Respiratory Rate Values Research Articles

Aplicação da ventilação não-invasiva em insuficiência respiratória aguda após cirurgia cardiovascular

To examine ventilatory response, oxygenation-related, and hemodynamics of patients with hypoxemic acute respiratory failure (ARF) submitted to noninvasive mechanical ventilation (NIV) during the postoperative phase of cardiovascular surgery in order to identify predictive variables of success, and to compare the different types of NIV. Seventy patients with hypoxemic ARF were randomized to one of three modalities of NIV--continuous positive airway pressure (CPAP) and ventilation with two pressure levels (PEEP + SP and BiPAP). Ventilation, oxygenation-related, and hemodynamics variables were analyzed at pre-application, and 3, 6, and 12 hours after the protocol began. Thirteen patients were excluded. Thirty-one patients progressed to independence from ventilatory support and comprised the success group, and 26 required orotracheal intubation and were considered the nonsuccess group. Age, initial heart rate (HR), and respiratory rate (RR) showed elevated levels in the nonsuccess group (p=0.042, 0.029, and 0.002, respectively). A greater number of intraoperative complications were seen in the nonsuccess group (p=0.025). Oxygenation variables increased only in the success group. Among the NIV types, 57.9% of patients in the ventilator group, 57.9% in the two-pressure levels group, and 47.3% in the CPAP group progressed with success. Oxygenation and RR variables showed improvement only in the groups with two pressure levels. Patients with hypoxemic ARF in the postoperative stage after cardiovascular surgery showed better oxygenation, RR, and HR during NIV application. In older patients and those with higher baseline RR and HR values, NIV was not sufficient to reverse ARF. The two-pressure level modes showed better results.

Normal Values and Incidence of Cardiorespiratory Complications in Dogs During General Anaesthesia. A Review of 1281 Cases

This paper describes the cardiorespiratory variables and the incidence of anaesthetic complications in dogs. For this, a retrospective study of 1281 anaesthesias was performed. Heart rate (HR), non-invasive mean arterial (MAP), systolic (SP) and diastolic pressures (DP), invasive mean arterial (IMAP), systolic (ISP) and diastolic pressures (IDP), central venous pressure (CVP), respiratory rate (RR), tidal volume (V(T)), minute volume (V(M)), end-tidal CO(2) (EtCO(2)), arterial oxygen saturation (SpO(2)), temperature (T) and death are reported. Data were described both globally and separately for each ASA (American Society of Anaesthesiologists classification) status. An ANOVA and a Tukey's test were used for comparing the different ASA status' values (alpha=0.05). During anaesthetic maintenance, the mean +/- SD of the studied variables were: HR: 91+/-27 bpm. MAP: 86+/-24 mmHg. IMAP: 80+/-22 mmHg. SP: 114+/-25 mmHg. ISP: 109+/-26 mmHg. DP: 67+/-23 mmHg. IDP: 66+/-22 mmHg. CVP: 5+/-3 mmHg. RR: 19+/-11 rpm. V(T): 14+/-7 ml/kg. V(M): 191+/-93 ml/kg/min. EtCO(2): 40+/-8 mmHg. T: 37.1+/-1.7 degrees C. ASA III and ASA IV patients, compared with those with ASA I, showed higher values of HR, RR, V(T) and V(M) and lower in IMAP, CVP, EtCO(2), SpO(2) and T. The most frequent complications were bradycardia (36.3% of the patients), hypotension (37.9%), hypoventilation (63.4%), hypoxia (16.4%), hypothermia (4.8%) and death (0.9%). Cardiorespiratory complications frequently occur in dogs during general anaesthesia.

Transrectal ultrasonographic diagnosis of jejunoileal intussusception in a cow.

Transrectal ultrasonographic diagnosis of jejunoileal intussusception in a cow.

