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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(1): 49-52, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33565400

RESUMO

OBJECTIVE: To explore the effect of different tidal volumes (VT) on the hemodynamics of right heart in acute respiratory distress syndrome (ARDS) rats induced by oleic acid (OA). METHODS: Sixty adult male Sprague-Dawley (SD) rats were divided into control group (n = 20), ARDS model group (n = 20), low VT (LVT) group (n = 10) and high VT (HVT) group (n = 10) by random number table. ARDS model was reproduced by injecting OA 0.15 mL/kg through a jugular vein. The control group was given the same amount of normal saline. The success of modeling was judged by the oxygenation index (PaO2/FiO2) 2 hours after modeling, at the same time, the lung tissues were collected, the wet/dry weight (W/D) ratio was determined, and the lung histopathological changes were measured by lung injury score. The rats in the LVT group and HVT group were given mechanical ventilation with VT of 6 mL/kg or 20 mL/kg for 4 hours, respectively at 2 hours after modeling. The rats in the control group and the ARDS model group maintained spontaneous breathing. After mechanical ventilation for 4 hours, the heart rate (HR), right ventricular systolic pressure (RVSP), the maximum rate of rising of right ventricular pressure (dp/dt max), and the blood pressure (BP) were measured. Meanwhile, arterial blood samples were collected for blood gas analysis, including pH value, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and PaO2/FiO2. RESULTS: The rats in the ARDS model group showed symptoms of respiratory distress 1 hour after modeling, and the lung tissue samples showed obvious patchy bleeding 2 hours after modeling, while the control group showed no such changes. The PaO2/FiO2 in the ARDS model group was significantly lower than that in the control group [mmHg (1 mmHg = 0.133 kPa): 294.3±5.9 vs. 459.0±4.4, P < 0.01], and the lung W/D ratio and lung injury score were significantly higher (lung W/D ratio: 8.24±0.25 vs. 4.48±0.13, lung injury score: 0.60±0.03 vs. 0.12±0.02, both P < 0.01). It indicated that ARDS model was successfully reproduced. The arterial blood gas analysis and hemodynamic parameters of the ARDS model group were significantly worse than those of the control group. After 4-hour mechanical ventilation, the blood gas parameters of the LVT group were better than those of the ARDS model group and the HVT group [pH value: 7.36±0.02 vs. 7.24±0.02, 7.13±0.01; PaO2 (mmHg): 92.4±2.1 vs. 61.8±2.3, 76.6±2.2; PaCO2 (mmHg): 49.6±1.7 vs. 61.8±1.8, 33.6±1.3; PaO2/FiO2 (mmHg): 440.0±10.2 vs. 274.3±21.4, 364.7±10.5; all P < 0.05]. HR, BP and dp/dt max in the LVT group were significantly higher than those in the ARDS model group and the HVT group [HR (bpm): 346.9±5.4 vs. 302.3±10.1, 265.5±12.2; BP (mmHg): 125.4±2.2 vs. 110.0±2.5, 89.2±2.8; dp/dt max (mmHg/s): 1 393.3±30.3 vs. 1 236.4±20.5, 896.1±19.5; all P < 0.05], and RVSP was significantly lower than that in the ARDS model group and the HVT group (mmHg: 31.3±0.4 vs. 34.0±1.0, 38.8±0.9, both P < 0.05). CONCLUSIONS: Mechanical ventilation with low VT can improve the hemodynamic parameters of the right ventricle and protect the function of the right heart in ARDS rats.


Assuntos
Animais , Ventrículos do Coração , Hemodinâmica , Masculino , Ratos , Ratos Sprague-Dawley , Respiração Artificial/efeitos adversos , Volume de Ventilação Pulmonar
2.
Medicine (Baltimore) ; 100(1): e24158, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429797

