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Biomedical subjects

J P Nolan

Publications and source records attributed to J P Nolan.

At least 19 recordsLinked to original sources
PubMed2006

Therapeutic hypothermia after cardiac arrest: a survey of practice in intensive care units in the United Kingdom.

A telephone survey was carried out on the use of hypothermia as part of the management of unconscious patients following cardiac arrest admitted to United Kingdom (UK) intensive care units (ICUs). All 256 UK ICUs listed in the Critical Care Services Manual 2004 were contacted to determine how many units have implemented therapeutic hypothermia for unconscious patients admitted following cardiac arrest, how it is implemented, and the reasons for non-implementation. Two hundred and forty-six (98.4%) ICUs agreed to participate. Sixty-seven (28.4%) ICUs have cooled patients after cardiac arrest, although the majority of these have treated fewer than 10 patients. The commonest reasons given for not using therapeutic hypothermia in this situation are logistical or resource issues, or the perceived lack of evidence or consensus within individual ICU teams.

Critical Care↗
PubMed2006

Critical care in the emergency department: monitoring the critically ill patient.

The aim of monitoring patients is to detect organ dysfunction and guide the restoration and maintenance of tissue oxygen delivery. Monitoring is a crucial part of the care of the critically ill patient in the emergency department as the physiological response to critical illness is linked strongly to outcome. As it is important to appreciate the limitations of monitoring systems and monitored data, and to understand that invasive monitoring may be hazardous, this review concentrates on the techniques used to monitor critically ill patients in the emergency department. End tidal carbon dioxide monitoring, pulse oximetry, arterial blood pressure monitoring, central venous pressure monitoring, continuous central venous oxygenation saturation monitoring, temperature monitoring, and urine output are discussed. Practitioners should be familiar with the physiology and technology underlying these monitoring techniques and be aware of the pitfalls in interpretation of monitored data.

Aged↗
PubMed2005

Does changing the configuration of a motor racing circuit make it safer?

OBJECTIVES: To assess the pattern of injuries presenting to a racing circuit medical centre in two three-year periods before and after two chicanes were built into the track. METHODS: Medical centre records were used to identify all patients assessed during the two time periods. Those referred to hospital were categorised by injury severity into three groups. RESULTS: The proportions of those attending the medical centre that were referred and admitted to hospital were the same in both periods (12-13% and 3% respectively). During the two study periods, the risk of a severe injury for a car driver decreased from 0.1% to 0.03% (p<0.05). For a motorcyclist, similar values were 0% and 0.2% (not significant). CONCLUSIONS: Chicanes have improved the safety of the racing circuit for car drivers, reducing the risk of injury.

Accident Prevention↗
PubMed2004

Effects of instilled combustion-derived particles in spontaneously hypertensive rats. Part I: Cardiovascular responses.

Epidemiological studies have reported statistically significant associations between the levels of ambient particulate matter (PM) and the incidence of morbidity and mortality, particularly among persons with cardiopulmonary disease. While similar effects have been demonstrated in animals, the mechanism(s) by which these effects are mediated are unresolved. To further investigate this phenomenon, the cardiovascular and thermoregulatory effects of an oil combustion-derived PM (HP-12) were examined in spontaneously hypertensive (SH) rats. The particle used in this study had considerably fewer water-soluble metals than the residual oil fly ash (ROFA) particles widely used in previous animal toxicity studies, with Zn and Ni constituting the primary water-leachable elements in HP-12. Rats were surgically implanted with radiotelemeters capable of continuously monitoring electrocardiogram (ECG), heart rate (HR), systemic arterial blood pressure (BP), and core temperature (T(co)). Animals were divided into four dose groups and were administered one of four doses of HP-12 suspended in saline vehicle (0.00, 0.83, 3.33, 8.33 mg/kg; control, low, mid, and high dose, respectively) via intratracheal instillation (IT). Telemetered rats were monitored continuously for up to 7 days post-IT, and were sacrificed 4 or 7 days post-IT. Exposures to mid- and high-dose HP-12 induced large decreases in HR (decreasing 30-120 bpm), BP (decreasing 20-30 mmHg), and T(co) (decreasing 1.2-2.6 degrees C). The decreases in HR and BP were most pronounced at night and did not return to pre-IT values until 72 and 48 h after dosing, respectively. ECG abnormalities (rhythm disturbances, bundle branch block) were observed primarily in the high-dose group. This study demonstrates substantial dose-related deficits in cardiac function in SH rats after IT exposure to a low-metal content, combustion-derived particle.

Air Pollutants↗
PubMed2004

Effects of instilled combustion-derived particles in spontaneously hypertensive rats. Part II: Pulmonary responses.

