, Preschool; *Critical Care; Dexamethasone--Therapeutic Use (TU); Dopamine--Therapeutic Use (TU); *Head Injuries--Therapy (TH); Infant; Intracranial Pressure; Monitoring, Physiologic; Outcome and Process Assessment (Health Care); OUTCOME ASSESSMENT; Phenobarbital--Therapeutic Use (TU); Respiratory Therapy CAS Registry No.: 50-02-2 (Dexamethasone); 50-06-6 (Phenobarbital); 51-61-6 (Dopamine) Y004154 71 1001897 83156897 Prevention of suctioning-related arterial oxygen desaturation. Comparison of off-ventilator and on-ventilator suctioning. Brown SE; Stansbury DW; Merrill EJ; Linden GS; Light RW Medical Service, Long Beach Veterans Administration Medical Center. Chest (US), Apr 1983, 83 (4) p621-7, ISSN 0012-3692 Jrnl Code: D1C Lang.: ENG. Jrnl Ann.: 8307 Subfile: AIM; INDEX MEDICUS The purpose of this study was to determine the frequency and severity of arterial oxygen desaturation during and after endotracheal suctioning in a group of ventilator-dependent patients with acute respiratory failure (the majority of whom had underlying obstructive lung disease) and to evaluate the efficacy of several maneuvers designed to minimize desaturation. The adaptor method presented obviates both removal from and reconnection to the ventilator during suctioning, as well as the need to alter ventilator settings. It is concluded that o--ventilator adaptor suctioning is a simple and effective measure for minimizing suctioning-related arterial oxygen desaturation. Tags: Comparative Study; Human Desc.: Anoxemia--Etiology (ET); *Anoxemia--Prevention and Control (PC); Arteries; Bronchi; *Oxygen--Blood (BL); Respiration, Artificial--Methods (MT); *Respiratory Insufficiency--Blood (BL); Respiratory Insufficiency--Therapy (TH); *Suction--Adverse Effects (AE); Suction--Instrumentation (IS) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 72 0995746 83150746 Ventilatory status early after head injury. Vicario SJ; Coleman R; Cooper MA; Thomas DM Dept. of Emergency Medicine, Univ. of Louisville School of Medicine, Kentucky. Ann Emerg Med (US), Mar 1983, 12 (3) p145-8, ŠISSN 0196-0644 Jrnl Code: 4Z7 Lang.: ENG. Jrnl Ann.: 8306 Subfile: AIM; INDEX MEDICUS The ventilatory status of patients within the first few hours following head injury has not been well established. We prospectively studied 63 patients who presented to an urban trauma center with varying severity of head injury to determine whether any trend toward hypoor hyperventilation existed within the first two hours following injury. Arterial blood gas analysis done on emergency presentation showed that 14 patients with severe head injury (Glasgow coma scale less than or equal to 4) had mean pH values of 7.29 and mean PaCO2 of 41.86 torr. Twenty patients categorized as moderate head injury (GCS = 5-11) had mean pH values of 7.38 with a mean PaCO2 of 34.1 torr. Twenty-nine patients with GCS greater than or equal to 12 had mean pH and PaCO2 values of 7.4 and 31.8 torr, respectively. These differences in pH and PaCO2 were statistically significant between the GCS groups with mild and severe head injury (P less than or equal to .01 pH), (P = .05 PCO2), and could not be explained on the basis of hypoxemia, blood alcohol level, hypotension, or associated chest injury. It is concluded that patients with severe craniocerebral trauma show an early trend toward hypercapnea and acidosis. Immediate control of airway and assisted ve~rntilation is necessary in order to reduce PaCO2 to optimal levels in patients with severe head injury. Tags: Female; Human; Male Desc.: Adult; Alcohol, Ethyl--Blood (BL); Blood Gas Analysis; Emergencies; Head Injuries--Complications (CO); *Head Injuries--Metabolism (ME); *Hyperventilation--Etiology (ET); *Hypoventilation--Etiology (ET); Kentucky; Prospective Studies CAS Registry No.: 64-17-5 (Alcohol, Ethyl) Y004154 73 0983132 83138132 Reversibility of lung function abnormalities in children with perennial asthma. Kraemer R; Meister B; Schaad UB; Rossi E Dept. of Paediatrics, Univ. of Berne, Inselspital, Berne, Switzerland. J Pediatr (US) , Mar 1983, 102 (3) p347-50, ISSN 0022-3476 Jrnl Code: JLZ Lang.: ENG. Jrnl Ann.: 8306 Subfile: AIM; INDEX MEDICUS Extrinsic perennial bronchial asthma was studied by whole-body plethysmography in 118 patients to evaluate the degree and character of functional abnormalities during the asymptomatic "interval phase" of the disease. Study patients were divided into three functional subgroups, and the efficacy of albuterol (s-lbutamol), a beta-2-sympathomimetic drug, on bronchial obstruction of hyperinflation was analyzed. Response to medication was best in the group with predominant bronchial obstruction without hyperinflation. In contrast, patients with hyperinflation in the presence or absence of bronchial obstruction had only partial reversibility of their pathophysiologic alterations. Hyperinflation usually causes only minor clinical symptoms but tends to develop into irreversible lung damage in the form of "loss of elastic recoil." We suggest that early diagnosis and strict medical management in patients with hyperinflation are mandatory. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adolescence; Airway Resistance; *Asthma--Physiopathology (PP); Child; Child, Preschool; Lung Compliance; Lung Volume Measurements; *Lung--Physiopathology (PP); Plethysmography, Whole Body; Respiratory Function Tests Y004154 74 0975599 83130599 Breathing space. Hyperinflation maneuvers. Brooks CG Jr Crit Care Nurse (US), May-Jun 1982, 2 (3) p18, 21, ISSN 0279-5442 Jrnl Code: DT8 Lang.: ENG. Jrnl Ann.: 8306 Subfile: Nursing Tags: Human Desc.: Breathing Exercises; Intermittent Positive Pressure Breathing; *Respiratory Therapy--Methods (MT); Spirometry Y004154 75 0975570 83130570 Endotracheal suctioning: "are we harming our patients" Smith AE Crit Care Update (US), Jan 1983, 10 (1) p29-31, ISSN 0162-7252 Jrnl Code: DTA Lang.: ENG. Jrnl Ann.: 8306 Subfile: Nursing Tags: Human Desc.: *Intubation, Intratracheal--Methods (MT); *Respiration, Artificial--Nursing (NU); Suction--Adverse Effects (AE); *Suction--Methods (MT) Y004154 76 0968301 83123301 [Rapid treatment of atelectasis in patients with cranio-cerebral injuries] Tratamento rapido das atelectasias em doentes traumatizados cranio-encefalicos. da Camara MC; Murinello AN; de Oliveira AD Acta Med Port (PORTUGAL) , Jan 1983, 4 (1) p41-6, Jrnl Code: 13V Lang.: PORTUGUESE Summary Languages: ENG. ŠDoc. Type: English Abstract Jrnl Ann.: 8305 Subfile: INDEX MEDICUS Tags: Case Report; Female; Human; Male Desc.: Adolescence; Adult; Atelectasis--Etiology (ET); *Atelectasis--Therapy (TH); *Brain Injuries--Complications (CO); Middle Age ; Suction--Methods (MT) Y004154 77 0943674 83098674 Dynamic hyperinflation and ventilator dependence in chronic obstructive pulmonary disease. Kimball WR; Leith DE; Robins AG Dept. of Physiology, Harvard School of Public Health, Boston, Massachusetts. Am Rev Respir Dis (US), Dec 1982, 126 (6) p991-9, ISSN 0003-0805 Jrnl Code: 426 Contract/Grant No.: GM-07592; HL-19170 Lang.: ENG. Jrnl Ann.: 8304 Subfile: AIM; INDEX MEDICUS In advanced chronic obstructive pulmonary diseases, functional residual capacity (FRC) can be markedly increased by dynamic mechanisms involving expiratory flow limitation. We studied respiratory mechanics in a seated ventilator-dependent patient with such changes. Relaxed expiration was flow-limited; pressures of 9 to 27 cm H2O (varying with lung volume) could be applied to the airway opening (Pao) without decreasing expiratory flow rate. The FRC was at least 2 L above relaxation volume. Inspiratory total resistance was 16 cm H2O/L/s. Compliance of the lung was 0.16, chest wall was 0.04, and respiratory system was 0032 L/cm H2O. More importantly, recoil pressures at end inspiration and end expiration, respectively, were 6.5 and 1.5 cm H2O for the lung, 33 and 11 cm H2O for chest wall, and 38 and 12 cm H2O for the respiratory system. Thus the chest wall recoiled inward at all times, pleural pressure was always substantially positive (11 to 3 cm H2O), expiratory flow was maximal, and jugular veins were always full and nonpulsating. Inspiratory work was about 0.27 kg-m per breath (7 times normal), most of it elastic work done on the chest wall. Tags: Case Report; Human; Male; Support, U.S. Gov't, P.H.S. Desc.: Aged; *Functional Residual Capacity; Lung Compliance; *Lung Diseases, Obstructive--Physiopathology (PP); Lung Diseases, Obstructive--Therapy (TH); *Lung Volume Measurements; Pulmonary Gas Exchange; *Respirators; Spirometry; Work of Breathing Y004154 78 0941697 83096697 Analysis of the ICP pulse-pressure relationship as a function of arterial blood pressure. Clinical validation of a mathematical model. Hoffmann O; Zierski JT Dept. of Neurosurgery, Univ. of Giessen, Federal Republic of Germany. Acta Neurochir (Wien) (AUSTRIA), 1982, 66 (1-2) p1-21, ISSN 0001-6268 Jrnl Code: 19C Lang.: ENG. Jrnl Ann.: 8304 Subfile: INDEX MEDICUS The influence of arterial blood pressure (ABP) on the intracranial pulse pressure relationship (PPR) was studied in 17 patients in 29 recordings, with a total period of registration of 71.5 hours. The relationship between ICP and ABP was analysed by sampling the data every 15 seconds during spontaneous fluctuations of both these variables, and the analysis was performed on the basis of a mathematical model which includes pulsator components. MABP and ABP amplitude had an opposite effect on the slope of PPR. Flattening of the PPR slope was caused by a MABP increase or an ABP amplitude decrease. The slope became steeper with decreasing MABP or increasing ABP amplitude. In accordance with the theoretical assumptions the quotient MABP/ABP-AMP was found to be suitable to express these opposite effects on PPR. Qualitatively, the same pattern of reaction was found in all patients. Rapid changes in PPR occurring during monitoring can be explained by a change in MABP/ABP-AMP relationship, regardless whether ABP changes influence intracranial elastance or not. The breakpoint of the PPR was recorded only on two occasions and could be explained in one by the influence of ABP. Monitoring of PPR as a measure of intracranial elastance and correlation of PPR with the patient's condition it not permitted unless at least the influence of ABP is analysed in each individual case. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; Aged; *Blood Pressure; Cerebral Arteries--Physiopathology (PP); *Cerebrovascular Disorders--Physiopathology (PP); Compliance; Elasticity; *Head Injuries--Physiopathology (PP); *Intracranial Pressrue; Mathematics; Middle Age; Models, Biological; Vasoconstriction Y004154 79 0941685 83096685 The effect of Routine nursing care procedures on the ICP in severe head injuries. Tsementzis SA; Harris P; Loizou LA Dept. of Neurosurgery, Univ. of Birmingham, England. Acta Neurochir (Wien) (AUSTRIA), 1982, 65 (3-4) p153-66, ISSN 0001-6268 Jrnl Code: 19C Lang.: ENG. Jrnl Ann.: 8304 Subfile: INDEX MEDICUS The intracranial pressure (ICP) was monitored in a number of patients who were being treated by mechanical ventilation for head injury. The effect on the pressure of routine nursing procedures was studied. Fourteen out of thirty-three cases (group 1) showed small reversible rises in ICP during suction, insertion of a N/G tube, or i.m. injections. These were associated with similar small increases in intrathoracic pressure and small fluctuations in arterial blood pressure. These rises were effectively treated with additional doses of relaxants. In a small group of patients (group 2) irreversible intracranial hypertension was induced by some of these stimuli, but did not respond to the administration of more relaxants, although sedatives such as papaveretum reduced it in some cases, but only slightly. Tags: Female; Human; Male Desc.: Adolescence; Adult; Blood Pressure; *Brain Injuries--Nursing (NU); Child; Intermittent Positive Pressure Ventilation--Nursing (NU); *Intracranial Pressure; Outcome and Process Assessment (Health Care); OUTCOME ASSESSMENT Y004154 80 0941658 83096658 Does the patient appear acutely or chronically ill. An interobserver study of global assessments of hospital patients. Gjorup T; Hamberg O; Knudsen J; Rosenfalck AM; Bugge PM; Hendriksen C; Binder; Wulff HR; Jensen AM Medical Dept. C, Herlev Univ. Hospital, Copenhagen, Denmark. Acta Med Scand (SWEDEN), 1982, 212 (5) p325-8, ISSN 0001-6101 ŠJrnl Code: 14G Lang.: ENG. Jrnl Ann.: 8304 Subfile: INDEX MEDICUS The general appearance of 201 patients was assessed by a team of observers. Each patient was seen by two experienced physician, two junior physicians and two medical students who stated whether the patients did not appear ill or whether the patient appeared acutely or chronically ill. The interobserver variation was considerable and the kappa-values ranged from around 0 to 0.75. The level of agreement did not seem to depend on the clinical experience of the observers. One experienced clinician assessed the patients differently from the others. Tags: Human Desc.: *Acute Disease; Attitude to Health; *Chronic Disease; *Clinical Competence; Diagnosis, Differential; DIAG DIFFER Y004154 81 0927263 83082263 Adaptability of the hamster diaphragm to exercise and/or emphysema. Farkas GA; Roussos C Meakins-Christie Laboratories, McGill Univ., Montreal, Quebec, Canada. J Appl Physiol (US), Nov 1982, 53 (5) p1263-72, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8304 Subfile: INDEX MEDICUS In vitro contractile properties of the diaphragm were measured in four groups of inbred adult hamsters (greater than 40wk), randomly divided into sedentary control (SC), exercise control (EC), sedentary emphysematous (SE), and exercise emphysematous (EE) groups. Emphysema was induced by a single endotracheal instillation of elastase. Exercise consisted of running 1 h/day, 7 days/wk for 20 wk. Functional residual capacity (FRC), measured by means of a pressure box, was approximately 2.5 times greater in both emphysematous groups compared with control groups. Small diaphragmatic bundles were then isolated and subjected to in vitro analysis of isometric contractile properties. No differences were observed among the four groups in time to peak tension, half-relaxation time, and shape of the force-frequency curve. The diaphragmatic length-tension curve of emphysematous animals was displaced toward the left; maximal tetanic tension was similar in all groups, while optimal length (Lo), defined as the length at which maximal twitch tension occurred, was significantly shorter in both emphysematous groups. The Lo was negatively correlated with the FRC. Exercise tended to increase the in vitro endurance of the diaphragm bundles in control animals only. Diaphragms from both emphysematou groups, however, did show the greatest resistance to fatigue. It is concluded that 1) daily running for 1 h does not influence the diaphragmatic contracile properties in the hamster, but fatigue was reduced; 2) the load of chronic emphysema decreased the hamster's diaphragm fatiguability; and 3) the diaphragms of emphysematous hamsters chronically adapt by decreasing diaphragmatic length in proportion to the degree of hyperinflation and thus probably continue to operate at an Lo. Tags: Animal; Comparative Study; Male; Support, Non-U.S. Gov't Desc.: *Adaptation, Physiological; *Diaphragm--Physiology (PH); Diaphragm--Physiopathology (PP); Electric Stimulation; *Emphysema--Physiopathology (PP); *Hamsters--Physiology (PH); Lung Volume Measurements; *Mesocricetus--Physiology (PH); *Motor Activity; Muscle Contraction; Physical Endurance Y004154 82 0922913 83077913 Respiratory management in head injury. Jung RC Clin Neurosurg (US), 1982, 29 p300-11, ISSN 0069-4827 Jrnl Code: DF8 Lang.: ENG. Jrnl Ann.: 8304 Subfile: INDEX MEDICUS Tags: Human Desc.: Arteries; Carbon Dioxide--Blood (BL); *Head Injuries--Complications (CO); Hyperventilation--Physiopathology (PP); Partial Pressure; Penicillins--Therapeutic Use (TU); Pneumonia, Aspiration--Drug Therapy (DT); Pneumonia, Aspiration--Etiology (ET); Pulmonary Edema--Diagnosis (DI); Respiration Disorders--Etiology (ET); Respiration Disorders--Physiopathology (PP); *Respiration Disorders--Therapy (TH); Respiration, Artificial Y004154 83 0922911 83077911 Physiological monitoring of the head-injured patient. Levin AB; Braun SR; Grossman JE Clin Neurosurg (US), 1982, 29 p240-87, ISSN 0069-4827 Jrnl Code: DF8 Lang.: ENG. Jrnl Ann.: 8304 Subfile: INDEX MEDICUS Tags: Human Desc.: Blood Gas Analysis; Cardiovascular System--Physiopathology (PP); Central Nervous System--Physiopathology (PP); Cerebrovascular Circulation; Electroencephalography; EEG; *Head Injuries--Physiopathology (PP); Heart Catheterization--Methods (MT); Intracranial Pressure; Lung Volume Measurements; *Monitoring, Physiologic--Methods (MT); Respiratory System--Physiopathology (PP) Y004154 84 0918126 83073126 Dynamics of venturi jet ventilation through the operating laryngoscope. Wo P; Eurenius S Dept. of Otolaryngology, Univ. Hospital, Boston Univ. School of Medicine. Ann Otol Rhinol Laryngol (US), Nov-Dec 1982, 91 (6 Pt 1) p615-21, ISSN 0003-4898 Jrnl Code: 52? Lang.: ENG. Jrnl Ann.: 8303 ŠSubfile: AIM; INDEX MEDICUS Venturi jet ventilation with the oxygen injector needle placed within the lumen of the laryngoscope was studied systematically in two dogs undergoing repeated general anesthesia suspension laryngoscopy. Using a total body plethysmograph, the effect