Hemodynamics of subarachnoid hemorrhage arrest

1994 ◽  
Vol 80 (4) ◽  
pp. 710-715 ◽  
Author(s):  
Patrick W. McCormick ◽  
John McCormick ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Flow Rate ◽  
Low Flow ◽  
Initial Flow ◽  
Flow Rates ◽  
Content Type ◽  
Arterial Blood ◽  
Clinical Syndromes ◽  
Positive Linear Correlation ◽  
Suprasellar Cistern

✓ Subarachnoid hemorrhage (SAH) causes a spectrum of clinical syndromes from mild discomfort to rapid brain death. The reason for these heterogeneous consequences is poorly understood. A canine autologous shunt model of SAH was used to study this problem. The duration and volume of hemorrhage into the suprasellar cistern at each animal's mean arterial blood pressure were measured at variable hemorrhage flow rates. At high rates of bleeding in seven dogs (18.7 ± 2.2 ml/min, mean ± standard deviation), hemorrhage duration was significantly less (191 ± 116 seconds, p < 0.03) and hemorrhage volume was significantly greater (15.1 ± 7.0 ml, p < 0.05) than at low flow rates. At low flow rates of bleeding in nine dogs (4.4 ± 2.2 ml/min), hemorrhage duration was 394 ± 202 seconds and volume was 10.9 ± 6.5 ml. Cerebral perfusion pressure (CPP) decreased at all hemorrhage rates but never to 0 mm Hg (perfusion arrest). No correlation between a decrease in CPP and SAH volume or duration was identified. The initial flow rate of SAH had a positive linear correlation with the volume of hemorrhage (23 dogs, r = 0.64, p < 0.01). The data suggest that initial SAH flow rate, and not CPP, has a primary influence on hemorrhage arrest. This finding may influence the clinical rationale for acute management of SAH-induced brain injury.

Assessment of the Use of Humidified Nasal Cannulas for Oxygen Therapy in Patients with Epistaxis

ORL ◽  
2021 ◽  
pp. 1-5
Author(s):  
Jingjing Liu ◽  
Tengfang Chen ◽  
Zhenggang Lv ◽  
Dezhong Wu
Keyword(s):  
Flow Rate ◽  
Oxygen Therapy ◽  
Preliminary Investigation ◽  
Nasal Cannula ◽  
Low Flow ◽  
Antiplatelet Drugs ◽  
Flow Rates ◽  
The Past ◽  
Oxygen Inhalation ◽  
Significant Difference

<b><i>Introduction:</i></b> In China, nasal cannula oxygen therapy is typically humidified. However, it is difficult to decide whether to suspend nasal cannula oxygen inhalation after the nosebleed has temporarily stopped. Therefore, we conducted a preliminary investigation on whether the use of humidified nasal cannulas in our hospital increases the incidence of epistaxis. <b><i>Methods:</i></b> We conducted a survey of 176,058 inpatients in our hospital and other city branches of our hospital over the past 3 years and obtained information concerning their use of humidified nasal cannulas for oxygen inhalation, nonhumidified nasal cannulas, anticoagulant and antiplatelet drugs, and oxygen inhalation flow rates. This information was compared with the data collected at consultation for epistaxis during these 3 years. <b><i>Results:</i></b> No significant difference was found between inpatients with humidified nasal cannulas and those without nasal cannula oxygen therapy in the incidence of consultations due to epistaxis (χ<sup>2</sup> = 1.007, <i>p</i> &#x3e; 0.05). The same trend was observed among hospitalized patients using anticoagulant and antiplatelet drugs (χ<sup>2</sup> = 2.082, <i>p</i> &#x3e; 0.05). Among the patients with an inhaled oxygen flow rate ≥5 L/min, the incidence of ear-nose-throat (ENT) consultations due to epistaxis was 0. No statistically significant difference was found between inpatients with a humidified oxygen inhalation flow rate &#x3c;5 L/min and those without nasal cannula oxygen therapy in the incidence of ENT consultations due to epistaxis (χ<sup>2</sup> = 0.838, <i>p</i> &#x3e; 0.05). A statistically significant difference was observed in the incidence of ENT consultations due to epistaxis between the low-flow nonhumidified nasal cannula and nonnasal cannula oxygen inhalation groups (χ<sup>2</sup> = 18.428, <i>p</i> &#x3c; 0.001). The same trend was observed between the 2 groups of low-flow humidified and low-flow nonhumidified nasal cannula oxygen inhalation (χ<sup>2</sup> = 26.194, <i>p</i> &#x3c; 0.001). <b><i>Discussion/Conclusion:</i></b> Neither high-flow humidified nasal cannula oxygen inhalation nor low-flow humidified nasal cannula oxygen inhalation will increase the incidence of recurrent or serious epistaxis complications; the same trend was observed for patients who use anticoagulant and antiplatelet drugs. Humidification during low-flow nasal cannula oxygen inhalation can prevent severe and repeated epistaxis to a certain extent.

