Correctly selecting a liquid-filled nasogastric infant feeding catheter to measure intraesophageal pressure.

Polyvinyl chloride (PVC) nasogastric feeding catheters are used clinically to measure intraesophageal pressure as an estimate of pleural pressure for calculating lung compliance in infants. The accuracy of pressure measurement of 4 French gauge (FG) catheter sizes and three brands of liquid-filled catheter manometer systems (CMS) was evaluated by determining their resonance-frequency amplitude and phase properties. All CMS were underdamped and resonated. No CMS exhibited a uniform mean frequency response above 11 Hz. The maximum respiratory rate (Frr) within which CMS could potentially measure dynamic intraesophageal pressure within a 5% error limit was determined (Frr): the highest mean Frr recorded reliably in large-diameter catheters was 82 breaths/min. Significant CMS differences in accuracy existed between catheter FG sizes and between catheters of similar diameters but differing brands. Correlation (r2) between catheter inner diameter and CMS Frr was 0.66 across brands. In conclusion, intraesophageal PVC liquid-filled feeding catheters are suitable for estimating pleural pressures in subjects mechanically ventilated without sharp inspiratory waveforms or high respiratory rates. Quantitative frequency response characterization of different nasogastric catheter brands and different diameters is mandatory prior to their utilization.

Frequency responses of infant air-balloon versus liquid-filled catheters for intra-esophageal pressure measurement.

Amplitude and phase frequency response characteristics of infant air-balloon catheters (IABC) of differing French gauge (FG) sizes and brands were quantified to determine their suitability for measuring dynamic intra-esophageal pressure (Pes) accurately. Frequency response performances of matching IABC and water-filled catheters (WFC) were also compared using the swept sine wave technique. The maximum respiratory rate within which IABCs could potentially measure Pes within a 5% error limit was calculated (FRR). Frequency responses of IABCs greater than FG size 5 exhibited underdamped resonant properties, while smaller FG size IABCs exhibited near-critical damping or overdamping. IABCs maintained uniform amplitude frequency responses up to 25 Hz, demonstrating the ability to measure Pes potentially up to 148 breaths/min within a 5% error limit. The frequency response performance of FG size 6 IABCs was similar to that of FG size 10 IABCs. Compared with matching WFCs, the frequency response performance of IABCs was significantly superior, the frequency response variability within IABC samples was lower, and IABC correlation between FG size and FRR was advantageously lower than for WFCs. FRR values for differing IABC brands and FG sizes are presented. We conclude that IABCs manufactured to infant-appropriate balloon specifications exhibit significantly superior frequency response characteristics compared with matching WFCs. Measurement accuracy is not improved using IABCs greater than FG size 6. Inexpensive intra-esophageal IABCs are technical suitable for the accurate measurement of dynamic Pes during high-frequency respiratory mechanics encountered during infant artificial ventilation.

Lipoprotein (a) and cholesterol in body builders using anabolic androgenic steroids.

We examined the influence of self-administered anabolic androgenic steroids (AAS) on the lipogram of male body builders. Serum lipoprotein (a) (Lp(a)), total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were measured in 10 experimental and 8 control male competitive body builders. The proportion of subjects with serum Lp(a) levels above 30 mg.dl-1 was significantly lower in the AAS group than the non-AAS group. HDL-C levels were significantly lower and LDL-C levels significantly higher in the AAS group than the non-AAS group. These data suggest that AAS in male body builders have a beneficial effect on serum Lp(a) levels but reduce the HDL-C:LDL-C ratio.

Influence of ketanserin on regional myocardial blood flow after myocardial infarction in baboons.

Serotonin (5-hydroxytryptamine, 5-HT) mediates vasoconstriction and vasodilation in normal coronary circulation of various animal species. In the presence of coronary artery disease, serotonin may inhibit coronary collateral formation and stimulate predominantly vasoconstriction. We tested the effect of ketanserin, a selective 5-HT2 receptor antagonist and platelet aggregation inhibitor, on ischemic myocardium blood flow (BF) and collateral formation after coronary artery occlusion in primates. Fifteen baboons were subjected to left anterior descending coronary artery (LAD) ligation and thrombus formation. Hemodynamics and regional myocardial blood flow (RMBF) (microsphere technique) were measured before and 45 min and 1 week after coronary artery occlusion. There was no significant difference in the hemodynamic measurements, gross infarct size, or infarct-ischemic zone MBF in the experimental group (ketanserin 1 mg/kg daily, n = 9) as compared with the control group (injectable water, n = 6). Both groups had a significant increase in BF ratio of infarct-ischemic/normal myocardium at 1 week as compared with shortly after coronary occlusion. Thus, selective 5-HT2 receptor blockade has neither an adverse nor a protective effect on myocardial infarct resulting from acute thrombotic coronary occlusion in baboons.

Primate pleuroesophageal tissue barrier frequency response and esophageal pressure waveform bandwidth in health and acute lung injury.

BACKGROUND: Dynamic intraesophageal pressure (Pes) is used to estimate intrapleural pressure (Ppl) to calculate lung compliance and resistance. This study investigated the nonhuman primate Ppl-Pes tissue barrier frequency response and the dynamic response requirements of Pes manometers. METHODS: In healthy monkeys and monkeys with acute lung injury undergoing ventilation, simultaneous Ppl and Pes were measured directly to determine the Ppl-Pes tissue barrier amplitude frequency response, using the swept-sine wave technique. The bandwidths of physiologic Pes waveforms acquired during conventional mechanical ventilation were calculated using digital low-pass signal filtering. RESULTS: The Ppl-Pes tissue barrier is amplitude-uniform within the bandwidth of conventional Pes waveforms in healthy and acute lung injury lungs, and does not significantly attenuate Ppl-Pes signal transmission between 1 and 40 Hz. At Pes frequencies higher than conventional clinical regions of interest the Ppl-Pes barrier resonates significantly, is pressure amplitude dependent at low-pressure offsets, and is significantly altered by acute lung injury. Allowing for 5% or less Pes waveform error, the maximum Pes bandwidths during conventional ventilation were 1.9 Hz and 3.4 Hz for physiologic and extreme-case waveforms in healthy lungs and 4.6 Hz and 8.5 Hz during acute lung injury. CONCLUSIONS: In monkeys, the Ppl-Pes tissue barrier has a frequency response suitable for Ppl estimation during low-frequency mechanical ventilation, and Pes manometers should have a minimum uniform frequency response up to 8.5 Hz. However, the Ppl-Pes tissue barrier adversely affects the accurate estimation of dynamic Ppl at high frequencies, with varied airway pressure amplitudes and offsets, such as the Ppl encountered during high-frequency oscillatory ventilation.