of changes of needle angle, position and its effect on tidal volume delivery were measured. The changes of pressure regulator, flow rate and needle size were correlated with the volume delivery. Intratracheal pressure during Venturi ventilation as measured. Correlation of arterial blood gases and minute ventilation with the system was done. While ventilatory capacity is able to be achieved predictably, there are many variables. Optimal placement of the needle tip for maximum safety and efficiency appears to be at the midthird or lower third of the laryngoscope. It is important to center the needle axis to the laryngoscope axis. Other parameters subject to choice are the selection of needle size, regulator pressure setting and flow rate setting. By first selecting the correct needle size that will hyperinflate the subject, the pressure regulator can then be reduced to achieve ventilatory volumes similar to spontaneous tidal volumes. In prolonged use, the Venturi system was able to provide excellent ventilation safely and predictably. Tags: Animal Desc.: Blood Gas Analysis; Dogs; *Laryngoscopy--Instrumentation (IS); Laryngoscopy--Methods (MT); Lung Volume Measurements; Needles; Pressure; *Respiration, Artificial--Instrumentation (IS); Respiration, Artificial--Methods (MT) Y004154 85 0905048 83060048 Factitious asthma. Physiological approach to diagnosis. Downing ET; Draman SS; Fox MJ; Corrao WM Pulmonary Division, Rhode Island Hospital, Providence. JAMA (US) , Dec 3 1982, 248 (21) p2878-81, ISSN 0098-7484 Jrnl Code: KFR Lang.: ENG. Jrnl Ann.: 8303 Subfile: AIM; INDEX MEDICUS Three patients with recurrent emergency room visits and hospitalizations for bronchial asthma are described. Although each patient had respiratory distress associated with wheezing and an apparent response to conventional therapy, other features were inconsistent with the pathophysiology of asthma. These included absence of a significantly elevated alveolar arterial oxygen tension difference, lack of roentgenographic hyperinflation, and normal small airway function soon after clinical response. Furthermore, bronchial hyperreactivity, a constant feature of asthma, was absent in all patients. Each patient demonstrated wheezing that was self-induced and heard loudest over the neck. Two patients had previous psychiatric illness, one of whom had been hospitalized for factitious fever. We believe that these patients had a form of factitious illness not previously described. Recognition of this syndrome may avoid unnecessary medical care and allow initiation of appropriate psychiatric follow-up. Tags: Case Report; Female; Human Desc.: Adult; *Asthma--Diagnosis (DI); Asthma--Physiopathology (PP) ; Asthma--Radiography (RA); Bronchi--Physiopathology (PP); *Factitious Disorders--Diagnosis (DI); Oxygen--Analysis (AN); Oxygen--Blood (BL); Pulmonary Alveoli--Physiopathology (PP); Respiratory Function Tests; Respiratory Sounds CAS Registry No.: 7782-44-7 (Oxygen) Y004154 86 0903949 83058949 Severe head injury: current treatment and research. Bowers SA; Marshall LF Univ. of California at San Diego, Division of Neurological Surgery. J Neurosurg Nurs (US), Oct 1982, 14 (?) p210-9, ISSN 0047-2603 Jrnl Code: J?7 Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8303 Subfile: INDEX MEDICUS (39 Refs.) Tags: Human Desc.: Adrenal Cortex Hormones--Therapeutic Use (TU); Adult; Barbiturates--Therapeutic Use (TU); Child; Coma--Diagnosis (DI); Critical Care; Diabetes Insipidus--Therapy (TH); Diuretics--Therapeutic Use (TU); Emergencies; Fever--Therapy (TH); Fluid Therapy; Head Injuries--Diagnosis (DI); *Head Injuries--Therapy (TH); Hypertension--Therapy (TH); Hyperventilation--Therapy (TH); Inappropriate ADH Syndrome--Therapy (TH); Intracranial Pressure; Neurologic Examination; Posture; Respiration, Artificial--Methods (MT); Resuscitation; Seizures--Therapy (TH); Triage Y004154 87 0903900 83058900 Prognosis of severe head injuries. Levati A; Farina ML; Vecchi G; Rossanda M; Marrubini MB Neurosurgical Intensive Care Unit, Niguarda Hospital, Milan, Italy. J Neurosurg (US), Dec 1982, 57 (6) p779-83, ISSN 0022-3085 Jrnl Code: JD3 Lang.: ENG. Jrnl Ann.: 8303 Subfile: AIM; INDEX MEDICUS The authors have analyzed retrospectively a series of 288 consecutive patients with severe head injury observed between January, 1977, and May, 1980. Seventy-three patients were excluded as not being compatible with those of the International Data Bank. The remaining 215 patients complied with the definition of coma given by Jennett. All patients after appropriate cardiopulmonary resuscitation, diagnostic measures, and, when required, surgical treatment, were managed in the Neurosurgical Intensive Care Unit with endotracheal intubation, controlled hyperventilation, mild dehydration, dexamethasone in standard doses, and sedation. The mortality rate was 39.5%. Of the survivors, 59.2% made a good recovery, 18.4% remained moderately disabled, 6.1% were severely disabled, and 1.5% were in a persistent vegetative state. The most reliable predictive criteria were: absence of brain-stem reflexes, neurological status, abnormal motor patterns. arterial hypotension, and presence of mass lesions. It is concluded that no sign has an absolute prognostic value when considered independently of its time course. Tags: Female; Human; Male Desc.: Adolescence; Adult; Aged; Child; Child, Preschool; Coma--Complications (CO); Head Injuries--Complications (CO) *Head Injuries--Diagnosis (DI); Head Injuries--Mortality (MO); Head Injuries--Therapy (TH); Hypotension--Complications (CO); Middle Age; Nervous System--Physiopathology (PP); Outcome and Process Assessment (Health Care); OUTCOME ASSESSMENT; Prognosis Y004154 88 0871067 83026067 Hyperinflation on hyperventilation--a simple test to detect early airway disease. Jorfeldt L; Wranne B Dept. of Clinical Physiology, Linkoping Univ. Region Hospital, Sweden. Clin Physiol (ENGLAND), Apr 1982, 2 (2) p97-104, ISSN 0144-5979 ŠJrnl Code: DKG Lang.: ENG. Jrnl Ann.: 8302 Subfile: INDEX MEDICUS The hypothesis was raised that an increased end-expiratory lung volume when switching over from normal to hyperventilation (positive delta FRC) can be used as a criterion of early obstructive lung disease. In 20 normal subjects and in 24-patients with suspect of manifest lung disease delta FRC at breathing frequencies of 40, 60 and 80 min-1, forced expiratory volume in one second (FEV1), vital capacity (VC), maximal expiratory flow at 50 and 5% of VC (MEF50 and MEF25) and closing volume (CV) were determined. FEV% (FEV1 x VC-1 x 100) and VC% (CV x VC-1 x 100) were calculated. delta FRC40 correlated negatively with FEV%, MEF50 and EF25 for normals and patients separately with no difference between the groups. The residual standard deviation of delta FRC40 on FEV% was significantly reduced when MEF50 and MEF25 was included. delta FRC40 did not correlate with CV or VC%. delta FRC60 and delta FRC80 did not correlate with MEF50 and MEF25. The reproducibility of delta FRC40 was of the same order as the other variables studied. A delta FRC40 of +0.31 corresponded to MEF50 and MEF25 values 2 SD below the reference value. This suggests that a positive delta FRC40 of more than 0.31 indicates airway obstruction. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adolescence; Adult; Aged; Asthma--Physiopathology (PP); Functional Residual Capacity; *Hyperventilation--Physiopathology (PP); *Lung Diseases, Obstructive--Physiopathology (PP); Lung Volume Measurements ; *Lung--Physiopathology (PP); Maximal Expiratory Flow-Volume Curves; Middle Age Y004154 89 0851692 83006692 Lung inflation, lung solute permeability, and alveolar edema. Egan EA Dept.s of Pediatrics and Physiology, State Univ. of New York at Buffalo. J Appl Physiol (US), Jul 1982, 53 (1) p121-5, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8301 Subfile: INDEX MEDICUS A series of experiments in anesthetized rabbits were conducted to determine whether hyperinflation of the lung alone could produce a protein-permeable lung epithelium and whether a protein-permeable lung epithelium allowed accumulation of liquid in the alveolar space. Some animals had their entire lungs subjected to distending pressures; others had only an are of the lung subjected to the high distending pressure. Alveolar liquid was measured by dilution of radioactive solutes upon instillation of saline into atelectatic lung, and protein permeability was determined by the loss of labeled albumin from the alveolar space over 40-60 min. Inflation of the entire lung at 40 cmH2O for 20 in increases air-space gas volume three- to fourfold, does not produce a protein-permeable epithelium, and does not result in accumulation of alveolar liquid. Distension of a small area of the lung by 40 cmH2O pressure for 20 min increases the gas volume 6- to 12-fold and produces a protein-permeable epithelium, but does not result in liquid accumulation in the alveoli. It is concluded that only very high distending volumes cause the lung epithelium to become permeable to protein and that a protein-permeable epithelium alone does not induce alveolar edema. Tags: Animal Desc.: Cytochrome C--Physiology (PH); Epithelium--Physiology (PH); Lung Volume Measurements; *Lung--Physiopathology (PP); Permeability; Pressure; Proteins--Physiology (PH); *Pulmonary Alveoli--Physiopathology (PP); *Pulmonary Edema--Physiopathology (PP); Rabbits; Serum Albumin, Radio-Iodinated--Diagnostic Use (DU); RISA--Diagnostic Use (DU); Sodium Chloride; Vitamin B 12--Physiology (PH) CAS Registry No.: 68-19-9 (Vitamin B 12); 7647-14-5 (Sodium Chloride); 9007-43-6 (Cytochrome C) Y004154 90 0847184 83002184 Lung metabolism and systemic organ function. Hechtman HB; Shepro D Department of Surgery, Harvard Medical School, Boston, MA. Circ Shock (US), 1982, 9 (4) p457-67, ISSN 0092-6213 Jrnl Code: C9Y Contract/Grant No.: GM24891; HLB16714 Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8301 Subfile: INDEX MEDICUS In the past decade a variety of metabolic events have been described which occur in the lungs. These processes, such as the clearance of serotonin and norepinephrine, the inactivation of bradykinin and the activation of angiotensin II, and the synthesis of prostaglandins, may have a direct impact on systemic organ function. Under certain circumstances the lungs produce prostaglandins that may lead to severe hemodynamic instability and death. Pressure breathing with hyperinflation is a potent pulmonary metabolic stimulus. This commonly used therapeutic maneuver has been shown to increase fibrinolytic activity. The application of end-expiratory pressure will further enhance the fibrinolytic state by virtue of the pulmonary secretion of plasminogen activator. Positive end-expiratory pressure (PEEP) will also cause a lowering of the cardiac output, which is related at least in part to lung metabolism. Circulating factors are released during PEEP that have a negative inotropic effect. It is reasonable to view respiratory failure not only as a defect in gas exchange but also as a derangement in lung metabolis. (33 Refs.) Tags: Animal; Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non- .H.S.; Support, U.S. Gov't, P.H.S. Desc.: Angiotensin II--Mtabolism (ME); Bradykinin--Metabolism (ME) ; Cardiac Output; Coronary Circulation; Dogs; Endothelium--Metabolism (ME) Fibrinolysis; *Lung--Metabolism (ME); Lung--Physiopathology (PP); Norepinephrine--Metabolism (ME); Perfusion Positive Pressure Respiration; Prostaglandins--Metabolism (ME); Receptors, Serotonin; Respiration, Artificial CAS Registry No.: 1112899-7 (Angiotensin II); 51-41-2 (Norepinephrine 5882-2 (Bradykinin) Y004154 91 0837190 82282190 A randomized study of drugs for preventing increases in intracranial pressure during endotracheal suctioning. White PF; Schlobohm RM; Pitts LH; Lindauer JM Depart. of Anesthesia, Stanford Univ. Medical Center, California. Anesthesiology (US), Sep 1982, 57 (3) p242-4, ISSN 0003-3022 Jrnl Code: 4SG Lang.: ENG. Jrnl Ann.: 8212 Subfile: AIM; INDEX MEDICUS Tags: Human Desc.: *Brain Injuries--Physiopathology (PP); Brain Injuries--Therapy (TH); Fentanyl--Therapeutic Use (TU); *Intracranial Pressure--Drug Effects (DE); *Intubation, Intratracheal--Adverse Effects (AE); Lidocaine--Therapeutic Use (TU); Random Allocation; Succinylcholine--Therapeutic Use (TU); *Suction--Adverse Effects (AE); Thiopetal--Therapeutic Use (TU) CAS Registry No.: 137-58-6 (Lidocaine); 306-40-1 (Succinylcholine); 437-8-7 (Fentanyl); 76-75-5 (Thiopental) Y004154 92 0831463 82276463 ŠAirway function in saccoidosis: smokers versus nonsmokers. Sutton RE; Renzi PM; Lopez-Majano V; Renzi GD Respiration, 1982, 43 (3) p164-73, ISSN 0025-7931 Jrnl Code: R8Kde: Contract/Grant No.: HL-2564 Lang.: ENG. Jrnl Ann.: 8212 Subfile: INDEX MEDICUS Pulmonary function was measured in 24 sarcoidosis patients, 17 nonsmokers and 7 smokers. 12 (4 smokers) had evidence of small airway disease and 6 patients (3 smokers) had evidence of large airway disease. A significantly greater proportion of smokers had an increased closing volume, and closing volume appears to be the most sensitive test for small airway disease in sarcoidosis. However, 3 patients with normal closing volumes had evidence of small airway disease by forced expiratory flow rates or frequency dependence of compliance. We conclude that there is a high incidence of small airway disease in patients with sarcoidosis. There also appears to be a synergism between sarcoidosis and smoking that leads to a significant degree of hyperinflation of the lung. Tags: Comparative Study; Female; Human; Male; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. Desc.: Adult; Aged; Airway Obstruction--Diagnosis (DI); Airway Obstruction--Etiology (ET); Airway Resistance; Arteries; *Lung Diseases--Physiopathology (PP); Lung Volume Measurements; Middle Age; Oxygen--Blood (BL); *Respiratory System--Physiopathology (PP); Sarcoidosis--Complications (CO); *Sarcoidosis--Physiopathology (PP); *Smoking CAS Registry No.: 7782-44-7 (Oxygen) Y004154 93 015836 82260836 Lung volume, dynamic lung compliance, and blood gases during the first 3 days of postnatal life in infants with meconium aspiration syndrome. Yeh TF; Lilien LD; Barathi A; Pildes RS Division of Neonatology, Cook County Children's Hospital, Chicago IL. Crit Care Med (US), Sep 1982, 10 (9) p588-92, ISSN 0090-3493 Jrnl Code: DTF Lang.: ENG. Jrnl Ann.: 8212 Subfile: AIM; INDEX MEDICUS Serial measurements of pulmonary function and arterial blood gases during the first 3 postnatal days of life were obtained in 12 infants with meconium aspiration syndrome (MAS). Nine normal neonates with similar weight and gestational age were studied as controls. Infants with MAS has significantly lower pH on day 1, and had greater P(A-a)O2 throughout the study period than that of normal controls. The PCO2 was comparable between the groups. Both dynamic lung compliance (Cdyn) and specific lung compliance (C/VL) were lower in infants with MAS as compared with those of normal infants. The functional residual capacity (RC) for normal infants on days 1, 2, and 3 were 2.0 +/- 0.3, 2.1 +/- 0.3, and 2.2 +/- 0.3 ml/cm, respectively, and for infants with MAS were 1.8 +/- 0.4, 2.3 +!