Nieinwazyjna wentylacja mechaniczna w domu

Wentylacja mechaniczna w domu, zwłaszcza w formie nieinwazyjnej, jest metodę leczenia stosowaną w przewlekłej niewydolności oddechowej, która nie jest jeszcze powszechna w Polsce. Pozwala ona na zmniejszenie zmęczenia mięśni oddechowych, poprawę skuteczności wentylacji, poprawę komfortu życia chorych, a w wielu przypadkach umożliwia przeniesienie opieki nad chorym przewlekłym ze szpitala do przyjaznego, domowego otoczenia. W niniejszej pracy omówiono wskazania do wentylacji domowej, formy jej prowadzenia oraz sposoby postępowania w razie wystąpienia powikłań.Mechanical home ventilation, especially noninvasive, is a form of treatment of chronic respirator failure, which is not widespread in Poland. By diminishing the respiratory muscle fatigue, this way of treatment increases ventilatory efficiency, ameliorates the life comfort and allows, in many cases, to shift the care of chronic patient from hospital to home environment. Different aspects of home ventilation were discussed: indications, forms of management and complications

Efficient reduction of speckle noise in Optical Coherence Tomography

Speckle pattern, which is inherent in coherence imaging, influences significantly axial and transversal resolution of Optical Coherence Tomography (OCT) instruments. The well known speckle removal techniques are either sensitive to sample motion, require sophisticated and expensive sample tracking systems, or involve sophisticated numerical procedures. As a result, their applicability to in vivo real-time imaging is limited. In this work, we propose to average multiple A-scans collected in a fully controlled way to reduce the speckle contrast. This procedure involves non-coherent averaging of OCT A-scans acquired from adjacent locations on the sample. The technique exploits scanning protocol with fast beam deflection in the direction perpendicular to lateral dimension of the cross-sectional image. Such scanning protocol reduces the time interval between A-scans to be averaged to the repetition time of the acquisition system. Consequently, the averaging algorithm is immune to bulk motion of an investigated sample, does not require any sophisticated data processing to align cross-sectional images, and allows for precise control of lateral shift of the scanning beam on the object. The technique is tested with standard Spectral OCT system with an extra resonant scanner used for rapid beam deflection in the lateral direction. Ultrahigh speed CMOS camera serves as a detector and acquires 200,000 spectra per second. A dedicated A-scan generation algorithm allows for real-time display of images with reduced speckle contrast at 6 frames/second. This technique is applied to in vivo imaging of anterior and posterior segments of the human eye and human skin

Zmęczenie życiem codziennym a strategie radzenia sobie ze stresem opiekunów rodzinnych osób wentylowanych mechanicznie w domu

Background. Home mechanical ventilation is a form of long-term nursing intervention over people with chronic respiratory failure. The aim of this research was to determine the connections between daily life fatigue and coping strategies in caregivers of people supported by home mechanical ventilation, consid­ering the role of objective medical factors of the ill (ventilation method and time). Material and methods. The study included 61 caregivers aged 29–74. The variables were measured with Daily Life Fatigue Questionnaire, Inventory to Measure Coping Strategies with Stress Mini-COPE and survey. Results. Higher level of: general, physical, psychological and social fatigue contributes to increased avoid­ance behaviour and manifestation of helplessness among the caregivers of home mechanically-ventilated individuals. The method and time of mechanical ventilation application significantly differentiate the relation between daily life fatigue and coping strategies. Conclusions. The results acquired showed that the caregivers were significantly differentiate in measured variables. Diagnosing the fatigue and coping strategies is very important matter in creation of psychological support programmes for caregivers of home mechanically-ventilated individuals.Wstęp: Domowa wentylacja mechaniczna to leczenie niewydolności oddechowej za pomocą respiratora stosowanego w domu. Celem badań było określenie związku między zmęczeniem życiem codziennym a strategiami radzenia sobie ze stresem u opiekunów osób wentylowanych mechanicznie w domu z uwzględnieniem sposobu i czasu prowadzenia wentylacji. Materiał i metody: Przebadano 61 opiekunów w wieku 29 – 74 lat. Zastosowano Kwestionariusz Zmęczenia Życiem Codziennym (KZZC), Inwentarz do Pomiaru Radzenia Sobie ze Stresem (mini-COPE) i ankietę. Wyniki: Wraz ze wzrostem poczucia: ogólnego, fizycznego, psychicznego i społecznego zmęczenia życiem codziennym badani opiekunowie stosowali w głównej mierze strategie radzenia sobie ze stresem unikowe i manifestujące bezradność. Sposób oraz czas prowadzenia wentylacji mechanicznej u osób chorych istotnie modyfikował związek zmęczenia życiem codziennym ze strategiami radzenia sobie ze stresem ich opiekunów. Wnioski: Wyniki badań pozwalają stwierdzić, iż badani istotnie różnili się w zakresie analizowanych zmiennych. Diagnoza poczucia zmęczenia i stosowanych strategii radzenia sobie ze stresem w sytuacji opieki może pełnić znaczącą rolę w tworzeniu programu pomocy psychologicznej nieformalnym opiekunom osób wentylowanych mechanicznie w domu

