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Biomedical subjects

R Farré

Publications and source records attributed to R Farré.

At least 37 records · Page 2Linked to original sources
PubMed2002

Automatic regulation of the cuff pressure in endotracheally-intubated patients.

To avoid tracheal wall damage or inadvertent falls of the endotracheal tube cuff pressure (Pcuff) in intubated and mechanically-ventilated patients, the authors devised a simple procedure for automatic and continuous regulation of Pcuff. The procedure, only requiring a simple aquarium air pump and conventional tubing, was first tested at the bench when applied to an intubated and ventilated lung model, including an artificial trachea with an externally-variable section. The clinical performance of the procedure was tested in eight intubated patients, in whom the endotracheal tube cuff was connected to the designed Pcuff regulator during 24 h. The bench test showed that the procedure was able to maintain Pcuff constant, regardless of the changes imposed in the tracheal section. It was also effective in maintaining Pcuff during routine mechanical ventilation. Actual Pcuff recorded over the 24-h period always coincided with the target value within +/-2 cmH2O in all the patients. The procedure devised to maintain endotracheal tube cuff pressure is readily implemented, cheap, easy to operate and can be used regardless of the specific ventilator or tube used. Routine implementation of this procedure may be useful for protecting the trachea from tissue damage and for reducing the risk of ventilator-associated pneumonia.

Airway Obstruction↗
PubMed2001

Oscillatory resistance measured during noninvasive proportional assist ventilation.

Setting proportional assist ventilation (PAV) requires the measurement of patient resistance and elastance. To avoid patient sedation/paralysis or the use of an esophageal balloon, noninvasive PAV is indirectly set by the "runaway" method or in accordance with patient comfort. The aim of this study was to ascertain whether the forced oscillation technique (FOT) applied by the ventilator during noninvasive PAV is useful in assessing patient respiratory resistance. Nasal PAV was applied to 14 patients with severe chronic obstructive pulmonary disease. During PAV a modified ventilator applied a 5-Hz pressure oscillation to noninvasively assess FOT resistance (Rrs). Lung resistance (RL) was measured in seven of the patients by using an esophageal balloon. Moreover, measurements were also performed in five of the patients when PAV was applied through the mouth. Rrs was close to RL both during nasal (Rrs = 8.9 +/- 3.1, RL = 9.0 +/- 2.6; cm H(2)O x s/L; n = 7, p > 0.05) and mouth (Rrs = 5.6 +/- 2.1, RL = 5.8 +/- 1.4; cm H(2)O x s/L; n = 5, p > 0.05) breathing. Rrs was slightly greater than the maximum value of flow assistance applied during the setting of PAV (FAmax): 11.1 +/- 5.4 and 9.5 +/- 2.9 cm H(2)O x s/L, respectively (n = 14, p > 0.05), both variables being significantly correlated (r = 0.72, p < 0.05). FOT applied by the PAV ventilator allowed the assessment of patient resistance. These results suggest that FOT could be useful in setting PAV flow assistance and in automatically and continuously updating this setting in accordance with patient resistance.

Aged↗
PubMed2001

Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo.

Application of continuous positive airway pressure (CPAP) as the standard treatment for sleep apnea/hypopnea syndrome (SAHS) is a moot point. Studies on the effectiveness of this treatment have been challenged because of the lack of a suitable placebo. The recent description of a true placebo (sham CPAP) prompted us to conduct a randomized trial of CPAP or placebo to assess the effectiveness of CPAP in improving SAHS-related symptoms and daytime function in patients with moderate to severe SAHS. Forty-eight patients, stratified in four groups according to severity, were randomly allocated into two treatment groups (optimal and sham CPAP) for a 6-wk period. Of these, 45 completed follow-up (91% males; age: 54 +/- 10 yr; body mass index [BMI]: 32 +/- 6 kg/m(2); apnea-hypopnea index [AHI]: 54 +/- 19 events/h; and Epworth Sleepiness Scale [ESS]: 16 +/- 5). The ESS, a questionnaire on SAHS-related symptoms, Functional Outcomes Sleep Questionnaire (FOSQ), and the Short Form Health Survey (SF-36) were completed at inclusion and after treatment. After 10 d of washout, the placebo group was treated with optimal CPAP and reassessed before and after optimal CPAP. The group receiving optimal CPAP when compared with the group with sham CPAP showed considerably greater improvement in the relief of sleepiness (-9.5 versus -2.3, p < 0.001), other SAHS-related symptoms (-18.5 versus -4.5, p < 0.001), vigilance (+8.5 versus +3.4, p = 0.009), and general productivity (+4.0 versus +0.5, p = 0.04) FOSQ scales. Both groups used a similar number of hours for the optimal and the sham CPAP (4.3 versus 4.5, (p = NS). The patients initially treated with placebo CPAP improved significantly more when optimal CPAP was applied for ESS (-2.3 versus -6.7, p < 0.001) and other sleep apnea syndrome (SAS)-related symptoms (-4.5 versus -11.2, p = 0.02). Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe SAHS.

