Pressure Manometer Research Articles

Slaugytojų žinios apie tracheostomos vamzdelio manžetės priežiūrą prieš ir po mokymo

Tracheostomos vamzdelio manžetės priežiūra yra susijusi su didele rizika paciento sveikatai, todėl svarbu, kad slaugytojai turėtų mokslo įrodymais pagrįstų žinių apie manžetės priežiūrą. Jeigu slaugytojai turės pakankamai žinių ir gerus praktinius įgūdžius kokybiškai atlikti šią procedūrą, tai iki minimumo sumažins galimų nepageidaujamų įvykių dažnumą, užtikrins paciento saugumą. Darbo tikslas išanalizuoti slaugytojų žinias apie tracheostomos vamzdelio manžetės priežiūrą prieš ir po mokymo. Tyrimas vyko 2013 m. Kauno miesto ligoninių skyriuose, į kuriuos tracheostomuoti pacientai dažniausiai patenka iš Intensyviosios terapijos skyrių. Dalyvauti tyrime buvo pakviesti visi 111 tuose skyriuose dirbančių slaugytojų. Tyrimas buvo vykdomas etapais: 1) slaugytojų anketinė apklausa prieš mokymus; 2) slaugytojų mokymai; 3) slaugytojų apklausa po mokymų. Apklausoje prieš mokymus dalyvavo 93 slaugytojai, po mokymo – 81. Tyrimo duomenims rinkti buvo naudojama autorių sukurta Slaugytojų žinių nustatymo anketa. Rezultatai. Dauguma apklaustų slaugytojų teigė, jog manžetės slėgio specialiu manometru nematuoja (prieš mok. - 95,2 proc., po mok. - 98,3 proc.). Prieš ir po mokymų beveik pusė slaugytojų teigė, kad niekada nepripučia oro į tracheostomos vamzdelio manžetę (prieš mok. - 47,6 proc., po mok. - 45,8 proc.). Po mokymo statistiškai reikšmingai daugiau slaugytojų (44,4 proc.) nurodė, kad orą iš tracheostomos vamzdelio manžetės išleidžia kas tris – keturias val., o prieš mokymą taip darantys nurodė tik 20,1 proc. respondentų (χ²=12,162; lls=1; p=0,007). Prieš mokymą 60,9 proc. tiriamųjų nurodė, kad visai neišleidžia oro iš tracheostomos vamzdelio manžetės, o po mokymo taip teigė 40,3 proc. slaugytojų (χ²=12,162; lls=1; p=0,007). Po mokymo 50,6 proc. slaugytojų nurodė, kad manžetės slėgis turi būti mažesnis nei 20 cmH2O, nors prieš mokymą tokį slėgį nurodė 3,6 proc. respondentų (χ²=59,048; lls=3; p<0,001). Po mokymo 21,0 proc. tiriamųjų manė, kad nesvarbu, koks slėgis tracheostomos vamzdelyje, svarbu kad būtų daug išpūsta, o prieš mokymą taip teigė 65,5 proc. apklausoje dalyvavusių slaugytojų (χ²=59,048; lls=3; p<0,001). Didžioji dalis (79,6 proc.) slaugytojų, kurie išsimokslinimą įgijo medicinos mokykloje, po mokymo teigė, kad prieš išleidžiant orą iš tracheostomos vamzdelio manžetės išsiurbia sekretą iš burnos ir nosiaryklės, nors prieš mokymą taip teigė darantys 51,7 proc. respondentų (χ²=9,007; lls=1; p=0,003). Išvados. Po mokymo reikšmingai didesnė dalis slaugytojų teisingai nurodė, kad orą iš tracheostomos vamzdelio manžetės išleidžia kas tris – keturias val.; o manžetės slėgis turi būti ne mažesnis nei 20 cmH2O. Reikšmingai didesnė dalis slaugytojų, kurie išsimokslinimą įgijo medicinos mokykloje, po mokymo teigė, kad prieš išleidžiant orą iš tracheostomos vamzdelio manžetės išsiurbia sekretą iš burnos ir nosiaryklės. Prieš ir po mokymų dauguma apklaustųjų teigė, jog manžetės slėgio specialiu manometru nematuoja, o oro į vamzdelio manžetę pagal manometro rodiklius pripučia tik nedidelė dalis slaugytojų.

