Time-dependent blood flow and oxygenation in human skeletal muscles measured with noninvasive near-infrared diffuse optical spectroscopies

We have employed near-infrared optical methods to measure noninvasively the dynamics of muscle blood flow and oxygen saturation (StO2) during cuff occlusion and plantar flexion exercise. Relative muscle oxygen consumption (rVO2) was also computed from these data. Diffuse correlation spectroscopy provides information about blood flow, and diffuse reflectance spectroscopy provides information about blood oxygenation. Ten healthy subjects and one patient with peripheral arterial disease (PAD) were studied during 3-min arterial cuff occlusion of arm and leg, and during 1-min plantar flexion exercise. Signals from different layers (cutaneous tissues and muscles) during cuff occlusion were differentiated, revealing strong hemodynamic responses from muscle layers. During exercise in healthy legs, the observed approximately 4.7 fold increase in relative blood flow (rBF) was significantly lower than the corresponding increase in rVO2 (approximately 7 fold). The magnitudes of rBF and rVO2 during exercise in the PAD patient were approximately 1/2 of the healthy controls, and the StO2 recovery time was twice that of the controls. The hybrid instrument improves upon current technologies for measuring muscle responses by simultaneously measuring rBF and StO2. The instrument thus provides a method for evaluation of microcirculation and muscle metabolism in patients with vascular diseases.     

Threshold pressure for the pressure-dependent renin release in the autoregulating kidney of conscious dogs

1. The effect of varying renal artery pressure between 160 and 40 mm Hg on renal blood flow and renin release was studied in seven conscious foxhounds under β-adrenergic blockade receiving a normal sodium diet (4.1 mmol/kg/day). Pressure was either increased by bilateral common carotid occlusion or reduced in steps and maintained constant by a control-system using an inflatable renal artery cuff. Carotid occlusion itself had no influence on renal blood flow and renin release when renal artery pressure was kept constant and the β-receptors in the kidney were blocked.
2. Between 160 mm Hg and resting pressure there was no change in renal blood flow; between resting blood pressure and the lower limit of autoregulation (average 63.9 mm Hg) renal blood flow increased slightly (average 7%) indicating a high efficiency of renal blood flow autoregulation.
3. The relationship between renal artery pressure and renin release could be approximated by two linear sections:a low sensitivity to a pressure change (average slope: ?0.69 ±0.26ng AI/min/mm Hg) was found above a threshold pressure (average: 89.8±3.3 mm Hg) and a high sensitivity to a pressure change (average slope: ?64.4±20.8 ng AI/ min/mm Hg) was observed between threshold pressure and 60 mm Hg. There was no further increase of renin release between 60 and 40 mm Hg.
4. It is concluded that within the autoregulatory plateau the kidney of a conscious β-blocked dog receiving a normal sodium diet releases only negligible amounts of renin until renal artery pressure falls below a threshold pressure of 90 mm Hg which is close to the animals resting systemic pressure. Since beyond that a decrease of systemic pressure by as little as 1.3 mm Hg below threshold can raise resting renin release (84.8±29.8 ng/min) by 100%, it is suggested that systemic blood pressure tends to stabilize at a level at which renin release is minimal.

     

Theory of the oscillometric maximum and the systolic and diastolic detection ratios

It is proposed that the maximum in cuff pressure oscillations during oscillometry is due to the buckling of the brachial artery under a cuff. This theory is investigated by means of a mathematical model of oscillometry that includes the mechanics of the occlusive arm cuff, the arterial pressure pulse waveform, and the mechanics of the brachial artery. A numerical solution is provided for the oscillations in cuff pressure for one cycle of cuff inflation and deflation. The buckling pressure is determined from actual arterial data and the von Mises buckling criteria. The buckling of an artery under a cuff occurs near — 2 to 0 mm Hg transmural pressure. This effect corresponds with a maximum arterial compliance and maximum cuff pressure oscillations when cuff pressure is nearly equal to mean arterial pressure (MAP), in support of the suggested theory. The model was also found to demonstrate the basic characteristics of experimental oscillometry, such as an increasing and decreasing amplitude in oscillations as cuff pressure decreases, the oscillations that occur when cuff pressure is above systolic pressure, maximum oscillation amplitudes in the range of 1 to 4 mm Hg, and an oscillatory maximum at cuff pressure equal to MAP. These findings support the case that the model is representative of oscillometry. Finally, the model predicted values for the systolic and diastolic detection ratios of 0.593 and 0.717, respectively, similar to those found empirically. These ratios alter with blood pressure, but the tightness of the cuff wrap did not change their value.     

