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Biomedical subjects

T Gerhardt

Publications and source records attributed to T Gerhardt.

At least 55 records · Page 3Linked to original sources
PubMed1989

Comparison of dynamic and static measurements of respiratory mechanics in infants.

The objective of this study was to compare the conventional method of measuring respiratory mechanics, which requires the passage of an esophageal tube, with the occlusion technique, which is less invasive. Thirty-nine preterm infants who received mechanical ventilation on the first day were studied before discharge (mean +/- SD: postnatal age 67 +/- 23 days; weight 1790 +/- 300 gm), and 27 of them again at 1 year (weight 8.1 +/- 1.4 kg). Flows were measured through a nosepiece by pneumotachometry, tidal volume by integration of flow, esophageal pressure through a water-filled tube, and airway pressure directly at the nasal piece. Airway occlusion was performed at the end of inspiration, and the following relaxed exhalation was analyzed to give compliance (Crs) and resistance (Rrs) of the respiratory system. These values were compared with dynamic lung compliance (Cdyn) and expiratory resistance (Re) of the previous unoccluded breath. In the younger infants, dynamic and static measurements did not differ significantly and were well correlated (Cdyn/Crs, r = 0.91; Re/Rrs, r = 0.95). In the older infants, Crs was 80% of Cdyn (p less than 0.001), and Rrs was 24% higher than Re (p less than 0.001). The measurements were well correlated (Cdyn/Crs, r = 0.94; Re/Rrs, r = 0.91). The regression line Cdyn versus Crs had a slope (0.77) significantly less than 1; the regression Re versus Rrs had an intercept (13.8) significantly greater than zero. The lower Crs and higher Rrs values can be expected because the static determinations include the chest wall. In the more immature infants, the very compliant chest wall, in combination with an underestimation of Cdyn because of the higher breathing frequency of these infants, may obscure this difference. We conclude that the occlusion technique gives accurate and reproducible results, is easily applied, does not need the passage of an esophageal tube, and is well tolerated by the infants.

Acute Disease↗
PubMed1988

Plasma concentrations of noradrenaline and 3,4-dihydroxyphenylethyleneglycol under conditions of enhanced sympathetic activity.

Antecubital venous blood was sampled at rest and during orthostasis or supine bicycle exercise. The plasma was analyzed for noradrenaline and 3,4-dihydroxyphenylethyleneglycol (DOPEG) by HPLC. Orthostasis resulted in increases in plasma concentrations of both noradrenaline and DOPEG. The magnitude of changes in both was dependent on the degree of orthostasis. In conditions of supine rest, sitting, and standing the plot of the geometric mean values of plasma DOPEG (ordinate) against those of plasma noradrenaline was linear, had a slope of about unity, and intersected the ordinate at a finite value of plasma DOPEG. After administration of desipramine (to block uptake), plasma concentrations of DOPEG fell both at rest and during orthostasis. Moreover, desipramine abolished the plasma DOPEG response to orthostasis without affecting the plasma noradrenaline response. Hence, changes in plasma DOPEG brought about by changes in sympathetic tone are presynaptic in origin. The plasma concentration of DOPEG observed in the presence of desipramine was virtually identical with the ordinate intercept of the regression line relating plasma DOPEG to plasma noradrenaline in the absence of desipramine. This pool of plasma DOPEG (which amounted to about 75% of that observed at supine rest in the absence of desipramine) probably stems from intraneuronal noradrenaline leaking out of the storage vesicles of peripheral sympathetic neurones and may in part also be derived from the central nervous system. Supine bicycle exercise failed to increase plasma DOPEG. This may be due to the separation of the sampling site from the site of noradrenaline release (i.e. the exercising limbs) by organs involved in DOPEG extraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Assay of catecholamines and dihydroxyphenylethyleneglycol in human plasma and its application in orthostasis and mental stress.

