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J J Votto

Publications and source records attributed to J J Votto.

12 recordsLinked to original sources
PubMed2005

Weaning from long-term mechanical ventilation.

As many as 5% of patients who need mechanical ventilation will require prolonged mechanical ventilation (PMV). The cost of their care and its associated morbidity is alarming; however, good outcomes can be achieved when their care is specialized and delivered in a programmatic manner. In this article, we review some of the common and potentially reversible reasons why patients fail successfully liberation from mechanical ventilation. We examine the outcomes of patients requiring PMV and present evidence that supports the development of specialized units where patients can be cohorted and may produce better outcomes than would be likely if these patients remained in the ICU.

Acute Kidney Injury↗
PubMed2001

Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury.

OBJECTIVE: To evaluate the effects of functional electric stimulation (FES) of lower limb muscles during 30 minutes of upright standing on the central and peripheral hemodynamic response in persons with spinal cord injury (SCI). DESIGN: A repeated-measure design. Subjects were used as their own control and underwent 2 testing protocols of FES-augmented standing (active standing) and non-FES standing (passive standing). SETTING: Rehabilitation hospital. PARTICIPANTS: Fourteen individuals with SCI (7 with tetraplegia, 7 with paraplegia). INTERVENTIONS: During active standing, FES was administered to 4 muscle groups of each leg in an overlapping fashion to produce a pumping mechanism during standing. During passive standing, subjects stood for 30 minutes using a standing frame with no FES intervention. MAIN OUTCOME MEASURES: Central hemodynamic responses of stroke volume, cardiac output, heart rate, arterial blood pressure, total peripheral resistance (TPR), and rate pressure product (RPP) were evaluated by impedance cardiography. All measurements were performed during supine and sitting positions before and after standing, and during 30 minutes of upright standing. RESULTS: Comparisons between the groups with paraplegia and tetraplegia showed a significant increase in heart rate in the paraplegics after 30 minutes of active standing. During active standing, paraplegics' heart rate increased by 18.2% (p = .015); during passive standing, it increased by 6% (p = .041). TPR in the tetraplegics significantly (p = .003) increased by 54% when compared with the paraplegics during passive standing. Overall, the tetraplegic group had a significantly lower systolic blood pressure (p = .013) and mean arterial pressure (p = .048) than the paraplegics during passive standing. These differences were not detected during active standing. When data were pooled from both groups and the overall groups response to active and passive standing were compared, the results showed that cardiac output, stroke volume, and blood pressure significantly decreased (p < .05) during 30 minutes of passive standing, whereas TPR significantly increased (p < .05). All of the hemodynamic variables were maintained during 30 minutes of active standing, and there were increases in RPP and heart rate after 30 minutes of active standing. CONCLUSION: FES of the lower extremity could be used by persons with SCI as an adjunct during standing to prevent orthostatic hypotension and circulatory hypokinesis. This effect may be more beneficial to those with tetraplegia who have a compromised autonomic nervous system and may not be able to adjust their hemodynamics to the change in position.

Adult↗
PubMed2000

Functional status and survival following pulmonary rehabilitation.

BACKGROUND: Functional exercise capacity has been shown to be a strong predictor of survival following pulmonary rehabilitation. This study evaluated whether questionnaire-rated functional status is also predictive of survival. PATIENTS AND METHODS: Following pulmonary rehabilitation, patients with advanced chronic lung disease were evaluated for survival, 6-min walk distance, and questionnaire-rated functional status. The latter was measured using the pulmonary functional status scale, which has subscores of functional activities, psychological status, and dyspnea. Information on survival was available on 149 patients. RESULTS: The mean age was 69 years, and 45% of patients were male. Eighty-nine percent had a diagnosis of COPD, and their FEV(1) was 37+/-18% of predicted. Ninety-one (61%) were married. The 3-year survival for the group was 85%. Age, gender, body mass index, and primary diagnosis were not related to survival. Variables strongly associated with increased survival following pulmonary rehabilitation included a higher postrehabilitation Functional Activities score, a longer postrehabilitation 6-min walk distance, and being married (vs widowed, single, or divorced). Disease severity variables associated with survival included an initial referral to outpatient pulmonary rehabilitation, no supplemental oxygen requirement, and a higher percent-predicted FEV(1). CONCLUSION: Indicators of functional status are strong predictors of survival in patients with advanced lung disease.

Aged↗
PubMed1999

Long-term benefits of short-stay inpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease.

The beneficial effects of pulmonary rehabilitation programmes on the overall quality of life in patients with chronic obstructive pulmonary disease (COPD) has been well documented. However, there has been a paucity of studies demonstrating the long-term benefits of short-stay inpatient pulmonary rehabilitation (SSIPR) programmes in patients with severe COPD (forced expiratory volume in one second (FEV1) < 40% of predicted). The authors have previously reported that their multidisciplinary SSIPR programme improved outcome measurements immediately post-rehabilitation in 38 patients with severe COPD. The purpose of this study was to evaluate the long-term (1-yr follow-up) benefits of SSIPR in these patients. The outcome measurements used were: timed 12-min walking distance, Borg dyspnoea scale, annual days of acute care hospitalization, and Pulmonary Functional Status Scale. All outcome measurements were significantly improved at 1 yr post-SSIPR as compared to pre-SSIPR values. The 12-min walking distance was significantly improved in patients 1 yr post-SSIPR (251 m) as compared to either pre-SSIPR (133 m, p < 0.0001) or immediately post-SSIPR (224 m, p < 0.01). The number of annual days of acute care hospitalization was reduced from 15.4 pre-SSIPR to 3.8 (p < 0.0001) 1 yr post-SSIPR. The Borg dyspnoea scale measurement showed improvement, both at rest and after 12 min walking at 1 yr post-SSIPR. Also, the Pulmonary Functional Status Scale analysis showed significant (p < 0.001) sustained improvement at 1 yr post-SSIPR as compared to pre-SSIPR. In conclusion, it has been demonstrated that long-term sustained outcome benefits can be achieved from a comprehensive short-stay inpatient pulmonary rehabilitation programme for patients with severe chronic obstructive pulmonary disease.