Soft-robotic esophageal swallowing as a clinically-inspired bolus rheometry technique

To investigate the impact of viscosity and peristaltic transport parameters on manometric pressure signatures, a reproducible swallowing process is required. Due to inter- and intra-subject variability from swallow to swallow, the human body does not represent an optimal mechanism for such an investigation. A smooth and continuous swallowing soft-robot has been developed to produce biomimetic swallowing trajectories, and is proposed to operate as a bench-top bolus rheometric investigation method. The method compares conventional viscometry and pressure signature findings from robotic swallowing experiments. The robotic aspect of experimentation involved 450 biomimetic swallows (10 repetitions of 45 unique experiments). The method examined swallowing transport in three dimensions: bolus formulation, peristaltic wavelength, and peristaltic velocity, each of which are known to contribute to safe and effective swallowing in vivo. It is found that the pressure gradients and magnitudes are commensurate with clinical reports on biological swallowing, on the order of 100 mmHg peak, however, the relationship between viscosity and pressure signatures is less clear. Bolus transport cannot be predicted as a function of bolus viscosity alone. Traditional viscometric data at 50 s−1, as used in clinical practice, may not be a strong indicator of swallow effort, safety, or efficacy in vivo.

Comparison between Two Endotracheal Tube Cuff Inflation Methods; Just-Seal Vs. Stethoscope-Guided.

The Endotracheal Tube (ETT) cuff performs a critical function of sealing the airway during positive pressure ventilation. There is a narrow range of cuff pressure required to maintain a functionally safe seal without exceeding capillary blood pressure. We aimed to compare Just-Seal (JS) and Stethoscope-Guided (SG) method of ETT cuff inflation with respect to the volume of air required to inflate the cuff, the manometric cuff pressure achieved and also to assess for the occurrence of postoperative sore throat after extubation in both the groups. It was a prospective observational study done in a Tertiary Teaching Public Hospital over a period of 1½ years on 100 patients with 50 each in two groups; JS or SG method of cuff inflation. SPSS Version 17 was used for data analysis. Statistically significant difference (p-value of less than 0.05) was noted between the two methods based on the volume of air injected into the cuff {the mean volume injected in JS was 6.79 ml and in the SG was 4.95 ml with p=5.71E-16 (< 0.05)} and cuff pressure achieved {mean cuff pressure achieved was 38.80 cm H2O in the JS and 29.64 cm H2O in SG with p=2.29E-14 (< 0.05)}. The incidence of post extubation sore throat was 54% (27 in 50) in the JS group and only 12% (6 in 50) in the SG; p= 0.00000797. ETT cuff inflation guided by a stethoscope is an effective technique for ensuring appropriate cuff pressures thus accomplishing the objective of providing safe and superior quality care of the patient both during and after anaesthesia and reducing the likelihood of even minimal risk complications that may still have legal implications.

Lower limb intracast pressures generated by different types of immobilisation casts.

AIMTo determine if complete, split casts and backslabs [plaster of Paris (POP) and fiberglass] generate different intracast pressures and pain.METHODSIncreased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups.RESULTSA significant difference between the various types of casts was noted when the saline volume was greater than 100 mL (P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs (P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL (P = 0.009). Intracast pressures were significantly lower in split casts (P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs (P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mmHg and greater (P = 0.001). Split fiberglass casts had significantly reduced pain levels (P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmHg. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mmHg and lower.CONCLUSIONFibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.

Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation.

Background Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20–30 cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Methods This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results One hundred seventy-eight patients were analyzed. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. This was statistically significant. Conclusion The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation.

Efficacy and Safety of Using Air Versus Alkalinized 2% Lignocaine for Inflating Endotracheal Tube Cuff and Its Pressure Effects on Incidence of Postoperative Coughing and Sore Throat.