- 1.1, and 2.2 +/- 0.6 ml/cm, respectively. Radiographic hyperinflation of the lungs was seen in 6 infants with MAS on day 1; 3 were associated with high FRC (greater than 2 SD of normal) and 2 with low FRC, indicating air trapping. The early use of PEEP should be cautious if hyperinflation or air trapping is present. Tags: Human Desc.: Blood Gas Analysis; Infant, Newborn; *Infant, Newborn, Diseases--Physiopathology (PP); Lung Compliance; Lung Volume Measurements; *Meconium; *Pneumonia, Aspiration--Physiopathology (PP) Y004154 94 0768431 82213431 Bronchial-arterial interdependence in isolated dog lung. Lai-Fook SJ; Kallok MJ Division of Thoracic Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. J Appl Physiol (US), Apr 1982, 52 (4) p1000-7, ISSN 0161-7567 Jrnl Code: HAL Contract/Grant No.: HL-21584; HL-00674 Lang.: ENG. Jrnl Ann.: 8210 Subfile: INDEX MEDICUS The bronchus and artery, embedded in the lung parenchyma, were modeled as adjoining cylindrical tubes in an elastic continuum. Solutions using finite-element analysis of nonuniform stress and strain occurring from an initial uniform state were computed for a reduction in arterial pressure. Maximal nonuniform principal and shear stresses in the ?arenchyma, equal to 2.5 times the mean peri?rterial stresses, occurred in the region adjacent to the bronchial-arterial joint. Bronchial cross section became oval and elongated along the line passing through the centers of the tubes, whereas arterial cross section elongated at right angles to this line. These predicted changes in shape of bronchus and artery were verified by radiographic measurements in isolated lobes, held at constant transpulmonary pressures of 4 and 25 cmH2O while arterial pressure was varied. Results suggest that peribronchovascular interstitial fluid pressure may be nonuniform and that the bronchial-arterial joint may be the preferential site for emphysematous perivascular lesions, which may occur on lung hyperinflation. Tags: Animal; Support, U.S. Gov't, P.H.S. Desc.: Blood Pressure; Bronchi--Anatomy and Histology (AH); *Bronchi--Physiology (PH); Bronchial Arteries--Anatomy and Histology (AH); *Bronchial Arteries--Physiology (PH); Dogs; Lung--Radiography (RA); Models, Biological Y004154 95 0764560 82209560 Hyperinflation on hyperventilation-a simple test to detect early airway disease. Jorfeldt L; Wranne B Dept. of Clinical Physiology, Linkoping Univ., Sweden. Clin Physiol (ENGLAND), Apr 1982, 2 (2) p97-104, ISSN 0144-5979 Jrnl Code: DKG Lang.: ENG. Jrnl Ann.: 8210 Subfile: INDEX MEDICUS The hypothesis was raised that an increased end-expiratory lung volume when switching over from normal to hyperventilation (positive delta FRC) can be used as a criterion of early obstructive lung disease. In 20 normal subjects and in 24 patients with suspect or manifest lung disease delta FRC at breathing frequencies of 40, 60 and 80 min-1, forced expiratory volume in one second (FEV1), vital capacity (VC), maximal expiratory flow at 50 and 25% of VC (MEF50 and MEF25) and closing volume (CV) were determined. FEV% (EV1 X VC-1 X 100) and CV% (CV X VC-1 X 100) were calculated. delta FRC40 correlated negatively with FEV%, MEF50 and MEF25 for normals and patients separately with no difference between the groups. The residual standard deviation of delta FRC40 on FE% was significantly reduced when MEF50 and MEF25 was included. delta FRC40 did not correlate with CV or CV%. delta FRC60 and delta FRC80 did not correlate with MEF50 and MEF25. The reproducibility of delta FRC40 was of the same order as the other variables studied. A delta FRC40 of +0.31 corresponded to MF50 and MEF25 values 2 SD below the reference value. This suggests that a positive delta FRC40 of more than 0.31 indicates airway obstruction. Tags: Comparative Study; Female; Human; Male; Support, Non-U.S. Gov't ŠDesc.: Adolescence; Adult; Aged; Closing Volume; Forced Expiratory Flow Rates; Forced Expiratory Volume; *Hyperventilation; *Lung Diseases, Obstructive--Diagnosis (DI); *Lung Volume Measurements; Middle Age; Vital Capacity Y004154 96 0764435 82209435 Emergency intracranial pressure monitoring in pediatrics: management of the acute coma of brain insult. Mayer T; Walker ML Dept. of Pediatrics, Georgetown Univ. School of Medicine, ~rWashington, D.C. Clin Pediatr (Phila) (US), Jul 1982, 21 (7) p391-6, ISSN 0009-9228 Jrnl Code: DHE Lang.: ENG. Jrnl Ann.: 8210 Subfile: AIM; INDEX MEDICUS Over an 18-month period, 56 pediatric patients who sustained severe neurologic insults underwent intracranial pressure (ICP) monitoring. Indications for monitoring ICP were (1) a Glasgow Coma Scale (GCS) score of 7 or less or (2) loss of consciousness with inability to utter recognizable words or follow commands. Diagnoses were head trauma (n = 40), Reye's syndrome (n = 10), and hypoxic encephalopathy due to near-drowning (n = 6). Eighty per cent of patients had ICP elevations requiring treatment. The complication rate was 5.3 per cent, with no serious complications or infections noted. Overall mortality was 14 per cent, but patients with hypoxic encephalopathy had significantly higher mortality (33%) when compared to patients with head trauma (12.5%) or Reye's syndrome (10%). Other factors associated with a poor outcome included presence of an intracranial mass lesion, GCS score, ICP elevations, hypoxemia, hypotension, hypercarbia, and the presence of multiple injuries (p less than 0.01). Early diagnosis and aggressive treatment in these patients, including the use of ICP monitoring, has resulted in acceptable recovery in over 85 per cent of these patients. Tags: Comparative Study; Human Desc.: Acute Disease; Adolescence; Anoxia--Complications (CO); Anoxia--Mortality (MO); Child; Child, Preschool; Coma--Etiology (ET); Coma--Physiopathology (PP); *Coma--Therapy (TH); Dexamethasone--Therapeutic Use (TU); *Emergencies; Head Injuries--Complications (CO); Head Injuries--Mortality (MO); Hyperventilation--Physiopathology (PP); Infant; *Intracranial Pressure; Intubation; *Monitoring, Physiologic; Reye's Syndrome--Complications (CO); Reye's Syndrome--Mortality (MO) CAS Registry No.: 50-02-2 (Dexamethasone) Y004154 97 0759445 82204445 Some physical signs in patients with chronic airflow obstruction. Stubbing DG; Mathur PN; Roberts RS; Campbell EJ Dept. of Medicine, McMaster Univ. Medical Centre, Hamilton, Ontario, Canada. Am Rev Respir Dis (US), May 1982, 125 (5) p549-52, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8209 Subfile: AIM; INDEX MEDICUS Forty subjects with chronic airflow obstruction were examined independently by 2 observers, and their assessment of several physical signs was recorded. Spirometry and lung volumes were measured. Most of the signs studied correlated closely with the degree of airflow obstruction as assessed by the forced expiratory volume in one second. Certain signs also correlated closely with the degree of hyperinflation, the duration of symptoms, or the age of the subject. The agreement between observes in this study was good. Although all the signs are related in one way or another to the severity of airflow obstruction, some are due to large variations in intrathoracic pressure, some to hyperinflation and some, possibly, to changes in the shape of the chest and the action of the respiratory muscles. Hence, we suggest that these signs should not be regarded as inferior to tests of pulmonary function; physical examination and spirometry should be complimentary. Tags: Female; Human; Male Desc.: Adult; Aged; Forced Expiratory Volume; *Lung Diseases, Obstructive--Physiopathology (PP); Middle Age; Physical Examination; Regression Analysis; Residual Volume Y004154 98 0740385 82185385 Radiologic considerations in the adult respiratory distress syndrome treated wih positive end expiratory pressure (PEEP). Johnson TH; Altman AR; McCaffree RD Clin Chest Med (US) Jan 1982, 3 (1) p89-100, ISSN 0272-5231 Jrnl Code: DLR Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8209 Subfile: INDEX MEDICUS Radiographic changes with ARDS are similar to alveolar pulmonary edema in the typical case, although early changes may also be nodular in a small number of cases. These may last about 4 days. Following early alveolar changes the later ARDS findings evolve into a diffuse interstitial pattern, and if the patient survives without complications, the chest x-ray may eventually clear completely. PEEP therapy may cause no x-ray changes or may manifest an apparent hyperinflation appearance to the chest x-ray. PEEP may result in barotrauma changes to the lungs manifested by vesicular rarefactions, lucent lines streaking toward the hilus, radiolucent halos around vessels, pneumatocele formation, and subpleural emphysema manifested by blebs or lucent lines on the chest x-ray. Barotrauma pulmonary changes preceded more serious complications such as pneumothorax, mediastinal emphysema and extrathoracic as collection. (45 Refs.) Tags: Female; Human; Male Desc.: Adult; *Lung--Radiography (RA); Middle Age; Pneumothorax--Etiology (ET); Pneumothorax--Radiography (RA); *Positive Pressure Respiration--Adverse Effects (AE); Pulmonary Emphysema--Etiology (ET); Pulmonary Emphysema--Radiography (RA); *Respiratory Distress Syndrome, Adult--Radiography (RA); Respiratory Distress Syndrome, Adult--Therapy (TH) Y004154 99 0733986 82178986 A model based description of a head injury treatment. Black AM; Harris RI; Judson JA Acta Neurochir (Wien), 1982, 60 (3-4) p265-79, ISSN 0001-6268 Jrnl Code: 19C Lang.: ENG. Jrnl Ann.: 8208 Subfile: INDEX MEDICUS Tags: Female; Human; Male ŠDesc.: Adolescence; Adult; Aged; Brain Edema--Etiology (ET); *Brain Edema--Therapy (TH); Child; Child, Preschool; Coma; Electroencephalography EEG; Head Injuries--Complications (CO); *Head Injuries--Therapy (TH); Hyperventilation; Hypnotics and Sedatives--Therapeutic Use (TU); HYPNOTICS--Therapeutic Use (TU); Infant; Infant, Newborn; Middle Age; *Models, Biological; Prognosis; Pupil; Wounds, Nonpenetratin--Complications (CO); *Wounds, Nonpenetratin--Therapy (TH) Y004154 100 0730606 82175606 Characterization of intrapulmonary, rapidly adapting receptors of guinea pigs. Bergren DR; Sampson SR Cardiovascular Research Institute, Univ. of California, San Francisco, CA. Respir Physiol (NETHERLANDS), Jan 1982, 47 (1) p83-95, ISSN 0034-5687 Jrnl Code: R88 Contract/Grant No.: HL19156 Lang.: ENG. Jrnl Ann.: 8208 Subfile: INDEX MEDICUS The activity of 33 afferent vagal fibers arising from rapidly adapting pulmonary stretch receptors in the lungs of 21 guinea pigs was studied. These receptors were identified by their response to constant pressure hyperinflation and to negative pressure deflation of the lungs. The response was irregular bursts of action potentials with an adaptation index greater than 70% in 2s. Little or no activity was noted in these receptors during eupneic breathing. The conduction velocity of the afferent fibers from these receptors ranged from 3.1 to 57.1 m/s (mean = 20.2 +/- 5.1 SD). Receptors were stimulated by intravenous injection of histamine and also by vapors of ether, alcohol, acetone, ammonia, and cigarette smoke. Stimulation by the inhalation of the vapors usually occurred in the absence of any chance in tracheal pressure or even when the tracheal pressure became slightly lower than before vapor challenge, thus suggesting a direct action. If an increase in tracheal pressure occurred, the discharge of the receptor began well in advance. However, stimulation of the receptor by histamine was always accompanied by significant increases in tracheal pressure. Isoproterenol prevented the increase in tracheal pressures produced by histamine challenge. In addition, isoproterenol blocked the response of rapidly adapting receptors to histamine as well. Isoproterenol had no effect on receptor response to the various vapors used in this study. Therefore, stimulation of rapidly adapting receptors by histamine seems to be dependent on an increase in tracheal pressure, while a direct action in indicated by several 'irritant' gases. The characteristics of the rapidly adapting receptors in guinea pig lungs are more closely related to the irritant receptor of the rabbit and the cat than to the rapidly adapting receptors in lungs of dogs. Tags: Animal; Female; Male; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. Desc.: Chlorpheniramine--Pharmacodynamics (PD); Electrophysiology; Guinea Pigs; Histamine--Pharmacodynamics (PD); Irritants--Pharmacodynamics (PD); Isoproterenol--Pharmacodynamics (PD); *Lung--Innervation (IR); *Mechanoreceptors--Physiology (PH); Pulmonary Stretch Receptors--Drug Effects (DE); *Pulmonary Stretch Receptors--Physiology (PH); *Respiration; Respiration, Artificial; Stimulation, Chemical; *Vagus Nerve--Physiology (PH) CAS Registry No.: 132-22-9 (Chlorpheniramine); 51-45-6 (Histamine); 7683-59-2 (Isoproterenol) Y004154 101 0720006 82165006 Persistent cough a forme-fruste of asthma. Yhav Y; Katznelson D; Benzaray S Eur J Respir Dis, Jan 1982, 63 (1) p43-6, ISSN 0106-4339 Jrnl Code: EPS Lang.: ENG. Jrnl Ann.: 8208 Subfile: INDEX MEDICUS Fifteen children presented with persistent cough as the sole complaint. Physical examination was entirely within normal limits. Personal and family histories of atopy and blood eosinophilia suggested an allergic diathesis. Chest radiographs showed hyperinflation in many and spirometry showed bronchospasm in all the children studied. The added observation that theophylline and salbutamol were effective suggests that the condition is a manifestation of asthma. Tags: Female; Human; Male Desc.: Adolescence; Aerosols; Albuterol--Therapeutic Use (TU); *Asthma--Complications (CO); Asthma--Drug Therapy (DT); Bronchial Spasm--Diagnosis (DI); Bronchial Spasm--Drug Therapy (DT); Bronchial Spasm--Etiology (ET); Child; Child, Preschool; Cough--Diagnosis (DI); Cough--Drug Therapy (DT); *Cough--Etiology (ET); Eosinophils--Analysis (AN) ; Lung Volume Measurements; Lung--Radiography (RA); Respiratory Airflow; Respiratory Function Tests; Spirometry; Theophylline--Therapeutic Use (TU) CAS Registry No.: 18559-94-9 (Albuteral); 58-55-9 (Theophylline) Y004154 102 0713522 82158522 Electrical and mechanical activity of the diaphragm accompanying body position in severe chronic obstructive pulmonary disease. Druz WS; Sharp JT Pulmonary Section, Medical Service, Hines Veterans Administration Hospital, Hines, Illinois. Am Rev Respir Dis (US), Mar 1982, 125 (3) p275-80, ISSN 0003-0805 Jrnl Code: 426 Contract/Grant No.: HL-08789-13 Lang.: ENG. Jrnl Ann.: 8207 Subfile: AIM; INDEX MEDICUS Using a special gastroesophageal catheter, electromyographic measurements of the diaphragm (Edi) and transdiaphragmatic pressure (Pdi) were taken in the supine, standing, erect siting, and leaning forward (sitting) positions in 8 normal subjects and 6 patients with severe chronic obstructive pulmonary disease (COPD) with marked hyperinflation and low fat diaphragms. Four patients had pronounced postural relief of their dyspnea from assuming the supine and/or leaning forward positions. All 8 normal subjects and 4 of the 6 patients with COPD showed substantial (2- to 5-fold) increases in delta Edi, the phasic inspiratory amplitude of Edi, on assuming the standing and erect sitting postures. In the normal subjects, delta Pdi, the phasic inspiratory increment in Pdi, was maintained in all 4 postures, whereas in all patients with OPD, it decreased significantly in the erect sitting and standing postures. In 2 of the 6 patients with COPD, the delta Edi did not increase in the erect postures. This suggested that in these patients a reflex, which normally compensates for reduced diaphragmatic efficiency because of shortened muscle fibers in the erect postures, was not operating. Although it is not clear what mechanism(s) might account for suppression of this compensatory reflex, such reflex suppression might be advantageous from the viewpoint of diaphragmatic muscle energetics. The diaphragm would be thus spared energetically wasteful attempts to accomplish a fatiguing mechanical task. Tags: Human; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S. Desc.: Adult; *Diaphragm--Physiopathology (PP); *Electromyography; *Lung Diseases, Obstructive--Physiopathology (PP); Middle Age; *Posture; Pressure; *Respiration; Tidal Volume; Vital Capacity Y004154 103 0700049 82145049 Complications of gastroesophageal reflux in patients with cystic fibrosis. Bendig DW; Seilheimer DK; Wagner ML; Ferry GD; Barrison GM Dept. of Pediatrics, Baylor College of Medicine and The Texas Childrens Hospital J Pediatr (US) , Apr 1982, 100 (4) p536-40, ISSN 0022-3476 Jrnl Code: JLZ Lang.: ENG. ŠJrnl Ann.: 8207 Subfile: AIM; INDEX MEDICUS Seven patients with cystic fibrosis who had complications of gastroesophageal reflux including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. We believe that these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to increase the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition. Tags: Female; Human; Male Desc.: Adolescence; Adult; Antacids--Therapeutic Use (TU); Child; Cimetidine--Therapeutic Use (TU); *Cystic Fibrosis--Complications (CO); Gastroesophageal Reflux--Diagnosis (DI); *Gastroesophageal Reflux--Etiology (ET); Gastroesophageal Reflux--Therapy (TH); Esophageal Stenosis--Etiology (ET); Esophageal Stenosis--Therapy (TH); Esophagitis, Peptic--Etiology (ET) ; Hydrogen-Ion Concentration; PH; Posture CAS Registry No.: 51481-61-9 (Cimeidine) Y004154 104 0699781 82144781 Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. Saul TG; Ducker T Division of Neurological Surgery, Univ. of Maryland School of Medicine, Baltimore. J Neurosurg (US), Apr 1982, 56 (4) p498-503, ISSN 0022-3085 Jrnl Code: JD3 Lang.: ENG. Jrnl Ann.: 8207 Subfile: AIM; INDEX MEDICUS During 1977-1978, 127 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring. All patients had Glasgow Coma Scale (GCS) scores of 7 or less. All received identical initial treatment according to a standardized protocol. The patients' average age was 29 years; 60% had multiple trauma, and 35% needed emergency intracranial operations. Treatment for elevations of ICP was begun when ICP rose to 20 to 25 mm Hg, and included mannitol therapy and drainage of cerebrospinal fluid (CSF) when possible. Forty-three patients (34%) had ICP greater than or equal to 25 mm Hg; of these, 36 (84%) died. The mortality rate of the entire group was 46%. During 1979-1980, 106 patients with severe head injury were admitted and underwent ICP monitoring. Their average ager was 29 years; 51% had multiple trauma, and 31% underwent emergency intracranial surgery. All patients received the same standardized protocol as the previous series, with the exception of the treatment of ICP. In this present series: if ICP was 15 mm Hg or less (normal ICP), patients were continued on hyperventilation, steroids, and intensive care; if ICP was 16 to 24 mm Hg, mannitol was administered and CSF was drained; if ICP was 25 mm Hg or greater, the patients were randomized into a controlled barbiturate therapy study. Twenty-six patients (25%) had ICP's of 25 mm Hg or greater, compared to 34% in the previous series (p less than 0.05), and 18 of these 26 patients (69%) died. The overall mortality for this current series was 28% compared to 46% in the previous series (p less than 0.0005). This study reconfirms the high mortality rate if ICP is 25 mm Hg or greater; however, the data also document that early aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25 mm Hg or greater and reduces the overall mortality rate of severe head injury. Tags: Comparative Study; Female; Human; Male Desc.: Adolescence; Adult; Aged; Barbiturates--Therapeutic Use (TU) ; Brain Injuries--Cerebrospinal Fluid (CF); Brain Injuries--Mortality (MO) Brain Injuries--Surgery (SU); *Brain Injuries--Therapy (TH); Emergencies; *Intracranial Pressure; Mannitol--Therapeutic Use (TU); Middle Age; Monitoring, Physiologic; Outcome and Process Assessment (Health Care); OUTCOME ASSESSMENT Respiration, Artificial; Steroids--Therapeutic Use (TU) CAS Registry No.: 87-78-5 (Mannitol) Y004154 105 0684770 82129770 Predicting recovery from acute severe asthma. Jenkins PF; Benfield GF; Smith AP Llandough Hospital, Penarth, South Glamorgan. Thorax (ENGLAND), Nov 1981, 36 (11) p835-41, ISSN 0040-6376 Jrnl Code VQW Lang.: ENG. Jrnl Ann.: 8206 Subfile: INDEX MEDICUS Fifty-two patients admitted to hospital with acute severe asthma took part in a prospective study investigating the rate and pattern of their subsequent recovery. Clinical assessment of the severity of the acute attack on admission (according to pulse rate, degree of pulsus para?oxus, and peak expiratory flow rate) did not reliably predict the results of arterial blood gas analysis. Subjects were divided into three groups according to the speed of recovery of peak expiratory flow rate. Historical features associated with slow recovery were: age over 40 years, non-atopic asthma, a longer duration of the acute attack before hospital admission, poor long-term control of asthma, and the use of maintenance oral corticosteroids. The degree of pulsus paradoxus on admission and the improvement in PEFR at six hours and arterial oxygen tension (PaO2) at 48 hours were also useful in predicting speed of recovery. The severity of the attack, assessed on admission by arterial blood gas analysis and PEFR, did not differ between the three groups of recovering patients. Hyperinflation was still present in 15 out of 44 patients investigated five days after admission even though PEFR had returned to mre than 80% of predicted normal in seven of these 15 subjects. The recovery of hypoxia was also commonly delayed with 12 out of 52 patients having PaO2 values of less than 80 mmHg at five days. Persistent hypoxia was more common in those with delayed delayed recovery PEFR. Tags: Female; Human; Male Desc.: Acute Disease; Adolescence; Adult; Aged; Anoxia--Physiopathology (PP); *Asthma--Physiopathology (PP); Heart Rate; Lung--Physiopathology (PP); Middle Age; Prognosis; Prospective Studies; Respiratory Function Tests; Time Factors Y004154 106 0683606 82128606 Inhaled atropine sulfate in acute asthma. Fairshter RD; Habib MP; Wilson AF Dept. of Medicine, Univ. of California Irvine, Orange. Respiration (SWITZERLAND), 1981, 42 (4) p263-72, ISSN 0025-7931 Jrnl Code: R8K Lang.: ENG. Jrnl Ann.: 8206 Subfile: INDEX MEDICUS We administered inhaled atropine sulfate to acute asthmatics already receiving therapeutic doses of adrenergic agonists, theophylline, and corticosteroids. Following atropine, hyperinflation diminished whereas vital capacity and expiratory flow rates breathing air and helium-oxygen increased (p less than 0.025 - p less than 0.005). Initial density dependence correlated inversely with changes in density dependence after atropine (r = -0.69, p less than 0.001). We conclude that: (1) inhaled atropine sulfate was effective therapy for acutely ill asthmatics already being treated with multiple antiasthmatic agents; (2) atropine caused large and peripheral airways bronchodilatation, and (3) the predominant site of bronchodilatation after atropine was related to the site of flow limitation before atropine. Tags: Female; Human; Male Desc.: Acute Disease; Adult; Aerosols; *Asthma--Drug Therapy (DT); Atropine--Administration and Dosage (AD); *Atropine--Therapeutic Use (TU); Drug Therapy, Combination; Maximal Expiratory Flow Rate; Middle Age; Residual Volume; Respiratory Airflow; Respiratory Therapy; Total Lung Capacity; Vital Capacity CAS Registry No.: 51-55-8 (Atropine) Y004154 107 0662127 82107127 Effect of bronchoconstriction on the firing behavior of pulmonary stretch receptors. Davenport PW; Lee LY; Lee K; Yu LK; Miller R; Frazier DT Dept. of Physiology and Biophysics, Univ. of Kentucky, Lexington. Respir Physiol (NETHERLANDS), Dec 1981, 46 (3) p295-307, ŠISSN 0034-5687 Jrnl Code: R88 Contract/Grant No.: BRSG RR-05374; AM-17082 Lang.: ENG. Jrnl Ann.: 8205 Subfile: INDEX MEDICUS To study the effect of bronchoconstriction on the activity of pulmonary stretch receptors (PSRs), acetylcholine aerosols (0.05% solution) were delivered continuously into the lung while the afferent activity of a single PSR was recorded from a filament of the vagus nerve. The relationship between the PSR frequency (fPSR) and the transpulmonary pressure (Ptp) was examined during both constant volume ventilation and hyperinflation. During bronchoconstriction, the peak fPSR for the same tidal volume increased significantly (P less than 0.05) compared to the control response obtained with saline aerosols. However, the fPSR at functional residual capacity decreased in the receptors above the carina but increased in those below. Bronchoconstriction induced a hysteresis in the dynamic Ptp-fPSR relationship during hyperinflation in 11 out of the 2 receptors studied: a clockwise hysteresi? was found in those receptors above the carina whereas a counterclockwise one in those below. Results of these studies suggest that the response of PSRs to bronchoconstriction depends on their locations in the tracheobronchial tree. Tags: Animal; Support, U.S. Gov't, P.H.S. Desc.: Acetylcholine--Administration and Dosage (AD); Action Potentials; Aerosols; Bronchi--Drug Effects (DE); *Bronchi--Physiopathology (PP); Constriction; Dogs; Lung Volume Measurements; *Mechanoreceptors--Physiopathology (PP); *Pulmonary Stretch Receptors--Physiopathology (PP) CAS Registry No.: 51-84-3 (Acetylcholine) Y004154 108 0659302 82104302 Pulmonary effects of head trauma. Baigelman W; O'Brien JC Boston Univ. School of Medicine, Massachusetts. Neurosurgery (US), Dec 1981, 9 (6) p729-40, ISSN 0148-396X Jrnl Code: NZL Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8205 Subfile: INDEX MEDICUS Knowledge of the interrelation of the central nervous system-respiratory axis is crucial to the management of patients with head injuries with or without concomitant pulmonary-thoracic problems. Damage to the central nervous system (CNS) can result in unexplained hypoxemia, noncardiac pulmonary edema, altered patterns of respiration, and an increased risk of aspiration. The damaged thorax and lung can contribute to brain ischemia and rises in intracranial pressure. The treatment of one end of the CNS-respiratory axis is not without effect on the other end of the continuum. Corticosteroids, diuretics, mannitol, iatro?enic hyperventilation, barbiturates, and vasopressors are used in the management of patients with head trauma, but may have an impact on oxygenation and ventilation. When positive end expiratory pressure is used in the management of a pulmonary process, it should be optimized and used with caution while monitoring for its effect on intracranial pressure. Pulmonary toilet, while remaining a necessity, must be performed in a manner so as to minimize potential negative effects on the brain. Hyperoxia and hypothermia should be avoided. Mechanical ventilation should be used as dictated by the desired PaCO2 and not as a mandatory adjunct to endotracheal intubation. (289 Refs.) Tags: Human Desc.: Adrenal Cortex Hormones--Therapeutic Use (TU); *Brain Injuries--Complications (CO); Brain Injuries--Physiopathology (PP); Brain Injuries--Therapy (TH); Central Nervous System--Physiopathology (PP); Cerebrovascular Circulation; Mannitol--Therapeutic Use (TU); Positive Pressure Respiration; Respiration; *Respiratory Tract Diseases--Complications (CO); Respiratory Tract Diseases--Therapy (TH); Thoracic Injuries--Physiopathology (PP) CAS Registry No.: 87-78-5 (Mannitol) Y004154 109 0652770 82097770 Decay of inspiratory muscle activity in chronic airway obstruction. Citterio G; Agostoni E; Del Santo A; Marazzini L Istituto di Fisiologia Umana, Ia Cattedra, Universita de Milano, Italy. J Appl Physiol (US), Dec 1981, 51 (6) p1388-97, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Announcement: 8205 Subfile: INDEX MEDICUS Relative decay rate of inspiratory muscle electrical activity (RDRI) in patients with chronic airway obstruction increased with decreasing expiratory time (TE), being faster than in normal subjects for a given TE. Time course of decay was similar in shape to that of normal subjects, whereas persistence time of activity during expiration was about half. Hence, braking action of inspiratory muscles in patients was smaller than in normal subjects. No tonic activity of inspiratory muscles was fund in patients, even when frequency was increased and hyperinflation enhanced. Hence toxic activity of inspiratory muscles found by others in asymptomatic asthmatic or normal subjects after histamine inhalation seems elicited by histamine. In normal subjects breathing under resistive load, RDRI became similar to that of patients for a given TE: tonic activity of extradiaphragmatic inspiratory muscles occurred only if frequency was voluntarily increased at least three times, an unphysiological condition with resistive load. Under discontinuous inspiratory elastic load, RDRI of patients decreased or did not change, whereas previously that of normal subjects was found to increase. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; Aged; Airway Resistance; Electromyography; Electrophysiology; *Lung Diseases, Obstructive--Physiopathology (PP); Middle Age; *Muscles--Physiopathology (PP); Respiration; Spirometry; Tidal Volume Y004154 110 0644523 82089523 Static transdiaphragmatic pressures in normal subjects and in patients with chronic hyperinflation. Gibson GJ; Clark E; Pride NB Dept. of Medicine (Respiratory Division), Royal Postgraduate Medical School, Hammersmith Hospital, London, England. Am Rev Respir Dis (US), Dec 1981, 124 (6) p685-9, ISSN 0003-0805 Jrnl Code: 426 Lang.: ENG. Jrnl Ann.: 8204 Subfile: AIM; INDEX MEDICUS Transdiaphragmatic pressure (Pdi) during static maximal inspiratory effort was measured in 11 normal subjects and in 4 patients with severe chronic hyperinflation (mean total lung capacity, 138% predicted). The Pdi varied widely among subjects, some production positive abdominal pressure (Pab) at all volumes and some producing Pab close to zero or negative. During modified maximal inspiratory efforts in which the abdomen was protruded, several subjects produced greater Pdi, but in none was pleural pressure (Ppl) more negative, possibly because of inhibition of diaphragmatic activation during spontaneous inspiratory efforts. In the hyperinflated patients, spontaneous maximal inspiratory inspiratory efforts produced smaller values of Pdi, but the diaphragm retained an inspiratory effect and Pdi could still be increased by abdominal protrusion during the effort. Although Pdi during such modified maneuvers probably gives a better index of the strength of the diaphragm, this may not be directly related to its effective capacity as an inspiratory muscle, which may be best assessed by comparing Pdi with Ppl during spontaneous maximal inspiratory efforts. Tags: Comparative Study; Female; Human; Male Desc.: Abdomen; Adult; Aged; *Diaphragm--Physiopathology (PP); Functional Residual Capacity; Middle Age; Pleura; Pressure; *Pulmonary Emphysema--Physiopathology (PP); Total Lung Capacity ŠY004154 111 0639310 82084310 Staphylococcus aureus pneumonua as a complication during treatment of neurosurgical patients with mechanical ventilation. Espersen F; Gabrielsen J Statens Seruminstitut, Dept. of Clinical Microbiology, Hvidovre Univ. Hospital, Copenhagen, Denmark. Scand J Infect Dis (SWEDEN), 1981, 13 (3) p161-3, ISSN 0036-5548 Jrnl Code: UCX Lang.: ENG. Jrnl Ann.: 8204 Subfile: INDEX MEDICUS During 1978 a high incidence of Staphylococcus aureus pneumonia (11/54) was found in patients treated with mechanical hyperventilation for cerebral lesions, compared to other patients on mechanical ventilation in the same ward (1/148). Patients with cerebral lesions also had an increased risk of colonization with Staph. aureus. The patients were colonized and infected with different phage types of Staph. aureus. These factors in combination with the epidemiological data indicate that the increased infection rate is due to a specific impairment of the local defence mechanism in the respiratory tract of these patients and not to an increased exposure to epidemic strains of Staph. aureus. The course of the infections indicates that microscopical examination of material from endotracheal suctions is important in order to diagnose the infection as early as possible. Tags: Human Desc.: *Nervous System--Surgery (SU); *Pneumonia, Staphylococcal--Etiology (ET); *PNEUMONIA STAPH--Etiology (ET); Pneumonia, Staphylococcal--Microbiology (MI); PNEUMONIA STAPH--Microbiology (MI); *Postoperative Complications--Microbiology (MI); *POSTOP COMPL--Microbiology (MI); *Respiration, Artificial Y004154 112 0628026 82073026 Long-term treatment with corticosteroids and ACTH in asthmatic children. I. A pulmonary function study with re-investigation after 5 years. Oberger E; Engstrom I The Allergy Unit, Dept. of Pediatrics, Karolinska Hospital, Stockholm, Sweden. Eur J Respir Dis (DENMARK) , Aug 1981, 62 (4) p256-67, ISSN 0106-4339 Jrnl Code: EPS Lang.: ENG. Jrnl Ann.: 8204 Subfile: INDEX MEDICUS Twenty-one children aged 6-17 years with severe bronchial asthma and on long-term treatment with corticosteroids and/or ACTH, were studied when they were as symptom-free as possible. They were found to have increased lung volumes and hyperinflation with a high end-expiratory level. The forced expiratory 1-s volume (FEV1) was within +/- 2 SD for healthy children, but the FEV% was significantly decreased, as a sign of sub-clinical bronchial obstruction. Arterial oxygen tensions was within normal limits, except in one patient with clinical signs of bronchial obstruction. On re-examination 5 years later, hyperinflation and sub-clinical obstruction were even more pronounced, despite the fact that the majority of the patients had improved clinically. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adolescence; *Adrenal Cortex Hormenes--Therapeutic Use (TU) Aging; *Asthma--Drug Therapy (DT); Asthma--Physiopathology (PP); Body Height; Carbon Dioxide--Metabolism (ME); Child; Chronic Disease; *Corticotropin--Therapeutic Use (TU); Follow-Up Studies; Hydrogen-Ion Concentration; PH; Oxygen--Blood (BL); Respiratory Function Tests CAS Registry No.: 7782-44-7 (Oxygen); 9002-60-2 (Corticotropin) Y004154 113 0627230 82072230 [Transitory bacteraemia after endotracheal suction (author's transl)] Transitorische Bacteriamien nach endotrachealem Absaugen. Storm W Universitats-Kinderklinik, Abteilung fur Padiatrische Intensivmedizin, Dusseldorf. Dtsch Med Wochenschr (GERMANY, WEST) , Nov 6 1981, 106 (45) p1496-8, ISSN 0012-0472 Jrnl Code: ECL Lang.: GERMAN Summary Languages: ENG. Doc. Type: English Abstract Jrnl Ann.: 8204 Subfile: INDEX MEDICUS Tags: Human Desc.: Infant, Newborn; Respiration, Artificial; *Septicemia--Etiology (ET); *Suction--Adverse Effects (AE); Time Factors; Trachea Y004154 114 0607432 82052432 Oxygen insufflation during endotracheal suctioning. Langrehr EA; Washburn SC; Guthrie MP Univ. of Wisconsin School of Nursing, Madison. Heart Lung (US), Nov-Dec 1981, 10 (6) p1028-36, Jrnl Code: G2V Lang.: ENG. Jrnl Ann.: 8203 Subfile: AIM; INDEX MEDICUS Tags: Animal; Comparative Study; Female; Human; Male Desc.: Aged; Dogs; Heart Surgery; Middle Age; *Oxygen--Administration and Dosage (AD); Oxygen--Blood (BL); Partial Pressure; Postoperative Period; POSTOP PERIOD; *Suction--Adverse Effects (AE); *Trachea ŠCAS Registry No.: 7782-44-7 (Oxygen) Y004154 115 0604755 2049755 Factors influencing pulsus paradoxus in asthma. Martin J; Jardim J; Sampson M; Engel LE Meakins Christie Laboratories, McGill Univ., Montreal. Chest (US), Nov 1981, 80 (5) p543-9, ISSN 0012-3692 Jrnl Code: D1C Lang.: ENG. Jrnl Ann.: 8203 Subfile: AIM; INDEX MEDICUS In five normal subjects with pulsus paradoxus (change in systolic blood pressure greater than 10 mm Hg) induced by breathing through external inspiratory resistance, the change in systolic blood pressure was related to swing in esophageal pressure (change in intrapleural pressure [PpI]). Effects of hyperinflation (to 75 to 85 percent of vital capacity) were examined by adding expiratory resistances, and the influence of the configuration of the chest wall was studied by using "intercostal" and "abdominal" breathing patterns. There was a curvilinear relationship between the change in systolic blood pressure and the change in PpI, and hyperinflation was not necessary for the production of pulsus paradoxus. At the same change in PpI, there was no significant difference between "intercostal" and "abdominal" breathing, suggesting that pulmonary overdistention with tensing of the mediastinum is not an important etiologic mechanism. Analysis of sustained Muller's maneuvers suggested that the temporal breathing pattern may be important in determining the degree of paradox and may account for its variability in patients with a given degree of obstruction of air flow. Tags: Human; Male Desc.: *Asthma--Physiopathology (PP); Blood Pressure; Functional Residual Capacity; Pleura--Physiopathology (PP); *Pulse; Respiration Y004154 116 0567749 82012749 Drugs affecting the respiratory system with particular reference to asthma. Anderson SD Med Sci Sports Exerc, 1981, 13 (4) p259-65, ISSN 0195-9131 Jrnl Code: MG8 Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8201 Subfile: INDEX MEDICUS In ?0-80% of asthmatic patients, an attack of asthma will follow 6-10 min of strenuous exercise. The increase in airway resistance is accompanied by hyperinflation and arterial hypoxemia and makes it difficult to continue or resume exercise. The past 10 yr have seen major advances in the prevention and treatment of exercise-induced asthma (EIA). The beta-sympathomimetic drugs, when administered as aerosols, have been shown to be most effective in reversing the airway obstruction, hyperinflation, and exercise-induced hypoxemia in patients with asthma. When administered as aerosols prior to exercise, the increase in airways resistance, hyperinflation, and hypoxemia are blocked in about 90% of patients. In addition to the sympathomimetic agents, sodium cromoglycate will also ameliorate or prevent EIA in 60-70% of patients. Oral administration of beta sympathomimetics or methylxanthines is less efficacious in the prevention or treatment of EIA. Delay in absorption from the gastrointestinal tract requires at least 1-2 h before a significant response is observed. Prevention of EIA requires an adequate blood level, possibly because a high concentration of the drug does not reach the airway when the drug is given by the oral route. More importantly, aerosol administration prevents EIA at a fraction of the dose required orally. The side effects, such as nausea, tachycardia, and skeletal muscle tremor commonly observed following oral bronchodilator administration are rare with aerosol therapy. (40 Refs.) Tags: Human Desc.: Adrenergic Alpha Receptor Blockaders--Pharmacodynamics (PD) ADREN ALPHA RECEPT BLOCK--Pharmacodynamics (PD); *Asthma--Drug Therapy (DT) ; *Asthma, Exercise-Induced--Drug Therapy (DT); Asthma, Exercise-Induced--Prevention and Control (PC); Bronchi--Drug Effects (DE); Child; Cystic Fibrosis--Drug Therapy (DT); Disodium Cromoglycate--Pharmacodynamics (PD); Histamine H1 Receptor Blockaders--Pharmacodynamics (PD); RECEPT BLOCK H1--Pharmacodynamics (PD); Parasympatholytics--Pharmacodynamics (PD); Peak Expiratory Flow Rate; *Respiration--Drug Effects (DE); Sports; Sympathomimetics--Pharmacodynamics (PD); Theophylline--Pharmacodynamics (PD) CAS Registry No.: 15826-37-6 (Disodium Cromoglycate); 58-55-9 (Theophylline) Y004154 117 0523963 8153963 The effects of intermittent positive pressure breathing on patients with respiratory muscle weakness. De Troyer A; Deisser P Am Rev Respir Dis, Aug 1981, 124 (2) p32-7, ISSN 0003-0805 Jrnl Code 426 Lang.: ENG. Jrnl Ann.: 8111 Subfile: AIM; INDEX MEDICUS Marked reductions in pulmonary compliance have been noted in patients with respiratory muscle weakness, which greatly contribute to the losses of lung volume. In an attempt to reverse this abnormality and to decrease the work of breathing, we evaluated the effects of a 15-min period of positive pressure, mechanical hyperinflation of the lungs in 10 patients with generalized neuromuscular disorders and long-standing involvement of the respiratory muscles. The vital capacity was 46, and the static expiratory lung compliance was 59% of control values. The recoil pressure of the lung at full inflation was 19 cm H2O. Using positive pressure breathing devices, we inflated the lungs either with inflation pressures ranging between 20 and 40 cm H2O or with volume that were at least twofold larger than the patients' natural inspiratory capacity. Lung volumes, including functional residual capacity, and static pulmonary compliance were not modified by these procedures. Maintaining 10 cm H2O of positive end-expiratory pressure did not alter the results. These findings suggest that (1) alveolar collapse, rather than a simple decrease in the compliance of the surface film of the lung, is the major cause of the low pulmonary compliance in patients with chronic respiratory muscle weakness; (2) these patients do not acutely benefit from intermittent positive breathing treatment. Tags: Female; Human; Male Desc.: Adolescence; Adult; Evaluation Studies; *Intermittent Positive Pressure Breathing; Lung Compliance; Lung Volume Measurements; *Neuromuscular Diseases--Complications (CO); Partial Pressure; *Positive Pressure Respiration; Respiratory Insufficiency--Etiology (ET); Respiratory Insufficiency--Physiopathology (PP); *Respiratory Insufficiency--Therapy (TH); Work of Breathing Y004154 118 0511951 81241951 Ruptured spleen--when to operate Wesson DE; Filler RM; Ein SH; Shandling B; Simpson JS; Stephens CA J Pediatr Surg, Jun 1981, 16 (3) p324-6, ISSN 0022-3468 Jrnl Code: JMJ Lang.: ENG. Jrnl Ann.: 8111 Subfile: INDEX MEDICUS Sixty-three patients with splenic injuries were treated during a 5-yr period from 1974-1979. The decision to operate was based on the patient's clinical course, not on the presence of splenic injury alone. Those who were stable on admission or after initial resuscitation were treated nonoperatively. This consisted of strict bed rest, nasogastric suction, and i.v. fluids--including blood--as required. Those who bled massively were operated on promptly. At operation, the spleen was repaired if possible or excised if damaged beyond repair. Forty patients were treated nonoperatively. Sixteen of these required blood transfusions (mean 31.2 +/- 5.3 ml/kg). One patient in this group developed a large defect on spleen scan at 3 wk post injury. There was no other morbidity and no mortality following nonoperative treatment. Nineteen required operation all within 16 hr of admission. Fifteen underwent splenectomy, 2 partial splenectomy, and 1 splenorrhaphy. In 1 the bleeding had stopped. All required blood before operation (mean 80.4 +/- 10.1 ml/kg). Seven in this group died (6 from head injuries and 1 from bleeding). Thus surgery was avoided in 2 out of 3 and the spleen saved in 3 out of 4 patients with documented splenic injuries. We believe that where adequate facilities exist nonoperative treatment of splenic injuries is both safe and effective. When bleeding is massive from the beginning or replacement requirements exceed 40 ml/kg, operation is indicated. Tags: Female; Human; Male Desc.: Adolescence; Child; Child, Preschool; Hemorrhage--Surgery (SU); Infant; Risk; Splenectomy; Splenic Rupture--Surgery (SU); *Splenic Rupture--Therapy (TH) Š Y004154 119 0495071 81225071 Hemodynamic characteristics in chronic obstructive lung disease as related to cardiac size. Hutsebaut J; Scano G; Garcia-Herreros P; Degre S; De Coster A; Sergysels R Respiration , 1981, 4 (1) p25-32, ISSN 0025-7931 Jrnl Code: R8K Lang.: ENG. Jrnl Ann.: 8110 Subfile: INDEX MEDICUS The hemodynamic adaptation during exercise was evaluated in 19 patients suffering from chronic obstructive lung disease. They were divided into two groups according to cardiac size on the X-ray (group 1, small; group 2, normal). A small cardio-thoracic ratio could be correlated with 'emphysema' assessed on the basis of hyperinflation and a low transfer test for CO. No clear-cut difference could be found between the two groups concerning the hemodynamic data at rest or during exercise. However, for all subjects, the cardiac output was found to be slightly related to the cardiac size (smaller cardiac output for smaller cardiac size). During exercise, low cardiac output was characterized by a low oxygen transport and a high level of lactate. From this, it is suggested that a small cardiac size, a classical feature of hyperinflation and emphysema, may lead to a low cardiac output. The explanation for these results is speculative, but variable hemodynamic profiles in chronic obstructive lung disease with or without hyperinflation may be related to the morphology of the cardiac chambers and of variable intrathoracic pressure regimes during respiration. Tags: Human Desc.: Adult; Blood Chemical Analysis; *Cardiac Output; *Cardiac Volume; *Exertion; Lactates--Blood (BL); Lung Diseases, Obstructive--Blood (BL); *Lung Diseases, Obstructive--Physiopathology (PP); Middle Age; Oxygen Consumption; Respiratory Function Tests; Rest Y004154 120 042874 81212874 Altered cardiovascular reflex responses during positive pressure breathing. Stinnett HO Fed Proc, Jun 1981, 40 (8) p2182-7, ISSN 0014-9446 Jrnl Code: EUVde: Lang.: ENG. Jrnl Ann.: 8110 Subfile: INDEX MEDICUS Cardiovascular responses during hyperinflation produced by positive end-expiratory pressure (PEEP) are considered to be reflexly influenced by pulmonary mechanoreceptors. Numerous studies have indicated heart and vascular effects attributed to mechanical events and cardiopulmonary mechanoreflexes. Yet interactions of these modalities with the systemic baroreflexes are not clear. We examined aspects of these modulatory interactions by distinguishing changes in pulmonary, heart, and vascular responses during PEEP-hyperinflation before and after progressive elimination of chemo-, mechano-, and baroreflex influences in the closed-chest anesthetized rabbit. During respiratory alkalosis PEEP was imposed in increments of 2.5 cm H2O (range 0.0 to 7.5 cm H2O) before and during control of carotid intrasinus pressure and following aortic denervation and vagotomy. Heart rate responses during PEEP increased prior to aortic denervation, decreased following elimination of baroreflexes, and were abolished after vagotomy. The fall in mean arterial pressure (MAP) during PEEP was accentuated during elimination of the baroreflexes and ameliorated following vagotomy. Mean right atrial (MRAP), intrapleural (MIP), and right atrial transmural pressure increased during PEEP prior to vagotomy. Regression analyses of MAP versus MRAP and MAP versus MIP suggest that vagally receptors reflexly influence venous as well as systemic arterial vascular pressure. Conclusion indicate that when superimposed on mechanical events, cardiopulmonary mechanoreceptors and arterial baroreceptors effect conflicting facilitory reflex influences on heart and vascular responses during PEEP-hyperinflation. Tags: Animal; Support, Non-U.S. Gov't Desc.: Blood Pressure; *Cardiovascular System--Physiology (PH); Chemoreceptor--Physiology (PH); Heart Atrium--Physiology (PH); Mechanoreceptors--Physiology (PH); *Positive Pressure Respiration; Pressoreceptors--Physiology (PH); Rabbits; *Reflex Y004154 121 0470520 81200520 Lung function studies in a patient with diffuse pulmonary fibroleiomyomas. Magnussen H; Hole JP; Stiens R; Mattern H; Koischwitz D; Hartmann V Respiration , 1980, 40 (5) p241-9, ISSN 0025-7931 Jrnl Code: R8K Lang.: ENG. Jrnl Ann.: 8109 Subfile: INDEX MEDICUS Diffuse pulmonary fibroleiomyomas were detected by open-lung biopsy in a 33-year-old male patient. Lung function studies revealed severe airflow obstruction, hyperinflation, grossly impaired single-breath-diffusing capacity and a decrease in PaO2 during exercise, i.e. data which are compatible with pulmonary emphysema. However, static lung compliance was within normal limits excluding the existence of pure emphysema. Additional special lung function tests confirmed the assumption that in diffuse fibroleiomyomas of the lung, functional patterns characteristic of obstructive and restrictive lung disease are present that are in agreement with the histological features of this disease. Tags: Case Report; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; *Leiomyoma--Physiopathology (PP); Lung Compliance; *Lung Neoplasms--Physiopathology (PP); Lung Volume Measurements; *Lung--Physiopathology (PP); Oxygen; Respiration CAS Registry No.: 7782-44-7 (Oxygen) Y004154 122 0461686 81191686 Ventilation by high-frequency oscillation in rabbits with oleic acid lung disease. Wright K; Lyrene RK; Truog WE; Standaert TA; Murphy J; Woodrum DE J Appl Physiol, May 1981, 50 (5) p1056-60, ISSN 0161-7567 Jrnl Code: HAL Contract/Grant No.: SCOR HMD-19187; MCT-000955 Lang.: ENG. Jrnl Ann.: 8109 Subfile: INDEX MEDICUS The feasibility and efficiency of ventilation by high-frequency oscillation (HFO) were examined in animals with diffuse hemorrhagic lung disease. Twenty-four hours after injection with 0.12 ml/kg oleic acid, 11 spontaneously breathing rabbits had a mean (+/- SD) arterial O2 partial pressure (PaO2) of 65 +/- 6 Torr and arterial CO2 partial pressure (PaCO2) of 38 +/- 7 Torr [inspired fractional O2 concentration (FIO2) of 0.21]. Following paralysis animals were ventilated using a high-frequency oscillator for periods of 20 min followed by three successive hyperinflations to prevent atelectasis. Maintaining a constant mean airway pressure (MAP) of 6 cmH2O and fresh gas flow (FGF) of 2 1/min (FIO2 = 0.21), all combinations of frequency (5, 10, 20, and 30 Hz) and stroke volume (Vs) 2.6, 5.0, and 8.9 ml) were tested. At each frequency, an increase in Vs tended to lower mean PaCO2. At each Vs, CO2 elimination appeared maximal at 20 Hz, an effect attributable to decreasing effective Vs with increasing frequency. With constant Vs, MAP, and frequency, increasing FGF from 1 to 2 or 61/min decreased mean PaCO2 (P less than 0.05). With constant Vs, frequency, and FGF, increases in MAP from 2 to 10 cmH2O increased mean PaO2 (P less than 0.05). HFO, coupled with periodic hyperinflation, supports satisfactory gas exchange in rabbits with oleic acid lung injury. The efficiency of gas exchange is improved by independent increases in Vs, FGF, MAP, or frequency. Tags: Animal; Support, U.S. Gov't, P.H.S. Desc.: Carbon Dioxide--Blood (BL); Hemodynamics--Drug Effects (DE) Hemorrhage--Chemically Induced (CI); *Lung Diseases--Chemically Induced (CI); *Oleic Acids--Toxicity (TO); Oxygen--Blood (BL); Rabbits; *Respiration--Drug Effects (DE) CAS Registry No.: 7782-44-7 (Oxygen) Š Y004154 123 0457399 81187399 Effects of endotracheal suction versus apnea during interruption of intermittent or continuous positive pressure ventilation. Ehhart IC; Hofman WF; Loveland SR Crit Care Med, Jun 1981, 9 (6) p464-8, ISSN 0090-493 Jrnl Code: DTF Lang.: ENG. Jrnl Ann.: 8109 Subfile: AIM; INDEX MEDICUS The hypoxemia, elevated vascular pressure, and cardiac arrhythmias occurring during endotracheal suction may be related both to suction and the interruption of ventilation during suction. Although effects of suction vs. apnea have been compared in healthy patients, interruption of ventilation for purely investigational purposes precludes such a study in critically ill patients. Thus, in the present study, cardiovascular and blood gas changes attendant to endotracheal suction or equivalent periods of apnea were compared in anesthetized, paralyzed dogs in acute respiratory failure induced by oleic acid. Suction of 45-sec duration during interruption of intermittent positive pressure ventilation (IPPV) was associated with decreases in PaO2, pH, and heart rate and increases in PaCO2, cardiac output, pulmonary arterial and systemic arterial pressure. These changes were not different from those observed during interruption of ventilation (apnea) alone. Cardiovascular and blood gas changes were also similar when suction and apnea were compared during interruption of continuous positive pressure ventilation (CPPV). Neither apnea nor suction was associated with cardiac arrhythmias. Tags: Animal; Comparative Study; Support, Non-U.S. Gov't Desc.: *Apnea--Complications (CO); Blood Gas Analysis; Cardiac Output; Dogs; *Intermittent Positive Pressure Ventilation; *Positive Pressure Respiration; *Suction--Adverse Effects (AE); *Trachea--Physiopathology (PP) Y004154 124 045551 81185517 Responses to cortical injury: II. Widespread depression of the activity of an enzyme in cortex remote from a focal injury. Dail WG; Feeney DM; Murray HM; Linn RT; Boyeson MG Brain Res, Apr 27 1981, 211 (1) p79-89, ISSN 0006-8993 Jrnl Code: BL? Contract/Grant No.: NS 13684-03 Lang.: ENG. Jrnl Ann.: 8109 Subfile: INDEX MEDICUS As a part of a broader study of the reaction of the brain to injury, we report here an interesting loss of the activity of an enzyme in areas quite remote from the site of direct injury. At 36 h following a laceration or contusion injury to the hindpaw area of the motor cortex, a peculiar loss of staining for the enzyme alpha glycerophosphate dehydrogenase (alpha-GPDH) was noted. alpha-GPD activity was markedly depressed in cortical layers II and III throughout the hemisphere on the side of the injury. The depression of alpha-GPDH activity extended far laterally across the rhinal fissure into the pyriform cortex. The decrease in alpha GPDH staining was prominent 4 days after the injury: however, the staining pattern had returned to normal at 9 days. Enzyme changes in animals lesioned in the occipital cortex paralleled that seen in animals with a lesion in the motor cortex. Animals which had received an undercut lesion in the motor cortex 56 days earlier were contused in the occipital cortex. The old injury site presented the same sequelae of changes as seen in others lesioned animals. Additionally, a suction ablation injury involving only a small part of motor cortex resulted in the same widespread reduction of staining for alpha-GPDH in layers II and III. The derangement in energy metabolism suggests that cells in layers II and III of the cerebral cortex may be particularly vulnerable to perturbations induced by cortical trauma. These findings may be related to the diffuse and transient functional losses observed after head injury in man. Tags: Animal; Support, U.S. Gov't, P.H.S Desc.: Astrocytes--Enzymology (EN); *Brain Concussion--Physiopathology (PP); Cerebral Cortex--Enzymology (EN); Cerebral Cortex--Injuries (IN) ; *Cerebral Cortex--Physiopathology (PP); *Glycerolphosphate Dehydrogenase--Metabolism (ME); Histocytochemistry; Rats; *Spreading Cortical Depression Enzyme No.: EC 1.1.99.5 (Glycerolphosphate Dehydrogenase) Y004154 125 0443294 81173294 The clinical outcome of patients with severe head injuries, treated with highdose dexamethasone, hyperventilation and barbiturates. Hoppe E; Christensen L; Christensen KN Neurochirurgia (?tuttg), Jan 1981, 24 (1) p17-20, ISSN 0028-3819 Jrnl Code: NXM Lang.: ENG. Jrnl Ann.: 8108 Subfile: INDEX MEDICUS The outcome in 45 consecutive patients following severe head injuries is presented. All patients were evaluated according to the Glasgow Coma Scale and the Glasgow Outcome Scale. All patients received a combined treatment consisting of dexamethasone, barbiturate and hyperventilation. A primary operative intervention was performed in 14 patients with intracranial haematomas. There was a good recovery in 53%, 20% were moderately disabled, 11% were severely disabled. 