scholarly journals Carbon Dioxide Changes during High-flow Nasal Oxygenation in Apneic Patients: A Single-center Randomized Controlled Noninferiority Trial

2021 ◽  
Author(s):  
Thomas Riva ◽  
Robert Greif ◽  
Heiko Kaiser ◽  
Thomas Riedel ◽  
Markus Huber ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Partial Pressure ◽  
High Flow ◽  
Low Flow ◽  
Anesthesia Induction ◽  
Flow Rates ◽  
Linear Rate ◽  
Arterial Partial Pressure ◽  
Medium Flow ◽  
Ventilatory Effect

Background Anesthesia studies using high-flow, humidified, heated oxygen delivered via nasal cannulas at flow rates of more than 50 l · min–1 postulated a ventilatory effect because carbon dioxide increased at lower levels as reported earlier. This study investigated the increase of arterial partial pressure of carbon dioxide between different flow rates of 100% oxygen in elective anesthetized and paralyzed surgical adults before intubation. Methods After preoxygenation and standardized anesthesia induction with nondepolarizing neuromuscular blockade, all patients received 100% oxygen (via high-flow nasal oxygenation system or circuit of the anesthesia machine), and continuous jaw thrust/laryngoscopy was applied throughout the 15-min period. In this single-center noninferiority trial, 25 patients each, were randomized to five groups: (1) minimal flow: 0.25 l · min–1, endotracheal tube; (2) low flow: 2 l · min–1, continuous jaw thrust; (3) medium flow: 10 l · min–1, continuous jaw thrust; (4) high flow: 70 l · min–1, continuous jaw thrust; and (5) control: 70 l · min–1, continuous laryngoscopy. Immediately after anesthesia induction, the 15-min apnea period started with oxygen delivered according to the randomized flow rate. Serial arterial blood gas analyses were drawn every 2 min. The study was terminated if either oxygen saturation measured by pulse oximetry was less than 92%, transcutaneous carbon dioxide was greater than 100 mmHg, pH was less than 7.1, potassium level was greater than 6 mmol · l–1, or apnea time was 15 min. The primary outcome was the linear rate of mean increase of arterial carbon dioxide during the 15-min apnea period computed from linear regressions. Results In total, 125 patients completed the study. Noninferiority with a predefined noninferiority margin of 0.3 mmHg · min–1 could be declared for all treatments with the following mean and 95% CI for the mean differences in the linear rate of arterial partial pressure of carbon dioxide with associated P values regarding noninferiority: high flow versus control, –0.0 mmHg · min–1 (–0.3, 0.3 mmHg · min–1, P = 0.030); medium flow versus control, –0.1 mmHg · min–1 (–0.4, 0.2 mmHg · min–1, P = 0.002); low flow versus control, –0.1 mmHg · min–1 (–0.4, 0.2 mmHg · min–1, P = 0.003); and minimal flow versus control, –0.1 mmHg · min–1 (–0.4, 0.2 mmHg · min–1, P = 0.004). Conclusions Widely differing flow rates of humidified 100% oxygen during apnea resulted in comparable increases of arterial partial pressure of carbon dioxide, which does not support an additional ventilatory effect of high-flow nasal oxygenation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Effect of expiratory flow patterns on lung emptying

1963 ◽  
Vol 18 (1) ◽  
pp. 47-50 ◽  
Author(s):  
A. C. Young ◽  
C. J. Martin ◽  
William R. Pace
Keyword(s):  
Carbon Dioxide ◽  
Flow Pattern ◽  
Body Position ◽  
Volume Ratio ◽  
Flow Patterns ◽  
High Flow ◽  
Low Flow ◽  
Flow Rates ◽  
Single Breath ◽  
Expiratory Flow

Differences in expired alveolar gas concentrations with changes in expiratory flow were studied in single-breath experiments using nitrogen and carbon dioxide meters. High flow rates preferentially emptied lung areas having low ventilation-to-volume ratios and high ventilation-to-perfusion ratios, whereas low flow rates preferentially emptied areas of high ventilation-to-volume and low ventilation-to-perfusion ratios. Selective emptying of different lung areas by varying the expiratory flow pattern was not affected by age, sex, or body position. A model of the lung is proposed to explain how ventilation-to-volume ratio differences can be seen at mouth level during constant slow, varying, and constantly increasing or decreasing expiratory flow. Submitted on May 4, 1962

Experimental Investigation of Pressure Fluctuations on Inner Wall of a Centrifugal Pump