Background and Objective:We wished to compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation.Materials and Methods:This was a prospective randomized controlled study conducted in a tertiary care set up over a period of 1 year. We included 100 patients in age group of 18–65 years posted for elective surgeries of duration more than 90 min under general anesthesia with N2O-O2 mixture. Patients were randomized using computer-generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1 h and 24 h postoperatively.Results:Demographic data, baseline characteristics (American Society of Anesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anesthesia were comparable among study groups (P > 0.05). Cuff pressure and volume achieved in the end of surgery were much higher in air group as compared to lignocaine group (P < 0.05). Incidence of coughing and POST at immediately, 1 h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Impact of duration of anesthesia on rise in cuff pressure was significantly higher in air group and its effect on cuff-induced laryngotracheal morbidity was significant in both air and lignocaine group.Conclusion:This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST. Duration of anesthesia has also a significant effect on incidence of postoperative trachea-laryngeal morbidity.

Correlation between maximum voluntary contraction and endurance measured by digital palpation and manometry: An observational study.

Digital palpation and manometry are methods that can provide information regarding maximum voluntary contraction (MVC) and endurance of the pelvic floor muscles (PFM), and a strong correlation between these variables can be expected. To investigate the correlation between MVC and endurance, measured by digital palpation and manometry. Forty-two women, with mean age of 58.1 years (±10.2), and predominant symptoms of stress urinary incontinence (SUI), were included. Examination was firstly conducted by digital palpation and subsequently using a Peritron manometer. MVC was measured using a 0-5 score, based on the Oxford Grading Scale. Endurance was assessed based on the PERFECT scheme. We found a significant positive correlation between the MVC measured by digital palpation and the peak manometric pressure (r=0.579, p<0.001), and between the measurements of the endurance by Peritron manometer and the PERFECT assessment scheme (r=0.559, P<0.001). Our results revealed a positive and significant correlation between the capacity and maintenance of PFM contraction using digital and manometer evaluations in women with predominant symptoms of SUI.

Atomization of liquids by disintegrating thin liquid films using gas jets

Liquid atomization is useful in many applications, such as engineering, science, pharmaceutics, medicine, forensics and others. In the present research, an innovative methodology and a new device for atomization of liquids into mists of micron and submicron droplets have been developed. The new liquid-atomization method exploits the physical phenomenon of fragmentation of thin liquid films into fine micron and submicron droplets by gas jets. For several tested prototypes, the direct observations using a high-speed visualization technique have demonstrated that bubbles were generated within a liquid and their shells have been subsequently destroyed by applying a mechanical impulse (pressure of a compressed air) once the bubbles came over the liquid surface. The main characteristics of the generated tap water mists have been experimentally measured by means of the laser diffraction technique under various conditions for each prototype. One of the prototype devices allowed obtaining mists containing 90–99% of droplets smaller than 1µm, with the minimum arithmetic and Sauter mean droplet diameters of 1.48µm and 2.66µm, and the 2.64ml/min of droplet flow rate for 3.5bar manometer pressure of atomizing air. The gas to liquid mass ratios (GLR) in the new device are depending on the atomizing tube length and the number of perforated orifices in the tube: more the tube length, hence more the number of perforated orifices, and therefore more liquid droplets will form for the same gas flow rate. The measured GLR values related to 1m length of the utilized atomizing tube were in the range of 0.65–1.06, and for the specifically utilized atomizing tube of 72mm length were among 9.07–14.67. The results of this study demonstrate that the developed method of generation of very fine droplet mists has many advantages over the existing techniques and can be perspective for many practical applications.