Cerebral microdialysis monitoring: determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage

2000 ◽  
Vol 93 (5) ◽  
pp. 808-814 ◽  
Author(s):  
Mette K. Schulz ◽  
Lars Peter Wang ◽  
Mogens Tange ◽  
Per Bjerre
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Delayed Cerebral Ischemia ◽  
Neuronal Injury ◽  
Low Flow ◽  
Cerebral Microdialysis ◽  
Intracerebral Microdialysis ◽  
Content Type ◽  
Wide Range ◽  
Fine Print

Object. The success of treatment for delayed cerebral ischemia is time dependent, and neuronal monitoring methods that can detect early subclinical levels of cerebral ischemia may improve overall treatment results. Cerebral microdialysis may represent such a method. The authors' goal was to characterize patterns of markers of energy metabolism (glucose, pyruvate, and lactate) and neuronal injury (glutamate and glycerol) in patients with subarachnoid hemorrhage (SAH), in whom ischemia was or was not suspected.Methods. By using low-flow intracerebral microdialysis monitoring, central nervous system extracellular fluid concentrations of glucose, pyruvate, lactate, glutamate, and glycerol were determined in 46 patients suffering from poor-grade SAH. The results in two subgroups were analyzed: those patients with no clinical or radiological signs of cerebral ischemia (14 patients) and those who succumbed to brain death (five patients).Significantly lower levels of energy substrates and significantly higher levels of lactate and neuronal injury markers were observed in patients with severe and complete ischemia when compared with patients without symptoms of ischemia (glucose 0 compared with 2.12 ± 0.15 mmol/L; pyruvate 0 compared with 151 ± 11.5 µmol; lactate 6.57 ± 1.07 compared with 3.06 ± 0.32 mmol/L; glycerol 639 ± 91 compared with 81.6 ± 12.4 µmol; and glutamate 339 ± 53.4 compared with 14 ± 3.33 µmol). Immediately after catheter placement, glutamate concentrations declined over the first 4 to 6 hours to reach stable values. The remaining parameters exhibited stable values after 1 to 2 hours.Conclusions. The results confirm that intracerebral microdialysis monitoring of patients with SAH can be used to detect patterns of cerebral ischemia. The wide range from normal to severe ischemic values calls for additional studies to characterize further incomplete and possible subclinical levels of ischemia.

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.

The Cost-Benefit of Pulse-Oximeter Use in the Prehospital Environment

1999 ◽  
Vol 14 (4) ◽  
pp. 41-46 ◽  
Author(s):  
Andrew J. Macnab ◽  
Lark Susak ◽  
Faith A. Gagnon ◽  
Janet Alred ◽  
Charles Sun
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Flow Rate ◽  
Cost Savings ◽  
Cost Benefit ◽  
Standard Protocol ◽  
Clinical Value ◽  
Transport Time ◽  
Initial Flow ◽  
Flow Rates