Customizable tubular model for n-furcating blood vessels and its application to 3D reconstruction of the cerebrovascular system

Understanding the 3D cerebral vascular network is one of the pressing issues impacting the diagnostics of various systemic disorders and is helpful in clinical therapeutic strategies. Unfortunately, the existing software in the radiological workstation does not meet the expectations of radiologists who require a computerized system for detailed, quantitative analysis of the human cerebrovascular system in 3D and a standardized geometric description of its components. In this study, we show a method that uses 3D image data from magnetic resonance imaging with contrast to create a geometrical reconstruction of the vessels and a parametric description of the reconstructed segments of the vessels. First, the method isolates the vascular system using controlled morphological growing and performs skeleton extraction and optimization. Then, around the optimized skeleton branches, it creates tubular objects optimized for quality and accuracy of matching with the originally isolated vascular data. Finally, it optimizes the joints on n-furcating vessel segments. As a result, the algorithm gives a complete description of shape, position in space, position relative to other segments, and other anatomical structures of each cerebrovascular system segment. Our method is highly customizable and in principle allows reconstructing vascular structures from any 2D or 3D data. The algorithm solves shortcomings of currently available methods including failures to reconstruct the vessel mesh in the proximity of junctions and is free of mesh collisions in high curvature vessels. It also introduces a number of optimizations in the vessel skeletonization leading to a more smooth and more accurate model of the vessel network. We have tested the method on 20 datasets from the public magnetic resonance angiography image database and show that the method allows for repeatable and robust segmentation of the vessel network and allows to compute vascular lateralization indices. Graphical abstract: [Figure not available: see fulltext.]</p

In vivo volumetric imaging of human retinal circulation with phase-variance optical coherence tomography

We present in vivo volumetric images of human retinal micro-circulation using Fourier-domain optical coherence tomography (Fd-OCT) with the phase-variance based motion contrast method. Currently fundus fluorescein angiography (FA) is the standard technique in clinical settings for visualizing blood circulation of the retina. High contrast imaging of retinal vasculature is achieved by injection of a fluorescein dye into the systemic circulation. We previously reported phase-variance optical coherence tomography (pvOCT) as an alternative and non-invasive technique to image human retinal capillaries. In contrast to FA, pvOCT allows not only noninvasive visualization of a two-dimensional retinal perfusion map but also volumetric morphology of retinal microvasculature with high sensitivity. In this paper we report high-speed acquisition at 125 kHz A-scans with pvOCT to reduce motion artifacts and increase the scanning area when compared with previous reports. Two scanning schemes with different sampling densities and scanning areas are evaluated to find optimal parameters for high acquisition speed in vivo imaging. In order to evaluate this technique, we compare pvOCT capillary imaging at 3x3 mm^2 and 1.5x1.5 mm^2 with fundus FA for a normal human subject. Additionally, a volumetric view of retinal capillaries and a stitched image acquired with ten 3x3 mm^2 pvOCT sub-volumes are presented. Visualization of retinal vasculature with pvOCT has potential for diagnosis of retinal vascular diseases

Doppler imaging with dual-detection full-range frequency domain optical coherence tomography

Most of full-range techniques for Frequency Domain Optical Coherence Tomography (FD-OCT) reported to date utilize the phase relation between consecutive axial lines to reconstruct a complex interference signal and hence may exhibit degradation in either mirror image suppression performance or detectable velocity dynamic range or both when monitoring a moving sample such as flow activity. We have previously reported a technique of mirror image removal by simultaneous detection of the quadrature components of a complex spectral interference called a Dual-Detection Frequency Domain OCT (DD-FD-OCT) [Opt. Lett. 35, 1058-1060 (2010)]. The technique enables full range imaging without any loss of acquisition speed and is intrinsically less sensitive to phase errors generated by involuntary movements of the subject. In this paper, we demonstrate the application of the DD-FD-OCT to a phase-resolved Doppler imaging without degradation in either mirror image suppression performance or detectable velocity dynamic range that were observed in other full-range Doppler methods. In order to accommodate for Doppler imaging, we have developed a fiber-based DD-FD-OCT that more efficiently utilizes the source power compared with the previous free-space DD-FD-OCT. In addition, the velocity sensitivity of the phase-resolved DD-FD-OCT was investigated, and the relation between the measured Doppler phase shift and set flow velocity of a flow phantom was verified. Finally, we demonstrate the Doppler imaging using the DD-FD-OCT in a biological sample