16% died or remained in a vegetative state. The patients were aged between 5 and 83 years, 49% were under 20 years, and the relationship between age and outcome was demonstrated. 86% of the patients under 20 years and 60% over 20 years made a good recovery. These results indicate that a more favourable prognosis is possible after severe head injury, especially in children and thus the combined treatment described above appears justified. Tags: Female; Human; Male Desc.: Adolescence; Adult; Age Factors; Aged; Brain Injuries--Diagnosis (DI); *Brain Injuries--Drug Therapy (DT); Child; Child, Preschool; Chlorpromazine--Therapeutic Use (TU); *Dexamethasone--Therapeutic Use (TU); Hyperventilation; Meperidine--Therapeutic Use (TU); Middle Age ; Pentobarbital--Therapeutic Use (TU); *Phenobarbital--Therapeutic Use (TU) ; Prognosis CAS Registry No.: 50-02- (Dexamethasone); 50-06-6 (Phenobarbital); 50-53-3 (Chlorpromazine); 57-42-1 (Meperidine); 76-74-4 (Pentobarbital) Y004154 126 0426599 81156599 Suction in neurosurgery. Vallfors B; Hansson HA; Harsson S; Johansson G Acta Neurochir (Wien), 1980, 55 (1-2) p35-42, ISSN 0001-6268 Jrnl Code: ?9C Lang.: ENG. Jrnl Ann.: 8107 Subfile: INDEX MEDICUS Tags: Animal; Comparative Study Desc.: Brain Injuries--Etiology (ET); Dogs; Neurosurgery--Instrumentation (IS); *Neurosurgery--Methods (MT); Pressure; Suction--Adverse Effects (AE); Suction--Instrumentation (IS); *Suction--Methods (MT) ŠY004154 127 0411860 81141860 Tonic inspiratory muscle activity as a cause of hyperinflation in asthma. Muler N; Bryan AC; Zamel N J Appl Physiol, Feb 1981, 50 (2) p279-82, ISSN 011-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8107 Subfile: INDEX MEDICUS We studied tonic activity of the inspiratory muscles during exacerbation of asthma in five female and two male patients. Exacerbation was provoked by withholding bronchodilatary medication for 12 h prior to the study. Thoracic gas volume (TGV) at the end of resting expiration was determined before and after albuterol (salbutamol) inhalation with a body plethysmograph. Intercostal muscle electromyogram (EMG) was recorded with surface electrodes and diaphragmatic EMG with esophageal electrodes. Tonic activity was defined as electrical activity in the EMG present throughout expiration. After salbutamol the TGV decreased 13.4 +/- 2.9% (mean +/- SE) (P less than 0.01). This decrease in TGV was accompanied by a proportional reduction in tonic intercostal (r = 0.78, P less than 0.05) and diaphramatic activity (r = 0.84, P less than 0.05). These findings suggest that the hyperinflation present during exacerbation of asthma is at least in part due to active inspiratory muscle activity present throughout expiration. Tags: Female; Human; Male; Support, Non-U.S. Gov't Desc.: Adult; Albuterol--Therapeutic Use (TU); Asthma--Drug Therapy (DT); *Asthma--Physiopathology (PP); *Diaphragm--Physiopathology (PP); Electromyography; *Intercostal Muscles--Physiopathology (PP); Lung Volume Measurements; *Muscle Tonus; Muscle Tonus--Drug Effects (DE) CAS Registry No.: 18559-94-9 (Albuterol) Y004154 128 0407256 81137256 Intracranial pressure monitoring in perspective. Venes J Childs Brain, 1980, 7 (5) p236-51, ISSN 0302-2803 Jrnl Code: D2Wde Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8107 Subfile: INDEX MEDICUS Monitoring of intracranial pressure has become increasingly widespread in a variety of conditions. The information gained has allowed for the development of certain principles of management in patients with presumed or potential intracranial hypertension. These principles are applicable whether ICP monitoring is employed or not. Aggressive management of severe intracranial hypertension may improve survival; however, data from several studies are inconclusive. The author attempts to review developments in the field and assess the impact of this modality of therapy in pediatric neurosurgical practice. (94 Refs.) Tags: Human Desc.: Adolescence; Adult; Barbiturates--Therapeutic Use (TU); Brain Edema--Surgery (SU); Catheterization; Cerebral Anoxia--Physiopathology (PP); Cerebral Ventricles--Surgery (SU); Child; Child, Preschool; Fever--Complications (CO); Head Injuries--Psysiopathology (PP); Head Injuries--Therapy (TH); Hyperventilation--Physiopathology (PP); *Intracranial Pressure; Mannitol--Therapeutic Use (TU); Monitoring, Physiologic; Outcome and Process Assessment (Health Care); OUTCOME ASSESSMENT; Pseudotumor Cerebri--Physiopathology (PP); Reye's Syndrome--Physiopathology (PP); Stress, Psychological--Complications (CO) CAS Registry No.: 87-78-5 (Mannitol) Y004154 129 0401677 81131677 Isoflurane and cerebrospinal fluid pressure in neurosur~grica patients. Adams RW; Cucchiara RF; Gronert GA; Messick JM; Michenfelder JD Anesthesiology, Feb 1981, 54 (2) p97-9, ISSN 0003-3022 Jrnl Code: 4SG Lang.: ENG. Jrnl Ann.: 8106 Subfile: AIM; INDEX MEDICUS The effect of isoflurane on cerebrospinal fluid pressure (CSFP) was determined in 20 patients undergoing craniotomy for intracranial supratentorial neoplasm or hepatoma. In 15 of these patients, following endotracheal intubation, hyperventilation sufficient to result in PaCO2 25-30 torr was begun simultaneously with the introduction of 1 per cent isoflurane. In the remaining five patients ventilation was equivalent, but normocapnia was maintained by adding CO2 to the inspired gases. In the hypocapnic patients CSFPs did not increase above awake values (range 5-45 torr) following isoflurane administration. In the normocapnic patients (CSFPs consistently increased. In three of these five patients the increases were precipitous, but were corrected rapidly by establishment of hypocapnia. The authors conclude that the known cerebral vasodilator properties of isoflurance can be countered effectively by hypocapnia. Furthermore, unlike the situation with halothane, it is not necessary to establish hypocepnia prior to introducing isoflurane in order to avoid CSFP increases. Tags: Human Desc.: Adult; Anesthesia, Inhalation; Brain Injuries--Surgery (SU) Brain Neoplasms--Surgery (SU); Carbon Dioxide--Blood (BL); Craniotomy; Hematoma--Surgery (SU); *Intracranial Pressure--Drug Effects (DE); Isoflurane--Administration and Dosage (AD); *Isoflurane--Pharmacodynamics (PD); *Methyl Ethers--Pharmacodynamics (PD) CAS Registry No.: 26675-46-7 (Isoflurane) Y004154 130 0391560 81121560 The hypoxic drive to breathing in man. Leitch AG Lancet, Feb 21 1981, 1 (8217) p428-30, ISSN 023-7507 Jrnl Code: L0S Lang.: ENG. Jrnl Ann.: 8106 Subfile: AIM; INDEX MEDICUS Tags: Human; Support, Non-U.S. Gov't Desc.: *Anoxia--Physiopathology (PP); Bronchitis--Physiopathology (PP); Carbon Dioxide--Blood (BL); Head Injuries--Physiopathology (PP); Hyperventilation--Physiopathology (PP); Oxygen--Blood (BL); Pickwickian Syndrome--Physiopathology (PP); Pulmonary Emphysema--Physiopathology (PP); *Respiration; Sleep, REM--Physiology (PH) CAS Registry No.: 7782-44-7 (Oxygen) Š Y004154 131 0375717 81105717 Effect of 1% enflurane (Ethrane) anesthesia on cerebral blood flow and metabolism in neurosurgical patients during normo- and hyperventilation. Rood M; Deloof T; Berre J; Verbist A; Fruhling J; Dang Phuoc T Acta Anaesthesiol Belg, 1980, 31 Suppl p3-19, ISSN 0001-5164 Jrnl Code: 082 Lang.: ENG. Jrnl Ann.: 8105 Subfile: INDEX MEDICUS We have measured the CBF in ten neurosurgical patients. A first measurment was made during anesthesia with nitrous oxide 70% and a second with nitrous oxide 70% + 1% enflurane, both at a PaCO2 of 40 Torr. A third measurement was performed also with nitrous oxide + 1% enflurane, but at a PaCO2 of 30 Torr. We used the method of intracarotid 133Xe injection, with a gammacamera recording. In order to avoid any decrease of cerebral perfusion pressure, which might influence the CBF, an infusion of phenylephrine was used, if needed. At a constant PaCO2 of 40 Torr, there was no statistically significant difference in CBF with nitrous oxide + 1% enflurane compared to nitrous oxide alone. No change in cerebral vascular resistance was observed. When PaCO2 was lowered to 30 Torr, under 70% nitrous oxide + 1% enflurane, there was a 43% decrease in CBF (from a mean of 42 ml/100 G/min. to a mean of 24 ml/100 g/min.). Cerebral vascular resistance has an increase of 79%. In some instances, the decrease in CBF reached values around 20 ml/100 g/min. and in one case, even less. That level is generally considered to be the lowest acceptable limit in the conscious man, though not necessarily in the anesthetised one. Under hypocapnia, the cerebral arterio-venous oxygen difference increased, but the CMRO2 did not change. There were little differences in lactate and pyruvate cerebral metabolic rates, all values remaining within normal ranges. In conclusion, we believe that enflurane is a favorable anesthetic agent for neurosurgical operations at the concentration of 1%, CMRO2 is reduced, there is no significant effect on cerebral blood vessels, CBF and CVR do not change. However, a complementary use of hypocapnia may reduce CBF to dangerously low levels, if at the start, it shows already a pathological decrease and if hyperventilation is applied at a marked degree. Tags: Female; Human; Male Desc.: Adolescence; Adult; *Anesthesia, Inhalation; *Brain Injuries--Surgery (SU); Carbon Dioxide--Blood (BL); *Cerebrovascular Circulation--Drug Effects (DE); *Enflurane--Pharmacodynamics (PD); Hyperventilation--Physiopathology (PP); Kinetics; Middle Age; Nitrous Oxide ; Partial Pressure; Vascular Resistance--Drug Effects (DE) CAS Registry No.: 10024-97-2 (Nitrous Oxide); 13838-16-9 (Enflurane) Y004154 132 0375716 81105716 Influence of 1% enflurane (Ethrane) anesthesia on regional cerebral blood flow repartition under normo-and hyperventilation. de Rood M; Deloof T; Verbist A; Fruhling J Acta Anaesthesiol Belg, 1980, 31 Suppl p29-41, ISSN 0001-5164 Jrnl Code: 082 Lang.: ENG. Jrnl Ann.: 8105 Subfile: INDEX MEDICUS This study is based on the same group of neurosurgical patients as our previous publication. All, except one, had suffered from head injury. We made a first measurement of rCBF under N2O anesthesia, a second under N2O + 1% enflurane anesthesia, both at a PaCO2 of 40 Torr. A third measurement was performed under N2O + 1% enflurane but at a PaCO2 of 30 Torr. The method we used consists of the intracarotid injection of 133Xe and recording of the radioactivity by a gammacamera. Mean arterial pressure was maintained constant by an intravenous phenylephrine drip. For each measurement of each patient, a map was drawn, representing the distribution of the regional cerebral blood flows (rCBF), compared to the mean value of the hemisphere. We have studied rCBF in one case of normal hemisphere, and in cases of traumtic lesions in acute and chronic states, taking into account that the normal brain exhibits areas with higher flow in the frontoarietal and insular regions. In the normal brain, introduction of 1% enflurane decreases uniformally mean CBF, rCBF repartition not being changed. Hyperventilation to 30 Torr shows that regions with previously higher flow react more to hypocapnia by a slightly more decreased flow. In severe brain trauma, mean CBF is generally low, and it is difficult to visualize the lesions under N2O and N2O + 1% enflurane anesthesia. Neither mean CBF, nor rCBF repartition are significantly modified. On the other hand, in the acute phase, hypocapnia causes a more decreased flow in the previously well irrigated areas, and shows a lack of vascular reactivity in the damaged region. Passing to the chronic state, the patient clinically recovering, the rCBF repartition is normalized and the contused area becomes agains vasoactive. Severe losses of neuronal tissue are characterized by definitive low flows without reactivity by hyperventilation. Tags: Female; Human; Male Desc.: Adolescence; Adult; *Anesthesia, Inhalation; Brain Injuries--Surgery (SU); Carbon Dioxide--Blood (BL); *Cerebrovascular Circulation--Drug Effects (DE); *Enflurane--Pharmacodynamics (PD); Hyperventilation--Physiopathology (PP); Kinetics; Middle Age; Nitrous Oxide ; Partial Pressure CAS Registry No.: 10024-97-2 (Nitrous Oxide); 13838-16-9 (Enflurane) Y004154 133 0359537 81089537 Bacteriology of tracheal aspirates in intubated newborn. Brook I; Martin WJ; Finegold SM Chest , Dec 1980, 78 (6) p875-7, ISSN 0012-3692 Jrnl Code: D1C Lang.: ENG. Jrnl Ann.: 8105 Subfile: AIM; INDEX MEDICUS The bacteriology of tracheal aspirates from 28 intubated newborn babies was studied. There was no correlation between such colonization and the respiratory distress syndrome. Endotracheal suction of intubated infants did provide a reliable specimen source for determining the etiology of perinatal pneumonia. Presence of polymorphonuclear leukocytes in the aspirate correlated well with infection. Anaerobic bacteria were found to play a role in three of the five cases of pneumonia. Tags: Female; Human; Male Desc.: *Bacteria--Isolation and Purification (IP); Critical Care; *Exudates and Transudates--Microbiology (MI); *EXUDATES--Microbiology (MI) Infant Care; Infant, Newborn; *Infant, Newborn, Diseases--Microbiology (MI) ; *Intubation, Intratracheal; Meconium; Pneumonia--Microbiology (MI); Pneumonia, Aspiration--Microbiology (MI); Respiratory Distress Syndrome--Microbiology (MI); *Trachea--Microbiology (MI) Y004154 134 0323908 81053908 Mechanism responsible for the sustained fall in arterial oxygen tension after endotracheal suctioning in dogs. Woodburne CR; Powaser MM Nurs Res, Sep-Oct 1980, 29 (5) p312-6, ISSN 0029-6562 Jrnl Code: O9K Lang.: ENG. Jrnl Ann.: 8103 Subfile: AIM; INDEX MEDICUS Because a sustained fall in arterial oxygen tension (PaO2) was observed after endotracheal suctioning in previous studies on anesthetized dogs and in humans, this study was designed to investigate the nature of the fall, its duration, and its response to several challenges. Experiments were performed at weekly intervals using three anesthetized dogs. Each dog was subjected to five experiments. In spontaneously breathing dogs, the duration of the sustained fall after suctioning or after suction catheter insertion without application of suction pressure persisted through 15 minutes. At 30 minutes afterwards, PaO2 had partially or completely returned to control levels. One hyperinflation breath given after suctioning did not produce a lasting reversal of the sustained fall, and pretreatment with isoproterenol mist inhalations failed to prevent the sustained fall. In dogs which were mechanically ventilated both before and after suctioning or catheter insertion without application of suction pressure, three hyperinflations before suctioning or pretreatment with isoproterenol failed to prevent the sustained fall. The data supported the hypothesis that a reflex mechanism, initiated by mechanical stimulation of the airways, was responsible for the sustained fall in PaO2 observed. Tags: Animal; Female Desc.: Dogs; Evaluation Studies; Intubation, Intratracheal; Models, Biological; *Oxygen--Blood (BL); Respiration; *Suction; *Trachea CAS Registry No.: 7782-44-7 (Oxygen) Š Y004154 135 0316449 81046449 Tonic inspiratory muscle activity as a cause of hyperinflation in histamine-induced asthma. Muller N; Bryan AC; Zamel N J Appl Physiol, Nov 1980, 49 (5) p869-74, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8103 Subfile: INDEX MEDICUS We studied the change in tonic activity of the inspiratory muscles during acute hyperinflation. Hyperinflation was provoked in two asthmatic and three normal subjects by progressively doubling doses of histamine. Changes in lung volume were determined with magnetometers and with a body plethysmograph. Intercostal muscle activity was recorded with surface electrodes and diaphragmatic activity with esophageal electrodes. Tonic activity was defined as electrical activity in the electromyogram present at end expiration. After histamine the maximal observed increase in plethysmographic thoracic gas volume in the five subjects was 29.8 +/- 6.4% of control (mean +/- SE). Hyperinflation was accompanied by a significant increase in tonic activity of the intercostal muscles (P < 0.01) and