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Biomedical subjects

S G Olsson

Publications and source records attributed to S G Olsson.

10 recordsLinked to original sources

Breath alcohol concentration determined with a new analyzer using free exhalation predicts almost precisely the arterial blood alcohol concentration.

A new breath alcohol (ethanol) analyzer has been developed, which allows free exhalation, standardizes measured exhaled alcohol concentration to fully saturated water vapor at a body temperature of 37 degrees C (43.95 mg/L) and includes a built-in self-calibration system. We evaluated the performance of this instrument by comparing standardized alcohol concentration in freely expired breath (BrAC) with arterial (ABAC) and venous (VBAC) blood alcohol concentrations in fifteen healthy volunteers who drank 0.6 g of alcohol per kg body weight. The precision (coefficient of variation, CV) of the analyzer based on in vivo duplicate measurements in all phases of the alcohol metabolism was 1.7%. The ABAC/BrAC ratio was 2251+/-46 (mean+/-S.D.) in the post-absorptive phase and the mean bias between ABAC and BrAC x 2251 was 0.0035 g/L with 95% limits of agreement of 0.033 and -0.026. The ABAC and BrAC x 2251 were highly correlated (r=0.998, p<0.001) and the regression relationship was ABAC = 0.00045 + 1.0069 x (BrAC x 2251) indicating excellent agreement and no fixed or proportional bias. In the absorption phase, ABAC exceeded BrAC x 2251 by at most 0.04+/-0.03 g/L when tests were made at 10 min post-dosing (p<0.05). The VBAC/BrAC ratio never stabilized and varied continuously between 1834 and 3259. There was a proportional bias between VBAC and BrAC x 2251 (ABAC) in the post-absorptive phase (p<0.001). The pharmacokinetic analysis of the elimination rates of alcohol and times to zero BAC confirmed that BrAC x 2251 and ABAC agreed very well with each other, but not with VBAC (p<0.001). We conclude that this new breath analyzer using free exhalation has a high precision for in vivo testing. The BrAC reflects very accurately ABAC in the post-absorption phase and substantially well in the absorption phase and thereby reflects the concentration of alcohol reaching the brain. Our findings highlight the magnitude of arterio-venous differences in alcohol concentration and support the use of breath alcohol analyzers as a stand-alone test for medical and legal purposes.

Adult↗

A delivery system for inhalation of nitric oxide evaluated with chemiluminescence, electrochemical fuel cells, and capnography.

OBJECTIVE: To evaluate a system for delivery of inhaled nitric oxide. DESIGN: Prospective, laboratory study. SETTING: Engineering laboratory. SUBJECTS: A standard ventilator (Servo Ventilator 300), supplemented with extra gas modules for nitric oxide delivery. INTERVENTIONS: Two ventilator-integrated gas modules, delivering < or = 10 parts per million (ppm) or < or = 100 ppm of nitric oxide, were used in adult and neonatal modes during volume-controlled ventilation. Set nitric oxide concentration and FIO2 were systematically changed and compared with the measured concentration. Short-term mixing was tested in adult, pediatric, and neonatal modes by substituting nitric oxide with CO2, and measuring the delivered concentration by a fast-response CO2 analyzer during five successive respiratory cycles. Long-term mixing was tested with the administration of 25 ppm of nitric oxide for 7 days. MEASUREMENTS AND MAIN RESULTS: Delivered concentration of nitric oxide and nitrogen dioxide were simultaneously measured at the Y-place by two methods-chemiluminescence and electro-chemical fuel cells. The maximum absolute difference between set and measured concentrations of nitric oxide in the adult mode was 0.6 ppm at a set concentration of 10 ppm and 2.7 ppm at a set concentration of 100 ppm. In the neonatal mode, the maximal difference was 3.1 ppm at a set concentration of 100 ppm. Nitrogen dioxide concentration increased with increasing concentration of nitric oxide and oxygen to 2.6 ppm (as measured by the chemiluminescence analyzer) and 3.6 ppm (as measured by the electro-chemical fuel cell), at a setting of 100 ppm of nitric oxide with an FIO2 of 0.90 in the neonatal mode (2 L/min). During the short-term test of mixing stability throughout the respiratory cycles, a constant set CO2 concentration varied maximally by +/-6.2% from the set value in the neonatal mode, whereas the variance was by +/-6.5% in pediatric mode, and by +/-8.0% in the adult mode. During the long-term test, nitric oxide concentration varied maximally by +/-2.6% (as measured by the chemiluminescence analyzer) and by +/-2.3% (as measured by the electrochemical fuel cell). CONCLUSIONS: An accurate precision in delivered nitric oxide concentration was achieved during intermittent flow ventilation, and this accuracy was independent of tested ventilator settings. The delivery system administered an almost stable concentration throughout a respiratory cycle and during long-term delivery. If the mixing point is in the inspiratory part of the ventilator, valid measurement of nitric oxide and nitrogen dioxide delivery concentrations are possible. Both techniques for measuring nitric oxide and nitrogen dioxide have drawbacks.

Administration, Inhalation↗

Nitric oxide gives maximal response after coronary artery bypass surgery.

