Thesis (M.S.)--University of Michigan, 1975.

Thesis (M.S.)--University of Michigan, 1975.

Cette recherche est centrée sur l’optimisation des réglages au cours de la ventilation artificielle ou ventilation mécanique (support respiratoire fourni aux patients atteints d’insuffisance respiratoire aigüe ou chronique, aux patients opérés ou aux patients dans le coma) avec des outils innovants. Nous avons développé et évalué un outil totalement innovant et original permettant de mesurer la taille des patients alités sous ventilation artificielle et de fournir au clinicien en charge du patient les données pour appliquer une ventilation protectrice. En effet, nous avons démontré l’importance de la taille pour optimiser ce réglage, comparé les méthodes de mesure traditionnelles à des méthodes alternatives pour mesurer les patients alités, et conclu que les méthodes alternatives étaient au moins aussi précises mais plus faciles à utiliser en pratique. Finalement, nous avons développé un outil optique original utilisable avec un iPhone permettant de faciliter la tâche du clinicien pour régler des volumes courants sécuritaires. L’idée de ce projet de doctorat est basée sur la nécessité de l’automatisation de la ventilation mécanique. Il existe un véritable bouleversement en ventilation mécanique depuis quelques années: l’apparition de systèmes réglant automatiquement certains paramètres majeurs du ventilateur sans intervention humaine. Ce virage est lié à un autre bouleversement: le doublement prévu du nombre de patients ayant recours à la ventilation mécanique d’ici à une quinzaine d’années. L’augmentation prévisible du nombre de patients sous ventilation mécanique sans augmentation du nombre de cliniciens à même de prendre en charge ces patients, est un problème majeur de santé publique. Cette augmentation est liée à la pyramide des âges et à la sévérité croissante des patients traités qui présentent de plus en plus de comorbidités. D’autre part, ces systèmes automatisés permettront de réaliser de façon automatisée le « transfert de connaissance ». En effet, il a bien été démontré les difficultés de mise en place des recommandations cliniques. L’utilisation de systèmes automatisés de ventilation pourrait permettre d’implémenter automatiquement les recommandations dans ce domaine et ainsi de réaliser automatiquement le transfert des connaissances. Par exemple, la nécessité de réduire le volume courant au cours du syndrome de détresse respiratoire aigüe (SDRA) pour réduire les lésions induites par la ventilation et la mortalité a été bien démontrée mais les difficultés d’application de ces mesures ont été rapportées dans de nombreuses études. Nous nous sommes concentrés sur ce problème en apparence simple : mesurer simplement les patients sous ventilation artificielle, calculer le poids prédit et le volume courant à utiliser chez les patients. Ce nouveau système pourra probablement aider les cliniciens pour appliquer chez un grand nombre de patients la ventilation protectrice et ainsi réduire les complications associées à la ventilation mécanique. / This research focuses on artificial ventilation or mechanical ventilation (respiratory support provided to patients with acute respiratory failure or chronic patients or operated patients in a coma) under the direction of Dr. François Lellouche at the Research Center of the Quebec Herat and Lung Institute. This research project has several themes: the automation of mechanical ventilation, the technology assessment of material used during mechanical ventilation and weaning from mechanical ventilation. My PhD project is based on the automation of mechanical ventilation (MV). There has been a revolution happening in mechanical ventilation for several years: the emergence of systems without human intervention that automatically adjust certain key parameters such as fan pressure used during the inspiratory phase or frequency of the fan cycles dispensed to patients. This move anticipates another major factor occurring in the health care system: the expected doubling of the number of patients using mechanical ventilation within the next fifteen years. The expected increase in the number of patients on mechanical ventilation without increasing the number of clinicians able to take care of these patients will be a major public health problem. This increase is related to the age and increasing severity of mechanically ventilated patients who have more co-morbidities. On the other hand, these automated systems enable automated knowledge translation (KT). It has been demonstrated that the implementation of clinical guidelines also encounters many barriers. We hope that our automated KT system will help implement recommended lower tidal volumes. For example, the need to reduce the tidal volume during acute respiratory distress syndrome (ARDS) in patients to reduce injuries and mortality has been well documented, but the difficulties in applying these measures have been reported in many studies. We focused on this seemingly simple problem: simply measuring patients with artificial ventilation, calculating the predicted body weight and the tidal volume to use for patients.

