Treatment-emergent central sleep apnea resolves with lower inspiratory pressure.

Study Objectives: Treatment emergent central sleep apnea (TECSA) is an important problem during therapy with continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA). Here we tested a device designed to improve CPAP comfort through reducing IPAP (-Com) to determine if such a reduction in IPAP could eliminate central apneas in patients with TECSA. Since increasing tidal volume (potentially via IPAP increments) has been suggested as a possible mechanism contributing to TECSA onset, our hypothesis was that reducing IPAP would yield a drop in the central apnea index (CAI).

Kairos positive airway pressure (KPAP) equals continuous PAP in effectiveness, and offers superior comfort for obstructive sleep apnea treatment.

Study Objectives: A recent study challenged the prevailing clinical view that maintaining inspiratory positive airway pressure (IPAP) is necessary for upper airway patency, demonstrating no differences in apnea hypopnea index (AHI) between continuous PAP (CPAP) with and without a resistor to reduce IPAP. In this study, we assessed the effect of Kairos PAP (KPAP), a new algorithm which features multiple drops in IPAP, only returning to therapeutic pressure near the end expiration, on sleep apnea severity and subjective comfort.

Methods: Two randomized clinical trials were conducted.

Circuit-dependent carbon dioxide rebreathing during continuous positive airway pressure.

Background: The current standard treatment for obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP), is characterized by a low adherence rate due to various factors including circuit-dependent carbon dioxide (CO) rebreathing, which can exacerbated by disparate factors, such as low PAP, use of auto-titrating PAP or ramps. However, risk factors for rebreathing are often overlooked or poorly understood in clinical practice. Therefore, our objective was to evaluate the extent of rebreathing occurring with commonly used CPAP masks across varying PAPs, tidal volumes, and respiratory rates.

The effect of tracheal gas insufflation on gas exchange efficiency.

Transtracheal gas insufflation (TGI) improves gas exchange efficiency, but is associated with hyperinflation, and usually requires ventilator adjustment to compensate for the increased gas flow. Although bidirectional TGI (Bi-TGI) minimizes hyperinflation, it does not preclude the need to reduce tidal volumes to prevent hyperinflation. A flow-compensation system was developed by Respironics (Murrysville, PA) to match TGI flows; however, neither that nor the efficacy of Bi-TGI have been tested in vivo.

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.

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.

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%.

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 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.

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.