Blood flow rate estimation in optic disc capillaries and vessels using Doppler optical coherence tomography with 3D fast phase unwrapping

The retinal volumetric flow rate contains useful information not only for ophthalmology but also for the diagnosis of common civilization diseases such as diabetes, Alzheimer's disease, or cerebrovascular diseases. Non-invasive optical methods for quantitative flow assessment, such as Doppler optical coherence tomography (OCT), have certain limitations. One is the phase wrapping that makes simultaneous calculations of the flow in all human retinal vessels impossible due to a very large span of flow velocities. We demonstrate that three-dimensional Doppler OCT combined with three-dimensional four Fourier transform fast phase unwrapping (3D 4FT FPU) allows for the calculation of the volumetric blood flow rate in real-time by the implementation of the algorithms in a graphics processing unit (GPU). The additive character of the flow at the furcations is proven using a microfluidic device with controlled flow rates as well as in the retinal veins bifurcations imaged in the optic disc area of five healthy volunteers. We show values of blood flow rates calculated for retinal capillaries and vessels with diameters in the range of 12-150 µm. The potential of quantitative measurement of retinal blood flow volume includes noninvasive detection of carotid artery stenosis or occlusion, measuring vascular reactivity and evaluation of vessel wall stiffness

Swept-source based, single-shot, multi-detectable velocity range Doppler optical coherence tomography

Phase-Resolved Doppler Optical Coherence Tomography (PR-DOCT) allows visualization and characterization of the location, direction, velocity, and profile of flow activity embedded in a static sample structure. The detectable Velocity Dynamic Range (VDR) of each particular PR-DOCT system is governed by a detectable Doppler phase shift, a flow angle, and an acquisition time interval used to determine the Doppler phase shift. In general, the lower boundary of the detectable Doppler phase shift is limited by the phase stability of the system, while the upper boundary is limited by the π phase ambiguity. For a given range of detectable Doppler phase shift, shortening the acquisition duration will increase not only the maximum detectable velocity but unfortunately also the minimum detectable velocity, which may lead to the invisibility of a slow flow. In this paper, we present an alternative acquisition scheme for PR-DOCT that extends the lower limit of the velocity dynamic range, while maintaining the maximum detectable velocity, hence increasing the overall VDR of PR-DOCT system. The essence of the approach is to implement a technique of multi-scale measurement to simultaneously acquire multiple VDRs in a single measurement. We demonstrate an example of implementation of the technique in a dual VDR DOCT, where two Doppler maps having different detectable VDRs were simultaneously detected, processed, and displayed in real time. One was a fixed VDR DOCT capable of measuring axial velocity of up to 10.9 mm/s without phase unwrapping. The other was a variable VDR DOCT capable of adjusting its detectable VDR to reveal slow flow information down to 11.3 μm/s. The technique is shown to effectively extend the overall detectable VDR of the PR-DOCT system. Examples of real time Doppler imaging of an African frog tadpole are demonstrated using the dual-VDR DOCT system

Combined photoacoustic microscopy and optical coherence tomography can measure metabolic rate of oxygen

We proposed to measure the metabolic rate of oxygen (MRO2) in small animals in vivo using a multimodal imaging system that combines laser-scanning optical-resolution photoacoustic microscopy (LSOR-PAM) and spectral-domain optical coherence tomography (SD-OCT). We first tested the capability of the multimodal system to measure flow rate in a phantom made of two capillary tubes of different diameters. We then demonstrated the capability of measuring MRO2 by imaging two parallel vessels selected from the ear of a Swiss Webster mouse. The hemoglobin oxygen saturation (sO2) and the vessel diameter were measured by the LSOR-PAM and the blood flow velocity was measured by the SD-OCT, from which blood flow rate and MRO2 were further calculated. The measured blood flow rates in the two vessels agreed with each other