A high performance liquid chromatographic method involving electrochemical detection is described which permits the assay of noradrenaline (NA), adrenaline (A), dopamine (DA), and dihydroxyphenylethyleneglycol (DOPEG) in human plasma and brings about analytical recoveries of 70% and more. This method was used to assess the effects of graded orthostasis and mental stress on the plasma levels of these catechols. Orthostasis elicited increases in plasma NA and DOPEG, but did not cause any change in plasma A and DA. The increases in NA and DOPEG were dependent on the degree of orthostasis and correlated closely (rs = 0.724; n = 30, P less than 0.001). Pretreatment with desipramine abolished the DOPEG response to standing, indicating that orthostasis - induced increases in plasma DOPEG are presynaptic in origin. Mental stress evoked pronounced increases in plasma A, less pronounced increases in plasma NA and no changes in plasma DA and DOPEG. Hence, the simultaneous measurement of plasma NA and DOPEG may help to distinguish between various types of activation of the sympathetic nervous system.

Adult↗
PubMed1988

Effect of distal endotracheal bias flow on PaCO2 during high frequency oscillatory ventilation.

In order to evaluate the effect of distal endotracheal bias flow during HFOV on PaCO2 we studied adult rabbits with normal lungs and those who had meconium-induced lung dysfunction. Animals were studied while 1.0, 1.4 and 1.8 ml/kg tidal volumes (VT) were delivered by a high frequency oscillator. In animals with normal lungs and a 1.0 liter/min distal bias flow, the PaCO2 decreased significantly (p less than 0.01) with all VT used. In animals with meconium instillation the decrease in PaCO2 was also significant (p less than 0.05) at all combinations of VT and distal bias flow. The higher the distal bias flow the more pronounced was the lowering effect on PaCO2. We conclude that during HFOV it is possible to improve CO2 elimination using small additional bias flow delivered near the tip of the endotracheal tube in animals with normal abnormal lung function. This may allow adequate alveolar ventilation with even smaller VT, thus reducing the risk of barotrauma.

Animals↗
PubMed1987

Serial determination of pulmonary function in infants with chronic lung disease.

Pulmonary function was measured in 39 infants with chronic lung disease who had required mechanical ventilation starting during the first week of life for a median of 9 days (range 1 to 46 days) and supplemental oxygen for a median of 48 days (range 28-162 days). Their mean birth weight was 1140 g (range 550 to 2325 g), and mean gestational age 29.8 weeks (range 26 to 37 weeks). Ventilation was measured by pneumotachography, esophageal pressure through a water-filled feeding tube, and functional residual capacity (FRC) by a modified nitrogen washout technique. Lung compliance, pulmonary conductance, and FRC were determined at 1, 3, 6, 12, 18, 24, and 36 months after birth. Pulmonary function was also determined in 40 normal children, ranging in age from neonates to 5 years, who served as controls. In infants with chronic lung disease, growth in weight and length followed the 10th to 25th percentiles of the normal curve. Minute ventilation and respiratory effort remained elevated throughout the follow-up. FRC per kilogram of body weight was decreased at 1, 3, and 6 months after birth, but thereafter was in the normal range. FRC increased in proportion to weight at the same rate as in the controls. Lung compliance was only half of normal at 1 month, increased with growth in close correlation with weight, and was approximately 80% of normal at the end of follow-up. Pulmonary conductance was 50% of normal at 1 month, increased little during the first 6 months, but reached 85% of normal at 3 years of age. There was no evidence of gas trapping. These results indicate that in infants with chronic lung disease after mechanical ventilation, lung volume increases normally, probably by formation of new alveoli, which also leads to improvement in lung compliance. Airway growth is slow during the first 6 months after birth, but the subsequent faster growth leads to conductance values close to normal at 3 years of age.

Body Weight↗
PubMed1987

Gas trapping with high-frequency ventilation: jet versus oscillatory ventilation.