Propofol‐ketamine vs propofol‐fentanyl for sedation during pediatric upper gastrointestinal endoscopy

The aim of this study was to compare the clinical efficacy and safety of propofol-ketamine with propofol-fentanyl in pediatric patients undergoing diagnostic upper gastrointestinal endoscopy (UGIE). This was a prospective, randomized, double blinded comparison of propofol-ketamine with propofol-fentanyl for sedation in patients undergoing elective UGIE. Ninety ASA I-II, aged 1 to 16-year-old patients were included in the study. Heart rate (HR), systolic arterial pressure, peripheral oxygen saturation, respiratory rate (RR) and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either propofol-ketamine (PK; n = 46) or propofol-fentanyl (PF; n = 44). PK group received 1 mg x kg(-1) ketamine + 1.2 mg x kg(-1) propofol, and PF group received 1 microg x kg(-1) fentanyl + 1.2 mg x kg(-1) propofol for sedation induction. Additional propofol (0.5-1 mg x kg(-1)) was administered when a patient showed discomfort in either group. The number of patients who needed additional propofol in the first minute after sedation induction was eight in Group PK (17%), and 22 in Group PF (50%) (P < 0.01) and those who did not need additional propofol throughout the endoscopy were 14 in Group PK (30%) and three in Group PF (7%) (P < 0.01). HR and RR values after induction in Group PF were significantly lower than Group PK (P < 0.01). Both PK and PF combinations provided effective sedation in pediatric patients undergoing UGIE, but the PK combination resulted in stable hemodynamics and deeper sedation though more side effects.

The objective medical emergency team activation criteria: A case–control study

To evaluate the ability of pre-defined clinical criteria to identify patients who subsequently suffer cardiac arrest, unplanned intensive care unit admission or unexpected death; to determine the ability of modified criteria to identify these patients. Nested, matched case-control study. Seven Australian public hospitals. Four hundred and fifty cases and 520 controls matched for age, sex, hospital, and hospital ward. None. Highest and lowest respiratory and heart rates, lowest systolic blood pressure, presence of threatened airway, seizures or decrease in Glasgow Coma Scale score of greater than two points and incidence of the three adverse events were measured. Combining a heart rate greater than 140, respiratory rate greater than 36, a systolic blood pressure less than 90 mmHg and a greater than two point reduction in the Glasgow Coma Scale identified adverse events with a sensitivity of 49.1% (44.4-53.8%), specificity of 93.7% (91.2-95.6%), and positive predictive value of 9.8% (8.7-11.1%). Adding threatened airway, seizures, low respiratory rate and low heart rate did not substantially improve sensitivity (50.4%; 45.7-55.2%). After modifying the cut-off values for respiratory rate, heart rate and systolic blood pressure, the best achievable positive predictive value remained below 16%. In combination, the respiratory rate, heart rate, systolic blood pressure, and level of consciousness identify patients at risk of cardiac arrest, unplanned intensive care admission or unexpected death with high specificity; however the sensitivity and positive predictive value are relatively low, even after modification of the activation criteria cut-off values.

Comparison of time and frequency domain measures of RSA in ambulatory recordings

The extent to which various measures of ambulatory respiratory sinus arrhythmia (RSA) capture the same information across conditions in different subjects remains unclear. In this study the root mean square of successive differences (RMSSD), peak valley RSA (pvRSA), and high frequency power (HF power) were assessed during ambulatory recording in 84 subjects, of which 64 were retested after about 3 years. We used covariance structure modeling to test the equality of the correlations among three RSA measures over two test days and three conditions (daytime sitting or walking and nighttime sleep) and in groups with low, medium, and high mean heart rate (HR), or low, medium, and high mean respiration rate (RR). Results showed that ambulatory RMSSD, pvRSA, and HF power are highly correlated and that their correlation is stable across time, ambulatory conditions, and a wide range of resting HR and RR values. RMSSD appears to be the most cost-efficient measure of RSA.

A Five-Year Experience With the Use of BiPAP in a Pediatric Intensive Care Unit Population