The effect of hypoxia, hypercapnia and hypotension upon carotid body blood flow and oxygen consumption in the cat

1. Carotid body blood flow (c.b.f.), the arterio-venous oxygen (A-V O(2)) difference and oxygen consumption were measured in forty-seven cats, anaesthetized with pentobarbitone, paralysed with gallamine and ventilated artificially. Carotid sinus and cervical sympathetic nerves were intact throughout.2. A system for perfusing the carotid body artificially with blood is described and evidence is given which shows that similar results were obtained whether the carotid body was naturally or artificially perfused.3. With arterial pressure, blood gas tensions and pH within physiological limits, c.b.f. varied between 33 and 68 mul./min, average 41.5; A-V O(2) difference between 0.21 and 0.46 ml./100 ml., average 0.34, and calculated oxygen consumption between 0.115 and 0.195 mul. O(2)/min, average 0.147.4. With constant mean arterial pressure, hypoxia (30-40 mm Hg P(a, O2)) or hypercapnia (> 50 mm Hg P(a, CO2)) resulted in a small increase of c.b.f., up to 14 mul./min above control; an average fall of A-V O(2) difference by 49% of control and an average fall of oxygen consumption by 36% of control.5. Carotid body blood flow fell linearly with mean arterial pressure over the range 100-170 mm Hg, the slope of the curve varying between 0.78 and 1.22 mul. min(-1). mm Hg(-1). M.A.P. A-V O(2) difference was unaffected so that oxygen consumption fell in proportion to c.b.f.6. It is concluded that the unique response of the carotid body to these stimuli is a fall in oxygen consumption and that this bears a closer relation to the known pattern of chemoreceptor discharge than do changes in total blood flow.     

The effect of hypercapnia on myocardial blood flow and metabolism

1. In closed-chest dogs anaesthetized with trichlorethylene, the inhalation of carbon dioxide sufficient to increase the arterial P(CO2) from 40 to about 100 mm Hg, increased myocardial blood flow (measured using a (133)Xe clearance technique) and right atrial pressure. There were no consistent changes in mean arterial blood pressure, heart rate or cardiac output.2. The effect of hypercapnia on myocardial blood flow was not influenced by the previous administration of atropine and propranolol or of bretylium. It can be concluded, therefore, that the elevated arterial P(CO2) has a direct vasodilator effect on the myocardial microcirculation.3. During hypercapnia the coronary sinus P(O2) was increased and the coronary arteriovenous oxygen content difference, and calculated myocardial oxygen consumption, reduced. It is suggested that this latter effect may be the result of myocardial depression produced by the decrease in arterial blood pH.4. There was no evidence of myocardial glucose uptake either before or during hypercapnia. The myocardial extraction of lactate and pyruvate at rest varied between 0 and 55%. During acute hypercapnia the extraction of lactate usually fell.5. When the arterial P(CO2) was maintained at 100 mm Hg for a period of 1 hr the effects on myocardial blood flow and on oxygen consumption were not sustained.6. Stepwise increments and decrements in arterial P(CO2) of 10-20 mm Hg produced corresponding increases and decreases in myocardial blood flow and demonstrated that changes in arterial P(CO2) of 20-30 mm Hg can markedly affect blood flow in the myocardium.     