AbstractIntroduction:Pulse-oximetry has proven clinical value in Emergency Departments and Intensive Care Units. In the prehospital environment, oxygen is given routinely in many situations. It was hypothesized that the use of pulse oximeters in the prehospital setting would provide a measurable cost-benefit by reducing the amount of oxygen used.Methods:This was a prospective study conducted at 12 ambulance stations (average transport times >20 minutes). Standard care protocols and paramedic assessments were used to determine which patients received oxygen and the initial flow rate used. Pulse-oximetry measurements (oxygen-saturation measured by pulse oximetry) were then taken. If oxygen-saturation measured by pulse oximetry fell below 92% or rose above 96% (except in patients with chest pain), oxygen (O2) flow rates were adjusted. Costs of oxygen use were calculated: volume that would have been used based on initial flow rate; and volume actually used based on actual flow rates and transport time.Methods:A total of 1,907 patients were recruited. Oximetry and complete data were obtained on 1,787 (94%). Of these, 1,329 (74%) received O2 by standard protocol: 389 (27.5%) had the O2 flow decreased; 52 had it discontinued. Eighty-seven patients (6%) not requiring O2 standard protocol were hypoxemic (oxygen-saturation measured by pulse oximetry < 92%) by oximetry, and 71 patients (5%) receiving oxygen required flow rate increases. Overall, O2 consumption was reduced by 26% resulting in a cost-savings of $0.20 / patient. Prehospital pulse-oximetry allows unncessary or excessive oxygen therapy to be avoided in up to 55% of patients transported by ambulance and can help to identify suboptimally oxygenated patients (11%).Conclusion:Rationalizing the O2 administration using pulse-oximetry reduced O2 consumption. Other health care savings likely would result from a reduced incidence of suboptimal oxygenation. Oxygen cost-saving justifies oximeter purchase for each ambulance annually where patient volume exceeds 1,750, less frequently for lower call volumes, or in those services where the mean transport time is less than the 23 minute average noted in this study.

Effects of short blades on performance and inner flow characteristics of a low-specific-speed centrifugal pump

2017 ◽  
Vol 231 (4) ◽  
pp. 290-302 ◽  
Author(s):  
Can Kang ◽  
Ning Mao ◽  
Chen Pan ◽  
Yang Zhu ◽  
Bing Li
Keyword(s):  
Centrifugal Pump ◽  
Flow Rate ◽  
Pressure Fluctuations ◽  
Flow Characteristics ◽  
Low Flow ◽  
Back Surface ◽  
Flow Rates ◽  
Pump Operation ◽  
Low Specific Speed ◽  
Specific Speed

A low-specific-speed centrifugal pump equipped with long and short blades is studied. Emphasis is placed on the pump performance and inner flow characteristics at low flow rates. Each short blade is intentionally shifted towards the back surface of the neighboring long blade, and the outlet parts of the short blades are uniformly shortened. Unsteady numerical simulation is conducted to disclose inner flow patterns associated with the modified design. Thereby, a comparison is enabled between the two schemes featured by different short blades. Both practical operation data and numerical results support that the deviation and cutting of the short blades can eliminate the positive slope of pump head curve at low flow rates. Therefore, the modification of short blades improves the pump operation stability. Due to the shortening of the outlet parts of the short blades, velocity distributions between impeller outlet and radial diffuser inlet exhibit explicitly altered circumferential flow periodicity. Pressure fluctuations in the radial diffuser are complex in terms of diversified periodicity and amplitudes. Flow rate influences pressure fluctuations in the radial diffuser considerably. As flow rate decreases, the regularity of the orbit of hydraulic loads exerted upon the impeller collapses while hydraulic loads exerted upon the short blades remain circumferentially periodic.

Cerebral Hyperperfusion Syndrome by the Numbers: Transient Focal Neurological Deficit, Imaging-Proven Focal Hyperperfusion, and High Graft Flow Rate Following Superficial Temporal Artery-Middle Cerebral Artery bypass in a Patient With Symptomatic Carotid Occlusion—Case Report

2018 ◽  
Vol 15 (6) ◽  
pp. E94-E99 ◽  
Author(s):  
Ralph Rahme ◽  
Tejaswi D Sudhakar ◽  
Marjan Alimi ◽  
Timothy G White ◽  
Rafael A Ortiz ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Flow Rate ◽  
Perfusion Imaging ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Low Flow ◽  
Flow Rates ◽  
Cerebral Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Graft Flow