RESUMO

BACKGROUND: The pelvic floor muscle (PFM) is associated with respiratory function. We investigated the effects of PFM training by pelvic floor electrical stimulation (PFES) on PFM strength, diaphragm excursion, and upper rib cage movement during tidal and forceful breathing and coughing in women with stress urinary incontinence (SUI). METHODS: In total, 33 participants with SUI were divided into PFES and control groups. The two groups were measured pre- and post-8 weeks of training. Diaphragm excursion and upper rib cage movement during tidal and forceful breathing and coughing and PFM strength were measured using sonography, electromagnetic sensors, and perineometry. RESULTS: There were significant difference of main effect between pre- and post-training and between groups in PFM strength (between groups: P = .001, between time: P < .001) and diaphragm excursion during forceful breathing (between groups: P = .015, between time: P = .026) and coughing (between groups: P = .035, between time: P = .006). There were significant differences in diaphragm excursion during tidal (P = .002) and forceful breathing (P = .005) and coughing (P < .001) between pre- and post-training in the PFES group. Elevation of the upper rib cage during tidal (P < .001) and forceful breathing (P = .001) was significantly decreased after 8 weeks of training in the PFES group. Widening in the horizontal plane in the upper rib cage during forceful breathing (P < .001) was significantly increased after 8 weeks of training in the PFES group. PFM strength (P < .001) was significantly increased after 8 weeks of training in the PFES group. CONCLUSIONS: Pelvic floor muscles training by electrical stimulation can improve diaphragm excursion and breathing patterns in women with SUI.


Assuntos
Tosse/complicações , Diafragma/inervação , Estimulação Elétrica/métodos , Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Tosse/fisiopatologia , Diafragma/fisiopatologia , Estimulação Elétrica/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , República da Coreia , Caixa Torácica/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Resultado do Tratamento , Ultrassonografia/métodos
7.
Curr Opin Anaesthesiol ; 34(1): 13-19, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315642

RESUMO

PURPOSE OF REVIEW: Quantification and optimization of perioperative risk factors focusing on anesthesia-related strategies to reduce postoperative pulmonary complications (PPCs) after lung and esophageal surgery. RECENT FINDINGS: There is an increasing amount of multimorbid patients undergoing thoracic surgery due to the demographic development and medical progress in perioperative medicine. Nevertheless, the rate of PPCs after thoracic surgery is still up to 30-50% with a significant influence on patients' outcome. PPCs are ranked first among the leading causes of early mortality after thoracic surgery. Although patients' risk factors are usually barely modifiable, current research focuses on procedural risk factors. From the surgical position, the minimal-invasive approach using video-assisted thoracoscopy and laparoscopy leads to a decreased rate of PPCs. The anesthesiological strategy to reduce the incidence of PPCs after thoracic surgery includes neuroaxial anesthesia, lung-protective ventilation, and goal-directed hemodynamic therapy. SUMMARY: The main anesthesiological strategies to reduce PPCs after thoracic surgery include the use of epidural anesthesia, lung-protective ventilation: PEEP (positive end-expiratory pressure) of 5-8 mbar, tidal volume of 5 ml/kg BW (body weight) and goal-directed hemodynamics: CI (cardiac index) ≥ 2.5 l/min per m2, MAD (Mean arterial pressure) ≥ 70 mmHg, SVV (stroke volume variation) < 10% with a total amount of perioperative crystalloid fluids ≤ 6 ml/kg BW (body weight) per hour.


Assuntos
Pneumopatias/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Torácica Vídeoassistida/efeitos adversos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Humanos , Pulmão , Pneumopatias/etiologia , Respiração com Pressão Positiva , Complicações Pós-Operatórias/etiologia , Volume de Ventilação Pulmonar
8.
J Surg Res ; 257: 344-348, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892129

RESUMO

BACKGROUND: The movement of a double-lumen endotracheal tube (DLT) out of its appropriate position during thoracic surgery can result in the loss of one-lung ventilation (OLV), especially during pulmonary resection and node dissection. Our study aimed to validate the efficacy of automatic retention pressure control of the DLT bronchial cuff in maintaining OLV in an artificial intubation model. MATERIALS AND METHODS: A 35-Fr left-sided DLT was intubated to the left main bronchus in an intubation simulator and connected to an anesthesia machine. The inspiratory volume, respiratory rate, and inspiratory-expiratory ratio were set at 500 mL, 12 times/min, and 1:2, respectively. A 1-kg right main bronchial traction in the lateral right was provided after OLV was established. SmartCuff (Smiths Medical, Minneapolis, Minnesota, USA) was used to maintain cuff pressure. The efficacy of retention pressure with SmartCuff (Group S) and without SmartCuff (Group WS) was compared. The primary outcome was the rate of tidal volume (TV) reduction following bronchial traction in the two groups. RESULTS: The TVs were 289.8 ± 28.9 mL and 242.8 ± 31.9 mL in Group S and Group WS, respectively (P = 0.003). The rate of TV reduction after bronchial traction was significantly lower in Group S (29 ± 5%) than in Group WS (43 ± 6%) (P < 0.001). CONCLUSIONS: Automatic retention pressure control of the DLT bronchial cuff improves the rate of TV reduction during right main bronchial traction in an artificial intubation model. Continuous retention cuff pressure may be useful in maintaining OLV during thoracic surgery.