The separate and combined influences of common carotid occlusion and nonhypotensive hemorrhage on kidney blood flow

The separate and combined effects of bilateral common carotid occlusion (C.C.O.) and hemorrhage on renal blood flow (R.B.F.) were studied in 11 unanesthetized dogs.C.C.O. increased arterial blood pressure (4.4 kPa; 33 mm Hg) and heart rate (10 beats/min) while R.B.F. remained unchanged. When kidney perfusion pressure was maintained at its resting level during C.C.O. (implanted pneumatic cuff) there was also no change in R.B.F.After cutting the aortic nerves in 2 dogs the increase in blood pressure and heart rate with C.C.O. was greater (10.6 kPa; 80 mm Hg and 72 beats/min); however, there was no change in R.B.F.A blood loss of 16% (13.6 ml/kg) reduced central venous pressure (0.3 kPa; 2 mm Hg), increased heart rate (8–14 beats/min) and decreased arterial mean pressure by a maximum of 0.7 kPa (5 mm Hg) (nonhypotensive hemorrhage, N.H.H.). R.B.F. showed a tendency to rise and 90 min after the onset of bleeding was slightly increased (12% of control).After N.H.H. carotid occlusion had no effect on R.B.F. when kidney perfusion pressure increased; when perfusion pressure was controlled during C.C.O. the maximum observed decrease of R.B.F. was 15 ml/min (5% of control).It is concluded that the control of R.B.F. during the baroreceptor reflex under normovolemia and after a blood loss of 16% in the conscious dog at rest does not involve sympathetic vasoconstrictor effects which result in a significant changes in total blood flow.This study was supported by the German Research Foundation within the S.F.B. 90, Heidelberg     

Osler's maneuver and pseudohypertension

We describe a simple bedside procedure (which we call "Osler's maneuver") that differentiates patients with true hypertension from those whose blood pressure is spuriously elevated because of excessive sclerosis of the large arteries ("pseudohypertension"). The maneuver is performed by assessing the palpability of the pulseless radial or brachial artery distal to a point of occlusion of the artery manually or by cuff pressure. We classified 24 elderly hypertensive patients as either Osler-positive (n = 13) or Osler-negative (n = 11), and measured their intraarterial pressure, arterial compliance, and systemic hemodynamics. Patients with pseudohypertension (Osler-positive) had falsely elevated blood-pressure readings, with a difference of 10 to 54 mm Hg between cuff and intraarterial pressure. Arterial compliance was lower in Osler-positive subjects and correlated with the difference between cuff and intraarterial pressures, indicating that the stiffer the artery, the more pronounced the degree of pseudohypertension. Pseudohypertension is common in the elderly and becomes more severe as arterial compliance decreases and sclerosis of large arteries progresses.     

Evaluation of the harmonized alert sensing technology device for hemodynamic monitoring in chronic hemodialysis patients

The Harmonized Alert Sensing Technology (HASTE) device was developed to overcome the primary shortcomings of interval based noninvasive blood pressure (BP) monitoring. This study was conducted to assess the reliability of the HASTE system compared with standard cuff BP values in patients on hemodialysis. A total of 1,370 HASTE measurements were compared with oscillometric standard cuff systolic BP values in 42 sessions of 15 patients on hemodialysis. The average discrepancy between the HASTE and cuff systolic BP was 1.41 +/- 16.90 mm Hg. Compared with cuff measurements, 31% of systolic BP fell within a range of 5 mm Hg difference, 57% of systolic BP fell within 10 mm Hg, and 73% of systolic BP fell within a 15 mm Hg band. According to British Hypertension Society standards or Association for the Advancement of Medical Instrumentation criteria, the current HASTE method did not perform well. Technology to provide noninvasive hemodynamic monitoring is, however, in its developmental stage. The effort at continuous systolic pressure monitoring using existing, readily available, and frequently used techniques is exciting. Although the HASTE system as currently configured and calibrated did not adequately perform, variations in site analysis and conversion factors may increase pressure sensitivity and tracking over the course of a standard dialysis treatment.     