2019 ◽  
Vol 36 (4) ◽  
pp. 401-410 ◽  
Author(s):  
Xiao-Qi Jia ◽  
Bao-Ling Cui ◽  
Zu-Chao Zhu ◽  
Yu-Liang Zhang
Keyword(s):  
Centrifugal Pump ◽  
Flow Rate ◽  
Pressure Fluctuation ◽  
Pressure Fluctuations ◽  
High Flow ◽  
Low Flow ◽  
Centrifugal Pumps ◽  
Flow Rates ◽  
Pressure Distributions ◽  
Blade Passing Frequency

Abstract Affected by rotor–stator interaction and unstable inner flow, asymmetric pressure distributions and pressure fluctuations cannot be avoided in centrifugal pumps. To study the pressure distributions on volute and front casing walls, dynamic pressure tests are carried out on a centrifugal pump. Frequency spectrum analysis of pressure fluctuation is presented based on Fast Fourier transform and steady pressure distribution is obtained based on time-average method. The results show that amplitudes of pressure fluctuation and blade-passing frequency are sensitive to the flow rate. At low flow rates, high-pressure region and large pressure gradients near the volute tongue are observed, and the main factors contributing to the pressure fluctuation are fluctuations in blade-passing frequency and high-frequency fluctuations. By contrast, at high flow rates, fluctuations of rotating-frequency and low frequencies are the main contributors to pressure fluctuation. Moreover, at low flow rates, pressure near volute tongue increases rapidly at first and thereafter increases slowly, whereas at high flow rates, pressure decreases sharply. Asymmetries are observed in the pressure distributions on both volute and front casing walls. With increasing of flow rate, both asymmetries in the pressure distributions and magnitude of the pressure decrease.

Leach Behavior of SRL TDS-131 Defense Waste Glass in Water at High&Low Flow Rates

1983 ◽  
Vol 26 ◽  
Author(s):  
Aaron Barkatt ◽  
William Sousanpour ◽  
Alisa Barkatt ◽  
Morad A. Boroomand ◽  
Pedro B. Macedo
Keyword(s):  
Contact Time ◽  
Protective Layer ◽  
High Flow ◽  
Low Flow ◽  
Matrix Elements ◽  
Flow Rates ◽  
Low Concentrations ◽  
Controlling Mechanism ◽  
The Matrix ◽  
Leach Behavior

ABSTRACTLeach tests carried out on SRL TDS-131 Defense Waste Class indicate that at high flow rates the controlling mechanism is simple corrosion. The matrix elements (Si, Al) are leached out at rates similar to those of the leaching of the alkalis and of boron, and the leaching process is nearly linear with time. At slow flow rates (below 1 m/yr) leaching becomes controlled by the build-up of a protective layer. Al and most of the Si remain in the leached surface layer. The leach rates decrease in the course of the test before leveling off at constant values which are almost inversely proportional to the contact time, indicating that leachate concentrations have become solubility-limited. The low concentrations observed at this stage indicate the formation of alteration products.

scholarly journals Second-generation laryngeal mask airway as an alternative to endotracheal tube during prolonged laparoscopic abdominal surgery: a comparative analysis of intraoperative gas exchanges

2021 ◽  
Author(s):  
S Park ◽  
JE Lee ◽  
GS Choi ◽  
JM Kim ◽  
JS Ko ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Gas Exchange ◽  
Laryngeal Mask Airway ◽  
Abdominal Surgery ◽  
Partial Pressure ◽  
Endotracheal Tube ◽  
Second Generation ◽  
Laryngeal Mask ◽  
Arterial Partial Pressure ◽  
Prolonged Surgery

Introduction: Despite several advantages over endotracheal tube (ETT), laryngeal mask airway (LMA), which is used in emergencies under difficult airway maintenance conditions, is rarely utilized in prolonged surgery. We compared the variables representing intraoperative gas exchange with second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. Methods: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. Parameters including end-tidal pressure of carbon dioxide (ETCO2), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO2), pH, and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery were compared between the two groups. In addition, the incidence of postoperative pulmonary complications (PPC) including pulmonary aspiration was also compared. Results: The values of ETCO2, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO2 at 2 h after induction was higher in patients with LMA (40.5 vs. 38.5 mmHg, p < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was not different. Conclusion: During prolonged laparoscopic abdominal surgery, the second-generation LMA facilitates adequate intraoperative gas exchange and represents an alternative to ETT.

scholarly journals An In Vitro Evaluation of the Red Cell Damage and Hemocompatibility of Different Central Venous Catheters

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Alojz Ihan ◽  
Stefan Grosek ◽  
David Stubljar
Keyword(s):  
Blood Cell ◽  
Flow Rate ◽  
Blood Cells ◽  
Cell Damage ◽  
Central Venous Catheters ◽  
High Flow ◽  
High Flow Rate ◽  
Low Flow ◽  
Central Venous ◽  
Flow Rates