Assuntos
Intubação Intratraqueal/instrumentação , Modelos Anatômicos , Ventilação Monopulmonar , Humanos , Cirurgia Torácica Vídeoassistida , Volume de Ventilação Pulmonar
9.
Curr Opin Crit Care ; 27(1): 6-12, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315636

RESUMO

PURPOSE OF REVIEW: To summarize the current knowledge of pathophysiology and ventilatory management of acute respiratory failure in COVID-19. RECENT FINDINGS: Early reports suggested that COVID-19 is an 'atypical ARDS' with profound hypoxemia with normal respiratory system compliance (Crs). Contrarily, several more populated analyses showed that COVID-19 ARDS has pathophysiological features similar to non-COVID-19 ARDS, with reduced Crs, and high heterogeneity of respiratory mechanics, hypoxemia severity, and lung recruitability. There is no evidence supporting COVID-19-specific ventilatory settings, and the vast amount of available literature suggests that evidence-based, lung-protective ventilation (i.e. tidal volume ≤6 ml/kg, plateau pressure ≤30 cmH2O) should be enforced in all mechanically ventilated patients with COVID-19 ARDS. Mild and moderate COVID-19 can be managed outside of ICUs by noninvasive ventilation in dedicated respiratory units, and no evidence support an early vs. late intubation strategy. Despite widely employed, there is no evidence supporting the efficacy of rescue therapies, such as pronation, inhaled vasodilators, or extracorporeal membrane oxygenation. SUMMARY: Given the lack of evidence-based specific ventilatory strategies and a large amount of literature showing pathophysiological features similar to non-COVID-19 ARDS, evidence-based lung-protective ventilatory strategies should be pursued in all patients with COVID-19 ARDS.


Assuntos
Respiração Artificial , Humanos , Pulmão , Volume de Ventilação Pulmonar
10.
PLoS One ; 15(12): e0243971, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332454

RESUMO

BACKGROUND: Expiratory flow-initiated pressure-controlled inverse ratio ventilation (EF-initiated PC-IRV) reduces physiological dead space. We hypothesised that EF-initiated PC-IRV would be lung protective compared with volume-controlled ventilation (VCV). METHODS: Twenty-eight men undergoing robot-assisted laparoscopic radical prostatectomy were enrolled in this randomised controlled trial. The EF-initiated PC-IRV group (n = 14) used pressure-controlled ventilation with the volume guaranteed mode. The inspiratory to expiratory (I:E) ratio was individually adjusted by observing the expiratory flow-time wave. The VCV group (n = 14) used the volume control mode with a 1:2 I:E ratio. The Mann-Whitney U test was used to compare differences in the serum cytokine levels. RESULTS: There were no significant differences in serum IL-6 between the EF-initiated PC-IRV (median 34 pg ml-1 (IQR 20.5 to 63.5)) and VCV (31 pg ml-1 (24.5 to 59)) groups (P = 0.84). The physiological dead space rate (physiological dead space/expired tidal volume) was significantly reduced in the EF-initiated PC-IRV group as compared with that in the VCV group (0.31 ± 0.06 vs 0.4 ± 0.07; P<0.001). The physiological dead space rate was negatively correlated with the forced vital capacity (% predicted) in the VCV group (r = -0.85, P<0.001), but not in the EF-initiated PC-IRV group (r = 0.15, P = 0.62). Two patients in the VCV group had permissive hypercapnia with low forced vital capacity (% predicted). CONCLUSIONS: There were no differences in the lung-protective properties between the two ventilatory strategies. However, EF-initiated PC-IRV reduced physiological dead space rate; thus, it may be useful for reducing the ventilatory volume that is necessary to maintain normocapnia in patients with low forced vital capacity (% predicted) during robot-assisted laparoscopic radical prostatectomy.