Gas trapping was evaluated during high-frequency jet ventilation (HFJV) and high-frequency oscillatory ventilation (HFOV) in nine adult rabbits under basal conditions and after instillation of a mixture of 20% human meconium (2 mL/kg). The anesthetized animals underwent tracheostomy and were placed inside a body plethysmograph. Respiratory compliance and resistance were calculated from airway pressure and simultaneous flow, and volume was measured with a pneumotachograph. Gas trapping was measured as the change in volume observed in the plethysmograph after clamping the jet or the oscillatory line at respiratory rates of 10 and 15 Hz and tidal volumes of 1.0 and 2.0 mL/kg. Mean airway pressure was similar with both ventilators. Inspiratory/expiratory ratios were 1:4 at 10 Hz and 1:2 at 15 Hz with HFJV, and 1:1 during HFOV. Under all conditions, gas trapping was significantly greater with HFJV than with HFOV. More gas trapping was observed with higher tidal volume (2 mL/kg) and respiratory rate (15 Hz) during HFJV, before and after meconium instillation. After meconium instillation, gas trapping during HFJV at 15 Hz and tidal volume 2 mL/kg decreased significantly (32.7 +/- 10.4 to 24.9 +/- 10.3; P less than 0.05), compared with basal conditions. This finding may be explained by the shorter time constant of the respiratory system after meconium instillation (0.118 vs 0.083 seconds, P less than 0.01). Thus gas trapping was significantly greater with HFJV than with HFOV, a difference most likely related to the active expiratory phase of HFOV.

Airway Obstruction↗
PubMed1987

Extrathoracic airway stability during resistive loading in preterm infants.

Extrathoracic airway (ETA) stability was tested in 10 preterm infants during sleep with a drop in intraluminal pressure produced by the application of an external inspiratory flow-resistive load (IRL, 125 cmH2O.1-1.s at 1 l/min). An increase in total pulmonary resistance was sought as the measure of airway narrowing. The role of the ETA in the increased pulmonary resistance with loading was examined by testing the same infants while endotracheally intubated and after extubation. Total pulmonary resistance decreased with loading during the intubated studies (102.5 +/- 41.2 to 82.4 +/- 33.3 cmH2O.1-1.s, P less than 0.05), whereas a significant increase in pulmonary resistance was seen with loading in the extubated studies (101 +/- 58.1 to 128 +/- 68.6 cmH2O.1-1.s, P less than 0.01). Intraluminal pressure in the ETA, measured by the lowest proximal airway pressure, fell significantly with loading in both conditions, with values changing from -0.7 +/- 0.3 to -4.7 +/- 2.7 cmH2O in the intubated infants and from -0.9 +/- 0.3 to -4.6 +/- 0.9 cmH2O) in the extubated infants (P less than 0.01). The results suggest ETA narrowing with loading in extubated infants despite the absence of overt obstructive apnea. Measurements of total pulmonary resistance with IRL can be used as a simple test of ETA stability.

Airway Obstruction↗
PubMed1987

Blood transfusion effect on the respiratory pattern of preterm infants.

Anemia may increase the risk of tissue hypoxia in preterm infants. This could lead to respiratory center depression and an increased risk for apnea. Heart rate and breathing pattern were recorded in 30 preterm infants (gestational age 30.0 +/- 2.3 weeks, postnatal age 46.6 +/- 20.8 days, and weight 1,438 +/- 266 g) before and after a transfusion of 10 mL/kg of packed RBCs. All infants were stable clinically, breathing room air, and free of prolonged apneic episodes. After transfusion, hematocrit levels increased from 27.0% +/- 2.5% to 35.8% +/- 4.7%. Heart rate decreased from 157.2 +/- 13.6 beats per minute to 148.4 +/- 13.9 beats per minute. There was no change in respiratory rate or BP. The duration of periodic breathing decreased significantly, as did the duration of the longest periodic breathing episode (P less than .01). The number of respiratory pauses lasting 5 to 10 seconds and the number of pauses lasting 11 to 20 seconds also decreased significantly (P less than .05). The total duration of respiratory pauses, excluding pauses during periodic breathing, were significantly lower after transfusion (P less than .05), as was the number of episodes of bradycardia. These results indicate that preterm infants have a more irregular breathing pattern while anemic than after correction of the anemia. The irregular breathing pattern is probably caused by mild hypoxic respiratory center depression.