The authors retrospectively reviewed their experience with bilevel positive airway pressure (BiPAP) to treat respiratory insufficiency in pediatric patients over a 5-year period. After excluding patients on chronic home BiPAP and those in whom BiPAP was used to facilitate tracheal extubation (because there were no pre-BiPAP values on which to judge its efficacy), the study cohort included 45 patients (1.5 to 22 years) in whom BiPAP was used for acute respiratory insufficiency. The primary indication for BiPAP was a primary pulmonary parenchymal process in 29 patients and postoperative atelectasis with respiratory insufficiency following cardiac or upper abdominal surgery in 16 patients. There were no differences in the pre-BiPAP values of oxygen requirement, PCO2, oxygen saturation, and respiratory rate between the 2 groups. With the application of BiPAP in patients with primary pulmonary parenchymal disease, there was a decreased oxygen requirement, PCO2, and respiratory rate. No change in oxygen saturation was noted. In patients with postoperative respiratory insufficiency, there was an improvement in all 4 parameters. There was no difference in post-BiPAP values of oxygen requirement, respiratory rate, or PCO2 between the 2 groups. The post-BiPAP oxygen saturation was greater in patients with postoperative respiratory insufficiency (96% +/- 4%) than in patients with primary pulmonary parenchymal disease (92% +/- 6%, P = .02). Endotracheal intubation was required in 11 of 29 patients with primary pulmonary parenchymal pathology versus 1 of 16 patients with postoperative atelectasis and/or respiratory insufficiency (P = .03). The chances of requiring intubation were greater in patients < or = 6 years of age (relative risk 1.9), if the oxygen requirement did not decrease to less than 60% within the first 24 hours of BiPAP use (relative risk 3.3) and if there were any PCO2 values > or = 55 mmHg during the first 24 hours of BiPAP use (relative risk 9.8). No severe complications to BiPAP were noted. BiPAP safely and effectively improves the respiratory status of and might decrease the need for endotracheal intubation in pediatric patients with acute respiratory insufficiency of various etiologies.

Efficient gas exchange with low tidal volume ventilation in acute respiratory distress syndrome

The immediate and ultimate objectives of mechanical ventilation in the acute respiratory distress syndrome (ARDS) are to maintain gas exchange, ensure survival and allow the patient to regain a high quality of life. To achieve these goals, ventilation must be adequate and ventilator-induced lung injury minimal. A trade-off between the immediate and ultimate goals is required in order to secure adequate gas exchange with respect to CO2 and O2, and this can be achieved with lung-protective ventilation (LPV). LPV is achieved with low tidal volume ventilation, an adequate positive end-expiratory pressure (PEEP) and a limited plateau pressure. These features tend to compromise gas exchange. Dead space is large in ARDS. In this review, methods to enhance gas exchange, even at low tidal volume, by decreasing the huge dead space in ARDS are discussed. Optimizing the ventilator setting involves combining the best values for respiratory rate, minute ventilation and tidal volume, PEEP, the flow or pressure pattern o...

AnaConDa?? Reflection Filter: Bench and Patient Evaluation of Safety and Volatile Anesthetic Conservation

The AnaConDa filter permits administration of volatile anesthetic without the use of an anesthesia machine. It is intended for use in the intensive care unit. We studied the AnaConDa reflection filter on the bench and in anesthetized patients. The bench analysis used a test lung, a gas analyzer, an intensive care ventilator, the AnaConDa filter, and a syringe pump. We studied a range of tidal volume, respiratory rate, and positive end-expiratory pressure values. We simulated errors during syringe refilling and patient transportation. In 15 anesthetized patients, we used the AnaConDa with constant ventilation variables, a constant sevoflurane infusion rate (4-5 mL/h), and two consecutive fresh gas flow levels. In the bench study, the expired volatile anesthetic fraction decreased linearly with respiratory frequency at constant minute ventilation, and decreased markedly in a hyperbolical manner when tidal volume increased at a constant respiratory rate. Changing the positive end-expiratory pressure level and inspiration/expiration ratio did not modify the AnaConDa's performance. Several safety failures were observed: refilling caused a transient change in AnaConDa output because of a pumping effect, and a standard Luer lock made it possible to connect the halogenate syringe on an IV infusion line. In anesthetized patients, reducing fresh gas flow from 8 to 1 L/min led to a median 40% increase in the expired volatile anesthetic fraction. This study shows that the device is generally reliable, but that there are several conditions under which it might deliver more anesthetic than intended.

