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Biomedical subjects

D T Raphael

Publications and source records attributed to D T Raphael.

7 recordsLinked to original sources
PubMed2000

Acoustic reflectometry profiles of endotracheal and esophageal intubation.

BACKGROUND: Acoustic reflectometry can be used to create a "one-dimensional image" of a cavity, such as the airway and lung, with the image displayed as an area-length curve. This pilot study was undertaken to determine whether acoustic reflectometry could be used to distinguish between an endotracheal and an esophageal intubation. METHODS: Ten adult patients underwent general endotracheal anesthesia and neuromuscular blockade. The reflectometer wavetube was attached to an endotracheal tube, and a reflectometric profile was obtained of the endotracheal tube and the airway and lung cavity. After confirmation of tracheal intubation, a second endotracheal tube was placed in the esophagus. After four breaths were administered, a reflectometric profile of the endotracheal tube-esophagus cavity was obtained. RESULTS: The acoustic reflectometric profiles for tracheal and esophageal intubation profiles were distinctive and characteristic. For an endotracheal tube-airway cavity, the profile shows a constant cross-sectional area throughout the length of the endotracheal tube, followed by a rapid rise in the area past the carina. For an esophageal intubation, the profile shows constant cross-sectional area throughout the length of the endotracheal tube, followed by a sudden decrease in the cross-sectional area to zero. CONCLUSIONS: In this pilot study, acoustic reflectometry within seconds, and without resort to capnography, was able to generate characteristic and distinctive area-length profiles for both endotracheal and esophageal intubation. Acoustic reflectometry may have a role in the emergency imaging of the airway, and in the immediate detection of esophageal intubations, particularly in cases of cardiopulmonary arrest in which the usual techniques for confirmation of breathing tube placement fail.

Acoustics↗
PubMed1989

Resonance mode analysis for volume estimation of asymmetric branching structures.

The resonance conditions associated with the propagation of a harmonic wave within a rigid, lossless branching structure can be explicitly derived. In this study, exact resonance conditions are derived for multi-order, rigid, asymmetric branching structures. These are compared with resonance conditions for rigid, multi-order, symmetric branching structures which we reported previously. The effect of asymmetry on the form of the higher-order resonance condition is discussed. In the low-frequency range, the resonance condition can be modified into simpler forms which facilitate volume estimation of the branching structure. Two such volume approximation techniques are presented: (a) a fundamental frequency method, in which the lowest resonance frequency is inversely proportional to the structure volume, and (b) an effective-length method, in which an effective length is calculated for all branches distal to the first bifurcation. Equivalence of the two methods is demonstrated. An experimental study was performed to measure the resonance modes of several second-order glass models with asymmetric branching structures similar to those of mammalian lungs. The resulting volume estimates were in close agreement with the true volumes.

Acoustics↗
PubMed1988

A response algorithm for the low-pressure alarm condition.

A response algorithm consists of a logical sequence of maneuvers to be performed in response to a specific condition. With the advent of alarm-equipped monitors that alert anesthesiologists to the presence of potentially hazardous clinical conditions, a need has arisen to develop the corresponding alarm-oriented responses expected from anesthesiologists; this problem, however, has not been satisfactorily addressed in the literature. An algorithm is proposed that guides the anesthesiologist through the three limbs of the ventilation system--gas supply system, breathing circuit, and mechanical ventilator--in response to a low-pressure alarm condition during automatic mechanical ventilation. The three-limbed algorithm rapidly and efficiently localizes the likely cause of the low-pressure condition without compromising patient safety; in the event that the search for a cause is fruitless, a default mode of ventilation is employed. A discussion is provided of common causes (e.g., disconnections), alarm-defeating circumstances (false negatives), and potential algorithm-defeating situations (multiple faults).

Algorithms↗
PubMed1987

Ultrasound confirmation of endotracheal tube placement.

Real-time B-mode ultrasound imaging was performed in 24 intubated patients in order to confirm the correct placement of endotracheal tubes. The large acoustic impedance mismatch between the air within the endotracheal tube cuff and the tracheal wall could be bypassed by (1) use of a foam-cuffed Bivona endotracheal tube, or by (2) cuff inflation with saline instead of air. Optimal repositioning of the endotracheal tube could be done under direct visualization. Imaging of the foam-filled and saline-filled cuffs was easier in the longitudinal (sagittal) than in the transverse view, was enhanced by a slight longitudinal to-and-fro motion of the tube, and was often improved with the use of a stand-off pad. Cases of esophageal intubation were not considered. Use of a noninvasive imaging modality such as ultrasound will spare selected patients from the radiation exposure associated with a chest x-ray. This is of value in pregnant patients and in those requiring frequent chest radiographs for the sole purpose of confirming correct endotracheal tube placement. Limitations of the techniques are discussed.

Adult↗
PubMed1987

Volume estimation of symmetrical branching structures by resonance mode analysis.

An exact resonance condition is derived for rigid symmetric second-order bifurcating structures. In the low-frequency range, the resonance condition can be reduced into forms that facilitate volume estimation of bifurcating structures. Two such volume approximation techniques are presented: (1) a fundamental frequency method, in which the lowest resonant frequency is inversely proportional to the structure volume, and (2) an equivalent-length method, in which an equivalent length of two daughter branches is calculated for all branches distal to the first bifurcation. An experimental study to determine the resonance modes of seven bifurcating glass structures was performed. The volume estimates obtained by either method were in very close agreement with the true volumes.

Animals↗