Anemia↗
PubMed1986

Bronchopulmonary dysplasia.

Bronchopulmonary dysplasia has become the most common pulmonary sequelae in neonates receiving mechanical ventilation. The pathogenesis of BPD is multifactorial, but prematurity, positive pressure ventilation, oxygen toxicity and pulmonary edema are some of the most important factors in its development. By minimizing these factors, it is possible to reduce the incidence and severity of BPD.

Airway Resistance↗
PubMed1986

Functional residual capacity in normal neonates and children up to 5 years of age determined by a N2 washout method.

Functional residual capacity (FRC) was determined in 50 infants by a simplified N2 washout method. Fourteen infants were preterm, four full-term newborns and the rest were 1 month to 5 yr of age. Weight ranged from 1.19 to 25.8 kg. The method gave well reproducible values with a mean coefficient of variation of 3.9%. The FRC values are equally well correlated to weight and length (r = 0.98). The correlation with weight is linear, intercepting the x axis (FRC = 0) at a weight of 480 g, the one with length is best described by a power curve. The course of the regression lines reflects the observation that FRC per kg weight or per cm length is lower in neonates than in larger infants. The FRC measurements are in the same range as values obtained by other investigators using the N2 washout or He-dilution techniques. The values are significantly smaller than thoracic gas volume measurements obtained by plethysmography. This difference may be due to air trapping or to possible methodological problems with the plethysmographic technique. The data demonstrate that FRC can be measured easily and accurately in preterm and older infants using a N2 washout technique.

Child, Preschool↗
PubMed1985

Conventional vs high-frequency jet ventilation in a piglet model of meconium aspiration: comparison of pulmonary and hemodynamic effects.

The pulmonary and cardiovascular effects of high-frequency jet (HFJV) and conventional (CV) ventilation were evaluated in a piglet model of meconium aspiration. A mixture of 20% human meconium and 0.9% saline solution was instilled deep into the trachea of 10 piglets, after which either HFJV or CV was administered for 4 hours. Arterial blood gases, cardiac output, mean pulmonary and systemic arterial pressures, pulmonary and systemic vascular resistances, and pulmonary mechanics were compared between groups. During the 4 hours of ventilation, PaO2 and PaCO2 were not statistically different between groups. The peak inspiratory pressure necessary to maintain PaCO2 in the preset range was approximately half as much in the HFJV group as in the CV group (P less than 0.002). Mean airway pressure was lower in the HFJV group only during the second hour (P less than 0.03). Cardiac output, mean aortic and pulmonary artery pressures, systemic and pulmonary vascular resistance, dynamic lung compliance, and pulmonary resistance were not statistically different between groups. Our results suggest that HFJV may be more effective than CV in the early stages of meconium aspiration syndrome because HFJV allows more efficient ventilation and adequate oxygenation at lower peak inspiratory pressures.

Animals↗
PubMed1985

A simple method for measuring functional residual capacity by N2 washout in small animals and newborn infants.