The dose-response to inhalation of nitric oxide (NO) after coronary artery bypass surgery was studied in seven patients with normal preoperative lung function and chest radiograms. During postoperative controlled ventilation with PEEP 5 and 10 cmH2O, the patients inhaled NO in concentrations of 2 to 25 ppm, in random order, for 6 to 10 minutes. Hemodynamic and oximetric data were analyzed before, 5 minutes after start of the NO inhalation, and 5 minutes after the cessation. The response was the same at all concentrations; mean pulmonary artery pressure decreased by 11 +/- 1% (P < 0.05) and pulmonary vascular resistance decreased by 22 +/- 2% (P < 0.05). Systemic hemodynamics did not change, but oximetric parameters tended to improve. Changes in PEEP did not affect the response. It is concluded that, in patients who have undergone coronary artery bypass grafting, inhalation of 2 to 25 ppm NO causes a dose-independent decrease in pulmonary artery pressure and pulmonary vascular resistance. In order to investigate the dose-response curve, concentrations lower than 2 ppm of NO must be used.

Aged↗

[Effects of positive end-expiratory pressure (PEEP) or prolonged inspiration time on lung mechanics, gas exchange and hemodynamics in differential pulmonary ventilation].

In the case of patients with unilateral lung disorders one must anticipate a further increase in the intake volume of the more elastic lung and a decrease in intake volume of the less elastic lung when the inspiratory pressure is increased or the inspiratory time is extended within the framework of mechanical ventilation. Therefore, differential pulmonary ventilation lends itself for the treatment of unilateral damage of the lung by enabling the selective application of a positive end-expiratory pressure or an inverse inspiratory time. For a better understanding of the overlapping pathophysiologic reactions, the changes in lung mechanics, haemodynamics and gas exchange were measured on the healthy lung with unilateral application of a positive and expiratory pressure or an increased inspiratory time. Thirteen male and female patients, who had to undergo intracranial surgery were ventilated with two synchronized servoventilators using a Carlens tube. The positive end expiratory pressure varied in the right lung in spans of 6 cm each, 0-12 cm H2O, inspiratory time varied 34-70%. The left lung was ventilated with a 35% inspiratory time and an end expiratory pressure of 0. The respiratory intake volume was divided up into 45% (left lung) and 55% (right lung) based on the physiological difference in size between the left and right lung. Our results show that a directed unilateral application of a positive end expiratory pressure or an increased inspiratory time does not have any relevant damaging effects on the other lung. It can be expected that in the case of non-differentiated mechanical ventilation the ensuing unequal distribution of alveolar ventilation and perfusion with consecutive increase of intrapulmonary shunt volume can be decreased by the discriminate treatment of each lung.

Adult↗

[Development and use of a computerized anesthesia protocol].

The real-time anaesthetic record allows the continuous on-line monitoring and the informative graphical presentation of important anaesthetic parameters; in this respect it is superior on the conventional made record. Preoperative findings and personal data of the patient are documented and presented by the aid of formulas on the terminal screen in addition to the on-line parameters and intraoperative off-line data e.g. drugs infusions, urine production, blood loss. The concept of the system is based on a microprocessor which is linked to daily used monitors by an analog-digital-converter. The wide use of the automatic record requires a relative high standard of monitors (e.g. mass spectrography), such that the applicability is limited to very extensive procedures of high risk patients.

Anesthesiology↗

Clinical studies of gas exchange during ventilatory support--a method using the Siemens-Elema CO2 analyzer.

We describe a new portable infra-red analyses for use with the Siemens-Elema Servo ventilator. The sensor head constitutes a Y-piece connecting the patient to the ventilator tubing, and gives instant carbon dioxide determination. It is based upon simple principles that can be realized with modern techniques, offering for instance freedom from interference by anaesthetic gases, and eliminating the need for calibration. A non-zero inspired carbon dioxide concentration interferes with the measurements. Integration of the carbon dioxide signal with the flow signal from the Servo ventilator yields data about carbon dioxide excretion, and additional calculation yields VD/VT if PaCO2 is known. The accuracy of determination of end-tidal carbon dioxide and carbon dioxide elimination was found to be adequate for research purposes, and that of VD/VT for clinical purposes. The device is considered to be of value in the operating theatre and intensive care unit, for monitoring, as a guide to ventilatory needs, and for the investigation of the magnitude and causes of increased deadspace.

Aged↗

A new device for continuous measurement of gas exchange during artificial ventilation.

A new apparatus, which uses a fuel cell for measuring O2 concentration and calculates O2 consumption (VO2), has been developed for use on the Servo Ventilator. Together with an IR CO2 Analyzer, this equipment also provides CO2 production, end-tidal CO2 concentration, and the respiratory quotient.l The accuracy of this equipment was evaluated by comparison with results from two standard methods: the Scholander technique in combination with a dry gas meter, and mass spectrometry combined with a wet gas meter. The results show that the differences between the VO2 calculated from this equipment and two other standard methods are less than 5%. Thus, the accuracy of the new equipment seems reliable enough to make it a valuable tool in clinical use.

Adult↗

Monitoring of ventilation and lung mechanics during automatic ventilation. A new device.

A device that allows continuous monitoring and recording of expired minute volume, tidal volume, resistance, compliance, indices of hyperinflation and other measures of ventilation and lung mechanics during automatic ventilation is described. After connection to the ventilator (Servoventilator 900) with one cable it is operating without any calibrations or other measures. The calculation of expired minute volume is done in a new way that eliminates errors due to compression of gas in the connecting lines. Calculations of compliance is made in a way allowing measurements even in patients with hyperinflation. Expiratory and inspiratory resistance values are obtained. The indices of hyperinflation in terms of measured flow and estimated alveolar pressure at the end of an expiration are discussed. The problems and benefits associated with measurements in much obstructive patients are analyzed. A short study of the performance of the calculator is presented.

Lung Compliance↗