Abstract BACKGROUND AND IMPORTANCE Cerebral hyperperfusion syndrome (CHS) is a well-known complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass for ischemic cerebrovascular disease. While this argues against “low flow” in the bypass construct, flow rates in the graft have not been previously quantified in the setting of CHS. CLINICAL PRESENTATION A 58-yr-old man presented with recurrent left hemispheric ischemic strokes and fluctuating right hemiparesis and aphasia. Vascular imaging revealed left cervical internal carotid artery occlusion and perfusion imaging confirmed left hemispheric hypoperfusion. After failing to respond to maximal medical therapy, the patient underwent single-barrel STA-MCA bypass. Postoperatively, his symptoms resolved and blood pressure (BP) was strictly controlled within normal range. However, 2 d later, he developed severe expressive aphasia. CTA demonstrated a patent bypass graft and SPECT showed focal hyperperfusion in Broca's speech area. Seizure activity was ruled out. A high graft flow rate of 52 mL/min was documented by quantitative magnetic resonance angiography (MRA). Thus, the diagnosis of CHS was made and managed with strict BP control. The patient exhibited complete recovery of speech over a period of days and was discharged home. Repeat SPECT at 4 mo showed resolution of hyperperfusion and quantitative MRA demonstrated reduction of graft flow rate to 34 mL/min. CONCLUSION This is the first case of perfusion imaging-proven CHS after STA-MCA bypass, where high graft flow rates are objectively documented. Our observations constitute irrefutable evidence challenging the classic belief that the STA-MCA bypass is a low-flow construct.

Study on the effect of pore-scale heterogeneity and flow rate during repetitive two-phase fluid flow in microfluidic porous media

2021 ◽  
pp. petgeo2020-062
Author(s):  
Jingtao Zhang ◽  
Haipeng Zhang ◽  
Donghee Lee ◽  
Sangjin Ryu ◽  
Seunghee Kim
Keyword(s):  
Porous Media ◽  
Fluid Flow ◽  
Flow Rate ◽  
Sweep Efficiency ◽  
Residual Saturation ◽  
Flow Rates ◽  
Content Type ◽  
Lower Flow ◽  
Supplementary Material ◽  
Lower Flow Rate

Various energy recovery, storage, conversion, and environmental operations may involve repetitive fluid injection and, thus, cyclic drainage-imbibition processes. We conducted an experimental study for which polydimethylsiloxane (PDMS)-based micromodels were fabricated with three different levels of pore-space heterogeneity (coefficient of variation, where COV = 0, 0.25, and 0.5) to represent consolidated and/or partially consolidated sandstones. A total of ten injection-withdrawal cycles were applied to each micromodel at two different flow rates (0.01 and 0.1 mL/min). The experimental results were analyzed in terms of flow morphology, sweep efficiency, residual saturation, the connection of fluids, and the pressure gradient. The pattern of the invasion and displacement of nonwetting fluid converged more readily in the homogeneous model (COV = 0) as the repetitive drainage-imbibition process continued. The overall sweep efficiency converged between 0.4 and 0.6 at all tested flow rates, regardless of different flow rates and COV in this study. In contrast, the effective sweep efficiency was observed to increase with higher COV at the lower flow rate, while that trend became the opposite at the higher flow rate. Similarly, the residual saturation of the nonwetting fluid was largest at COV = 0 for the lower flow rate, but it was the opposite for the higher flow rate case. However, the Minkowski functionals for the boundary length and connectedness of the nonwetting fluid remained quite constant during repetitive fluid flow. Implications of the study results for porous media-compressed air energy storage (PM-CAES) are discussed as a complementary analysis at the end of this manuscript.Supplementary material: Figures S1 and S2 https://doi.org/10.6084/m9.figshare.c.5276814.Thematic collection: This article is part of the Energy Geoscience Series collection available at: https://www.lyellcollection.org/cc/energy-geoscience-series

Interaction between CO2 concentration and flow rate on peripheral airway resistance

1991 ◽  
Vol 70 (6) ◽  
pp. 2514-2521 ◽  
Author(s):  
A. Kaise ◽  
A. N. Freed ◽  
W. Mitzner
Keyword(s):  
Flow Rate ◽  
Airway Resistance ◽  
Co2 Concentration ◽  
Low Flow ◽  
Flow Rates ◽  
Peripheral Airway ◽  
Residual Capacity ◽  
Local Ventilation ◽  
End Tidal ◽  
The Relationship

