Biomedical subjects

R H Holle

Publications and source records attributed to R H Holle.

5 recordsLinked to original sources

PubMed1989

Recovery of airway protection compared with ventilation in humans after paralysis with curare.

d-Tubocurarine (dTc) was administered intravenously to six healthy unanesthetized volunteers to assess the sensitivity to neuromuscular blockade of those muscles involved in protecting the airway against obstruction and/or aspiration relative to the muscles of inspiration. Each subject was given an intravenous bolus of dTc followed by an infusion to allow three different levels of inspiratory muscle weakness as measured by maximum inspiratory pressure (MIP). Levels of MIP were control (-90 cm H2O), -60, -40, and -20 cm H2O. Vital capacity (VC), hand grip strength (HGS), and end-tidal CO2 (PETCO2) were obtained at each level. At each level of weakness and at intermediate values during recovery, muscles of airway protection were functionally assessed by noting the MIP at which the maneuver could be accomplished and the MIP at which they could not. The mean of these two values was calculated for each subject. The tests were: 1) ability to swallow, 2) ability to perform a valsalva maneuver, 3) prevent obstruction of the airway, and 4) ability to approximate teeth. These were compared with head lift and straight leg raising. At maximum neuromuscular blockade (MIP of -20 cm H2O), VC was 2.0 liters, HGs was 0, and PETCO2 was normal. Muscles of airway protection were still incapacitated. Swallowing returned above MIP of -43 cm H2O, approximation of teeth above -42 cm H2O, airway obstruction above -39 cm H2O, and valsalva above -33 cm H2O. Thus, although ventilation may be adequate at MIP = -25 mmHg, the muscles of airway protection are still nonfunctional.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Increased muscle efficiency and sustained benefits in an outpatient community hospital-based pulmonary rehabilitation program.

Previous reports of pulmonary rehabilitation programs have demonstrated improvement in exercise capacity in subjects with disabling pulmonary disease. However, the cost-effectiveness, benefits to outpatients in a community setting, durability of these improvements, and mechanism of improved exercise capacity remain unclear. Forty-four patients with an average FEV1 of 33 +/- 4 percent of predicted completed a six-week long period of supervised treadmill exercise, as well as a continuing home program. Twenty percent had previously unsuspected cardiac disease discovered through the program, while 36 percent had previously unsuspected exercise desaturation. Cardiopulmonary stress testing before and after the program revealed a 73 +/- 16 percent improvement in aerobic capacity (METs peak [power]) and a 250 +/- 78 percent improvement in endurance (MET-min [work]). No significant change was seen in VE max, HR max, FEV1, or the degree of exercise desaturation. Only a small improvement was noted in VO2 max (15 +/- 8 percent) and O2 pulse (16 +/- 8 percent), suggesting that most of the improvement was due to improved muscle efficiency. Follow-up testing at 12 +/- 3 months in 24 subjects revealed that 89 +/- 7 percent of the peak exercise performance was maintained. The cost of the basic program was +800. The results demonstrated that an outpatient community hospital pulmonary rehabilitation program can accomplish substantial exercise capacity improvement with sustained benefits in a cost-effective manner.

Arrhythmias, Cardiac↗

PubMed1987

Prediction of successful ventilator weaning using airway occlusion pressure and hypercapnic challenge.

We studied eleven patients during 14 attempts at weaning from mechanical ventilation to determine whether central ventilatory drive, measured as airway occlusion pressure 0.1 s after onset of inspiration (P 0.1), during spontaneous breathing before and during a brief hypercapnic challenge, could accurately predict the success or failure of the attempt. All patients were recovering from acute respiratory failure and could breathe spontaneously for 20 minutes on a T-piece but were judged clinically to be marginal weaning candidates. Minute ventilation (VI) and P 0.1 were measured while breathing spontaneously and were repeated during a hypercapnic challenge that raised end-tidal PCO2 approximately 10 mm Hg. Seven of the 14 weaning attempts were unsuccessful, requiring reinstitution of mechanical ventilation. Although the failure group had lower mean maximum inspiratory force and higher spontaneous respiratory rate, no threshold value separated the failure from the success group. Ventilation increased more during hypercapnic challenge in those patients whose weaning attempt was successful, but overlap of results between the two groups rendered this test inaccurate for predicting weaning success. In contrast, successfully weaned patients had greater augmentation of P 0.1 during hypercapnia, expressed as the ratio of P 0.1 during CO2-stimulated to P 0.1 during baseline values, than did those who failed weaning (p less than 0.005). This ratio succeeded, and was thus both specific and sensitive as a predictor of successful weaning from mechanical ventilation in these patients.

Acute Disease↗

PubMed1985

Smoking: perspectives 1985.

The magnitude of the smoking problem is overwhelming. The annual mortality and expense are staggering. The task of changing this apocalyptic problem seems impossible. The solution, however, is not remote: It begins with each physician and with each individual patient who smokes. A consistent attitude of nonacceptance of the smoking habit with recommendations and support for discontinuation can make a significant impact on the problem. Extension of this attitude into community affairs and regional and national politics will result in increased public awareness and eventually in the majority rejecting this costly habit.

Cardiovascular Diseases↗

PubMed1984

Effect of respiratory muscle weakness on P0.1 induced by partial curarization.

Mouth occlusion pressure 0.1 s after onset of inspiration (P0.1) reflects central respiratory drive (CRD), but its dependence on respiratory muscle strength is unknown. To clarify this relationship, we produced progressive levels of respiratory muscle weakness by infusion of d-tubocurarine in eight supine spontaneously breathing normal subjects. Hypercapnic ventilatory response (HCVR) was measured before curarization and at mild (mean inspiratory effort 62 +/- 3% of control), moderate (42 +/- 3%), and severe (23 +/- 1%) weakness. At the severe level of weakness 1) supine functional residual capacity was not significantly changed from base line, 2) the percent of base-line slope of delta P0.1/delta PCO2 (122 +/- 27%) was significantly greater (P less than 0.01) than that for change in expired minute ventilation (delta VE)/delta PCO2 (39 +/- 10%), 3) the percent of base-line delta P0.1/delta VE (381 +/- 46%) during HCVR was significantly increased (P less than 0.01), 4) the P0.1 response was significantly increased from base line at two out of three specific levels of PCO2 while the VE was unchanged or significantly decreased, and 5) peak inspiratory resistance did not significantly change. Thus P0.1, unlike VE, did not decrease with even severe respiratory muscle weakness. Indeed, P0.1 increased at two out of three levels of PCO2 under circumstances when higher CRD is expected. One potential explanation for the results is that P0.1 may at least qualitatively reflect CRD up to the level of severe respiratory muscle weakness attained in this study.

Adult↗