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Biomedical subjects

W Patrick

Publications and source records attributed to W Patrick.

14 recordsLinked to original sources
PubMed1996

Response of ventilator-dependent patients to different levels of proportional assist.

Proportional-assist ventilation (PAV) is a form of ventilatory support in which airway pressure increases in proportion to patient effort. Because it effectively reduces the mechanical load to an adjustable extent, PAV permits the study of the pattern of breathing in patients with respiratory disease when unconstrained by abnormal respiratory mechanics. We studied 11 patients with assorted medical problems requiring ventilatory support. The patients were switched to PAV, and the level of support was varied from near-maximal levels to the lowest tolerable level. Each level was maintained for several minutes while ventilation (VE), tidal volume (VT), and respiratory rate (f) were monitored. The breathing pattern observed with the highest assist varied substantially among patients. The ranges (and means) of VE, VT, and f were 5.6-18.7 (12.8) l/min, 203-844 (517) ml, and 18-33 (25) breaths/min, respectively. The correlation between VT and VE at the highest assist was very high (r = 0.91), suggesting that ventilatory demand is the most important determinant of VT variability. There were no systematic changes in breathing pattern as the level of assist was altered; at the highest and lowest levels of support, VE, VT, and f were, respectively, 12.8 +/- 5.4 (SD) vs. 11.6 +/- 4.3 l/min, 517 +/- 217 vs. 459 +/- 175 ml, and 25.0 +/- 4.2 vs. 25.7 +/- 3.9 breaths/min. These results indicate that within each patient, in a given state, there exist unique values for a desired VE, VT, and f that are largely independent of the mechanical load; if assist is increased, patient effort is decreased to maintain the desired ventilatory targets.

Adult↗
PubMed1996

Respiratory control during volume-cycled ventilation in normal humans.

The purpose of this study was to evaluate the extent of inhibition to respiratory rhythm associated with high volumes of ventilation during volume-cycled mechanical ventilation (neuromechanical inhibition). Two approaches were used. 1) In 18 normal awake subjects, ventilator tidal volume (VT) in the assist/control mode (A/C) was increased in steps from the minimum tolerable level up to 80% of the subject's inspiratory capacity or ventilator's maximum VT. We looked for appearance of intermittent apnea or a reduction in spontaneous rate (f). 2) Another 18 normal awake subjects were placed on controlled mechanical ventilation (CMV). When apnea was established, we abruptly terminated CMV and measured the time before the appearance of the next spontaneous effort. In the assist mode (protocol 1), we did not observe intermittent apnea because VT was increased from [from 944 +/- 198 to 1,867 +/- 277 (SD) ml], and there was only a modest reduction in f (14.1 +/- 3.9 to 12.4 +/- 4.0 breaths/min). End-tidal PCO2 (PETCO2) decreased precipitously as VT was increased. In protocol 2, we did not observe apnea after discontinuation of CMV in any subject. Total breath duration of the first breath after discontinuation did not differ significantly from total breath duration during A/C in the same subjects (4.84 +/- 2.2 vs. 5.2 +/- 2.0 s). This similarly applied regardless of route of breathing (nose vs. mouth) or PETCO2 level at time of discontinuation. We conclude that neuromechanical inhibition is quite weak and provides very little negative feedback that may help control PCO2 in the face of excessive VT and f demands of the subject.

Adult↗
PubMed1996

Noninvasive positive-pressure ventilation in acute respiratory distress without prior chronic respiratory failure.

We evaluated the efficacy of noninvasive mechanical ventilation (NIMV) in alleviating distress and avoiding intubation in patients with de novo acute respiratory failure complicating primary medical disorders. Eleven consecutive patients with severe respiratory distress were entered. In all patients a decision to intubate on an urgent basis had been made, but NIMV could be initiated within minutes. The patients suffered from acute pulmonary edema (five), sepsis/ARDS (two), status asthmaticus (two), and severe pneumonia (two). Dyspnea score (max=10) was (+/- SD) 8.4 +.- 1.6, scale for accessory muscle use (max=5) was 4.2 +/- 0.7, and respiratory rate was 37.6 +/- 3.8 min -1. Pa CO2, pH, and base excess (BE) were 48 +/- 18 mm Hg, 7.27 +/- 0.13, and -5.5 +/- 7.4, respectively, with five patients showing severe metabolic acidosis (BE < - 10). NIMV was applied using proportional assist ventilation. There were three early failures. These included the two patients with sepsis/ARDS who did not tolerate the mask. One patient failed because Pa CO2 and pH deteriorated despite subjective improvement. The remaining eight patients demonstrated progressive improvement, and none required intubation. The duration of NIMV was 3 h to 2 d. We conclude that when NIMV is made available on a "few minutes" basis, selected patients with severe de novo respiratory distress/failure caused by reversible medical disorders, who would otherwise have been intubated, can be given substantial relief and be spared intubation.

Acid-Base Imbalance↗
PubMed1995

Respiratory response to CO2 in the hypocapnic range in awake humans.