Systemic hypoxia and hyperoxia,and liver blood flow and oxygen consumption in the greyhound

The effects of systemic hypoxia upon liver blood flow and oxygen consumption were studied in a group of six pentobarbitone anaesthetised greyhounds. The effect of systemic hyperoxia upon the same factors were also studied in a further group of six greyhounds.Hypoxia studied atPaO₂ tensions of 9.3, 7.3, 5.3 and 3.3 kPa was found to increase mean arterial pressure significantly at eachPaO₂ tension studied immediately the hypoxic gas mixture was introduced but this pressure had returned to control by the time 20 min had passed. At the same time a significant decrease in hepatic arterial blood flow was seen, returning to control by 20 min. No significant changes were seen in portal venous blood flow. Hepatic arterial and mesenteric vascular resistance increased significantly immediately hypoxia was instituted at allPaO₂ tensions.Hepatic oxygen consumption, measured after 20 min, decreased at allPaO₂ tensions, significantly at 3.3 kPa (25 mm Hg). Hepatic venous oxygen content decreased significantly at eachPaO₂, decreasing to 20% of control at 3.3 kPa (25 mm Hg).Hyperoxia studied atPaO₂ tensions of 26.6, 39.9 and 53.2 kPa produced no significant effects upon liver blood flow. However, there was a small increase in hepatic oxygen consumption.     

Combined oral contraceptives do not influence post-exercise hypotension in women

The aim of the present study was to examine the pattern of cardiovascular recovery from exercise in 15 women (age, 20.3 +/- 1.4 years; body mass, 61.5 +/- 4.3 kg) across two phases of oral contraceptive (OC) use: 21 days of consumption and 7 days of withdrawal. Cardiovascular recovery was measured in the supine position for 60 min following 30 min of exercise at 60% maximal rate of oxygen consumption (VO2,max). Central and peripheral haemodynamics were assessed during consumption and withdrawal of the OC pill using occlusion plethysmography, Doppler flowmetry and echocardiography. Significant hypotension occurred following exercise (P < 0.05), returning to baseline values after 60 min. The peak hypotension occurred 5 min into recovery. Cardiac output and heart rate were elevated for 60 min following exercise (P < 0.05), whilst stroke volume remained at baseline values. Heart rate was greater throughout recovery during consumption compared to withdrawal (P < 0.05); however, although there was a trend for greater responses during consumption, phase of OC use did not affect the other central cardiovascular variables (P > 0.05). Post-exercise blood flow parameters were not significantly affected by exercise or OC phase; however, calf blood flow was greater, and resistance to flow lower during consumption (P > 0.05). The pattern of post-exercise fluctuations in cardiovascular parameters may differ from those seen in men, whilst oestrogen variation may influence research findings.     

The role of the cervical sympathetic nerve in the regulation of oxygen consumption of the carotid body of the cat

1. Carotid body blood flow (c.b.f.) and carotid arterial-carotid body venous oxygen (A-V O(2)) difference were measured and carotid body oxygen consumption calculated in twenty-six cats anaesthetized with pentobarbitone sodium, paralysed with gallamine triethiodide and ventilated mechanically.2. With the sinus nerves intact and with blood gas tensions and carotid sinus pressure within physiological limits, section of either the pre- or post-ganglionic cervical sympathetic nerve on the same side caused an average rise in c.b.f. of 9.2 mul./min, in A-V O(2) difference of 0.09 ml./100 ml. and in carotid body oxygen consumption of 0.075 mul./min.3. When the pre- or post-ganglionic cervical sympathetic nerves were stimulated, c.b.f. and A-V O(2) difference fell. The fall in c.b.f. was enhanced at high P(a, CO2); the fall in A-V O(2) difference and in calculated oxygen consumption was enhanced at low mean arterial pressure (M.A.P.) or P(a, O2).4. Following sympathectomy, a reduction of M.A.P. at constant P(a, O2) and P(a, CO2) caused a fall in c.b.f. and a commensurate rise in A-V O(2) difference so that carotid body oxygen consumption remained approximately constant.5. When P(a, O2) was altered over the range 35 to > 400 mm Hg, or P(a, CO2) over the range 27-70 mm Hg at constant M.A.P., c.b.f. changed by amounts which were similar to those observed when the sympathetic nerves were intact and A-V O(2) difference changed in the opposite direction so that carotid body oxygen consumption similarly remained constant.6. Comparison of these results with those observed when the sympathetic nerves were intact indicates that the sympathetic nerves exert a vasoconstrictor effect upon carotid body blood vessels over a wide range of blood gas tensions and arterial pressure and that they also tend to diminish the rate of carotid body oxygen consumption. The mechanisms which may be involved in this regulation are discussed.     

Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise

The purpose of this study was to determine the difference in cuff pressure which occludes arterial blood flow for two different types of cuffs which are commonly used in blood flow restriction (BFR) research. Another purpose of the study was to determine what factors (i.e., leg size, blood pressure, and limb composition) should be accounted for when prescribing the restriction cuff pressure for this technique. One hundred and sixteen (53 males, 63 females) subjects visited the laboratory for one session of testing. Mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area of the right thigh were assessed using peripheral quantitative computed tomography. Following the mid-thigh scan, measurements of leg circumference, ankle brachial index, and brachial blood pressure were obtained. Finally, in a randomized order, arterial occlusion pressure was determined using both narrow and wide restriction cuffs applied to the most proximal portion of each leg. Significant differences were observed between cuff type and arterial occlusion (narrow: 235 (42)?mmHg vs. wide: 144 (17)?mmHg; p?=?0.001, Cohen's D?=?2.52). Thigh circumference or mCSA/fCSA with ankle blood pressure, and diastolic blood pressure, explained the most variance in the cuff pressure required to occlude arterial flow. Wide BFR cuffs restrict arterial blood flow at a lower pressure than narrow BFR cuffs, suggesting that future studies account for the width of the cuff used. In addition, we have outlined models which indicate that restrictive cuff pressures should be largely based on thigh circumference and not on pressures previously used in the literature.     

Regulation of myocardial oxygen consumption by perfusion pressure in isolated fibrillating canine heart

In order to evaluate whether perfusion pressure or coronary flow affect myocardial oxygen metabolism, oxygen consumption of the isolated fibrillating blood-perfused canine heart was investigated at perfusion pressures of 100, 150, and 200 mm Hg. To obtain different coronary flow rates at a given coronary perfusion pressure, -adrenergic blockade by phenoxybenzamine (10 mg/kg b.w.) was applied, resulting in an increase in coronary flow and a decrease in myocardial oxygen extraction. Myocardial oxygen consumption was increased by elevation of perfusion pressure in both the control and phenoxybenzamine-pretreated group. At the same level of perfusion pressure there was no significant difference between the oxygen consumption of control and phenoxybenzaminepretreated preparations. It can be concluded that in the isolated fibrillating canine heart oxygen consumption is primarily regulated by perfusion pressure, and is independent from coronary blood flow.     

Preliminary experiment with a newly developed double balloon, double lumen catheter for extracorporeal life support vascular access