Aged↗
PubMed1998

Venous hemodynamics of the lower extremities in response to electrical stimulation.

OBJECTIVE: To evaluate the calf muscle pump function using an air plethysmograph (APG) applied to the lower leg of subjects during three different tiptoe exercises. DESIGN: A controlled trial design was selected to compare the hemodynamic effects of three exercise conditions on a group of able-bodied, healthy patients. SETTING: Testing was performed in an outpatient clinic at a rehabilitation hospital. SUBJECTS: Patient groups were selected from a convenience sample of 10 healthy volunteers with normal venous capacitance and no reflux, determined through impedance pleythysmography before the study. INTERVENTIONS: Three exercise conditions undertaken by each subject consisted of loaded and unloaded lower leg muscle contractions produced by (1) voluntary contraction (VOL), (2) electrical stimulation of the gastocnemius-soleus and tibialis anterior muscles (ES), and (3) combined ES and VOL (ES/VOL). MAIN OUTCOME MEASURE: Hemodynamic measurements of venous filling index upon standing from the supine (VFI), ejection fraction (EF), ejection volume (EV), residual volume (RV), and residual volume fraction (RVF) were recorded after each protocol. These results were used to compare the lower leg hemodynamic effects of the treatments. RESULTS: Combined ES/VOL single tiptoe exercise produced the highest EV (97.8mL), followed by VOL (80.6mL) and ES (51.7mL) (p < .0008). The EF was also highest for combined ES/VOL (73.1%), followed by VOL (64.5%) and ES (37.8%) (p < .0001). Ten tiptoe ES exercises produced the highest RV (96.2mL), followed by ES/VOL (44.7mL) and VOL (28.2mL) (p < .0001). RVF was also highest in the ES group (71%), followed by ES/VOL (33.4%) and VOL (22.8%) (p < .0001). CONCLUSION: Periodic single ES-induced calf muscle contractions produced significant muscle pump function and could be used to improve venous blood flow and reduce stasis in the lower leg. Continuous ES-induced contractions, on the other hand, could improve lower leg peripheral perfusion while eliciting the physiologic venous muscle pump. Higher RV and RVF after 10 ES-induced contractions in this sample of healthy subjects with normal VFI may be caused by an increase in arterial blood perfusion after repeated ES-induced contractions.

Adult↗
PubMed1997

A regional weaning center for patients requiring mechanical ventilation: an 18-month experience.

This report reviews the outcomes of patients on mechanical ventilation admitted to a new regional weaning center. We reviewed the records of 47 patients admitted to the weaning center over an 18-month period. All patients had a tracheostomy, were ventilator dependent, and considered difficult to wean by their referring physician. The mean days of ventilator dependence prior to transfer to our facility was 86 days, with a range of 21 to 332 days. Patients were admitted to a 12-bed weaning unit at our chronic disease and rehabilitation hospital and assessed by a multi-disciplinary team of physicians, nurses, and therapists. Thirty patients were successfully weaned from prolonged mechanical ventilation and subsequently discharged from our unit. These data indicate that the majority of difficult to wean patients admitted to our regional weaning center were successfully liberated from prolonged mechanical ventilation.

Aged↗
PubMed1995

Severe hypothermia in the elderly.

Hypothermia is not an uncommon clinical problem in the geriatric population. Several factors place elderly individuals at risk, including their reduced ability to sense and react to cold and their underlying medical conditions and medications. Successful detection and treatment of these patients involve an awareness of these risk factors and the characteristic physiology of the elderly, as well as an appreciation of the often controversial aspects of hypothermia management. Elderly victims of severe hypothermia have a particularly grave prognosis. We present one of the oldest reported survivors of severe hypothermia, and discuss some unique aspects of his presentation.

Aged↗
PubMed1987

A model of pulmonary granulomata induced by beryllium sulfate in the rat.

In humans beryllium is known to cause pulmonary granulomata which are histologically indistinguishable from sarcoidosis. There is some evidence in man that beryllium-induced pulmonary granulomata are immunologically mediated. We set out to develop an animal model to study the immunopathogenesis of beryllium-induced granulomatous lung disease. Beryllium sulfate (BeSO4) was injected intratracheally (i.t.) into F344 rats previously immunized to BeSO4. This results in well-formed, sarcoid-like lung granulomata at 6 weeks post BeSO4. There was a conspicuous presence at 4 weeks post BeSO4 of numerous, perivascularly located Langhans' giant cells which preceded the development of well-formed granulomas at 6 weeks. Rats were sacrificed at 4, 6, 8 and 12 weeks after i.t. BeSO4. At the time of sacrifice bronchoalveolar lavage (BAL) was performed; B and T (W3/25+ helper 0X8+ suppressor/cytotoxic) lymphocyte populations were quantitated and compared to lymphocyte populations obtained from lung tissue. Both B and T cells were significantly elevated in lung tissue post BeSO4. At 4 weeks when granulomata were just developing, a W3/25+ to 0X8+ ratio of 20:1 in lavage and 2:1 in lung tissue was seen. At 6 weeks when granulomata were well-formed there was a predominance of W3/25+ cells in lavage but not in lung tissue. At 8 and 12 weeks, when the granulomata were regressing, lavage fluid still contained a W3/25+ predominance in contrast to lung tissue which contained a predominance of 0X8+ cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