Prevalence of home mechanical ventilation in Poland

Wstęp: Domowe wspomaganie wentylacji (DWW) staje się coraz powszechniejszą metodą leczenia chorych z przewlekłą niewydolnością oddychania. Na jej rozwój wpływa starzenie się społeczeństwa, rozwój technologii umożliwiających stosowanie wentylacji w domu oraz stale poszerzający się zakres wskazań. Autorzy podjęli próbę oceny rozpowszechnienia DWW w Polsce, metod oraz wskazań do jej stosowania. Materiał i metody: Do wszystkich ośrodków prowadzących DWW oraz do wszystkich wojewódzkich oddziałów NFZ wysłano ankiety, w których proszono o udzielenie informacji na temat stosowania DWW. Wyniki: Na podstawie uzyskanych odpowiedzi ze wszystkich oddziałów NFZ ustalono, że na przełomie roku 2008/2009 w Polsce leczenie DWW stosowano u 846 chorych, w tym 31% dzieci, czyli u średnio 2,2 pacjenta na 100 tys. mieszkańców. Na ankiety odpowiedziało tylko 12 ośrodków (31%) prowadzących DWW. Zgłosiły one łącznie 206 leczonych chorych (24% wszystkich leczonych), z tego 122 (59%) było leczonych w sposób inwazyjny przez tracheostomię. Na schorzenia nerwowo-mięśniowe cierpiało 168 chorych (82%), pozostałych 38 (18%) na choroby układu oddechowego. Najczęstszymi przyczynami stosowania DWW była dystrofia mięśniowa (57 chorych, co stanowiło 34% pacjentów z chorobami nerwowo-mięśniowymi) i stwardnienie zanikowe boczne (39, 23%). Wśród chorób płuc i klatki piersiowej przeważali chorzy z POChP (17 pacjentów) oraz kifoskoliozą (10 chorych). Wnioski: Mimo znacznego rozwoju DWW w Polsce w ciągu ostatnich 10 lat, rozpowszechnienie tej metody leczenia nadal odbiega od stanu w innych krajach europejskich. Przyczyną tych różnic może być bardzo mała liczba pacjentów z chorobami układu oddechowego leczonych DWW. Wysoki odsetek chorych stanowią pacjenci leczeni w sposób inwazyjny. Głównymi przyczynami hamującymi rozwój DWW jest system kwalifikacji, który pomija udział specjalisty chorób płuc, brak ustalonych przez towarzystwa naukowe wskazań, wyjątkowo wymagające kryteria udzielania tego świadczenia nałożone przez NFZ oraz mała świadomość pulmonologów na temat potrzeby i możliwości leczenia tą metodą, zwłaszcza pacjentów z chorobami restrykcyjnymi układu oddechowego oraz zespołem hipowentylacji w przebiegu otyłości. Pneumonol. Alergol. Pol. 2010; 78, 6: 392-398Introduction: Home mechanical ventilation (HMV) is increasingly used in the treatment of chronic respiratory failure thanks to rapid technological development, increasing number of elderly people and extension of indications. The aim of the study was to assess: prevalence of HMV in Poland, the proportions of lung disease and neuromuscular patients using HMV and the type of interface (invasive v. non-invasive). Material and methods: The questionnaire was send to all institutions providing HMV in Poland and to regional departments of National Health System (NHS). Results: All NHS departments responded. They reported 846 HMV users, 31% of children. The prevalence of HMV in Poland was assessed as 2,2 patient per 100.000 population without striking differences between provinces. Among 39 HMV centers in Poland 12 (31%) answered. They reported 206 patients (24% of all HMV users). Proportion of ventilation mode consisted of 59% (122 pts) treated via a tracheostomy and 41% (84 pts) with non invasive ventilation (NIV). 168 patients (82%) had neuromuscular diseases (ND), majority of them muscular dystrophy - 57 patients ( 34% of ND) and amyotrophic lateral sclerosis - 39 patients (23% of ND). There were only 38 patients (18%) with lung and thoracic cage diseases: 17 with COPD and 10 with kyphoscoliosis. Conclusions: The prevalence of HMV treatment in Poland has developed dramatically in the last decade, but is still very low comparing to other European countries, especially due to very low number of patients with lung and chest wall diseases. The prevalence of invasive mode of ventilation is extremely high. The most important factors which inhibit development of HMV in Poland are: omission of respiratory physicians in the process of qualification, lack of national guidelines, sophisticated demands for HMV providers. The awareness of the need of HMV especially in patients with respiratory failure due to obesity hypoventilation syndrome and restrictive lung diseases should be increased among chest physicians. Pneumonol. Alergol. Pol. 2010; 78, 6: 392-39