Recently, venovenous extracorporeal life support (VVECLS) using a double lumen catheter has been clinically used to avoid neurologic complications in the treatment of respiratory failure for neonates. However, recirculation, which is a limiting factor for oxygen delivery, still exists, and thus it does not contribute to oxygenation of the patient. We developed a newly designed double lumen catheter with a double balloon (DBDL) catheter for ECLS vascular access and performed two animal preliminary experiments in normal and hypoxic dog models (normal ventilation and one lung ventilation experiments) to investigate whether the DBDL catheter could prevent recirculation and maintain oxygen delivery to systemic circulation. The DBDL catheter (JCT Co., Hiroshima, Japan) of 15 Fr was fabricated from silicone. It consists of two lumens for drainage and return of blood with two balloons (distal and proximal balloons) that prevent oxygenated blood mixing with unoxygenated blood. VVECLS using a DBDL catheter was performed in 13 mongrel dogs (8 dogs for normal ventilation experiment weighing 12.9 +/- 1.6 kg [mean +/- SD], 5 dogs for one lung ventilation experiment weighing 16.6 +/- 2.5 kg [mean +/- SD]) under anesthesia in the two experiments. The bypass flow ranged from 10-40 ml/kg per minute in the normal ventilation experiment. VVECLS in the one lung ventilation experiment was performed with maximal bypass flow for 6 hours (ranged from 25.2 +/- 8.0-28.3 +/- 8.7 ml/kg per minute at balloon inflation and deflation). Recirculation and oxygen transfer of artificial lung with or without balloon inflation during VVECLS were studied. Recirculation decreased with balloon inflation at varied bypass flows during VVECLS in the normal ventilation experiment (varied from 1.5 +/- 14.6-12.8 +/- 16.7%) and for 6 hours after VVECLS initiation in the one lung ventilation experiment (varied from 12.2 +/- 12.2-19.2 +/- 6.5%). In particular, the values at 3 and 6 hours were significantly lower than that of balloon deflation in the one lung ventilation experiment. The difference in O2 content between inlet and outlet in the artificial lung with balloon inflation was significantly higher than that of balloon deflation (varied from 3.7 +/- 1.8-4.8 +/- 1.9 ml/dl, p < 0.05) at the bypass flow of 10-30 ml/kg per minute in the normal ventilation experiment and at 5 hours after VVECLS initiation in the one lung ventilation experiment (varied from 10.6 +/- 1.6-11.7 +/- 1.8 ml/dl). The blood gas analysis of systemic circulation with balloon inflation revealed that the values of PaO2 (varied from 83.8 +/- 11.4-96.9 +/- 23.4 mm Hg) and PaCO2 (37.7 +/- 9.2-40.4 +/- 11.8 mm Hg) were higher and lower, respectively, compared with balloon deflation. In particular, PaO2 level was significantly higher than that of the preECLS value at the bypass flow of 20-40 ml/kg per minute (varied from 83.8 +/- 11.4-96.9 +/- 23.4 mm Hg, p < 0.05). In the one lung ventilation experiment, systemic PaO2 and PaCO2 levels at balloon inflation were higher and lower, respectively, compared with balloon deflation during VVECLS for 6 hours. At balloon inflation, the value of PaO2 at 6 hours after VVECLS initiation was significantly higher than that at balloon deflation. A newly designed DBDL catheter for ECLS vascular access successfully reduced recirculation and maintained oxygen delivery to systemic circulation during VVECLS. These results suggest that a high bypass flow may not be necessarily required in terms of oxygen delivery to systemic circulation when the DBDL catheter was used as an ECLS vascular access.     

Time-dependant oxygen partial pressure in capillaries and tissue in the hamster window chamber model

The possibility of a plasma oxygen diffusion barrier implies a significant resistance to oxygen diffusion and the existence of capillary erythrocyte-associated transients of oxygen. This effect was analyzed by measuring intracapillary blood and tissue pO(2) in the hamster chamber window model using a noninvasive intravital microscopy palladium porphyrin phosphorescence decay technique for two set light excitations (high and low). Using high light excitation, intracapillary blood pO(2) was 13.7 +/- 6.1 mm Hg, and increased to 18.0 +/- 4.5 mm Hg for low light excitation. For high light excitation, intracapillary blood pO(2) peaks were in the range of 25-30 mm Hg, and the lowest values were in the range of 5-10 mm Hg. Reducing the excitation provided a more uniform pO(2) ranging 15-25 mm Hg. With temporal reduction in blood capillary pO(2), levels were correlated to the increase in phosphorescent amplitude that corresponded to plasma gaps. Tissue pO(2) measured at low light excitation in the proximity of capillaries was 23.1 +/- 1.8 mm Hg. In conclusion, low intracapillary blood pO(2) measurements at full hematocrit are an artifact, only observed when oxygen consumption by the measurement technique was excessive and/or absorption of the excitation light was increased by the absence of RBCs. These findings suggest that resistance to oxygen diffusion in plasma is a minor factor in tissue oxygenation by capillaries in the hamster model.     