The importance of a high rectal pressure on strain in constipated patients: implications for biofeedback therapy

A subset of patients with chronic constipation display a relatively high manometric rectal pressure on strain. We hypothesized that these patients represent a unique phenotype of functional defecatory disorder (FDD) and would benefit from undergoing anorectal biofeedback (BF). Of 138 consecutive patients with chronic constipation and symptoms of FDD, 19 were defined as having a high rectal pressure on strain, using a statistically derived cut-off of 78mm Hg. This subset was compared with remaining patients in regard to baseline clinical profile and physiology, and outcome of BF. There was a greater representation of males in the high rectal pressure group. Their constipation score, impact of bowel dysfunction on quality of life and satisfaction with bowel habits did not differ from the remaining patients. Eighty-four percent of patients in the high group successfully expelled the rectal balloon and 95% displayed paradoxical anal contraction on strain (P<.05 compared with the remaining patients). Following BF, 89% of patients in the high group reduced their rectal pressure to normal. End of BF treatment outcomes improved significantly, and to a similar degree, in both groups. We have identified a subgroup of patients with dyssynergic symptoms but without a formal Rome III diagnosis of FDD, who were characterized by a high straining rectal pressure. Although these patients displayed some physiological differences to the patients with lower straining rectal pressure, they suffer similarly. Importantly, we have shown that these patients can respond favorably to anorectal BF.

Abstract 48: Differentiation of Moderate and Severe Ischemic Heart Failure by Invasive and Non-invasive Assessments of Diastolic Function in a Rat Model of Chronic Heart Failure

Background: This work is designed to determine if specific left ventricle (LV) pressure-volume relations, hemodynamic, and echo derived parameters of diastolic function are able to separate severe from moderate CHF in rats with left coronary artery occlusion. Hypothesis: Echocardiographic indices of diastolic function, end-diastolic pressure (EDP), dead volume, stiffness constants (k), and pressure volume relations predict the severity of CHF in infarcted rats. Methods: Male Sprague Dawley rats (N=14) were randomized to undergo left coronary artery ligation or sham operation. Echocardiography was performed at 3 and 6 weeks post coronary ligation. The rats were categorized into moderate or severe CHF according to their LVEDP at 6 weeks post ligation. Invasive hemodynamic measurements with solid state micro manometer pressure catheters as well as diastolic pressure-volume relation values were obtained at the 6 week end point. Results: Moderate and severe CHF rats had significantly (P&lt;0.05) elevated left ventricular (LV) end-diastolic pressure (LV EDPs), prolonged time constants of LV relaxation (tau), and decreased peak development pressures. When moderate versus severe CHF rats were separated based on LV EDP, early diastolic anterior wall radial relaxation velocity as well as e’, and E/e’ had strong correlations with invasive hemodynamic measurements of diastolic functions. There was a trend towards decreased compliance as measured by stiffness constants in severe heart failure group. Differences (P&lt;0.05) in dead volume, mean arterial pressure (MAP), tau, and ejection fraction (EF) were also displayed. End diastolic pressure-volume analyses illustrated significant differences in plot positioning and curvature. Conclusion: While it is possible to separate rats with moderate and severe CHF in the rat coronary artery ligation model, the separation is not simply based on a specific EF value. This work may be useful in deciding whether there is a differential effect of new treatments for severe versus moderate CHF.

Inspiratory work capacity is more severely depressed than inspiratory muscle strength in patients with heart failure: Novel applications for inspiratory muscle training

BackgroundWe hypothesized that the ability to sustain maximal inspiratory pressure (SPImax) over time as a measure of work capacity may be more severely affected than inspiratory muscle strength (PImax) in patients with heart failure (HF). MethodsWe retrospectively investigated eighty patients with HF, NYHA II/III/ ambulatoryIV and a (mean±SD) LVEF 27±8%, and compared them to 25 healthy subjects (HS). During a maximal inspiratory manoeuvre from residual volume (RV) to total lung capacity, PImax was measured as the maximum mouth pressure at RV, inspiratory contraction time (ICT) as the time from RV to end of inspiration and SPImax as the area under a pressure-time curve using an electronic pressure manometer with designed-purpose software (Trainair®, Project Electronics Ltd., London, UK). Exercise capacity was assessed with cardiopulmonary exercise testing and the 6-minute walk test (6MWT). ResultsPatients achieved a (mean±SD) peak VO2=15.7±3.4ml/kg/min and 6MWT=338±88m. PImax, ICT and SPImax were reduced in HF pts at 75%***, 61%*** and 52%*** of HS, and correlated with NYHA (r=−0.485***), (r=−0.507**), (r=−0.500***), peakVO2 (r=0.501***), (r=0.655***), (r=0.508***) and 6MWT (r=0.477***), (r=0.345**), (r=0.530***), respectively (*p<0.05, **p<0.01, ***p<0.001). ConclusionPImax, ICT and SPImax were impaired in HF patients compared to HS and may be important determinants of exercise capacity. SPImax was severely depressed even in patients with relatively preserved PImax and should be considered as an additional target index for inspiratory muscle training. Equations are provided to predict SPImax in relation to age and exercise capacity in HF.