the diaphragm (P < 0.01). There was a significant correlation between the increase in thoracic gas volume and the increase in tonic intercostal (r = 0.82, P = 0.003) and diaphragmatic (r = 0.89, P = 0.003) activity. We conclude that histamine-induced hyperinflation is accompanied by persistent inspiratory muscle activity throughout expiration. Tags: Human; Male; Support, Non-U.S. Gov't Desc.: Adult; Asthma--Chemically Induced (CI); *Asthma--Physiopathology (PP); Electromyography; *Histamine--Pharmacodynamics (PD); *Muscles--Physiology (PH); *Respiration CAS Registry No.: 51-45-6 (Histamine) Y004154 136 0316442 81046442 Role of H1- and H2-receptors in airway reactions to histamine in conscious sheep. Ahmed T; Eyre P; Januszkiewicz AJ; Wanner A J Appl Physiol, Nov 1980, 49 (5) p826-33, ISSN 0161-7567 Jrnl Code: HAL Contract/Grant No.: HL-20989 Lang.: ENG. Jrnl Ann.: 8103 Subfile: INDEX MEDICUS We investigated the role of histamine H1- and H2-receptors in the control of airway function in six conscious sheep. In five of these, inhalation of histamine (combined H1- and H2-receptor stimulation) caused an increase in pulmonary resistance (RL) and functional residual capacity and had a variable effect on distribution of ventilation as measured by N2-clearance delay. Pretreatment with the H1-antagonist, chlorpheniramine, prevented these functional effects of histamine challenge, whereas pretreatment with the H2-antagonist, metiamide, potentiated the effects of histamine on RL and caused a uniform increase in N2-clearance delay. Pretreatment with both chlorpheniramine and metiamide prevented the effects of histamine on all parameters indicating effective blockade of H1- and H2-receptors at the dosages used. In one sheep, an increase in RL and N2-clearance delay in response to histamine was only observed after mitiamide pretreatment. With or without pretreatment, histamine failed to alter the static pressure-volume curve of the lung. We conclude that in conscious sheep a) inhalation of histamine produces bronchoconstriction and pulmonary hyperinflation without changing lung elastic recoil, b) the observed effects of histamine are mediated by H1-receptors, and H2-receptors have a modulating role, and c) variable effects of histamine on RL and distribution of ventilation may be related to differences in the distribution of H1- and H2-receptors in central and peripheral airways. Tags: Animal; Female; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. Desc.: Aerosols; *Airway Resistance--Drug Effects (DE); Atropine--Pharmacodynamics (PD); Functional Residual Capacity; *Histamine--Pharmacodynamics (PD); Lung--Physiology (PH); *Receptors, Histamine H1--Physiology (PH); *RECEPT H1--Physiology (PH); *Receptors, Histamine H2--Physiology (PH); *RECEPT H2--Physiology (PH); *Receptors, Histamine--Physiology (PH); Respiration; Sheep CAS Registry No.: 51-45-6 (Histamine); 51-55-8 (Atropine) Y004154 137 0300228 81030228 Cystic fibrosis and bronchial hyperreactivity. Concomitant defects or cause and effect Burdon JG; Cade JF; Sutherland PW; Pain MC Med J Aust, Jul 26 1980, 2 (2) p77-8, ISSN 0025-729X Jrnl Code: M26 Lang.: ENG. Jrnl Ann.: 8102 Subfile: INDEX MEDICUS Bronchial reactivity and lung-function tests were measured in 19 young adults with cystic fibrosis. There was moderately severe airways obstruction without hyperinflation, and mild hypoxaemia with normocapnia. Bronchial reactivity (fall in FEV1 after the administration of methacholone aerosol) was increased in about two-thirds of patients, and was markedly enhanced in nearly half of them. It was considered that the airways obstruction characteristic of cystic fibrosis can have a reversible element, and that this may provide a rationale for the use of bronchodilators in some patients. Although bronchial hyperreactivity in cystic fibrosis could represent concomitant underlying defects, a more attractive suggestion is that the chronic inflammation of cystic fibrosis has, in turn, led to acquired bronchial hyperreactivity. Tags: Female; Human; Male Desc.: Adolescence; Adult; Airway Obstruction--Chemically Induced (CI); Bronchi--Drug Effects (DE); Bronchial Provocation Tests; BP TESTS; *Cystic Fibrosis--Physiopathology (PP); Lung Volume Measurements; *Lung--Physiopathology (PP); Methacholine Compounds--Pharmacodynamics (PD) METHACHOLINE CPDS--Pharmacodynamics (PD) Y004154 138 289800 81019800 The role of respiratory muscles in the hyperinflation of bronchial asthma. Martin J; Powell E; Shore S; Emrich J; Engel LA Am Rev Respir Dis, Mar 1980, 121 (3) p441-7, ISSN 0003-0805 Jrnl Code 426 Lang.: ENG. Jrnl Ann.: 8101 Subfile: AIM; INDEX MEDICUS To examine the mechanism of hyperinflation in bronchial asthma we studied lung and chest wall mechanics in 7 asymptomatic patients in whom progressive bronchoconstriction was induced by doubling the amount of inhaled aerosolized histamine. An increase in pulmonary resistance (RL) from 2.5 +/- 0.3 cmH2O . 1-1 . s (mean, +/- 1 SE) to 12.3 +/- 0.9 cmH2 was associated with a linear increase in functional residual capacity (FRC) up to 74.7 +/- 1.7% of control total lung capacity (TLCc). The mean regression coefficient was 2.3% TLCc . cmH2O-1 . 1 . s-1. At each level of hyperinflation the most positive expiratory pleural pressures measured during spontaneous breathing were generally less than the predicted chest will relaxation pressures, indicating persistent inspiratory muscle contraction throughout expiration. This was predominantly due to inspiratory intercostal and accessory muscle activity, because measurements of transdiaphragmatic pressure indicated complete diaphragmatic relaxation early in expiration. Recruitment of abdominal muscles during expiration, inferred from measurements of gastric pressure (Pg) and abdominal antero-posterior (A-P) diameter, was progressively more apparent with increasing bronchoconstriction. We concluded that the increase in FRC in induced asthma is substantially influenced by persistent inspiratory intercostal and accessory muscle activity during expiration. Concomitant abdominal muscle recruitment results in a chest wall configuration that tends to optimize diaphragmatic function. Tags: Human; Support, Non-U.S. Gov't Desc.: Abdomen--Physiopathology (PP); Adult; Airway Resistance; *Asthma--Physiopathology (PP); Branchi--Physiopathology (PP); Constriction, Pathologic; *Diaphragm--Physiopathology (PP); Forced Expiratory Volume; *Functional Residual Capacity; *Intercostal Muscles--Physiopathology (PP); *Lung Volume Measurements; Middle Age; Pleura--Physiopathology (PP); Pressure; Total Lung Capacity ŠY004154 139 0279039 81009039 Recurrent lobar atelectasis due to acquired bronchial stenosis in neonates. Nagaraj HS; Shott R; Fellows R; Yacoub U J Pediatr Surg, Aug 1980, 15 (4) p411-5, ISSN 0022-3468 Jrnl Code: JMJ Lang.: ENG. Jrnl Ann.: 8101 Subfile: INDEX MEDICUS Bronchial obstruction by granulation tissue caused atelectasis in ten infants who required frequent suctioning and mechanical ventilation for more than 20 days. The endotracheal suctioning had been performed with a No. 6 or No. 8 French catheter with multiple end and side holes at the tip. Bronchoscopic examination revealed nodular and polypoid granulation at the level of the carina and bronchus, more often on the right side. In five infants, atelectasis was treated with gentle, less frequent suctioning and vigorous pulmonary toilet. Two of these infants died of severe atelectasis and chronic lung disease. Five infants underwent excision or cauterization of granulation tissue. Histopathologic examination of this tissue disclosed inflammation, fibrosis, and squamous metaplasia in each of the five specimens. Eight of the ten infants are alive without symptoms, the oldest being 27 months. Prevention may require critical analysis of suction techniques and the catheter tips employed. Whistle tip catheters should be avoided. Mild obstructive lesions can be managed by gentle and less frequent suctioning and aggressive pulmonary care, but severe obstruction, as determined by a compromise of the lumen of greater than 20%, may require excision or cauterization. Tags: Human Desc.: *Atelectasis--Etiology (ET); Atelectasis--Pathology (PA); Bronchi--Pathology (PA); *Bronchial Diseases--Etiology (ET); Bronchial Diseases--Pathology (PA); Constriction, Pathologic; Infant, Newborn; *Infant, Newborn, Diseases--Etiology (ET); Infant, Newborn, Diseases--Pathology (PA); *Intubation, Intratracheal--Adverse Effects (AE) Lung--Pathology (PA); Recurrence Y004154 140 0249184 80249184 Ventilatory response to transient hyperoxia in head injury hyperventilation. Leitch AG; McLennan JE; Balkenhol S; McLaurin RL; Loudon RG J Appl Physiol, Jul 1980, 49 (1) p52-8, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8012 Subfile: INDEX MEDICUS We have measured breath-by-breath instantaneous minute ventilation (VIinst) before, during, and after the administration of 10 breaths of 100% oxygen to seven male patients with head injury hyperventilation. The patients were hypoxemic (PaO2 61.2 +/- 6.3) and hypocapnic (PaCO2 26.6 +/- 5.9) with a respiratory alkalosis (pH 7.53 +/- 0.06) while breathing air. Following the oxygen VIinst fell on the average by 40 +/- 12.7% from 16.06 +/- 3.75 1.min-1 to a minimum of 9.73 +/- 3.20 1.min-1 at 20.4 +/- 2.9 s after the first breath of oxygen. In the majority of our hyperventilating patients, almost all of the resting hyperventilation could be abolished transiently by 100% oxygen. This fall in ventilation represents the peripheral chemoreceptor contribution to resting ventilation and is increased in the head injury patients in comparison with normal subjects breathing air or hypoxic gas mixtures, altitude-acclimatized subjects and patients who are hypoxic because of chronic bronchitis or interstitial lung disease. We suggest that the increased reflex hydoxic drive to ventilation found in our patients is secondary to their cerebral injury, resulting in a reduction of descending cortical inhibitory influences on the medullary respiratory control centers. Tags: Human; Male Desc.: Adolescence; Adult; Aged; Anoxia--Physiopathology (PP); *Brain Injuries--Physiopathology (PP); Carbon Dioxide--Blood (BL); Chemoreceptors--Physiopathology (PP); *Hyperventilation--Physiopathology (PP); Middle Age; Oxygen Inhalation Therapy; *Oxygen--Blood (BL) CAS Registry No.: 7782-44-7 (Oxygen) Y004154 141 0236150 80236150 Dexamethasone-isonicotinate aerosol in the long-term treatment of steroid-dependent asthmatic children. Manicatide MA; Nicolaescu VV; Stroscu V; Voiculescu M Med Interne, Apr-Jun 1980, 18 (2) p103-10, ISSN 0377-1202 Jrnl Code: T3B Lang.: ENG. Jrnl Ann.: 8011 Subfile: INDEX MEDICUS Dexamethasone-isonicotinate aerosol (DIA) was administered to twenty-nine steroid-dependent children with chronic perennial asthma, in an open trial during one year. An attempt was made to withdraw systemic corticosteroid therapy. As judged by clinical results, inhaled dexamethasone-isonicotinate controlled the asthma quite as well as did previous therapy. Oral corticosteroids were withdrawn in 27 patients, and the dosage considerably reduced in another two. Cushingoid features subsided. There was a statistically significant improvement in most pulmonary function parameters (airway obstruction and lung hyperinflation were reduced towards normal). Reduction of systemic steroid dosage resulted in the appearance of previously suppressed manifestations such as hay fever, eczema, and nasal polyps. There was no increased tendency to the occurrence of respiratory tract infection; routine examination showed Candida albicans in about 37% cultures. Tags: Female; Human; Male Desc.: Adolescence; Aerosols; *Asthma--Drug Therapy (DT); Asthma, Exercise-Induced--Drug Therapy (DT); Bronchodilator Agents--Therapeutic Use (TU); Child; Chronic Disease; *Dexamethasone Isonicotinate--Therapeutic Use (TU); *Dexamethasone--Analogs and Derivatives (AA); Dosage Forms; Drug Evaluation; Histamine Antagonists--Therapeutic Use (TU); HISTAMINE ANTAG--Therapeutic Use (TU); Respiratory Function Tests CAS Registry No.: 226-64-7 (Dexamethasone Isonicotinate); 50-02-2 (Dexamethasone) Y004154 142 0218768 80218768 The effect of focal twitching on the intracranial pressure during paralysis and mechanical ventilation. Tsementzis SA; Gillingham FJ; Hitchcock ER Ann Clin Res, Dec 1979, 11 (6) p253-7, ISSN 0003-4762 Jrnl Code: 53A Lang.: ENG. Jrnl Ann.: 8010 Subfile: INDEX MEDICUS Three patients with head injuries developed minor facial twitching while their intracranial, intrathoracic and systemic arterial pressures were being monitored and they were on mechanical ventilation. These twitches were disclosed by the coincided great and damaging increases in the intracranial pressure, while the intrathoracic and arterial pressures were virtually unchanged. The intracranial hypertension was attributed to cerebral vasodilatation which was presumed to be due to the accumulation of cerebral metabolites since other causative factors such as systemic hypertension and hypoxia were under control. Cerebral elastance modulated the rise in intracranial pressure. Tags: Case Report; Human; Male Desc.: Acid-Base Equilibrium; Adolescence; Adult; Blood Pressure; Cerebrovascular Circulation; Child; *Epilepsy, Focal--Etiology (ET); Epilepsy, Focal--Physiopathology (PP); Epilepsy, Focal--Therapy (TH); *Head Injuries--Complications (CO); Head Injuries--Physiopathology (PP); Head Injuries--Therapy (TH); *Intermittent Positive Pressure Ventilation; *Intracranial Pressure; *Paralysis--Etiology (ET); Paralysis--Physiopathology (PP); Paralysis--Therapy (TH); *Positive Pressure Respiration; Vasodilation Y004154 143 0213246 80213246 ŠInspiratory muscle activity during induced hyperinflation. Martin JG; Habib M; Engel LA Respir Physiol, Mar 1980, 39 (3) p303-13, ISSN 0034-5687 Jrnl Code: R88 Lang.: ENG. Jrnl Ann.: 8010 Subfile: INDEX MEDICUS We studied the relationship between inspiratory muscle activity and lung volume in 5 normal subjects in whom hyperinflation to 78-8?% VC was induced with exgernal expiratory resistances. While breathing at this high lung volume the most negative pleural pressure (Ppl) during inspiration was -23.4 +/- 2.3 cm H2O (mean +/- 1 SE), whereas the maximum expiratory Ppl was -4.2 +/- 1.6 in four and +31 cm H2O in one subject. Using relaxation pressure-volume curves of the chest wall, we reasoned that in the 4 subjects inspiratory muscles showed a substantial persistence of activity throughout expiration. The minimum inspiratory mu~rscle force (Pmu) during expiration was 35.9 +/- 8.4% of the peak inspiratory Pmus. Similarly, the work of the inspiratory muscles in expiration was 57.8 +/- 9.5% of the work during inspiration. In all 5 subjects the diaphragm relaxed almost completely in expiration, as evidenced by the transdiaphragmatic pressure (Pdi), which fell during expiration to 10.0 +/- 4.1% of the peak inspiratory Pdi. Inspiratory intercostal and scalene electromyographic recordings, obtained in 3 subjects, demonstrated substantial activity in expiration. We conclude that during external, resistive, expiratory loading the volume of hyperinflation is influenced by persistent activity of inspiratory muscles in expiration, and that this is due largely to the inspiratory intercostal and accessory muscles rather than the diaphragm. Tags: Female; Human; Male Desc.: Diaphragm--Physiology (PH); Forced Expiratory Flow Rates; Functional Residual Capacity; Inspiratory Capacity; *Intercostal Muscles--Physiology (PH); Intermittent Positive Pressure Breathing; Pleura--Physiology (PH); *Respiration; Tidal Volume; Work of Breathing Y004154 144 0200460 80200460 Comparison of haemodynamic responses to positive-end-expiratory ventilation and pericardial effusion in dogs. Rabkin SW; Morris AL; Sharma GP; Ayotte B Clin Exp Pharmacol Physiol, Mar-Apr 1980, 7 (2) p183-93, ISSN 0305-1870 Jrnl Code: DD8 Lang.: ENG. Jrnl Ann.: 8010 Subfile: INDEX MEDICUS 1. The haemodynamic responses to progressive increments in positive end-expiratory pressure ventilation (PEEP) were assessed in dogs in the presence and absence of pericardial effusion (2.2 ml saline/kg). 2. Increasing levels of PEEP (3, 4, 8, 16 cm H2O) were associated with increases in right atrial, left atrial, pericardial and pulmonary artery diastolic pressure; increases in pulmonary vascular resistance; decreases in aortic blood pressure; and decreases in cardiac index or stroke index. 3. Pericardial effusion that was associated with an increase in pericardial pressure of 3 mmHg was not associated with significant changes in aortic blood pressure or stroke index. In contrast 8 cm PEEP was associated with significant decreases in both these hemodynamic variables yet pericardial pressure increased only 2.2 mmHg. 4. For these levels of PEEP and pericardial effusion, the same haemodynamic response to PEEP was observed regardless of the presence or the absence of pericardial effusion. 5. Similar changes in aortic blood pressure and stroke index despite different pericardial pressures is reflected by significantly different intercepts in the linear model relating these haemodynamic variables to pericardial pressure in the presence and absence of pericardial effusion. 