Effects of femoral vascular occlusion on ventilatory responses during recovery from exercise in human

We investigated the effect of occluding of femoral blood flow on the post-exercise ventilatory response of both the sub- and supra-anaerobic threshold (AT) leg cycling in humans. Seven healthy subjects (aged 21-44 years) volunteered to participate in this study. The protocol consisted of 6 min constant-load upright cycling at either a sub-AT (80% of AT) or supra-AT (midway between AT and VO(2)max) work rate and a subsequent 6 min rest period either with or without femoral blood flow being occluded by a rapid cuff inflation to 250 Torr during the first 2 min of recovery. Blood lactate levels at the cessation of the sub- and supra-AT exercise averaged 1.8+/-0.2 and 4.9+/-0.4 mequiv.l(-1) (mean+/-S.E.M.), respectively. Compared to spontaneous recovery, the circulatory occlusion significantly reduced ventilation irrespective of the intensity of the preceding exercise. The relative contribution of the ventilatory deficit to the total spontaneous ventilation (defined as the difference between the cumulative ventilation with and without cuff inflation during the first 2 min of recovery) was significantly greater supra-AT (18.0+/-3.9%) than sub-AT (9.3+/-2.9%, P<0.05). The subsequent release of occlusion was accompanied by a rapid increase in ventilation that began on the first breath after release. We concluded that the relatively greater speeding of ventilatory decline with occlusion during the first 2 min of recovery from supra-AT exercise argues against a significant role for an intramuscular chemoreflex-induced hyperpnoea. Rather, mechanisms related to the hemodynamic effects of suddenly altered muscle perfusion seem more consistent with this phenomenon.     

Computer-assisted measurement of peripheral blood flow

An automated system for the measurement of peripheral blood flow using venous occlusion plethysmography based on the low-cost Apple II microcomputer, together with purpose-built compressor unit and data acquisition interface, has been developed. The computer performs the dual role of controlling the timing of inflation and deflation of the occluding cuffs and recording the resulting increase in limb circumference. Ten 8 s epochs of data are acquired and analysed per session. Flow rate is computed using a least squares fit between 0.5 and 4.0 s after cuff inflation, giving on-line indication of blood flow. Venous capacitance and digital systolic pressure may be measured using additional algorithms. The system has been used for the investigation of circulatory disorders and in the assessment of drugs acting on the peripheral circulation.     

Assessment of temporary dialysis catheter performance on the basis of flow and pressure measurements in vivo and in vitro

The efficiency of hemodialysis treatments depends on catheter performance and, consequently, on effective blood flow that can be achieved at maximum extracorporeal pressures. Differences in effective and displayed flow were determined with ultrasound dilution technology, and a mathematical correction function for the MultiFiltrate hemodialysis machine was developed. This algorithm was used to calculate effective blood flow during treatment from displayed flow and arterial pressure. To assess catheter performance over time, we measured effective blood flow as function of extracorporeal pressure in 11 uncuffed, tunneled hemodialysis catheters with shotgun design. Pressure and flow profiles of the catheters were determined, and pressure symmetry was measured. To assess flow resistance over time, pressure trends of the catheters at different blood flow rates were measured for each patient over a mean period of 6.1 +/- 3.0 days. Increases in flow resistance during the study period were found to be small. Mean arterial pressure decreased from -185 mm Hg to -200 mm Hg, and mean venous pressure increased from 197 mm Hg to 215 mm Hg. Effective flow did not change significantly during the study. In conclusion, all catheters investigated easily provided effective flows above 450 mL/min over the study period at maximum extracorporeal pressures below +/-300 mm Hg.     