Performance of manual hyperinflation: consistency and modification of the technique by intensive care unit nurses during physiotherapy.

To assess the consistency and safety of manual hyperinflation delivery by nurses of variable clinical experience using a resuscitator bag during physiotherapy treatment. Manual hyperinflation involves the delivery of larger than normal gas volumes to intubated patients and is routinely used by nurses in collaboration with physiotherapists for the management of retained sputum. The aim is to deliver slow deep breaths with an inspiratory hold without unsafe airway pressures, lung volumes or haemodynamic changes. In addition, nursing staff should be able to 'feel' differences in resistance and adjust their technique accordingly. Prospective observational study utilising the simulation of a mechanically ventilated patient. Thirty-three nurses delivered manual hyperinflation to a SimMan3G mannequin who had three distinct lung scenarios applied (normal; asthma; Acute Respiratory Distress Syndrome) in randomised order during simulated physiotherapy treatment. Respiratory rate, tidal volume (Vt ), mean inspiratory flow rate (Vt /Ti), and peak airway pressure data were generated. Over all scenarios, mean respiratory rate=12·3 breaths/minute, mean Vt =638·6mls, mean inflation time=1·3seconds and peak airway pressure exceeded 40cm H2 O in 41% of breaths, although only in 10% of breaths during the 'normal' lung scenario. Experienced nurses were able to manually hyperinflate 'normal' patients in a simulated setting safely. Despite their knowledge of barotrauma, unsafe airway pressures were delivered in some scenarios. Training with regard to safe airway pressures, breath hold and adequate volumes is recommended for all nurses undertaking the procedure. Nurses and physiotherapists must closely monitor the patient's condition during manual hyperinflation thereby recognising changes with regard to lung compliance and airway resistance, with nurses responding by altering their technique. The addition of a pressure manometer in the circuit may improve patient safety when performing manual hyperinflation.

A new device to noninvasively estimate the intraocular pressure produced during ocular compression.

PurposeTo describe a noninvasive instrument that estimates intraocular pressure during episodes of external globe compression and to demonstrate the accuracy and reliability of this device by comparing it to the intraocular pressures simultaneously and manometrically measured in cannulated eyes.MethodsA thin fluid-filled bladder was constructed from flexible and inelastic plastic sheeting and was connected to a pressure transducer with high pressure tubing. The output of the pressure transducer was sent to an amplifier and recorded. This device was validated by measuring induced pressure in the fluid-filled bladder while digital pressure was applied to one surface, and the other surface was placed directly against a human cadaver eye or in vivo pig eye. The human cadaver and in vivo pig eyes were each cannulated to provide a manometric intraocular pressure control.ResultsThe measurements obtained with the newly described device were within ~5% of simultaneously measured manometric intraocular pressures in both a human cadaver and in vivo pig eye model for a pressure range of ~15–100 mmHg.ConclusionThis novel noninvasive device is useful for estimating the intraocular pressure transients induced during any form of external globe compression; this is a clinical setting where no other devices can be used to estimate intraocular pressure.