Assuntos
Expiração/fisiologia , Pulmão/fisiologia , Respiração com Pressão Positiva , Respiração Artificial/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ventilação com Pressão Positiva Intermitente , Masculino , Pessoa de Meia-Idade , Troca Gasosa Pulmonar/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Adulto Jovem
11.
PLoS One ; 15(11): e0242123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33196687

RESUMO

BACKGROUND: With large numbers of COVID-19 patients requiring mechanical ventilation and ventilators possibly being in short supply, in extremis two patients may have to share one ventilator. Careful matching of patient ventilation requirements is necessary. However, good matching is difficult to achieve as lung characteristics can have a wide range and may vary over time. Adding flow restriction to the flow path between ventilator and patient gives the opportunity to control the airway pressure and hence flow and volume individually for each patient. This study aimed to create and validate a simple model for calculating required flow restriction. METHODS AND FINDINGS: We created a simple linear resistance-compliance model, termed the BathRC model, of the ventilator tubing system and lung allowing direct calculation of the relationships between pressures, volumes, and required flow restriction. Experimental measurements were made for parameter determination and validation using a clinical ventilator connected to two test lungs. For validation, differing amounts of restriction were introduced into the ventilator circuit. The BathRC model was able to predict tidal lung volumes with a mean error of 4% (min:1.2%, max:9.3%). CONCLUSION: We present a simple model validated model that can be used to estimate required flow restriction for dual patient ventilation. The BathRC model is freely available; this tool is provided to demonstrate that flow restriction can be readily estimated. Models and data are available at DOI 10.15125/BATH-00816.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Ventiladores Mecânicos , Betacoronavirus , Desenho de Equipamento , Humanos , Modelos Lineares , Pandemias , Pressão , Respiração Artificial/instrumentação , Volume de Ventilação Pulmonar
12.
Rev Bras Ter Intensiva ; 32(3): 348-353, 2020.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-33053023

RESUMO

OBJECTIVE: A novel coronavirus emerged this year as a cause of viral pneumonia. The main characteristics of the virus are rapid transmission, high contagion capacity and potential severity. The objective of this case series study is to describe the clinical characteristics of patients with confirmed coronavirus disease (COVID-19) admitted to different intensive care units in Argentina for mechanical ventilation. METHODS: A descriptive, prospective, multicenter case series study was conducted between April 1 and May 8, 2020. Data from patients older than 18 years who were admitted to the intensive care unit for mechanical ventilation for acute respiratory failure with a positive diagnosis of COVID-19 were included. RESULTS: The variables for 47 patients from 31 intensive care units were recorded: 78.7% were men (median age of 61 years), with a SAPS II score of 43 and a Charlson index score of 3. The initial ventilatory mode was volume control - continuous mandatory ventilation with a tidal volume less than 8mL/kg in 100% of cases, with a median positive end-expiratory pressure of 10.5cmH2O. At the end of the study, 29 patients died, 8 were discharged, and 10 remained hospitalized. The SAPS II score was higher among patients who died (p = 0.046). Charlson comorbidity index was associated with higher mortality (OR = 2.27, 95% CI 1.13 - 4.55, p = 0.02). CONCLUSION: Patients with COVID-19 and on mechanical ventilation in this series presented clinical variables similar to those described to date in other international reports. Our findings provide data that may predict outcomes.


Assuntos
Infecções por Coronavirus/terapia , Unidades de Terapia Intensiva , Pneumonia Viral/terapia , Respiração Artificial , Insuficiência Respiratória/terapia , Adulto , Idoso , Argentina , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , Respiração com Pressão Positiva , Estudos Prospectivos , Insuficiência Respiratória/virologia , Volume de Ventilação Pulmonar
13.
Am J Vet Res ; 81(11): 857-864, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107749

RESUMO

OBJECTIVE: To determine the accuracy of tidal volume (VT) delivery among 5 different models of large-animal ventilators when tested at various settings for VT delivery, peak inspiratory flow (PIF) rate, and fresh gas flow (FGF) rate. SAMPLE: 4 different models of pneumatically powered ventilators and 1 electrically powered piston-driven ventilator. PROCEDURES: After a leak flow check, each ventilator was tested 10 times for each experimental setting combination of 5 levels of preset VT, 3 PIF rates, and 4 FGF rates. A thermal mass flow and volume meter was used as the gold-standard method to measure delivered VT. In addition, circuit systems of rubber versus polyvinyl chloride breathing hoses were evaluated with the piston-driven ventilator. Differences between preset and delivered VT (volume error [ΔVT]) were calculated as a percentage of preset VT, and ANOVA was used to compare results across devices. Pearson correlation coefficient analyses and the coefficient of determination (r2) were used to assess potential associations between the ΔVT and the preset VT, PIF rate, and FGF rate. RESULTS: For each combination of experimental settings, ventilators had ΔVT values that ranged from 1.2% to 22.2%. Mean ± SD ΔVT was 4.8 ± 2.5% for the piston-driven ventilator, compared with 6.6 ± 3.2%, 10.6 ± 2.9%, 13.8 ± 2.97%, and 15.2 ± 2.6% for the 4 pneumatic ventilators. The ΔVT increased with higher PIF rates (r2 = 0.69), decreased with higher FGF rates (r2 = 0.62), and decreased with higher preset VT (r2 = 0.58). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the tested ventilators all had ΔVT but that the extent of each of ΔVT varied among ventilators. Close monitoring of delivered VT with external flow and volume meters is warranted, particularly when pneumatic ventilators are used or when very precise VT delivery is required.