Impact of propofol on the optimal sedative depth in patients undergoing gastroscopy

To explore the optimal sedative depth and adequate bispectral index (BIS) value in patients undergoing gastroscopy treated with propofol and to explore the maneuverability and practicability of using BIS value as a variable to control the infusion of propofol. 160 patients, 76 males and 84 females, aged 44 +/- 15 voluntarily undergoing painless gastroscopy were randomly divided into 4 equal sex and age-matched groups. Propofol was given intravenously at the speed of 60 ml/min. Encephalographic monitoring was conducted to observe the BIS value. The first administration of propofol was stopped when the BIS value decreased to 80 ~ 75 (Group A), 65 ~ 74 (Group B), 55 ~ 64 (Group C), or < 55 (Group D). The amount of drug administered was recorded. Thirty seconds after the first administration the gastroscope was inserted. If the patients felt uncomforted an additional dose of 30 approximately 50 mg was used. The blood pressure, heart rate, respiratory rate, SpO(2), and BIS value before and during the gastroscopy, times needed for awakening and recovery of orientation were recorded. The patients were asked about if they were conscious during the operation. The doses of propofol in group A, B, C, and D were (1.15 +/- 0.34) mg/kg, (1.43 +/- 0.27) mg/kg, (1.78 +/- 0.31) mg/kg, and (2.15 +/- 0.27) mg/kg respectively, with a significant difference between each 2 groups (all P < 0.05). The successful rate of gastroscope insertion were 17.5%, 47.5%, 92.5%, and 97.5% in group A, B, C, and D respectively, with a. significant difference between each 2 groups (P < 0.05) except between Groups C and D. The heart rate and mean arterial pressure decreased significantly compared with those before the examination in Group D (both P < 0.05). 17 patients of Group A and 4 cases in Group B remembered that they felt unwell during the operation, and 11 patients in Group B said they heard voices but failed to remember the concrete contents. It is safe, reliable and feasible to regulate the sedative depth and the dosage of propofol infusion with the BIS monitor. The optimal BIS value in patients undergoing gastroscopy is from 55 to 64.

Partially antagonisable anaesthesia of the small hedgehog tenrec ( Echinops telfairi) with medetomidine, midazolam and ketamine

It was purpose of this study to establish a safe and stable anaesthesia for the small hedgehog tenrec ( Echinops telfairi) which can be used for short- and long-time interventions. Therefore 29 small hedgehog tenrecs were anaesthetized between 30 min and 4.5 h with a combination of the α 2-agonist medetomidine (0.2 mg/kg), the benzodiazepine midazolam (3 mg/kg) and the dissociative anaesthetic ketamine (20 mg/kg) (MMK). All injections were administered subcutaneously (SC) in the area of the back by carefully lifting the animal's quills with a forceps. After SC injection of MMK animals lost their righting reflexes after 3.6 min (±1.12). Oxygen was supplemented to the animals’ nose and their body temperature was maintained constantly at 30 °C by a heating plate. Values of respiratory rate, pulse rate and oxygen saturation during the experiment were statistically evaluated by ANOVA and post-hoc tests to a level of significance determined as 5%. The animals had stable cardiovascular and respiratory values and good muscle relaxation. Between the 15th and the 45th minute the level of anaesthesia was deep enough for surgical interventions. Respiratory rate in this phase was 29.6±8.1 breaths/min and pulse rate was about 81.9±20 beats/min. MMK was partially antagonised with a combination of atipamezole (1 mg/kg) and flumazenile (0.2 mg/kg) (AF) SC. Time of complete recovery took about 8.8 min (8.76±4.31 min) after administering the antagonists. The partially antagonisable combination of MMK produced a stable anaesthesia in small hedgehog tenrecs up to 4.5 h. Therefore MMK can be used for short time interventions as well as e.g. for long-lasting neurophysiological recordings, when animals should survive the trials.

A Comparison of Effects of Alfentanil, Fentanyl, and Remifentanil on Hemodynamic and Respiratory Parameters During Stereotactic Brain Biopsy

The aim of this study was to compare the effects of 3 different sedative-analgesic regimens in patients with intracranial mass lesions undergoing stereotactic brain biopsy. A 135 outpatients with American Society of Anesthesiologists I to II were divided into 3 groups: group A (n = 45) received a loading dose of IV alfentanil 7.5 microg/kg followed by infusion rate of 0.25 microg/kg/min; group F (n = 45) received a bolus dose of 1 microg/kg IV fentanyl and repeated as needed; and group R (n = 45) received infusion of 0.05 microg/kg/min remifentanil. Target level of sedation was 3 to 4 of the Ramsay Sedation Scale. Systolic and diastolic blood pressure, heart rate, respiratory rate, peripheric oxygen saturation (SpO2), and end-tidal carbon dioxide were recorded at different stages of the procedures. The patients in group F had significantly lower mean heart rate than those in groups A and R, but this was not in the limits of the bradycardia. The patients in group A had significantly lower mean SpO2 than those in the other groups, but mean SpO2 values did not drop below 94%. There were no significant differences in end-tidal carbon dioxide and respiratory rate values among the groups. Our results suggest that all 3 regimens have relatively similar hemodynamic and respiratory responses. The use of bolus fentanyl technique caused less hemodynamic stability. The continuous infusion technique of remifentanil or alfentanil provided better control on hemodynamic parameters.