Laparoscopic-aided transanal pull-through procedure for the management of Hirschsprung’s disease: an observational prospective study for children older than 12 months

Objective The aim of the present study was to evaluate the surgical and functional outcome of the laparoscopic-aided transanal pull-through procedure for the management of Hirschsprung’s disease (HD). Patients and methods The study included 17 patients older than 12 months. Diagnosis of HD relied on the inability of the patients to relax the anal internal sphincter in response to colonic extension on anorectal manometry. The laparoscopic part entailed transition zone identification, seromuscular biopsy for fresh frozen histopathology, and sigmoid and rectal mobilization up to 1 cm down the peritoneal reflection. The transanal part included mobilization of the rectal lower by 2 cm, resection till the ganglionic segment, and anastomosis. Patient outcome included evaluation of fecal consistency, frequency of soiling, and presence of perianal skin excoriation at 1, 3, and 6 months after the procedure. Colonic manometry and functional outcome evaluation according to qualitative clinical Holschneider scoring were carried out at 1 and 6 months after the procedure. Results One (5.9%) patient required open conversion for dissection of thick adhesions. Frequency of patients that passed formed stool and free of soiling increased progressively till the end of 6 months after the procedure. At 1 month after the procedure, six patients developed perianal skin excoriation, but all were free by the sixth postoperative (PO) month. Manometric pressure measures at 3 and 6 months after the procedure were significantly higher compared with the preoperative measures, with significant difference in favor of 6-month measures. At 6 months after the procedure, Holschneider scoring was significantly higher compared with that at 1 month, and 10 patients had a score of 14. No surgery-related complications were detected. Conclusion Laparoscopic-aided transanal pull-through is a feasible procedure for the management of children older than 12 months and who have HD. The procedure is safe with minimal PO complications, which are gradually resolved within 6 months PO.

Aneroid Blood Pressure Manometer Calibration Rates of Devices Used in Home Health.

Hypertension is associated with cardiovascular disease, stroke, and a range of other medical sequelae. Accurate blood pressure (BP) readings, which depend on the integrity and calibration of the measuring device, are essential to identifying suboptimal BP. This study describes calibration rates of aneroid BP devices (a) utilized in home healthcare (HHC) and (b) having the needle resting within the zero accuracy indicator. BP devices from one branch of a home care agency were inspected and checked for calibration according to the protocol set forth by the European Society of Hypertension. Of the 125 devices measured, 78.4% were in calibration. Of the 94 devices with the gauge needle resting in the zero accuracy indicator, 11.7% were not in calibration; whereas, 51.6% of the 31 devices with the gauge needle resting outside the zero accuracy indicator were found not in calibration. Twenty-one devices were not checked for calibration due to inflation bulb malfunction, tubing tears, or excessive wear. Furthermore, visual inspection of the needle placement did not confirm a device as being in or out of calibration. Proper maintenance and routine calibration of BP equipment is foundational to assuring accuracy of BP readings obtained by HHC providers.

Role of the mechanic muscular injury in the development of heterotopic ossifications. A study on an animal model

Optimising the first model developing heterotopic ossification (HO) on paraplegic mouse requires the study of cardiotoxin intramuscular injection substitution by a mechanical injury. Two lines of research were developed: pressure by extended crush and brief high-energy physical impact, with and without IM injection of LPS (purified bacterial lipopolysaccharides). The first kind of mechanical injury evaluated was the crush with a pressure manometer Jamar ® . The hamstring of the hind limbs of five groups of paraplegic mice underwent pressure forces from 2.5 to 10 kg with compression length going from 5 to 25 seconds. The second involved a brief high-energy physical impact on thigh muscles through an impactor, making possible a defined and reproducible soft tissue contusion. The hamstring of hind limbs of 2 subgroups of paraplegic mice underwent 2 different forces of muscular impact (energy for impact 1 = 0.19 J & for impact 2 = 0.32 J). In these two experiments, a spinal cord injury of T6 level was made, associated or not to LPS injection. The presence and the volume of the HO was measured by μCT after fixation and decalcification. There was no HO: (1) in the different groups after muscular crush and in the control groups with and without injection of LPS in the hamstring. (2) Neither in the brief high-energy impact without LPS groups. On the other hand, we found HO in the hamstrings of the brief high-energy impact with LPS injection group ( n = 7 mice) (mean volume: 0.355 mm 3 for impact 1 and 0.76 mm 3 for impact 2; mean density: 209.75 mg HA/cm 2 for impact 1 and 265.5 mg HA/cm 2 for impact 2). A brief high-energy impact could contribute to the damage mechanism favouring HO development. Extended muscular crush doesn’t seem to be involved. LPS role needs to be specifically study because it injection has to be associated with the brief high-energy impact.