Hemodynamic and energetic assessment of calves implanted with a left ventricular assist device (LVAD)

Hemodynamic and ventricular energetic parameters were measured in calves implanted with the air driven Utah Ventricular Assist Device (UVAD). Uptake site was varied to determine the effect of control mode and vacuum augmentation of filing. Uptake was drawn solely from the left atrium or combined with a left ventricular apical vent. LVAD outflow returned to the descending, thoracic aorta. Control modes examined included asynchronous pumping as well as 1:1 and 1:2 synchronous diastolic counterpulsation. The 85cc LVAD, vacuum formed from PELLETHANE, was implanted acutely in four animals and chronically in six (7, 49 and 116 days paracorporeally, 1, 28 and 32 days intrathoracically). Instantaneous blood pressures, intramyocardial pressure, aortic outflow, oxygen consumption, LVAD output and drive parameters were recorded. LVAD output was independent of control mode when the natural heart rate was greater than or equal to 80 beats per minute. Intrathoracically positioned LVADs pumped a mean flow of approximately equal to 5 liters/min without vacuum augmentation of filling. Paracorporeally positioned LVADs pumped approximately equal to 3 liters/min mean flow without vacuum augmentation and up to approximately equal to 6 liters/min with 38 mm Hg of vacuum augmentation of filling. Instantaneous ascending aortic pressure and flow showed distinct beat-to-beat variation depending on LVAD control mode. Lower average ventricular afterload was observed when pumping the LVAD asynchronously or 1:2 synchronously. In one acute preparation, left ventricular myocardial oxygen consumption was reduced from the unassisted average control level by 37% for the asynchronous and 1:1 synchronous control modes with left atrial uptake.(ABSTRACT TRUNCATED AT 250 WORDS)     

Model of interstitial pressure as a result of cyclical changes in the capillary wall fluid transport.

Reported interstitial pressures range from -8 to +6 mm Hg in different tissues and from <-20 mm Hg in burned tissue or more than +30 mm Hg in tumors. We have tried to link interstitial pressure to the here proposed cyclical changes in the fluid transport across the capillary wall.In the presented model interstitial pressure is considered as an average of pressures in numerous pericapillary spaces. A single pericapillary pressure is a dynamic difference between the net outward (hydraulic pressure+interstitial colloid osmotic pressure) and inward (plasma colloid oncotic pressure) forces. Hence, dominating net outward forces would result in a positive pericapillary interstitial pressure, while stronger inward forces would produce negative pressures in the pericapillary space. All interruptions of blood flow leave some blood in capillaries with a normal oncotic pressure and no hydrostatic pressure that might act as a strong absorber of interstitial fluid until the blood flow is reestablished.Model assumptions for the systemic circulation capillaries include (a) precapillary sphincters can almost entirely stop the capillary flow, (b) only a minority of sphincters are normally open in the tissue, and (c) hydrostatic pressures in unperfused capillaries are similar to the pressures at their venous ends.The key proposal is that capillaries with closed precapillary sphincters along their entire length have low hydrostatic pressure of 10 to 15 mm Hg. This pressure cannot force filtration, so these capillaries reabsorb interstitial fluid from the pericapillary space along their entire length. In the open capillaries, hydrostatic pressure filtrates fluid to the pericapillary space along most of their length. Fluid enters, moves some 20 or 30 micrometers away and back to be reabsorbed at the same point. Closed periods are periods of intense fluid reabsorption, while the short open periods refill the space with fresh fluid. It can be calculated that subcutaneous tissue interstitial pressure values might develop if the closed periods are 1.14 to 2.66 times longer than the open periods. Positive interstitial pressures observed in some organs might develop if open periods are longer than the closed periods.High interstitial colloid pressure in lungs makes both perfused and unperfused capillaries absorptive, resulting in more negative values of lung interstitial pressure. The same model is used to explain interstitial pressure values in tumors, burned tissue and intestinal villi.