6. The results suggest that these haemodynamic consequences of PEEP are primarily a function of pulmonary hyperinflation and are less dependent on increases in extracardiac pressure per se. Tags: Animal; Comparative Study; Female; Male Desc.: Blood Pressure; Cardiac Output; Dogs; Heart Rate; *Hemodynamics; *Pericardial Effusion; *Positive Pressure Respiration; Pressure; Stroke Volume Y004154 145 0196442 80196442 Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Donegan MF; Bedford RF Anesthesiology, Jun 1980, 52 (6) p516-8, ISSN 0003-3022 Jrnl Code: 4SG Lang.: ENG. Jrnl Ann.: 8009 Subfile: AIM; INDEX MEDICUS Tags: Human Desc.: *Brain--Physiopathology (PP); *Hypertension--Prevention and Control (PC); Injections, Intravenous; *Intubation, Intratracheal; *Lidocaine--Administration and Dosage (AD); Lidocaine--Therapeutic Use (TU) CAS Registry No.: 137-58-6 (Lidocaine) Y004154 146 0193042 80193042 Surperiosteal hematomas of the orbit in young males: a serious complication of trauma or surgery in the eye region. Wolter JR Trans Am Ophthalmol Soc, 1979, 77 p104-20, ISSN 0065-9533 Jrnl Code: W49 Lang.: ENG. Jrnl Ann.: 8009 Subfile: INDEX MEDICUS Three examples of subperiosteal hematomas in the region of the orbital roof of young males are used to demonstrate the unpredictable appearance, the obscure nature, the complications, and the treatment of this process. One occurred in a 14-year-old boy following blunt head trauma and was cured by aspiration. The second occurred in a 16-year-old boy also resulted from blunt head trauma; it was associated with a large subgaleal hematoma and caused permanent blindness of the involved eye. The third case developed in an 18-year-old male as a complication of acute purulent endophthalmitis following an intraocular foreign body. The purpose of this report is to separate subperiosteal hematoma on the roof of the orbit of young males from the other orbital hematomas to show that it is a concise clinical entity with its own typical history, appearance, and treatment. Tags: Case Report; Female; Human; Male Desc.: Adolescence; Adult; Blindness--Etiology (ET); Exophthalmos--Etiology (ET); Eye Foreign Bodies--Complications (CO); Eyelids; *Head Injuries--Complications (CO); Hematoma--Etiology (ET); *Hematoma--Surgery (SU); Infant; Middle Age; *Ophthalmia--Complications (CO); *Orbit--Surgery (SU); Scalp--Surgery (SU); Suction; Tomography, X-Ray Computed Y004154 147 0192452 80192452 Effects of lobectomy on lung function. Berend N; Woolcock AJ; Marlin GE Thorax , Feb 1980, 35 (2) p145-50, ŠISSN 0040-6376 Jrnl Code: VQW Lang.: ENG. Jrnl Ann.: 8009 Subfile: INDEX MEDICUS The effect of lobectomy on lung function was investigated in 16 patients in whom comprehensive lung function tests were performed before and between six weeks and six months after lobectomy. The operation was well tolerated even by patients with quite severe airways obstruction. The effect of lobectomy on forced flow rates was in keeping with the change in lung volumes. There was no alteration in the distribution of ventilation and the diffusion capacity remained unchanged. The changes in the pressure volume curves were difficult to explain. All patients, even those with nearly "complete" hyperinflation of the remaining lung, had appreciable increases in maximal intrapleural pressure at full inspiration. Tags: Female; Human; Male Desc.: Aged; Airway Obstruction--Surgery (SU); *Lung--Physiopathology (PP); Middle Age; *Pneumonectomy; Postoperative Period; POSTOP PERIOD; Respiratory Function Tests Y004154 148 175852 80175852 The role of respiratory mechanics in reducing the ventilatory response to CO2. Pride NB Bull Eur Physiopathol Respir, 1979, 15 (Suppl) p75-83, ISSN 0395-3890 Jrnl Code: BGX Lang.: ENG. Jrnl Ann.: 8009 Subfile: INDEX MEDICUS The overall relation between intrapulmonary airflow obstruction and hypercapnia possibly reflects the need to compensate for expiratory obstruction by increasing the work done by the inspiratory muscles. Pleural pressure swings during CO2 rebreathing can be nearly as large in patients with airflow obstruction as in normal subjects. They produce less ventilation not only because of the reduced dynamic compliance and increased inspiratory airways resistance, but because end-expired volume often increases during rebreathing. The increase in end-expired volume also restricts the possible increase in tidal volume. The load on the inspiratory muscles is probably greater in severe airflow obstruction than in lung fibrosis, but it is not clear why PCO2 levels vary so widely amongst patients with severe airflow obstruction. In chronic airflow obstruction hypercapnia is associated with low dynamic compliance and small tidal volume, but similar change are found in severe asthma. The extent to which inspiratory muscles can compensate for hyperinflation is uncertain. Y004154 149 0173275 80173275 Chances in total lung/thorax compliance following chest physiotherapy. Mackenzie CF; Shin B; Hadi F; Imle PC Anesth Analg (Cleve), Mar 1980, 59 (3) p207-10, ISSN 0003-2999 Jrnl Code: 4R8 Lang.: ENG. Jrnl Ann.: 8008 Subfile: AIM; INDEX MEDICUS To quantitate and obtain objective assessment of the effect of secretion clearance following chest physiotherapy (CPT), total lung/thorax complicance (CT) was calculated immediately before and for 2 hours after one treatment with CPT. Forty-two patients who were mechanically ventilated because of respiratory failure were studied. Therapy averaged 57 minutes and included postural drainage, percussion, vibration, and endotracheal suctioning. The increase in CT following CPT was statistically significant (p less than 0.01) and remained so for at least 2 hours after CP. There was no difference in the degree to which CT changed in patients with different indications for CPT or in patients ventilated with positive end-expiratory pressure. Largest mean values for CT were obtained 2 hours following CPT, the duration of our measurement of CT. Chest x-ray identification of affected areas of lung before CPT is necessary to allow the physiotherapist to produce the CT changes noted in this study. CT, which can be readily calculated from many recently designed ventilators, may be monitored during CPT to evaluate the efficacy of treatment and to quantitate the effect of secretion clearance following CPT. Duration of CPT should be determined by CT and auscultation. Tags: Female; Human; Male Desc.: Adolescence; Adult; Aged; *Lung Compliance; Middle Age; *Respiration, Artificial; Respiratory Insufficiency--Physiopathology (PP); Respiratory Insufficiency--Therapy (TH); *Respiratory Therapy; Time Factors Y004154 150 0166632 80166632 Pulmonary function abnormalities in thalassemia patients on a hypertransfusion program. Keens TG; O'Neal MH; Ortega JA; Hyman CB; Platzker AC Pediatrics, May 1980, 65 (5) p1013-7, ISSN 0031-4005 Jrnl Code: OXV Lang.: ENG. Jrnl Ann.: 8008 Subfile: AIM; INDEX MEDICUS Pulmonary function tests were performed in 12 thalassemia patients on a hypertransfusion program (age 18.4 +/- 2.6 SEM years) to determine the presence of any abnormalities of lung function. These included spirometry, expiratory flow rates, body plethysmography, single-breath nitrogen washout, single breath carbon monoxide diffusing capacity, and arterial blood gases. Only one patient had normal pulmonary function. Arterial hypoxemia was present in ten of 12 patients at rest. The total lung capacity (TLC) was normal. The residual volume was abnormally increased in five of 12 patients. The slope of phase III of single breath nitrogen washout curve was abnormal in five of 12 patients, but the closing volume was normal. The maximal expiratory flow rate at 60% total lung capacity was decreased in four of 12 patients, suggesting the presence of small airway disease. The single breath carbon monoxide diffusing capacity was normal in all patients. These pulmonary function abnormalities did not correlate with age or the cumulative amount of iron via blood transfused. The small airway obstruction, hyperinflation; and hypoxemia observed in thalassemia patients on a hypertransfusion program may result from the basic disease, iron deposition in the lungs, or other factors. Tags: Female; Human; Male Desc.: Adolescence; Adult; Airway Resistance; Blood Gas Analysis; *Blood Transfusion; Child; Closing Volume; Forced Expiratory Flow Rates; Forced Expiratory Volume; *Lung--Physiopathology (PP); Maximal Expiratory Flow-Volume Curves; Peak Expiratory Flow Rate; Plethysmography, Whole Body Pulmonary Diffusing Capacity; *Thalassemia--Physiopathology (PP); Thalassemia--Therapy (TH); Total Lung Capacity Y004154 151 0144536 80144536 Transient bacteremia following endotracheal suctioning in ventilated newborns. Storm W Pediatrics, Mar 1980, 65 (3) p487-90, ISSN 0031-4005 Jrnl Code: OXV Lang.: ENG. Jrnl Ann.: 8007 ŠSubfile: AIM; INDEX MEDICUS Endotracheal suctioning is a routine procedure in ventilated newborns. A study of ten neonates demonstrates the association of transient bactereia with endotracheal suctioning. This complication in ventilated newborns, with colonization of the respiratory tract by the same organism, must be considered in the pathogenesis of systemic infection. Tags: Female; Human; Male Desc.: Infant, Newborn; *Infant, Newborn, Diseases--Etiology (ET); Infant, Premature, Diseases--Etiology (ET); *Intubation, Intratracheal--Adverse Effects (AE); *Respiration, Artificial--Adverse Effects (AE); *Septicemia--Etiology (ET) Y004154 152 0141389 80141389 [Current status of aseptic management of endotracheal suction] Hayashi S Kango , Dec 1979, 31 (12) p75-83, ISSN 0022-8362 Jrnl Code: KU1 Lang.: JAPANESE Jrnl Ann.: 8007 Subfile: Nursing Tags: Human Desc.: *Antisepsis; *Asepsis; Pseudomonas Infections--Prevention and Control (PC); *Suction; *Tracheotomy Y004154 153 0136854 80136854 The effectiveness of two preoxygenation methods to prevent endotracheal suction-induced hypoxemia. Skelley BF; Deeren M; Powaser MM Heart Lung , Mar-Apr 1980, 9 (2) p316-23, Jrnl Code: G2? Lang.: ENG. Jrnl Ann.: 8007 Subfile: AIM; INDEX MEDICUS Tags: Animal; Human Desc.: Adult; Aged; *Anoxemia--Prevention and Control (PC); Blood Pressure; Dogs; Heart Rate; *Intubation, Intratracheal; Middle Age; *Models, Biological; *Oxygen Inhalation Therapy; Respiratory Function Tests ; *Suction Y004154 154 0099918 80099918 Mechanisms of hyperventilation in head injury: case report and review. Leitch AG; McLennan JE; Balkenhol S; Loudon RG; McLaurin RL Neurosurgery, Dec 1979, 5 (6) p701-7, ISSN 0148-396X Jrnl Code: NZL Lang.: ENG. Doc. Type: Review Jrnl Ann.: 8006 Subfile: INDEX MEDICUS We report the case of a head-injured patient with spontaneous hyperventilation who had recurrent episodes of relative hypoventilation associated with increases in intracranial pressure. Detailed ventilatory studies were performed during the 2nd week after injury. Our findings in this patient prompted us to review the possible mechanisms underlying the observed changes. We suggest that spontaneous hyperventilation in head injury is secondary to a decrease in cortical inhibitory influences on respiratory control mechanisms and that the transient episodes of relative hypoventilation observed in our patient may reflect modified ventilatory responses dependent on the altered state of consciousness. (Neurosurgery, 5: 701-707, 1979). (62 Refs.) Tags: Case Report; Female; Human Desc.: Adult; Brain Concussion--Complications (CO); Brain Edema--Etiology (ET); Brain Edema--Physiopathology (PP); *Brain Injuries--Complications (CO); Brain Injuries--Physiopathology (PP); Brain Stem--Injuries (IN); Cerebral Cortex--Physiopathology (PP); Cheroreceptors--Physiopathology (PP); Diencephalon--Physiopathology (PP); Glycerin--Therapeutic Use (TU); *Hyperventilation--Etiology (ET); Hyperventilation--Physiopathology (PP); Intracranial Pressure; *Reflex, Abnormal--Physiopathology (PP); Vagus Nerve--Physiopathology (PP); Ventilation-Perfusion Ratio Y004154 155 0074372 80074372 Subperiosteal hematomas of the orbit in young males: a serious complication of trauma or surgery in the eye region. Wolter JR J Pediatr Ophthalmol Strabismus, Sep-Oct 1979, 16 (5) p291-6, ISSN 0191-3913 Jrnl Code: JMI Lang.: ENG. Jrnl Ann.: 8004 Subfile: INDEX MEDICUS Three documented cases of subperiosteal hematomas in the region of the orbital roof of young males are used to demonstrate the unpredictable appearance, the obscure nature, the complications and the treatment of this process. One case occurred in a 14-year-old boy following blunt head trauma and was cured by aspiration. The second case, in a 16-year-old boy, also resulted from blunt head trauma; it was associated with a large subgaleal hematoma and caused permanent blindness of the involved eye. The third case developed in an 18-year-old male as a complication of acute purulent endophthalmitis following in intraocular foreign body. The aim of this study is to separate subperiosteal hematomas and to show that it is a concise clinical entity with its own typical history, appearance and treatment. Tags: Case Report; Human; Male Desc.: Adolescence; Blindness--Etiology (ET); Exophthalmos--Etiology (ET); *Eye Foreign Bodies--Complications (CO); Eye Foreign Bodies--Radiography (RA); Eye Foreign Bodies--Surgery (SU); *Head Injuries--Complications (CO); Hematoma--Complications (CO); Hematoma--Radiography (RA); *Hematoma--Surgery (SU); Infant; *Orbit--Injuries (IN); Orbit--Surgery (SU); Suction; Tomography, X-Ray Computed ŠY004154 156 0071835 80071835 Antigen-induced bronchospasm in conscious sheep. Wanner A; Mezel RJ; Reinhart ME; Eyre P J Appl Physiol, Nov 1979, 47 (5) p917-22, ISSN 0161-7567 Jrnl Code: HAL Lang.: ENG. Jrnl Ann.: 8004 Subfile: INDEX MEDICUS In 10 conscious ewes with cutaneous sensitivity to Ascars suum, measurements of pulmonary resistance (RL), static lung compliance (Cst), functional residual capacity (FRC), and arterial blood gas composition along with arterial plasma histamine concentration (H) were obtained before and after inhalation challenge with A. suum extract. Five animals showed no changes in respiratory mechanics after A. suum challenge; in these H did not change. The remaining five animals responded to A. suum challenge with bronchospasm reflected by the following maximum changes in mean values that were significant 15 and 30 min after beginning of challenge, respectively: RL 248, FRC 126%, specific pulmonary conductance 33%, and arterial PO2 63% of base line. These parameters returned towards base line by 120 min. No changes occurred in Cst, arterial PCO, and pH. Five minutes after beginning of A. suum challenge, mean H was increased to 423% of base line with a return to base line 10 min later. In the same 5 animals, no changes were observed in pulmonary function or H after inhalation of ragweed extract (control). These results suggest that antigen-induced bronchospasm in sensitized conscious sheep represents an anaphylactic airway response and shares distinct physiological features with human bronchial asthma including pulmonary hyperinflation Tags: Animal; Female; Support, U.S. Gov't, P.H.S. Desc.: *Airway Resistance; Allergens--Administration and Dosage (AD); Ascaris--Immunology (IM); Bronchial Spasm--Blood (BL); *Bronchial Spasm--Physiopathology (PP); Functional Residual Capacity; *Histamine--Blood (BL); Lung Compliance; *Lung--Physiopathology (PP); Sheep--Physiology (PH); Wakefulness--Physiology (PH) Y004154 157 0042827 80042827 I.c.p. increases with 50% nitrous oxide in oxygen in severe head injuries during controlled ventilation. Moss E; McDowall DG Br J Anaesth, Aug 1979, 51 (8) p757-61 ISSN 0007-0912 Jrnl Code: AUO Lang.: ENG. Jrnl Ann.: 8003 Subfile: INDEX MEDICUS In a randomized trial nitrous oxide 50% in oxygen (Entonox) or oxygen 100% was given during chest physiotherapy on 23 occasions to three mechanically ventilated patients with severe head injuries. Intracranial pressure (i.c.p.) increased by 22.7 mm Hg (SD 10.62) during chest physiotherapy with Entonox, compared with 10.5 mm Hg (SD 10.4) with oxygen 100% (P greater than 0.02). A further nine mechanically ventilated patients with severe head injuries were given Entonox without chest physiotherapy. There was a mean increase in i.c.p. of 3.8 mm Hg (SD 2.4) (P less than 0.001) when Entonox was given, and a mean decrease of 4.6 mm Hg (SD 2.8) when the nitrous oxide was withdrawn. End-tidal carbon dioxide concentration showed almost no change during nitrous oxide administration (decrease of 0--0.1%). We conclude that nitrous oxide causes an increase in i.c.p. in patients with severe head injuries and exacerbates the increases in i.c.p. occurring during chest physiotherapy. Tags: Human Desc.: Anesthesia, Inhalation; *Head Injuries--Physiopathology (PP) ; Head Injuries--Therapy (TH); *Intermitment Positive Pressure Ventilation *Intracranial Pressure--Drug Effects (DE); *Nitrous Oxide--Pharmacodynamics (PD); *Oxygen--Pharmacodynamics (PD); Physical Therapy; *Positive Pressure Respiration; Random Allocation; Stimulation, Chemical Y004154 158 0033919 80033919 Cerebral resuscitation in near-drowning. Conn AW; Edmonds JF; Barker GA Pediatr Clin North Am, Aug 1979, 26 (3) p691-701, ISSN 0031-3955 Jrnl Code: OUM Lang.: ENG. Jrnl Ann.: 802 Subfile: AIM; INDEX MEDICUS Tags: Human Desc.: Brain Death; *Brain Injuries--Prevention and Control (PC); Brain--Blood Supply (BS); *Cerebral Ischemia, Transient--Prevention and Control (PC); Child; *Drowning; Fever; Hyperkinesis; Hyperventilation; Hypothermia--Physiopathology (PP); Immersion; Muscle Rigidity; *Resuscitation; Time Factors; Water-Electrolyte Imbalance