Activities of Daily Living↗
PubMed2001

New technologies to detect static and dynamic upper airway obstruction during sleep.

Increase in upper airway resistance is the main patho-physiological feature in the obstructive breathing disorders during sleep. Upper airway events may be divided into two main groups: static obstruction (apneas) and dynamic obstruction (hypopneas, flow limitation, and snoring). This classification is useful to provide better information about the patho-physiological mechanisms of obstruction and to better define the diagnostic tools necessary for detecting abnormal respiratory events during sleep. Detection of dynamic obstruction requires sensors with a good frequency response. As thermistors have a poor dynamic response, they are not efficient in detecting the dynamic obstruction but are good enough to detect static obstruction. Nasal prongs (NP) connected a to pressure transducer and the impedance signal measured by the forced oscillation technique (FOT) are relatively new tools to noninvasively investigate dynamic upper airflow obstruction during sleep. FOT provides a direct index of the magnitude of airway obstruction and, therefore, of the upper airway patency, even under conditions of no flow (apneas). NP are aimed at assessing flow. Thus, both techniques have a different scope. The main advantages of NP are that they are easy to use and do not require sophisticated technology, while FOT needs a more complex instrumentation. For clinical routine studies NP are probably the best and simplest method for assessing the different respiratory events during sleep. However, FOT would be particularly useful in selected applications such as assessing upper airway patency in some central apneas; interpreting the irregular pattern of breathing during REM sleep; in better characterizing the inspiratory flow-limited breaths classified as intermediate; and in studying upper airway mechanics.

Polysomnography↗
PubMed2001

Simultaneous determination of thiamin and riboflavin in mushrooms by liquid chromatography.

A simple, fast, inexpensive, and reliable method useful for the simultaneous, routine determination of thiamin and riboflavin in mushrooms is examined. It uses the extraction procedure, with slight modifications, proposed by the AOAC for the extraction of thiamin and riboflavin, followed by a liquid chromatographic separation on a reversed-phase Spherisorb ODS column with methanol/water as mobile phase gradient. Fluorometric detection is used at the following excitation and emission wavelengths, respectively, 360 and 425 nm in the case of thiamin and 422 and 515 nm for riboflavin. The analytical parameters of linearity, the precision of the method (RSD = 2.45 and 2.51% for thiamin and riboflavin, respectively), and the results of the comparison with the corresponding AOAC fluorometric methods show that the studied method is useful for the measurement of thiamin and riboflavin in fresh mushrooms.

Agaricales↗
PubMed2001

Calcium, iron, and zinc uptake from digests of infant formulas by Caco-2 cells.

Our aim was to estimate the bioavailability of calcium, iron, and zinc from infant formulas using a model that includes in vitro digestion and a Caco-2 cell culture to estimate the uptake. The cell culture conditions were selected, and uptake assays were carried out first with calcium, iron, and zinc standard solutions, and then with the soluble fraction of enzymatic digests of an adapted milk-based and a soy-based infant formula. It was not possible to measure the uptake of calcium, iron, and zinc from standard solutions added to the cell cultures in amounts similar to those present in infant formula digests with our method. The fact that it was, however, possible in the case of enzymatic digests suggests the presence of components in the digests that enhance mineral uptake. When mineral uptakes were expressed as percentages of the mineral present, statistically significant differences were found in the case of calcium between the uptake from the milk- and the soy-based formulas. For iron and zinc no such differences were observed.

Biological Availability↗
PubMed2001

Relevance of linearizing nasal prongs for assessing hypopneas and flow limitation during sleep.