The response of respiratory motor output to CO2 in the hypocapnic range (< 36 Torr PCO2) in the absence of hypoxemia is not well characterized in awake normal humans. We induced hypocapnia with hyperoxia in 16 normal volunteers by placing them on a volume-cycled ventilator in the assist mode. Subjects were not aware of the purpose of the study. All subjects continued rhythmic breathing despite high tidal volumes and severe hypocapnia (approximately 25 Torr alveolar PCO2). Inspired CO2 fraction was increased in steps, and changes in respiratory motor output were quantitated from changes in airway pressure at constant volume and flow, changes in respiratory rate, and change in rate of decline in airway pressure before triggering (dP/dt). There was a significant increase in respiratory muscle pressure, but not in respiratory rate, from 26 to 36 Torr PCO2. The slope of the response increased gradually from 26 to 41 Torr PCO2. Respiratory rate significantly increased only above 36 Torr. We conclude that the response to PCO2 in the hypocapnic range is basically nonlinear with no clear CO2 threshold and the CO2 responsiveness extends well below eupneic CO2 levels.

Adult↗
PubMed1994

An approach to the study of upper airway function in humans.

Current methods for testing upper airway (UA) collapsibility in humans tend to produce intervention-related changes in some of the variables that affect UA stability. Therefore, their results may not reflect UA stability under the experimental conditions of interest. In the proposed method, the subject lies in a body enclosure with head and neck out. Pressure is altered in brief (approximately 0.2-s) pulses to avoid behavioral responses. The collapsibility of UA under "static" conditions is tested by delivering identical pressure pulses simultaneously to the airway and body surface inside the shell. Because the pressure applied to the respiratory system is not altered, cessation of flow indicates closure, and the pressure at which this happens is Pclosure. Collapsibility under dynamic conditions is tested by applying brief negative pulses to the shell only, thereby forcing an increase in inspiratory flow. Ten normal awake subjects were tested. None of the subjects developed closure when negative pulses (0 to -16 cmH2O) were applied to both airway and shell during inspiration or expiration with either nose or mouth breathing. There were only small reductions in flow, indicating minor narrowing. By contrast, pressure pulses of similar magnitude applied to the shell alone were associated with closure in 5 of 10 subjects. We conclude that the UA of normal awake humans is fairly stable under the influence of statistically applied pressure but susceptible to collapse under conditions of increased flow. Pclosure determined under static conditions underestimates the vulnerability of the UA to collapse under dynamic conditions.

Adult↗
PubMed1992

Increases in methyldopa absorption and renal excretion after multiple doses.

A retrospective analysis of previous studies examining methyldopa absorption suggested the possibility that the absorption of methyldopa might increase on repeat methyldopa ingestion. A prospective study was undertaken to determine the effect of repeated oral doses of methyldopa on methyldopa absorption. Thirteen healthy subjects ingested single 250 mg methyldopa doses on days 0, 7, 14, 28, 56, and 112; 24 urine samples were collected and analyzed for methyldopa and its major metabolites on each study day and methyldopa plasma levels were measured over 8 hours at days 0 and 56. There were significant increases in the absorption of methyldopa (as estimated by the urinary excretion of methyldopa and the measured metabolites over 24 hours) at day 56 (33.4 +/- 8.9%, P less than .025) compared with day 0 (26.0 +/- 10.8%). There was also a significant increase in renal clearance of unmetabolized methyldopa (62.7 +/- 13.6 vs. 99.3 +/- 29.1 mL/min, P less than .01) and a decrease in the plasma half-life of methyldopa at day 56 (2.22 +/- 0.91 vs. 1.56 +/- 0.68 hr, P less than .05). There was a tendency toward increases in methyldopa absorption at day 7, 14, 28, and 112. Several possible explanations for the changes in methyldopa disposition are discussed.

Adult↗
PubMed1989

Child Survival and Development toward Health for All: roles and strategies for Asia-Pacific universities.

Recently, discussion among academics and practitioners has focused on the potential roles, strategies, and functions of universities in the Asia-Pacific region in the next ten to fifteen years in the global initiative commonly referred to as the Child Survival and Development Revolution toward Health for All. (1) The purpose of this paper is to capture the practical key elements of recent discussions and to extend the current thinking into potentially useful guidelines or frameworks for universities of the region. Universities may then be better prepared to move forward in ways which promote the goals and interests of the Health For All movement and the well-being of particularly the world's children.

Asia, Southeastern↗
PubMed1980

Transabdominal exposure of the thoracic aorta.

The thoracic aorta can be exposed from an abdominal approach by means of an incision in the diaphragm. This method has been used extensively by Crawford and colleagues but has not been described in detail. Patients with normal renal function before the operation suffered no permanent renal damage from periods of ischemia for up to 45 minutes under normothermic conditions. One patient with impaired renal function before the operation sustained permanent renal damage.

Abdomen↗
PubMed1979

Polytetrafluoroethylene (PTFE) grafts for haemodialysis: patency and complications compared with those of saphenous vein grafts.

A comparison has been made between polytetrafluoroethylene (PTFE) and saphenous vein as graft material for the construction of arteriovenous fistulas for use in haemodialysis. Fifty patients with PTFE grafts have been examined and compared with 70 patients with saphenous vein grafts. At eighteen months the accumulative patency rate was 69.8% for PTFE grafts and 68.9% for saphenous grafts. Although the PTFE grafts were similar in terms of patency, their complication rate was higher. The infection rate and distal ischaemia rate for PTFE grafts were double those of the vein grafts. Two patients developed median and ulnar nerve paralysis respectively shortly after implantation of PTFE grafts. Because of this it is recommended that their use be restricted to the lower limb. Despite a higher incidence of complications, PTFE grafts are a satisfactory substitute if a suitable saphenous vein is not available.

Adult↗