Vertebroplasty and Kyphoplasty. Complications, Avoidance, and Technical Notes in our 7 Years' Experience

Introduction The vertebroplasty (VP) and kyphoplasty (KP) are well known methods for the treatment of vertebral bodies fractures, due osteoporosis, primary, and metastatic tumor. The major complications are the cord and root compression, due cement leakage, epidural and subdural hematomas, and pulmonary emboli. These complications are most described in VP. In this retrospective study, the authors describe the way they find to avoid major complications with KP and a modification of de VP technique. Patients and Methods Between January 2007 and July 2014, 138 patients with 184 levels were treated in the three institutions. In 124 levels, KP was performed and in 60 levels VP. Balloon KP with pressure manometer was used. The VP were performed using de bone feelers and the cannulas of the KP set, without the insufflation of the balloon. A retrospective analysis of the cases was made and a review of the literature. Results A total of 102 patients (73.9%) were females and 36 patients (26.1%) were males. The 69% of the total of patients were single fractures and 31% were double level fractures. The etiology was 92% osteoporotic fractures, four patients (2.9%) underwent KP due multiple myeloma, five patients (3.6%) for hemangioma, and two patients (1.4%) for spinal metastasis. Pain relief was reported in all the patients with a media of VAS 8 of 10 in pre-op and VAS 2 of 10 in post-op. Neither major complications nor post-op infections were reported. Overall, 3 patients with cement leakage in the spinal canal, 14 patients with interbody disc space leakage, and 9 patients with lateral and anterior extravasations were described without symptoms. Conclusion The cement injection with the bone fillers provides more control in the cement infusion in the VP as well as in the KP, avoiding the leakage of cement in great quantity and preventing major complications.

Biomimetic Investigation of Intrabolus Pressure Signatures by a Peristaltic Swallowing Robot

The relationships among bolus formulation, engineering rheometric quantities, and peristaltic transport effects are examined in this paper. Investigation of a series of synthetic bolus materials and swallowing strategies is conducted using a novel peristaltic swallowing robot inspired by esophageal swallowing, which manifests as a benchtop rheological instrument. To determine the validity of biomimetic swallowing, manometry, a clinical technique for capturing swallowing pressure profiles is used to establish congruence between the robotic findings and those of a clinical nature. To determine the contribution of the bolus and swallowing strategy to the intraluminal pressure signature (ILPS), three parameters were varied: peristaltic wave velocity (20, 30, 40 mm $\mathrm{s}^{-1}$ ), wavefront length (40, 50, and 60 mm) and starch thickener (Nutulis, Nutricia) concentration (25, 50, 75, 100, and 150 g $\mathrm{L}^{-1}$ ) were investigated. Wave velocity and starch-based bolus formulation concentration were found to exhibit the most profound changes in the intrabolus pressure signatures. The highest bolus tail pressure gradient of 0.33 kPa $\mathrm{mm}^{-1}$ was achieved with a 150 g $\mathrm{L}^{-1}$ bolus formulation being transported at 40 mm $\mathrm{s}^{-1}$ with a wavefront length of 60 mm. In each dimension, the relationship between the parameters and features of the manometric pressure signature are found to be nonlinear owing to the shear-thinning, non-Newtonian nature of the model bolus fluid. The robotic ILPSs are synonymous with those of a clinical nature, suggesting that the swallowing robot has merit as a novel, biologically inspired, bolus investigation tool external to the human body.

Alteration of anal sphincter function in patients with levator avulsion: observational study.