Respiratory disturbances in patients with the sleep apnea-hypopnea syndrome (SAHS) may be detected by means of nasal prongs (NP) pressure (PNP). Nevertheless, PNP is nonlinearly related to flow (V). Our aim was to demonstrate the relevance of linearizing P NP for assessing hypopneas and flow limitation in SAHS. V was measured with a pneumotachograph during the hypopneas and flow limitation events in a continuous positive airway pressure (CPAP) titration in six patients with severe SAHS. These flow patterns were reproduced by a flow generator through an analog of the nares and recorded by NP. PNP was linearized [V NP = (PNP)1/2] by a specially designed analog circuit. For each event we used V, P NP, and V NP to compute the hypopnea flow amplitude (HFA) and a flow limitation index (FLI). Owing to NP nonlinearity, PNP considerably misestimated HFA and FLI. By contrast, V NP provided HFA and FLI values that were very close to those obtained from V: HFA (V NP) = 1.098. HFA(V) - 0.063 (r2 = 0.98) and FLI(V NP) = 1.044. FLI(V) + 0.004 (r2 = 0.99). Square-root linearization of NP greatly increases the accuracy of quantifying hypopneas and flow limitation. This procedure, which could be readily carried out in routine practice by means of the analog circuit we developed, is of interest in optimizing the assessment of respiratory sleep disturbances in SAHS.

Computers, Analog↗
PubMed2001

Forced oscillation measurements do not affect upper airway muscle tone or sleep in clinical studies.

Upper airway obstruction in the sleep apnoea/hypopnoea syndrome (SAHS) can be easily assessed by measuring respiratory impedance with the forced oscillation technique (FOT). This methodology has been proposed as a useful clinical tool both for the diagnosis of sleep breathing disorders and for continuous positive airway pressure (CPAP) titration. However, previous studies suggest that the application of high-frequency pressure oscillation to the upper airway may induce changes in the electroencephalogram (EEG) or upper airway muscle function. The effect of FOT measurements on upper airway muscle tone and EEG in clinical sleep studies was examined. Seven patients with moderate SAHS were included (age: 54+/-11 yrs; apnoea/hypopnoea index: 43+/-21 events x h(-1); body mass index: 30+/-2 kg x m(-2)). Genioglossus surface electromyogram activity (EMGgg) and EEG signal were analysed with and without FOT application (frequency: 5 Hz and 30 Hz; peak-to-peak pressure oscillation: 1 cmH2O) during stable sleep. Measurements were carried out in two different situations. Step 1: applying FOT during episodes of obstructive events or flow limitation; and step 2: during prolonged periods of normal breathing at optimal CPAP. The root mean square of EMGgg activity and fast Fourier analysis (alpha and delta bands) of the EEG signal were performed. The application of FOT did not increase EMGgg activity in any of the situations studied. In addition, no evidence of the effects on EEG was found: alpha/delta relationship: awake:0.70, baseline sleep:0.13, FOT(5 Hz):0.18, FOT(30 Hz):0.11. The presented results suggest that the use of forced oscillation technique over the ranges of frequency and amplitude proposed for clinical sleep studies does not induce changes in upper airway muscle activity and neurological variables in patients with sleep apnoea/hypopnoea syndrome.

Airway Obstruction↗
PubMed2001

Evaluation of a simplified oscillation technique for assessing airway obstruction in sleep apnoea.

The forced oscillation technique (FOT) is a noninvasive method that is useful for assessing airway obstruction and for titrating continuous positive airway pressure (CPAP) in patients with sleep apnoea. The aim was to evaluate the routine applicability of a simplified FOT set-up based on recording pressure and flow at the level of the CPAP device, i.e. obviating the need for connecting the transducers to the nasal mask. A correction to account for the tubing and the exhaust port was applied. This simplified FOT was evaluated on nine patients with moderate or severe sleep apnoea during routine CPAP titration. Patient impedance measured by the simplified FOT ([Z]) was compared with actual patient impedance ([Zrs]) measured simultaneously with a reference FOT based on recording pressure and flow at the nasal mask. An excellent agreement was found between [Z] and [Zrs] over the wide range of airway obstruction explored (4.8-72.1 cmH2O x s x L(-1)): [Z] = [Zrs] x 0.86 + 1.3 cmH2O x s x L(-1) (r = 0.99). Moreover, the simplified and the conventional FOT settings detected the same respiratory events during sleep. These results demonstrate that this simplified FOT is applicable for measuring airway obstruction during routine sleep studies in patients with sleep apnoea.

Airway Obstruction↗
PubMed2001

Performance of nasal prongs in sleep studies : spectrum of flow-related events.