Background. The aim of our study was to evaluate the damaging impact of characteristics of the central venous catheters (CVCs) on red blood cells. Methods. CVCs from three different manufacturers were analyzed, including the presence of coating, tunnel geometry, length, lumen diameter, and number of lumens with two respective flow rates (33 mL/min and 500 mL/min). Blood cell damage was defined by analyzing microparticle (MP) and hematologic analysis. MPs were isolated by ultracentrifugation of erythrocyte concentrate and analyzed on a flow cytometer. Results. Characteristics of catheters were not associated with blood cell damage at a low flow rate but showed an effect with a high flow rate. CVCs with a polyhexanide methacrylate coating have caused statistically less blood cell damage than noncoated CVCs. The length of lumens, diameter, and geometry of the tunnel showed no differences in blood cell damage. Meanwhile, the number of lumens was predicted to have a greater effect on the erythrocyte damage, which was revealed with the formation of MPs and hematological parameters. CVCs with five lumens caused significantly less damage to the blood cells than CVCs with a single lumen. Moreover, a high flow rate of 500 mL/min caused less damage to the blood cells than a low rate of 33 mL/min. Conclusion. Properties of CVCs are an important factor for quality patient care, especially when transfusing blood with high flow rates, as we want to provide a patient with high-quality blood with as few damaged cells as possible.

Rheological Effects of Blood in a Nonplanar Distal End-to-Side Anastomosis

2008 ◽  
Vol 130 (5) ◽  
Author(s):  
Qian-Qian Wang ◽  
Bao-Hong Ping ◽  
Qing-Bo Xu ◽  
Wen Wang
Keyword(s):  
Flow Rate ◽  
Stokes Equations ◽  
Bypass Graft ◽  
High Flow ◽  
Secondary Flows ◽  
Newtonian Fluids ◽  
Low Flow ◽  
Flow Rates ◽  
Flow Recirculation ◽  
Low Flow Rate

This study investigates rheological effects of blood on steady flows in a nonplanar distal end-to-side anastomosis. The shear-thinning behavior of blood is depicted by a Carreau–Yasuda model and a modified power-law model. To explore effects of nonplanarity in vessel geometry, a curved bypass graft is considered that connects to the host artery with a 90deg out-of-plane curvature. Navier–Stokes equations are solved using a finite volume method. Velocity and wall shear stress (WSS) are compared between Newtonian and non-Newtonian fluids at different flow rates. At low flow rate, difference in axial velocity profiles between Newtonian and non-Newtonian fluids is significant and secondary flows are weaker for non-Newtonian fluids. At high flow rate, non-Newtonian fluids have bigger peak WSS and WSS gradient. The size of the flow recirculation zone near the toe is smaller for non-Newtonian fluids and the difference is significant at low flow rate. The nonplanar bypass graft introduces helical flow in the host vessel. Results from the study reveal that near the bed, heel, and toe of the anastomotic junction where intimal hyperplasia occurs preferentially, WSS gradients are all very big. At high flow rates, WSS gradients are elevated by the non-Newtonian effect of blood but they are reduced at low flow rates. At these locations, blood rheology not only affects the WSS and its gradient but also secondary flow patterns and the size of flow recirculation near the toe. This study reemphasizes that the rheological property of blood is a key factor in studying hemodynamic effects on vascular diseases.

Control of Self-Excited Flow Oscillations in Vaneless Diffuser of Centrifugal Compression Systems

1982 ◽  
Author(s):  
A. N. Abdelhamid
Keyword(s):  
Flow Field ◽  
Performance Improvement ◽  
High Flow ◽  
Low Flow ◽  
Flow Oscillation ◽  
Vaneless Diffuser ◽  
Flow Area ◽  
Flow Measurements ◽  
Flow Rates ◽  
Flow Oscillations

Experiments were conducted to evaluate the effectiveness of axisymmetric diffuser exit throttle in delaying the occurrence of self-excited flow oscillation in vaneless diffusers. Sharp edge rings were installed at diffuser exit in order to change the exit flow area. Tests were carried out with the rings attached to one or both of the diffuser walls. Steady and unsteady flow measurements were used to determine the flow field in the diffuser at the onset of the flow oscillations. Results showed that the occurrence of flow oscillation was continuously delayed as the diffuser exit flow area was reduced for all these configurations and impeller speeds. Comparison between the performance of the compression system with and without diffuser exit blockage indicated that although large losses occur at high flow rates, the use of diffuser exit rings resulted in overall diffuser performance improvement at low flow rates. Retractable diffuser exit rings would therefore be ideal for centrifugal compression systems with vaneless diffuser.

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