The prevalence of levator avulsion after vaginal delivery ranges from 10 to 30 %. To our knowledge, no previous studies have used anorectal manometry (AM) to assess this injury's impact on the functionality of the anal sphincter complex. We hypothesized that women with levator avulsion have lower manometric pressures. A prospective observational study was conducted on 83 women, 61 in the birth group and 22 in the control group. Patients in the deliveries group were recruited in the period immediately postpartum. The control group was recruited through hospital announcements. All patients underwent 3D transperineal (3D TPUS) and 2D endoanal ultrasound (2D EAUS), as well as AM at 6 months postpartum. Median maximum resting and squeeze pressures were measured, and the presence or absence of levator ani muscle (LAM) avulsion and/or occult sphincter injury was evaluated. Hiatal area at rest was significantly higher in women with vaginal birth compared with controls (p = 0.02) and there was a trend toward statistical significance compared with the cesarean section group (p = 0058). No statistical differences were observed for the hiatal area regarding Valsalva, external anal sphincter thickness, and internal anal sphincter thickness among groups. There was a significantly higher prevalence of levator avulsion in the vaginal birth group (32.43 %) compared with the controls (0 %) and the cesarean section group (5.8 %; p < 0001). There were 5 occult sphincter injuries detected at ultrasound, all of them in the vaginal birth group. Lower squeeze pressure was observed in patients with levator injury compared with control group patients and patients without avulsion (112.2 mmHg vs 128.2 mmHg and 121.2mmH; p = 0.032). Finally, there was no difference in resting pressure (p = 0.541) or squeeze pressure (p = 0.449) between patients with and those without occult anal sphincter injuries. Levator avulsion is associated with lower manometric squeeze pressure (p = 0.032).

A home brewed low cost cuff inflator and pressure monitor.

Sir, Endotracheal tube (ETT) cuff pressure management is an essential part of airway management in intubated and mechanically ventilated patients. Cuff pressures in the intubated patients in hospitals and Intensive Care Units are often too high. Acceptable cuff pressures are best achieved when a cuff pressure manometer has been used. Obstruction to mucosal blood flow occurs at pressures above 30 cm H2O, with total occlusion of flow at 50 cm H2O.[1] Commercially available cuff inflators are costly. The use of this crucial equipment is neglected and is often not available in many hospitals or hospital areas of economically poor countries. We have devised a cuff inflator and cuff pressure measuring device with readily available materials [Figure 1]. These include an airway low pressure manometer detached from an old unused Bird ventilator with a reading up to 100 cm H2O pressure. As an alternative, low cost commercially available low pressure monitor can also be made use of. Other spares include cuff inflating one-way valve cut from Foley's catheter, a 3-way connector and other easily available connectors. All the parts were bonded with the help of quick fix sealant and tested for air leak in a bowl of water. We tested the accuracy of the device by connecting it to mercury manometer and also commercially available Portex® cuff inflator which matched with the readings with an error as low as 2–3 cm H2O in the clinical range of 20–35 cm H2O. Keeping this small error into account we are practically using the device regularly both for ETT cuff and laryngeal mask airway (LMA) cuff. We have already used it in 80 cases to check the ETT cuff pressure and for inflating cuff of pro-seal LMA to the required pressure in 60 patients. Figure 1 The assembled cuff inflator and cuff pressure monitor connected to endotracheal tube (a) and its calibration (b) The incidence and severity of tracheal mucosal lesions increase with cuff pressure >30 cm H2O. It is revealed that the majority of cuff pressures exceeded safe pressure and required correction.[2] The pressure exerted on the trachea must be maintained within a range (25–30 cm H2O or 18–22 mmHg) to ensure perfusion to the tracheal capillaries without causing injury.[3] Only 27% of pressures were within 20–30 cm H2O; 27% exceeded 40 cm H2O. Hence, it is recommended that endotracheal cuff pressure be set and monitored with a manometer.[4] It is important to perform cuff pressure measurements at 6–12 hourly intervals and to use the correct method. At the time of periodic pressure check while connecting any cuff inflator to the ETT valve, loss of cuff pressure of about 6.6 cm H2O can occur on an average needing reinflation to adjust for pressure loss.[5] However, our device has the advantage that it can be pre-pressurized with the help of 3-way connector of the assembly before pressure check which can prevent cuff pressure loss and deflation. Our low cost cuff pressure inflator can be easily constructed and can be practically used. Innovative practice and translational research is an important aspect of higher education and postgraduate curriculum. It can be a useful as an aid in innovative teaching methodology to teach basic foundations in anaesthesiology by giving such projects to postgraduate students to imbibe spirit of creativity.