An open circuit N2 washout technique is described for the determination of functional residual capacity in infants. Either 100% O2 or any oxygen/helium mixture can be used as the washing gas. The subject breathes the washing gas through a T-tube and the washed out nitrogen is mixed with this gas in a mixing chamber, placed into the exhalation part of the circuit. The N2 concentration of the mixed gas is analyzed continuously, and the concentration signal is electronically integrated over time. Calibration of the system is accomplished by injecting known amounts of nitrogen or room air into the circuit. The gas flow through the system must remain constant and is adjusted to approximate peak inspiratory flow of the infant. In vitro testing of the system showed that the technique gives reproducible values (coefficient of variance less than 1.0%) and that the integrated signal output has a close linear correlation with the amount of N2 washed out (r = 0.99). In vivo measurements in 10 cats confirmed the accuracy and reproducibility of the method when compared with N2 collection. The technical advantages of the system are simplicity of components, absence of valves, easy calibration, low dead space, and no need to collect or measure expired gases. For the infant this means no added resistance during washout and no risk of hypoxia, hyperoxia, or hypercapnea. In the presence of pulmonary disease and poor gas mixing the washout period can be prolonged as needed. There is no lower limit of weight or size for functional residual capacity measurements in small infants or animals.

Animals↗
PubMed1984

Apnea of prematurity: I. Lung function and regulation of breathing.

It has been suggested that apnea of prematurity may be caused by "immaturity" of central control of breathing. To test the validity of this hypothesis tidal volume (VT), alveolar ventilation (VA), alveolar Pco2 (Paco2), esophageal pressure change, and the slope of the CO2 response curve (delta Ve [minute ventilation]/delta Paco2) were determined in 18 infants with apnea (mean of 32 episodes of more than 20 seconds duration per day) and in 18 healthy newborns used as control subjects. The infants were matched for birth weight (1,068 g v 1,065 g), gestational age (30.2 weeks v 30.2 weeks), and postnatal age (8.6 days v 8.3 days). The results were as follows: Vt (4.4 +/- 1.0 mL/kg v 5.3 +/- 1.6 mL/kg), Va (96 +/- 21 mL/kg/min v 129 +/- 33 mL/kg/min), Paco2 (45.4 +/- 8.5 mm Hg v 35.6 +/- 4.7 mm Hg), esophageal pressure change (4.5 +/- 0.9 cm H2O v 6.0 +/- 1.8 cm H2O), delta Ve/delta Paco2 (20.2 +/- 10.6 mL/min/kg/mm Hg CO2 v 40.7 +/- 19.9 mL/min/kg/mm Hg CO2). There was a significant difference between infants with and without apnea for all measurements. The results indicate a decreased respiratory center output and a depressed ventilatory response to CO2 in infants with apnea. As there was no difference between the two groups in pulmonary mechanics or oxygenation, the findings support the hypothesis that a central disturbance in regulation of breathing is the cause of apnea in these infants.

Apnea↗
PubMed1984

Apnea of prematurity: II. Respiratory reflexes.

Airway obstruction is a cause of apnea in preterm infants. The activity of protective respiratory reflexes was determined in 18 preterm infants with apnea (mean of 32 episodes of more than 20 seconds duration per day) and in 18 neonates without apnea used as control subjects. This was done in order to elucidate the role of respiratory reflexes in apnea of prematurity. The infants were matched for birth weight (1,068 g v 1,065 g), gestational age (30.2 weeks v 30.2 weeks), and postnatal age (8.6 days v 8.3 days). The airway occlusion technique was used to determine the inspiratory prolongation of the occluded breath and the effective elastance of the respiratory system. Inspiratory prolongation is a measure for the reflex influence on inspiratory duration, and effective elastance reflects load compensating ability. Inspiratory prolongation was 7.3% +/- 33.5% in infants with apnea and 30.6% +/- 22.7% in the control group (P less than .025). Effective elastance was 1.1 +/- 0.5 cm H2O/mL in the apneic group and 1.5 +/- 0.5 cm H2O/mL in the infants without apnea (P less than .025). The results indicate that during exposure to respiratory loads, the infants with apnea maintained inspiratory effort poorly and had a decreased ability for load compensation. Their respiratory reflexes were significantly more immature than the reflex activity of the infants without apnea. This functional immaturity of respiratory reflexes may be a contributing factor in the etiology of apnea of prematurity.