Noninvasive positive pressure ventilation: Five years of experience in a pediatric intensive care unit*

To evaluate the feasibility and outcome of noninvasive positive pressure ventilation (NPPV) in daily clinical practice. Observational retrospective cohort study. Pediatric intensive care unit in a university hospital. : Patients treated by NPPV, regardless of the indication, during five consecutive years (2000-2004). A total of 114 patients were included, and 83 of the 114 patients (77%) were successfully treated by NPPV without intubation (NPPV success group). The success rate of NPPV was significantly lower (22%) in the patients with acute respiratory distress syndrome (p < .05) than in the other patients. The Pediatric Risk of Mortality II (p = .003) and Pediatric Logistic Organ Dysfunction scores (p = .002) at admission were significantly higher in patients who were unsuccessfully treated with NPPV (NPPV failure group). Baseline values of Pco2, pulse oximetry, and respiratory rate did not differ between the two groups. A significant decrease in Pco2 and respiratory rate within the first 2 hrs of NPPV was observed in the NPPV success group. Multivariate analysis showed that a diagnosis of acute respiratory distress syndrome (odds ratio, 76.8; 95% confidence interval, 4.4-1342; p = .003) and a high Pediatric Logistic Organ Dysfunction score (odds ratio, 1.09; 95% confidence interval, 1.01-1.17; p = .01) were independent predictive factors for NPPV failure. A total of 11 patients (9.6%), all belonging to the NPPV failure group, died during the study. This study demonstrates the feasibility and efficacy of NPPV in the daily practice of a pediatric intensive care unit. This ventilatory support could be proposed as a first-line treatment in children with acute respiratory distress, except in those with a diagnosis of acute respiratory distress syndrome.

Can remifentanil be a better choice than propofol for colonoscopy during monitored anesthesia care?

This prospective, randomized trial was designed to test the hypothesis that continuous infusion of low-dose remifentanil can provide effective analgesia, sedation, amnesia, patient comfort and stable recovery profile without respiratory depression when compared with propofol infusion during colonoscopy. One hundred patients were randomly assigned to receive either remifentanil (group R, 0.5 microg/kg followed by 0.05 microg/kg/min, n = 50) or propofol (group P, 0.5 mg/kg followed by 50 microg/kg/min, n = 50). Supplemental doses of remifentanil 12.5 microg in group R and propofol 10 mg in group P were given to treat complaints of moderate to severe pain and discomfort. Hemodynamic and respiratory data, pain, discomfort and sedation scores, patient and gastroenterologist satisfaction and recovery profiles were recorded. The duration of colonoscopy was longer in group P. The mean arterial pressure, heart rate and end-tidal CO2 remained stable during the procedure and were comparable between the groups. After bolus injection of the study drugs, the respiratory rate and oxygen saturation values were lower in group R than in group P. Only one patient in group R required airway support. Pain and discomfort scores were better in group R than in group P. Sedation levels were higher in group P than in group R. Group P needed more supplemental doses than group R. The time to reach an Aldrete score of nine or more was shorter in group R, but discharge times were similar in the two groups. Amnesia was better in group P. Nausea and vomiting were more frequent in group R during the recovery phase. Low-dose remifentanil infusion with intermittent bolus injections can provide adequate sedation, amnesia and better analgesia than propofol infusion during colonoscopy. However, remifentanil-induced nausea and vomiting may be a problem during the recovery phase.