Call number: LD2668 .T4 1966 R264 / Master of Science

Ability to duplicate an inspired volume level was studied in five healthy males using the psychophysical method of reproduction. Three conditions were evaluated in order to investigate the perceptual cues used for obtaining a specific inspired volume. Conditions were designed to progressively remove cues that might affect the subject's ability to duplicate an inspired lung volume. In each, the subject performed a standard inspiration, spanning from end expiratory position to 35% of inspiratory capacity. Conditions were varied as follows: (1) subjects were instructed to perform both the standard and test (reproduction) inspirations at the same flow rate and beginning at the same lung volume, (2) subjects were instructed to make the flow rate of the test inspiration faster or slower from standard inspiration, and (3) subjects were instructed to begin the test inspiration at a different lung volume than the standard inspirations. The group mean error for all conditions combined for the first day on which each condition was performed was 173 ml, compared to a mean error of 133 ml. Reduction in errors for all conditions from the first to the second day of performance indicates a practice effect. There was no significant difference in errors between conditions. These results indicate the final lung volume, which remained constant for all three conditions, is important for accurate duplication of inspired volume. This finding for learned respiratory movements is comparable to that found by other researchers for skilled limb movements.

No description available.

No description available.

Crop productivity is a balance between carbon gain by photosynthetic assimilation of CO₂ and the release of fixed carbon as CO₂ via respiration. Respiration is the process by which carbohydrates are oxidised to produce ATP to fuel biochemical reactions, whilst simultaneously releasing CO₂ as a by-product; therefore, increased demand for ATP or decreased efficiency of ATP production by uncoupling of the mitochondrial electron transport chain results in greater CO₂ production. ATP produced by respiration is either used to support processes involved in growth or to power cell maintenance processes, such as macromolecule turnover or maintenance of membrane ion gradients. Respiration increases when plants are exposed to high temperatures; a factor that will become increasingly important as we try to maximise food production as the global climate changes. However, it is unknown if increased respiration at high temperature is necessary to provide energy to support growth, is a consequence of increased ATP consumption for maintenance processes or is due to increased mitochondrial uncoupling at high temperature. Flux measurements showed that CO₂ production by excised Arabidopsis thaliana roots increases with temperature up to 37°C. Although growth also increased up to 37°C resulting in increased respiration associated with growth processes, the majority of overall CO2 production at high temperatures could be accounted for by non-growth respiration. An analysis of ATP-consuming processes demonstrated that protein turnover and maintenance of ion gradients collectively account for the majority of maintenance respiration, but that ATP consumption for the maintenance of ion gradients is quantitatively more important than protein turnover at high temperature. Furthermore, a decrease in in vivo P/O ratio at high temperature was demonstrated; the results presented suggest that this is most likely due to increased basal proton leak across the inner mitochondrial membrane. It can be concluded that increased CO₂ production at high temperature results from a combination of increased ATP consumption for the maintenance of ion gradients and a decrease in coupling of the mitochondrial electron transport chain through a common mechanism of increased membrane fluidity and ion leak.

Neuroepithelial cells (NECs) of the zebrafish gill filament have been previously identified as bimodal O2 and CO2/H+ sensors that depolarize in response to chemostimuli via inhibition of background K+ channels. To further elucidate the signaling pathway underlying CO2/H+ chemoreception in the NECs we employed microspectrofluorometric techniques to examine the effects of hypercapnia on [Ca2+]i and pHi. NECs increased their [Ca2+]i in response to acidic hypercapnia (5% CO2, pH 6.6) and isocapnic acidosis (normocapnia, pH 6.6), but not to isohydric hypercapnia (5% CO2, pH 7.8). The acid- induced increase in [Ca2+]i persisted in the absence of extracellular Ca2+, and Ca2+ channel blockers (Cd2+, Ni2+ and nifedipine). NECs exhibited a rapid and reversible drop in pHi in response to acidic hypercapnia and isohydric hypercapnia. Isocapnic acidosis also induced intracellular acidification within NECs, but it was less severe than the drop in pHi elicited by acidic hypercapnia and isohydric hypercapnia. The rate and magnitude of intracellular acidification was reduced by the CA-inhibitor, acetazolamide, without effect on the acid-induced increase in [Ca2+]i. Acetate was used to investigate the relationship between pHi and [Ca2+]i. Acetate induced intracellular acidification without augmentation of [Ca2+]i. The results of this thesis demonstrate that (1) extracellular acidification, but not CO2, is critical to the hypercapnia-induced increase in [Ca2+]i (2) the increase in [Ca2+]i is independent of the drop in pHi (3) the increase in [Ca2+]i is not mediated by the influx of Ca2+ across the plasma membrane.

Thèse de doctorat : Imagerie et rayonnements en médecine : INPL : 2007. / Titre provenant de l'écran-titre. Bibliogr.