Assuntos
Respiração Artificial , Ventiladores Mecânicos , Animais , Respiração , Respiração Artificial/veterinária , Volume de Ventilação Pulmonar , Ventiladores Mecânicos/veterinária
14.
Rev Soc Bras Med Trop ; 53: e20190481, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027412

RESUMO

INTRODUCTION: Patients with acute respiratory failure due to influenza require ventilatory support. However, mechanical ventilation itself can exacerbate lung damage and increase mortality. METHODS: The aim of this study was to describe a feasible and protective ventilation protocol, with limitation of the tidal volume to ≤6 mL/kg of the predicted weight and a driving pressure ≤15 cmH2O after application of the alveolar recruitment maneuver and PEEP titration. RESULTS: Initial improvement in oxygenation and respiratory mechanics were observed in the four cases submitted to the proposed protocol. CONCLUSIONS: Our results indicate that the mechanical ventilation strategy applied could be optimized.


Assuntos
Influenza Humana , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Respiração Artificial , Volume de Ventilação Pulmonar
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2274-2278, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018461

RESUMO

We have refactored the Pulse Physiology Engine respiratory software with enhanced parameterization for improved simulation functionality and results. Realistic patient variability can be applied using discretized lumped-parameters that define lung volumes, compliances, and resistances. A new sigmoid compliance waveform helps meet validation of compartment pressures, flows, volumes, and substance values. Further parameterization and enhanced logic for the application of pathophysiology allows for more accurate modeling of both restrictive and obstructive diseases for mild, moderate, and severe cases.Clinical Relevance- This free and open model provides a well-validated respiratory system for integration with medical simulations and research. It improves the Pulse modeling software and allows for new, low-cost training and in silico testing use-cases. Applications include virtual/augmented environments, manikin-based simulations, and clinical explorations.


Assuntos
Pulmão , Software , Simulação por Computador , Humanos , Manequins , Volume de Ventilação Pulmonar
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2438-2441, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018499

RESUMO

We have created a lung simulation to quantify lung heterogeneity from the results of the inspired sinewave test (IST). The IST is a lung function test that is non-invasive, non-ionising and does not require patients' cooperation. A tidal lung simulation is developed to assess this test and also a method is proposed to calculate lung heterogeneity from IST results. A sensitivity analysis based on the Morris method and linear regression were applied to verify and to validate the simulation. Additionally, simulated emphysema and pulmonary embolism conditions were created using the simulation to assess the ability of the IST to identify these conditions. Experimental data from five pigs (pre-injured vs injured) were used for validation. This paper contributes to the development of the IST. Firstly, our sensitivity analysis reveals that the IST is highly accurate with an underestimation of about 5% of the simulated values. Sensitivity analysis suggested that both instability in tidal volume and extreme expiratory flow coefficients during the test cause random errors in the IST results. Secondly, the ratios of IST results obtained at two tracer gas oscillation frequencies can identify lung heterogeneity (ELV60/ELV180 and Qp60/Qp180). There was dissimilarity between simulated emphysema and pulmonary embolism (p < 0.0001). In the animal model, the control group had ELV60/ELV180 = 0.58 compared with 0.39 in injured animals (p < 0.0001).


