Respiratory and haemodynamic changes during decremental open lung positive end-expiratory pressure titration in patients with acute respiratory distress syndrome

INTRODUCTION: To investigate haemodynamic and respiratory changes during lung recruitment and decremental positive end-expiratory pressure (PEEP) titration for open lung ventilation in patients with acute respiratory distress syndrome (ARDS) a prospective, clinical trial was performed involving 12 adult patients with ARDS treated in the surgical intensive care unit in a university hospital. METHODS: A software programme (Open Lung Tool) incorporated into a standard ventilator controlled the recruitment (pressure-controlled ventilation with fixed PEEP at 20 cmH2O and increased driving pressures at 20, 25 and 30 cmH2O for two minutes each) and PEEP titration (PEEP lowered by 2 cmH2O every two minutes, with tidal volume set at 6 ml/kg). The open lung PEEP (OL-PEEP) was defined as the PEEP level yielding maximum dynamic respiratory compliance plus 2 cmH2O. Gas exchange, respiratory mechanics and central haemodynamics using the Pulse Contour Cardiac Output Monitor (PiCCO), as well as transoesophageal echocardiography were measured at the following steps: at baseline (T0); during the final recruitment step with PEEP at 20 cmH2O and driving pressure at 30 cmH2O, (T20/30); at OL-PEEP, following another recruitment manoeuvre (TOLP). RESULTS: The ratio of partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) increased from T0 to TOLP (120 +/- 59 versus 146 +/- 64 mmHg, P < 0.005), as did dynamic respiratory compliance (23 +/- 5 versus 27 +/- 6 ml/cmH2O, P < 0.005). At constant PEEP (14 +/- 3 cmH2O) and tidal volumes, peak inspiratory pressure decreased (32 +/- 3 versus 29 +/- 3 cmH2O, P < 0.005), although partial pressure of arterial carbon dioxide (PaCO2) was unchanged (58 +/- 22 versus 53 +/- 18 mmHg). No significant decrease in mean arterial pressure, stroke volume or cardiac output occurred during the recruitment (T20/30). However, left ventricular end-diastolic area decreased at T20/30 due to a decrease in the left ventricular end-diastolic septal-lateral diameter, while right ventricular end-diastolic area increased. Right ventricular function, estimated by the right ventricular Tei-index, deteriorated during the recruitment manoeuvre, but improved at TOLP. CONCLUSIONS: A standardised open lung strategy increased oxygenation and improved respiratory system compliance. No major haemodynamic compromise was observed, although the increase in right ventricular Tei-index and right ventricular end-diastolic area and the decrease in left ventricular end-diastolic septal-lateral diameter during the recruitment suggested an increased right ventricular stress and strain. Right ventricular function was significantly improved at TOLP compared with T0, although left ventricular function was unchanged, indicating effective lung volume optimisation

Surface Region of Superfluid Helium as an Inhomogeneous Bose-Condensed Gas

We present arguments that the low density surface region of self-bounded superfluid $^4$He systems is an inhomogeneous dilute Bose gas, with almost all of the atoms occupying the same single-particle state at $T = 0$. Numerical evidence for this complete Bose-Einstein condensation was first given by the many-body variational calculations of $^4$He droplets by Lewart, Pandharipande and Pieper in 1988. We show that the low density surface region can be treated rigorously using a generalized Gross-Pitaevskii equation for the Bose order parameter.Comment: 4 pages, 1 Postscript figur

Structural and dynamical properties of superfluid helium: a density functional approach

We present a novel density functional for liquid 4He, properly accounting for the static response function and the phonon-roton dispersion in the uniform liquid. The functional is used to study both structural and dynamical properties of superfluid helium in various geometries. The equilibrium properties of the free surface, droplets and films at zero temperature are calculated. Our predictions agree closely to the results of ab initio Monte Carlo calculations, when available. The introduction of a phenomenological velocity dependent interaction, which accounts for backflow effects, is discussed. The spectrum of the elementary excitations of the free surface and films is studied.Comment: 37 pages, REVTeX 3.0, figures on request at [email protected]

Influence of Water Content in an ADN Based Liquid Monopropellant on Performance Characteristics

Hydrazine is advantageous for attitude control systems of satellites because it is space storable for long times and the developed thrusters are reliable for long term operations. Unfortunately hydrazine is very difficult to handle on ground due to its very high toxicity. Especially with regard to the REACH regulation of the European Community, which has passed some years ago, Hydrazine is on the candidate list of substances whose use could be limited in future. Thus strong research efforts have to be conducted today to find and to qualify alternative propellants, which have significantly simpler handling characteristics, are less toxic, environmentally benign and have similar or even better performance characteristics. One of the most promising candidates to replace hydrazine is the ADN based ionic liquid FLP-106, which is a monopropellant and has been developed by FOI. This monopropellant has a higher Isp in comparison to hydrazine and to LMP-103S which is currently used by the ECAPS company from Sweden. Also FLP-106 has a lower vapor pressure than LMP-103S. Thrusters using ionic liquid propellants are working with heated catalysts to decompose the propellant. One of the main drawbacks of this design is the lack of cold-start capability. Additionally, the high combustion temperature is a concern, possibly requiring high-temperature alloys like Iridium/Rhenium. FLP-106 consists of 64.6 % ADN (ammonium dinitramide), 23.9 % water and 11.5 % of a low volatile hydrocarbon fuel. In order to use simpler materials with lower melting points the combustion temperature of FLP-106 can be decreased by increasing the water content in the propellant. However, the increased water content will decrease the specific impulse and may also influence the ignition properties