Air Pressure↗
PubMed1983

Effects of aminophylline on respiratory center and reflex activity in premature infants with apnea.

Fourteen preterm infants with apnea (body weight, 1052 +/- 44 g; gestational age, 30.2 +/- 0.5 wks; and postnatal age, 9.9 +/- 1.5 days) were studied in an effort to evaluate the effects of aminophylline on respiratory center output and respiratory reflex activity in the preterm infant with idiopathic apnea. This was done by using the airway occlusion technique. The infants were studied before and 48 h after aminophylline was begun as a treatment for apnea. Occlusion pressure, which reflects respiratory center output, was measured at 100 msec after occlusion started (P100) and at its maximum (Pmo). P100 increased from 2.4 +/- 0.2 to 3.1 +/- 0.2 cmH2O (P less than 0.005), and Pmo from 6.1 +/- 0.7 to 8.8 +/- 1.0 cmH2O (P less than 0.001) after aminophylline therapy was started. The % prolongation of inspiratory time during the occluded breaths, when compared to the unoccluded breaths increased from 26.2 +/- 10.6 to 55.8 +/- 12.5% (P less than 0.01). This reflects a significant increase in the strength of the Hering Breuer reflex. Effective elastance, a measure of respiratory load compensation, was significantly higher during aminophylline treatment. It increased from 1.09 +/- 0.14 to 1.33 +/- 0.14 cmH2O/ml (P less than 0.02).

Aminophylline↗
PubMed1982

Components of effective elastance and their maturational changes in human newborns.

The newborn's ability to compensate for a sudden increase in respiratory load remains unclear. The mouth occlusion pressure (Pmo) and the effective elastance (E'rs) were determined in 58 neonates ranging in gestational age from 28 to 41 wk. These results were compared with the esophageal pressure change (delta Pes) and with lung elastance (EL) obtained during regular breathing. Since E'rs = Pmo/delta Pes X EL, E'rs is proportional to an active component, Pmo/delta Pes and a passive component, EL. Although EL is 1.10 +/- 0.31 (mean +/- SD) cmH2O/ml at 28 wk gestation, this value decreases to 0.20 +/- 0.04 cmH2O/ml at full-term. The active component Pmo/delta Pes changes in the opposite direction. It is 0.92 +/- 0.25 at 28 wk gestation, indicating that there is no load compensation in the very premature infant. It increases to 2.06 +/- 0.50 in the full-term newborn, reflecting a linear increase in the ability for load compensation with advancing gestational age. The E'rs is largely determined by EL and is, therefore, not a good measure to compare load compensating ability. The quotient Pmo/delta Pes, being independent of tidal volume, lung maturation, and growth, reflects load compensating activity better than E'rs.

Compliance↗
PubMed1981

Maturational changes of reflexes influencing inspiratory timing in newborns.

Premature infants have frequent apneic spells, which in some cases are triggered by airway obstruction or increase in respiratory load. The response of the preterm infant to increased respiratory loads has not been adequately studied. Utilizing the airway occlusion technique, we determined the percent prolongation of the occluded, compared with the preceding unoccluded breath, in 58 newborns (gestational age 28-41 wk) during the first days of life. A significant correlation was found between gestational age and percent prolongation of inspirations (r = 0.76). At 29 wk gestation, prolongation was zero and increased up to 55% at term. The low mean prolongation obtained in the very premature infants can be explained by the large number of these infants who responded with shortening of their inspiratory time during airway occlusion. The response may be secondary to the intercostal phrenic inhibitory reflex, which inhibits inspiration when distortions of the chest wall occur. The shortening of inspiration during airway occlusion in many premature newborns reflects their inability to tolerate respiratory loads and may contribute to the high incidence of apnea in these infants. The progressive increase in prolongation with gestational age reflects the maturation of the respiratory system toward the more stable respiratory function of the full-term neonate.

Gestational Age↗