In the present study, we investigated the interaction between CO2 concentration and rate of delivered flow on peripheral airway resistance (Rp) in the intact canine lung. Dogs were anesthetized, intubated, paralyzed, and mechanically ventilated with room air to maintain end-tidal CO2 between 4.8 and 5.2%. Using a wedged bronchoscope technique, we measured Rp at functional residual capacity. The relationship between CO2 concentration and Rp was measured at flow rates of 100 and 400 ml/min with 5, 3, 2, 1, and 0% CO2 in air. Measurements were made at the end of a 3-min exposure to each gas. At low flow rates (100 ml/min) responses to hypocapnia were small, whereas at high flow rates (400 ml/min) responses were large. The PC50 (defined as the CO2 concentration required to produce a 50% increase in Rp above baseline Rp established on 5% CO2) at 400 ml/min (1.73%) was significantly larger than that at 100 ml/min (0.38%). We also directly measured the relationship between Rp and flow rate with 5% CO2 (normocapnia) or 1% CO2 (hypocapnia) delivered into the wedged segment. Increases in normocapnic flow caused small but significant decreases in Rp. In contrast, increases in hypocapnic flow from 100 to 400 ml/min caused a 108% increase in Rp. Thus the response to hypocapnia is augmented by increasing flow rate. This interaction can be explained by a simple model that considers the effect of local ventilation-perfusion ratio and gas mixing on the local CO2 concentration at the site of peripheral airway contraction.

Turbulence Measurements in a Centrifugal Pump With a Synchronously Orbiting Impeller

1991 ◽  
Author(s):  
Ronald D. Flack ◽  
Steven M. Miner ◽  
Ronald J. Beaudoin
Keyword(s):  
Centrifugal Pump ◽  
Reynolds Stress ◽  
Flow Rate ◽  
Cross Product ◽  
Design Flow ◽  
Low Flow ◽  
Rate Variation ◽  
Flow Rates ◽  
The Individual ◽  
Design Flow Rate

Turbulence profiles were measured in a centrifugal pump with an impeller with backswept blades using a two directional laser velocimeter. Data presented includes radial, tangential, and cross product Reynolds stresses. Blade to blade profiles were measured at four circumferential positions and four radii within and one radius outside the four bladed impeller. The pump was tested in two configurations; with the impeller running centered within the volute, and with the impeller orbiting with a synchronous motion (ε/r2 = 0.016). Flow rates ranged from 40% to 106% of the design flow rate. Variation in profiles among the individual passages in the orbiting impeller were found. For several regions the turbulence was isotropic so that the cross product Reynolds stress was low. At low flow rates the highest cross product Reynolds stress was near the exit. At near design conditions the lowest cross product stress was near the exit, where uniform flow was also observed. Also, near the exit of the impeller the highest turbulence levels were seen near the tongue. For the design flow rate, inlet turbulence intensities were typically 9% and exit turbulence intensities were 6%. For 40% flow capacity the values increased to 18% and 19%, respectively. Large local turbulence intensities correlated with separated regions. The synchronous orbit did not increase the random turbulence, but did affect the turbulence in the individual channels in a systematic pattern.

Suppression of Self-Excited Flow Instability in a Radial Diffuser Using Rough Surfaces

2006 ◽  
Author(s):  
Saad A. Ahemd ◽  
Hayder Salem
Keyword(s):  
Flow Rate ◽  
Smooth Surface ◽  
Flow Instability ◽  
Rough Surfaces ◽  
Flow Coefficient ◽  
Flow Instabilities ◽  
Low Flow ◽  
Flow Rates ◽  
Flow Limit ◽  
Stable Operating

Flow instabilities in a compression system at low flow rates set the flow limit of the stable operating range. Experiments to investigate the feasibility of controlling the stall in the radial diffuser of a low speed centrifugal compressor were carried out. The technique was very simple and involved using rough surfaces (i.e., sand papers) attached to the diffuser shroud. The results showed that the flow instability in the diffuser (stall) was delayed to a lower flow coefficient (the mass flow rate could be reduced to 70% of its value with the smooth surface) when the rough surfaces were positioned on the diffuser shroud.

Sign in / Sign up

Export Citation Format

Share Document