A consistent association between exposure to high concentrations of ambient particulate matter (PM) and excess cardiopulmonary-related morbidity and mortality has been observed in numerous epidemiological studies, across many different geographical locations. To elicit a similar response in a controlled laboratory setting, spontaneously hypertensive rats were exposed to an oil combustion-derived PM (HP-12) and monitored for changes in pulmonary function and indices of pulmonary injury. Rats were implanted with radiotelemeters to monitor electrocardiogram, heart rate, systemic arterial blood pressure, core temperature, and activity. Animals were divided into four groups and exposed via intratracheal instillation (IT) to suspensions of HP-12 (0.0, 0.83, 3.33, and 8.33 mg/kg; control, low, mid, and high dose, respectively) in saline vehicle. Telemetered rats were monitored continuously for 4-7 days post-IT and pulmonary function was examined using a whole-body plethysmograph system for 6 h/day on post-IT days 1-7. At 24, 96, and 192 h post-IT, bronchoalveolar lavage fluid (BALF) was obtained from subsets of nontelemetered animals in order to assess the impact of HP-12 on biochemical indices of pulmonary inflammation and injury. Immediate dose-related changes in pulmonary function were observed after HP-12 exposure, consisting of decreases in tidal volume (decreasing 12-41%) and increases in breathing frequency (increasing 52-103%), minute ventilation (increasing 12-25%), and enhanced pause (increasing 113-187%). These functional effects were resolved by 7 days post-IT, although some average BALF constituents remained elevated through day 7 for mid- and high-dose groups when compared to those of the saline-treated control group. This study demonstrates significant deficits in pulmonary function, along with significant increases in BALF indices of pulmonary inflammation and injury in SH rats after IT exposure to HP-12.

Air Pollutants↗
PubMed2002

Randomized crossover comparison of the proseal with the classic laryngeal mask airway in unparalysed anaesthetized patients.

BACKGROUND: The ProSeal is a wire-reinforced laryngeal mask airway with an additional drain tube that leads to the distal tip of the laryngeal cuff. The design should improve the seal with the larynx. METHODS: The ProSeal and classic laryngeal mask airways were compared in 180 patients in a randomized crossover study. Patients were anaesthetized without neuromuscular blocking drugs. RESULTS: The ProSeal took more time and more attempts to insert successfully than the classic laryngeal mask airway. Insertion was successful on the first attempt in 81% of cases with the ProSeal and 90% with the classic laryngeal mask airway. The ProSeal required more air to achieve an intracuff pressure of 60 cm H2O (6 ml more for size 4 and 12 ml more for size 5). Laryngeal seal pressure was better with the ProSeal than the classic laryngeal mask airway. Median seal pressure was 29 cm H2O with the ProSeal and 18 cm H2O with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 20 cm H2O in 87% of patients with the ProSeal and 41% with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 40 cm H2O in 21% of patients with the ProSeal and in none of the patients with the classic laryngeal mask. Once placed, the ProSeal remained a stable and effective airway. Gastric tube insertion through the drain tube was attempted in 147 cases and was successful in 135 (92%). CONCLUSION: The ProSeal is more difficult to insert than the classic laryngeal mask airway but allows positive pressure ventilation more reliably than the classic laryngeal mask airway.

Adolescent↗
PubMed2001

A dynamic inline sample thermoregulation unit for flow cytometry.

BACKGROUND: Flow cytometry is a valuable tool for the study of cellular and molecular interactions. We sought to develop instrumentation that would allow accurate and precise inline dynamic temperature control of flow cytometry samples in order to expand the analytical capabilities of flow cytometry. METHODS: Using a temperature controller, DC power supply, and a Peltier module, we designed a temperature control circuit that regulates the temperature of a heat transfer block. The heat transfer block surrounds the sample line to efficiently heat and cool the sample. We attached DNA oligomers to microspheres and observed the denaturation of fluorescently labeled complementary oligomers to verify that the sample was achieving the desired temperature. RESULTS: The inline thermoregulation unit can ramp between 30 and 95 degrees C (>2 degrees C per second) within 30 s repeatedly. The accuracy of the instrument was verified by comparing the observed melting temperatures of the oligomer sets to the predicted values. These values varied within 6% of the predicted and were reproducible over a variety of conditions. CONCLUSIONS: The apparatus we constructed accurately and dynamically controls the sample temperature of inline samples. Flow cytometers equipped with our inline thermoregulation unit will be able to conveniently use temperature as a robust experimental parameter.

Base Sequence↗
PubMed2001

The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for patients with an unprotected airway.

The fear of acquiring infectious diseases has resulted in reluctance among healthcare professionals and the lay public to perform mouth-to-mouth ventilation. However, the benefit of basic life support for a patient in cardiopulmonary or respiratory arrest greatly outweighs the risk for secondary infection in the rescuer or the patient. The distribution of ventilation volume between lungs and stomach in the unprotected airway depends on patient variables such as lower oesophageal sphincter pressure, airway resistance and respiratory system compliance, and the technique applied while performing basic or advanced airway support, such as head position, inflation flow rate and time, which determine upper airway pressure. The combination of these variables determines gas distribution between the lungs and the oesophagus and subsequently, the stomach. During bag-valve-mask ventilation of patients in respiratory or cardiac arrest with oxygen supplementation (> or = 40% oxygen), a tidal volume of 6-7 ml kg(-1) ( approximately 500 ml) given over 1-2 s until the chest rises is recommended. For bag-valve-mask ventilation with room-air, a tidal volume of 10 ml kg(-1) (700-1000 ml) in an adult given over 2 s until the chest rises clearly is recommended. During mouth-to-mouth ventilation, a breath over 2 s sufficient to make the chest rise clearly (a tidal volume of approximately 10 ml kg(-1) approximately 700-1000 ml in an adult) is recommended.

History, Ancient↗