Imprecision in lower "inflection point" estimation from static pressure-volume curves in patients at risk for acute respiratory distress syndrome.

BACKGROUND: Static pressure-volume (PV) curves have been promoted as a tool for selecting positive end-expiratory pressure (PEEP) by identifying a lower "inflection point" (Pflex) from these curves. Their visual interpretation is subjective and difficult, however, particularly with subtle changes in the slope of the curves. This study was designed to examine the physician-to-physician variability in estimating the lower Pflex from these curves. METHODS: Static PV curves for eight patients were obtained within 24 hours of admission. Five intensivists and one respiratory therapist independently estimated the lower Pflex from these curves. RESULTS: Pflex estimates for individual patients were highly variable, ranging from 5 to 9 cm H2O. This variability was not attributable to a single discordant estimate, nor was a single physician responsible for consistently high or low estimates. CONCLUSION: Static PV curve interpretation with current methods imprecisely estimates the lower inflection point and is of limited usefulness in PEEP selection.

Molecular genetic analysis of distal mouse chromosome 6 defines gene order and positions of the deafwaddler and opisthotonos mutations.

Two neurological mutants deafwaddler (dfw) and opisthotonos (opt) and a cluster of three Shaker-like potassium (K) channel genes Kcna1, Kcna5, and Kcna6 were all independently mapped to distal mouse chromosome six (Chr 6). In this study, genetic and molecular techniques were employed to assess directly the linkage of the two mutants and to investigate the likelihood that a mutation in one of the three K channel genes may underlie dfw and/or opt. Genetic crosses testing for allelism showed that the dfw and opt mutations complement each other. Additional crosses demonstrated that the mutants are separated by a recombination distance of 3.1 +/- 1.8 cM. Microsatellite marker analysis of the crossover chromosomes recovered from the opt, dfw recombination study indicated that opt maps centromeric to dfw. The location of the K channel genes relative to the dfw mutation was determined by mapping these genes and 15 microsatellite markers in an intersubspecific backcross (IB) segregating for dfw [(CAST/Ei-+/+ x C3HeB/FeJ-dfw/dfw) x C3HeB/FeJ-dfw/dfw]. Analysis of the backcross progeny positioned the dfw locus in the interval between the microsatellite markers D6Mit11 and D6Mit55, D6Mit63. The K channel cluster maps telomeric to dfw. This study establishes the gene order cen-opt-dfw-Rho (D6Mit44)-Kcna1, Kcna5, Kcna6 on distal mouse Chr 6 and suggests that the neurological mutants opt and dfw affect two different genes, neither of which is caused by a mutation in any one of the three clustered K channels.

Physical and genetic maps of the deafwaddler region on distal mouse Chr 6.

The deafwaddler (dfw) mutation, displaying motor ataxia and profound deafness, arose spontaneously in a C3H/HeJ colony and was mapped previously to distal mouse Chr 6. In this study, a high-resolution genetic map was generated by positioning 10 microsatellite markers and 5 known genes on a 968-meioses intersubspecific backcross segregating for dfw [(CAST/Ei(-)+/+ x C3HeB/ FeJ-dfw/dfw) x C3HeB/FeJ-dfw/dfw], giving the following marker order and sex-averaged distances: D6Mit64-(0.10 + 0.10 cM)-Pang-(1.24 + 0.36 cM)-Itpr1-(0.62 + 0.25 cM)-D6Mit108-(0.52 + 0.23 cM)-D6Mit54-(0.21 + 0.15 cM)-D6Mit23, D6Mit107, D6Mit328-(0.72 + 0.27 cM)-D6Mit11-(0.21 + 0.15 cM)-dfw-(0.93 + 0.31 cM)-Gat4, D6Mit55-(0.10 + 0.10 cM)-D6Mit63-(0.31 + 0.18 cM)-Syn2-(0.62 + 0.25 cM)-D6Mit44 (Rho). Female and male genetic maps are similar immediately surrounding the dfw locus, but show marked differences in other areas. A yeast artificial chromosome-based physical map suggests that the closest markers flanking the dfw locus, D6Mit11 (proximal) and Gat4, D6Mit55 (distal), are contained within 650-950 kb. The human homologues of the flanking loci Itpr1 (proximal) and Syn2 (distal) map to chromosome 3p25-p26, suggesting that the human homologue of the dfw gene is located within this same region.