OBJECTIVES: The use of nasal prongs connected to a pressure transducer is a noninvasive, sensitive method to detect respiratory events, and can be easily implemented in routine sleep studies. Moreover, its good time response allows the detection of several flow-related phenomena of high interest, in addition to apnea and hypopnea. The aims of the study were to examine the quality and performance of the nasal prong flow signal, and to describe other flow-related events during full-night polysomnography studies. METHODS: Twenty-seven subjects were studied (16 male subjects; mean +/- SD age, 49 +/- 14 years; mean body mass index, 27 +/- 4 kg/m(2)): 15 subjects recruited from the general population and 12 consecutive patients with suspected sleep apnea/hypopnea syndrome (SAHS). RESULTS: A blind analysis of the respiratory events detected both by nasal prongs and thermistor was done. The quality of the nasal prong signal recordings was considered optimal for scoring purposes in 78% of cases, and no recording was considered uninterpretable. The nasal prong signal detected additional flow-related events not observed by the thermistor: (1) short and long (> 2 min) periods of inspiratory flow limitation morphology without decrease in the amplitude of the signal; (2) periods of mouth expiration; and (3) snoring. The apnea/hypopnea index was significantly higher with the nasal prong scoring (18 vs 11 [p < 0.05] in the general population and 37 vs 27 [p < 0.001] in the group with suspected SAHS). CONCLUSIONS: The incorporation of nasal prongs in routine full-night studies is an attainable technical option that provides adequate recordings in most cases. Additionally, relevant information not scored by thermistors is obtained on flow-related respiratory events, thus increasing diagnostic accuracy.

Adult↗
PubMed2001

Copper, iron, and zinc contents in human milk during the first three months of lactation: a longitudinal study.

The aim of the study has been to analyze the evolution of copper, iron, and zinc contents in human milk, from colostrum to the third postpartum month, following a longitudinal design, under specific conditions of sample collection and to apply an analytical procedure previously optimized to reduce any variation outside physiological lactation. The copper, iron, and zinc concentrations in 144 milk samples from 39 healthy puerpera women, were analyzed in five stages by flame atomic absorption spectrometry, following a standardized protocol. Copper presented a gradual decrease from 0.38 mg/L to 0.19 mg/L by the 90th day; the particular analysis from colostrum to transitional milk manifested the following two tendencies. Whereas an increase from 0.19 to 0.42 mg/L was observed in some women, a decrease from 0.53 to 0.45 mg/L was detected in others; therefore, copper presented two significant behaviors in the evolution from colostrum to transitional milk. In both cases, the evaluated changes were significant. The iron content varied from 0.56 to 0.40 mg/L by the 30th day, remaining constant until the first trimester concluded. The average zinc concentration decreased sharply from 7.99 to 3.3 mg/L on d 15; the rate of decrease slowed down gradually until 1.05 mg/L.

Colostrum↗
PubMed2001

Forced oscillation technique: from theory to clinical applications.

The forced oscillation technique (FOT) allows the noninvasive assessment of the mechanical properties of the respiratory system. Given that the technique does not require patient cooperation, it is suitable for the routine evaluation of respiratory function in a variety of clinical applications. In this paper, the rationale and the most conventional equipment and data processing of the technique are described. A number of clinical applications of FOT are briefly reviewed. One common use of the technique is to assess respiratory function in patients with different pathologies and in epidemiology. One of the most referenced applications of FOT is in tests of airway responsiveness to inhaled agents (bronchoprovocation and bronchodilatation). Finally, two recent promising applications of FOT are described: monitoring respiratory resistance during invasive and noninvasive mechanical ventilation, and detection of upper airway obstruction during sleep.

Humans↗
PubMed2000

Forced oscillation assessment of respiratory mechanics in ventilated patients.

The forced oscillation technique (FOT) is a method for non-invasively assessing respiratory mechanics that is applicable both in paralysed and non-paralysed patients. As the FOT requires a minimal modification of the conventional ventilation setting and does not interfere with the ventilation protocol, the technique is potentially useful to monitor patient mechanics during invasive and noninvasive ventilation. FOT allows the assessment of the respiratory system linearity by measuring resistance and reactance at different lung volumes or end-expiratory pressures. Moreover, FOT allows the physician to track the changes in patient mechanics along the ventilation cycle. Applying FOT at different frequencies may allow the physician to interpret patient mechanics in terms of models with pathophysiological interest. The current methodological and technical experience make possible the implementation of portable and compact computerised FOT systems specifically addressed to its application in the mechanical ventilation setting.

Humans↗
PubMed2000

High-performance liquid chromatographic determination of Maillard compounds in store-brand and name-brand ultra-high-temperature-treated cows' milk.

