SAMAY S24: a novel wireless 'online' device for real-time monitoring and analysis of volumetric capnography.

Volumetric capnography (VCap) provides information about CO2 exhaled per breath (VCO2br) and physiologic dead space (VDphys). A novel wireless device with a high response time CO2 mainstream sensor coupled with a digital flowmeter was designed to monitor all VCap parameters online in rabbits (SAMAY S24).Ten New Zealand rabbits were anesthetized and mechanically ventilated. VCO2br corresponds to the area under the VCap curve. We used the modified Langley method to assess the airway VD (VDaw) and the alveolar CO2 pressure. VDphys was estimated using Bohr's formula, and the alveolar VD was calculated by subtracting VDaw from VDphys. We compared (Bland-Altman) the critical VCap parameters obtained by SAMAY S24 (Langley) with the Functional Approximation based on the Levenberg-Marquardt Algorithm (FA-LMA) approach during closed and opened chest conditions.SAMAY S24 could assess dead space volumes and VCap shape in real time with similar accuracy and precision compared to the 'offline' FA-LMA approach. The opened chest condition impaired CO2 kinetics, decreasing the phase II slope, which was correlated with the volume of CO2 exhaled per minute.

[Synchronization of the contraction of the right ventricle against an acute afterload increase. Left ventricle-like mechanical function of the right ventricle]. / Sincronización de la contracción del ventrículo derecho frente a un aumento agudo de su poscarga. Izquierdización del comportamiento mecánico del ventrículo derecho.

AIM: The aim of this study was to demonstrate right ventricular contraction synchronization during acute and moderate afterload increase. MATERIAL AND METHOD: Right and left ventricular pressures, pulmonary and aortic pressures, pulmonary flow, and ventricular volumes by sonomicrometry were measured in seven anesthetized sheep. Pulmonary arterial hypertension was induced by Escherichia coli endotoxemia. RESULTS: Acute increase of the right ventricular afterload, measured as the mean arterial pulmonary pressure (11.9 1.3 to 24 3.6 mmHg) produced the following changes in the right ventricle without preload and contractility changes: a) maximal elastance shifted towards the end of the ejection (127.5 18.5 ms) and the ejection time shortened (57.5 20.3 ms), so that the negative peak of the first ventricular pressure derivative occurred at the end of the ejection; b) the pressure-volume loop became rectangular, i.e.; the systolic and diastolic phases were isovolumic, and c) the ejection showed a single phase. CONCLUSIONS: Asynchronous and sequential right ventricular contraction with normal afterload changed to a synchronic contraction pattern as in the left ventricle during an acute and moderate afterload increase. This left ventricle-like mechanical property establishes a novel mechanical reserve mechanism of the right heart, since it allows the right ventricle to maintain its systolic function during an afterload increase, independently of the preload and contractility.

[Study of the relaxation phase of the right ventricle]. / Estudio de la fase de relajación del ventrículo derecho.

The purpose of our study was to investigate the existence or not of an isovolumic relaxation period in the right ventricle in experimental animals with normal pressures in the pulmonary artery. Right and left ventricular pressures, pulmonary and aortic pressures (microtransducers), pulmonary flow, ventricular diameters (sonomicrometer), were recorded at the same time, in 10 sheep anesthetized intravenously with pentobarbital. We obtained "off line" the first ventricular pressures derivative, the ventricular volumes and the pressure-volume loops of both ventricles. The minimum systolic right ventricular volume coincided with 0 pulmonary flow, and both with a diastolic pressure value of 0-5 mmHg in that ventricle. Once the minimum systolic volume was reached, a rapid increase of the right ventricular volume started. The right ventricular pressure-volume loop, unlike the left ventricular one, adopted a non-rectangular shape. The right ventricular ejection period lasted until the beginning of the next filling phase. We concluded that there is no right ventricular isovolumic relaxation period.

[The characteristics proper of the cardiac cycle phases of the right ventricle]. / Características propias de las fases del ciclo cardíaco del ventrículo derecho.

AIMS: The purpose of our study was to define at physiological conditions, the existence or not of an isovolumic relaxation phase in the right ventricle and its ejective phase properties. MATERIAL AND METHODS: Right and left ventricular pressures, pulmonary and aortic pressures, pulmonary flow and ventricular diameters by sonomicrometry were measured in nine anesthetized sheep. The first ventricular pressure derivative, ventricular volumes, and the right and left pressure-volume loops, were calculated "off line". An abrupt preload reduction was generated by a posterior vena caval occlusion. RESULTS: Right ventricle showed an ejection phase which can be subdivided in two phases (early and late). The end of the ejection phase was established by the temporal coincidence of the zero pulmonary flow, the minimum systolic value of the right ventricular volume and a right ventricular pressure of 0-4 mmHg. The time between the beginning of the ejection phase and: a) the end of systole; b) the negative peak of the first derivative of ventricular pressure and c) the end of ejection, were different for the right ventricle (67 +/- 15 ms, 274 +/- 30 ms, 412 +/- 33 ms, respectively), meanwhile the left ventricle showed the following values: 204 +/- 33 ms, 262 +/- 23 ms, 266 +/- 24 ms, respectively. CONCLUSIONS: Right ventricle exhibits a long lasting ejection phase which can be subdivided in two phases, spreading at the beginning of the next filling phase. This fact allows us to affirm that right ventricle does not show an isovolumic relaxation phase in comparison to left ventricle.