Assuntos
Pulmão , Animais , Humanos , Testes de Função Respiratória , Suínos , Volume de Ventilação Pulmonar
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4632-4635, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019026

RESUMO

Various measurement systems can be used to obtain dynamic circumferences of the human upper body, but each of these systems has disadvantages. In this feasibility study we introduce a non-invasive and wearable thoracic belt to measure dynamic changes of circumferences of thorax or abdomen. To evaluate this approach, five subjects undertook various breaths of disparate tidal volumes, which were measured by the belt and simultaneously by a motion capture system which provided a reference metric.The results of the belt concurred with the reference system. A coefficient of determination (adjusted R2) of 0.99 and a mean squared error of less than 0.87 mm2 showed that the belt is capable of measuring changes accurately and a couple of respiratory parameters, such as the respiratory rate, can be obtained.Clinical Relevance-The introduced system links surface motions of the upper body with the underlying respiratory mechanics. Thus it provides some respiratory parameters without the disadvantages of a facemask or a mouthpiece. The system could allow the analysis of breathing status in some clinical applications and could be used for low-cost monitoring in homecare or to analyse respiratory parameters during sports.


Assuntos
Respiração , Tórax , Estudos de Viabilidade , Humanos , Projetos Piloto , Volume de Ventilação Pulmonar
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 596-599, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018059

RESUMO

A pilot study on tracking changes in tidal volume (TV) using ECG signals acquired by a wearable armband is presented. The wearable armband provides three ECG channels by using three pairs of dry electrodes, resulting in a device that is convenient for long-term daily monitoring. An additional ECG channel was derived by computing the first principal component of the three original channels (by means of principal component analysis). Armband and spirometer signals were simultaneously recorded from five healthy subjects who were instructed to breathe with varying TV. Three electrocardiogram derived respiration (EDR) methods based on QRS complex morphology were studied: the QRS slopes range (SR), the R-wave angle (Փ), and the R-S amplitude (RS). The peak-to-peak amplitudes of these EDR signals were estimated as surrogates for TV, and their correlations with the reference TV (estimated from the spirometer signal) were computed. In addition, a multiple linear regression model was calculated for each subject, using the peak-to-peak amplitudes from the three EDR methods from the four ECG channels. Obtained correlations between TV and EDR peak-to-peak amplitude ranged from 0.0448 up to 0.8491. For every subject, a moderate correlation (>0.5) was obtained for at least one EDR method. Furthermore, the correlations obtained for the subject-specific multiple linear regression model ranged from 0.8234 up to 0.9154, and the goodness of fit was 0.73±0.07 (median ± standard deviation). These results suggest that the peak-to-peak amplitudes of the EDR methods are linearly related to the TV. opening the possibility of estimating TV directly from an armband ECG device.Clinical Relevance- This opens the door to possible continuous monitoring of TV from the armband by using EDR.


Assuntos
Processamento de Sinais Assistido por Computador , Dispositivos Eletrônicos Vestíveis , Eletrocardiografia , Humanos , Projetos Piloto , Volume de Ventilação Pulmonar
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 750-753, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018095

RESUMO

In addition to the global parameter- and time-series-based approaches, physiological analyses should constitute a local temporal one, particularly when analyzing data within protocol segments. Hence, we introduce the R package implementing the estimation of temporal orders with a causal vector (CV). It may use linear modeling or time series distance. The algorithm was tested on cardiorespiratory data comprising tidal volume and tachogram curves, obtained from elite athletes (supine and standing, in static conditions) and a control group (different rates and depths of breathing, while supine). We checked the relation between CV and body position or breathing style. The rate of breathing had a greater impact on the CV than does the depth. The tachogram curve preceded the tidal volume relatively more when breathing was slower.


Assuntos
Análise de Dados , Respiração , Atletas , Humanos , Postura , Posição Ortostática , Volume de Ventilação Pulmonar
20.
Best Pract Res Clin Anaesthesiol ; 34(3): 561-567, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004167

RESUMO

Coronavirus disease 2019 (COVID-19) is a new disease with different phases that can be catastrophic for subpopulations of patients with cardiovascular and pulmonary disease states at baseline. Appreciation for these different phases and treatment modalities, including manipulation of ventilatory settings and therapeutics, has made it a less lethal disease than when it emerged earlier this year. Different aspects of the disease are still largely unknown. However, laboratory investigation and clinical course of the COVID-19 show that this new disease is not a typical acute respiratory distress syndrome process, especially during the first phase. For this reason, the best strategy to be applied is to treat differently the single phases and to support the single functions of the failing organs as they appear.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Pulmão/fisiopatologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Respiração com Pressão Positiva/métodos , Humanos , Pandemias , Volume de Ventilação Pulmonar/fisiologia
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