Furosine and furfural products of the Maillard reaction are used as specific indicators of the effect of heating treatments on milk quality. Their contents were measured in representative samples of store- and name-brand ultra-high-temperature-treated milks using RP-HPLC with UV detection. Furosine contents ranged from 40.32 to 50.67 and from 65.48 to 310.58 mg/100 g protein in name- and store-brand milks, respectively. Of the furfurals, only hydroxymethylfurfural was detected. The free hydroxymethylfurfural contents of store-brand milks ranged from 0.22 to 1.70 mg/100 g protein. Total hydroxymethylfurfural contents ranged from 0.29 to 0.41 and from 0.72 to 2.21 mg/100 g protein, for name- and store-brands, respectively.

Animals↗
PubMed2000

Effect of proteins, phytates, ascorbic acid and citric acid on dialysability of calcium, iron, zinc and copper in soy-based infant formulas.

The possible effect of ascorbic acid, citric acid, proteins and phytate on dialysability of Ca, Fe, Zn and Cu in soy-based infant formulas is studied, taking dialysability as a measure of the amount of element available for absorption. Different dialysis percentages for similar element contents in different formulas are found. A regression analysis was applied between Ca, Zn, Cu and Fe dialysis percentages and soy-based formula components to estimate the possible influence of the latter on the dialysability of the elements. Significant correlations were found between citric acid contents and dialysability of Zn and Fe. No correlations were found between protein, ascorbic acid and phytic acid contents and the dialysis percentages of the four minerals. However, we must to point out that the range of protein contents was narrow and the ascorbic acid: iron ratio was high in our formulas.

Ascorbic Acid↗
PubMed2000

Effects of thermal processing and storage on available lysine and furfural compounds contents of infant formulas.

The Maillard reaction-related effects that thermal treatments during the manufacturing process and storage (at 20 and 37 degrees C) have on powdered adapted and follow-up milk-based infant formulas were estimated by measuring the available lysine and furfural compounds contents of raw cow milk used in manufacturing, intermediate products and formulas. A fluorimetric method was used to measure the available lysine contents, and free and total furfural compounds were determined by HPLC. Statistically significant losses in available lysine (about 20%) in the infant formulas with respect to raw milk were found. The storage period did not affect the available lysine contents of adapted formulas but reduced (16%) the contents of the follow-up ones (from 6.61 to 5.33 g/100 g of protein). No furfural compounds were detected in raw milk, and free and total furyl methyl ketone (FMC) and methylfurfural (MF) were not observed in the analyzed samples. After 6 months of storage, an increase in free hydroxymethylfurfural (HMF) (from 0.34 to 0.77 mg/100 g of protein) and furfural (F) (from nondetectable to 0.1 mg/100 g of protein) in adapted formulas and free HMF (from 1.84 to 2.62 mg/100 g of protein) in follow-up formulas was observed.

Food Handling↗
PubMed2000

Noninvasive assessment of respiratory resistance in severe chronic respiratory patients with nasal CPAP.

Noninvasive measurement of respiratory resistance during nasal ventilatory support could be useful to assess the mechanical status of the patient and to optimize the ventilator settings. The aim was to investigate whether the forced oscillation technique (FOT) applied through a nasal mask allows reliable noninvasive estimation of respiratory resistance (Rrs) in patients with severe chronic respiratory disease. FOT Rrs (5 Hz) and lung resistance (R(L)) measured simultaneously from spontaneous breathing signals by an oesophageal balloon were compared in eight patients with chronic obstructive pulmonary disease and in six patients with a restrictive ventilatory defect due to chest wall disease. Measurements were performed in sitting and supine postures during application of nasal continuous positive airway pressure (CPAP): 4, 8 and 12 cmH2O in obstructive patients and 4 cmH2O in restrictive patients. In the restrictive patients Rrs and R(L) (in cmH2O x s x L(-1)) were virtually coincident: mean+/-SD, 12.6+/-6.1 and 11.6+/-6.6 (r=0.96) in sitting and 9.7+/-3.1 and 10.2+/-3.3 (r=0.92) in supine posture, respectively. In the obstructive patients (CPAP = 4 cmH2O), Rrs slightly underestimated R(L): mean+/-SD, 11.5+/-5.9 and 14.4+/-16.8 (r=0.92) in sitting and 15.0+/-9.8 and 21.1+/-12.6 (r=0.96) in supine posture, respectively. Similar results were found at CPAP = 8 and 12 cmH2O. The results obtained in patients with resistance values in the range typically found in nasal ventilatory support suggest that forced oscillation technique could be valuable to noninvasively estimate a patient's respiratory mechanical resistance.

Aged↗