Effects of continuous, expiratory, reverse, and bi-directional tracheal gas insufflation in conjunction with a flow relief valve on delivered tidal volume, total positive end-expiratory pressure, and carbon dioxide elimination: a bench study.

INTRODUCTION: Tracheal gas insufflation (TGI) can increase total positive end-expiratory pressure (total-PEEP) when flow is delivered in a forward direction, necessitating adjustments to maintain total-PEEP constant. When TGI is delivered throughout the respiratory cycle, additional adjustments are needed to maintain tidal volume (V(T)) constant. OBJECTIVE: Determine if bi-directional TGI (bi-TGI) (simultaneous flows toward the lungs and upper airway) in combination with a flow relief valve eliminates the increase in total-PEEP and maintains a constant V(T), thus simplifying TGI administration. METHODS: Using an artificial lung model and pressure control ventilation, we studied the effect of TGI at 10 L/min on inspired V(T), total-PEEP, and CO(2) elimination during 6 conditions: (1) control (no TGI, no catheter in the airway), (2) baseline (catheter in the airway but no TGI), (3) continuous TGI, (4) expiratory TGI, (5) reverse TGI, and (6) bi-TGI. Each condition was studied under 3 inspiration-expiration ratios (1:1, 1:2, and 2:1). A preset flow relief valve was inserted into the ventilator circuit during all TGI conditions with continuous flow. SETTING: University research laboratory. RESULTS: CO(2) elimination efficiency was similar under all conditions. Total-PEEP increased with continuous TGI and expiratory TGI, decreased during reverse TGI, and was unchanged during bi-TGI. With the flow relief valve in place, and no adjustment in mechanical ventilation, the change in minute ventilation ranged from 0% to 10%, with the least change during bi-TGI (0-5%). During bi-TGI, gas flow was equivalent in both directions during dynamic conditions and the flow relief valve consistently removed gas at 10 L/min under various pressures. CONCLUSIONS: Our data from an artificial lung model support that continuous bi-TGI minimizes the change in total-PEEP seen during other TGI modalities. The flow relief valve compensated for the extra gas volume delivered by the TGI catheter, thereby eliminating the need to make ventilator adjustments. Used in combination with a flow relief valve, bi-TGI appears to offer unique advantages by providing a simpler method to deliver TGI. Further testing is indicated to determine if similar benefits occur in the clinical setting.

A study of the relationship between mechanical and ultrasonic properties of dystrophic and normal skeletal muscle.

A study has been made of the application of radio frequency (RF) ultrasound to the detection of muscular dystrophy by monitoring passively stretched skeletal muscle. The tests included detection of integrated backscatter changes in response to both static loading, in which muscle samples were stretched and allowed to relax, and stress relaxation. In both static and step strain loading conditions, the dystrophic muscle was found to exhibit little change in backscatter power while normal muscle responded to loading with significant changes in integrated backscatter. The backscatter response is compared with mechanical properties of the tissue (time constants and stress-strain constants). Both mechanical and ultrasonic time constants of relaxation are not significantly different between normal and dystrophic tissue, but stress-strain constants do differ. The difference in response of dystrophic and normal tissue appears to be due to a repression of motion of the constituent anatomy of dystrophic muscle which is responsible for the change of echogenicity with passive stretch.

Scattering of ultrasound from skeletal muscle tissue.

The purpose of this work was to explore the mechanisms which are responsible for the scattering of ultrasound from skeletal muscle tissue. It was undertaken in response to an interesting phenomenon observed in the authors' laboratory whereby scattering power from avian skeletal muscle changed in concordance with passive stretch. Ultrasonic scattering from skeletal muscle samples was measured as they were stretched passively in increments of 10% of their original length up to 40%. The samples were illuminated with an ultrasound beam from a transducer which was oriented orthogonally to and at 20 degrees from the normal to the long axis of the muscle sample. It was found that the integrated backscatter increased significantly over the strain range for the orthogonal orientation, but it changed very little after the initial stretch when the orientation was 20 degrees . It is postulated that this phenomenon may be caused by reorientation of the endomysial collagen fibers surrounding each muscle fiber.

A feasibility study on quantitating myocardial perfusion with Albunex, an ultrasonic contrast agent.

Quantitating regional myocardial perfusion has been the much sought-after but still elusive goal of many intensive investigations over the years. Videodensitometry of the variation of myocardial echogenicity in two-dimensional (2-D) echocardiograms as a function of time in conjunction with the injection of a bolus of an ultrasound contrast agent has been used clinically as a tool for a direct assessment of regional myocardial perfusion, despite that the precise relationship between tissue echogenicity observed on an image and the echoes detected by the ultrasonic probe is unknown. A study was undertaken to determine whether ultrasonic backscatter calculated from unprocessed radio frequency (RF) echoes returned from myocardium could be used to quantitate regional myocardium perfusion. A real-time ultrasonic scanner has been modified and interfaced to a microcomputer to acquire RF data at a rate up to 10 frames per second. Preliminary experimental data were obtained from four open-chest dogs following intracoronary injection of a bolus of Albunex and two dogs following intravenous injection with this modified scanner. On one hand, these results indicate that the integrated backscatter measured from the region of myocardium perfused by the coronary artery where Albunex is injected and selected for monitoring initially increases, reaches a peak, and then decreases as the contrast agent is washed out and that the magnitude of the peak is approximately linearly proportional to the volume concentration of Albunex microspheres injected, clearly demonstrating the feasibility of this approach for quantitating region myocardial perfusion. On the other hand, intravenous injections did not result in any appreciable change in myocardial backscatter in the left ventricle although a response could be observed in the left ventricular blood pool.

A novel method for the measurement of acoustic speed.

Traditional methods for measuring acoustic speed require knowledge of either the specimen thickness or the distances between the transducers and the specimen. In general, the accuracy in measuring these quantities determines the accuracy of the experimental technique for measuring speed. This problem is particularly acute in measuring sound speed in biological specimens. A new method for measuring acoustic speed of materials, which eliminates the need for determining these quantities, has been developed. The technique, which necessitates the use of only one transducer, requires measurement of four times of flight of a sound pulse and the knowledge of the speed of sound in a reference fluid medium in which the specimen is placed. Ultrasonic speed in stainless steel and Plexiglas was measured using this method to verify its validity. Results on measurements on porcine liver, myocardium, and soft fat are also reported.

High-pressure portable pneumatic drive unit.

The left ventricular assist device (LVAD) of the Cleveland Clinic Foundation (CCF) is a single-chamber assist pump, driven by a high-pressure pneumatic cylinder. A low-cost, portable driver that will allow cardiac care patients, with a high-pressure pneumatic ventricle assist, more freedom of movement has been developed. The compact and light-weight configuration can provide periods of 2 h of freedom from a fixed position driver and does not use exotic technology.

The E4T electric powered total artificial heart (TAH).

The E4T is a totally implantable total artificial heart (TAH) resulting from many years of research work at the Cleveland Clinic Foundation (CCF) and Nimbus, Inc. It consists of four implanted subsystems: the pumping unit, the variable volume device, the transcutaneous transformer, and the internal battery. The pumping unit consists of two CCF biolized pusher plate pumps, and a Nimbus electrohydraulic energy converter. The control logic is based on a left master, alternating beating scheme. The timing difference between end right eject and end left fill determines the actuator speed adjustment. The pumps free fill, so left-right flow differences are easily accommodated. A prototype system has been built and begun testing to validate and refine the design details.