Reproductive toxicological effects of gossypol on male rabbits: semen characteristics and hormonal levels

AbstractThe objective of this study was to evaluate the effects of two sublethal doses (4 and 20 mg/kg live weight (LW); every other day) of gossypol on semen and hormonal characteristics of male rabbits. The experiment lasted 16 weeks and included two periods: a treatment period (first 8 weeks) where the animals were given the test materials, and a recovery period (second 8 weeks) where drugs were withdrawn. Results showed that LW and respiration rate (RR) decreased ( P&lt;0·05) among animals that received gossypol, while rectal temperature increased ( P&lt;0·05). Animals in gossypol treatment groups had decreased ( P&lt;0·05) blood plasma levels of tri-iodothyronine (T3) and testosterone. This was accompanied by reductions ( P&lt;0·05) in sperm concentration, total sperm output, percentage incidence of forward motility, total functional sperm fraction and semen initial fructose concentration. Gossypol however increased ( P&lt;0·05) reaction time (i.e. decreased libido), percentages of dead sperm and abnormal sperm (AbSp) and altered acrosomes. Estimated weights of testes and semen ejaculate volume increased ( P&lt;0·05) possibly due to increased water retention. Values of LW, RR, AbSp, and blood plasma T3 and testosterone returned to control levels after withdrawal of gossypol, while the effect of this drug on other parameters continued during the recovery period.

Effect of expiratory flow increase technique on pulmonary function of infants on mechanical ventilation

Although chest physiotherapy techniques are commonly used in the treatment of respiratory diseases, there are, however, few studies in the literature on the effectiveness of these techniques in paediatric patients. The purpose of the present study was to evaluate the effect of the expiratory flow increase technique (EFIT) on the pulmonary function of infants on invasive mechanical pulmonary ventilation. A prospective, non-randomized study design was used, with consecutive enrolment conducted in the paediatric intensive care unit (PICU) of a university hospital. All infants with acute obstructive respiratory failure who were on invasive mechanical pulmonary ventilation between April 2001 and April 2003 were included in this study. Respiratory rate, PaO2, PaCO2, SatO2, PaO2/FiO2, P(A-a)O2/PaO2, PaO2/PAO2, VD/VT, dynamic compliance, inspiratory and expiratory resistance values were compared before and after application of the EFIT. Blood gas and pulmonary function measurements were recorded before and after EFIT. Repeated-measures analysis of variance (ANOVA) was used. The results were considered statistically significant when p values were < 0.05. Twenty-two infants were enrolled. There was a significant increase in respiratory rate, SatO2 and PaO2/PAO2 and a significant decrease in P(A-a)O2/PaO2 after application of the EFIT. There was a short-term improvement in the oxygenation of infants who were submitted to the EFIT. Additional studies are necessary to establish the efficacy and effectiveness of this technique.

Normal Values of Pulse Oximetry in Newborns at High Altitude

The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rate, heart rate, and blood pressure in healthy newborns at high altitude. Vital signs and oximetry saturation readings were collected from healthy term newborns at birth, at 1 h, and at 24 h of life. These were analyzed and compared with reference ranges at sea level. This study was carried out at altitudes of 1640 m above sea level in Taif city, Saudi Arabia. A total of 6011 term newborns were examined at birth and 1 h and 4274 were examined at 24 h of life. At birth, the mean SpO(2) was 68.6 per cent and 60.3 per cent from the right upper and lower limbs, respectively. Mean SpO(2) was 94.3 per cent and 95.4 per cent at the age of 1 and 24 h, respectively. These values were significantly lower than those reported at sea level. The mean respiratory rate, heart rate, and mean blood pressure at 24 h were 45.7/min, 149.7/min, and 46.9 mmHg, respectively. It is concluded that pulse oximetry saturation for newborn babies is lower at higher altitudes than at sea level. This effect is observable at altitudes of 1600 m above sea level. Cut-off levels lower than those used at sea level should be adopted when dealing with newborns living at high altitudes.

Inclusion Criteria for Clinical Trials in Sepsis: Did the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Definitions of Sepsis Have an Impact?

Over the last 25 years, a growing number of clinical trials have evaluated novel sepsis therapies. To promote uniformity in inclusion criteria for patient enrollment, the American College of Chest Physicians and Society of Critical Care Medicine first published consensus conference definitions for sepsis in 1992.To characterize (1) the utilization of specific criteria for patient enrollment in sepsis clinical trials and (2) the impact that the consensus conference definitions have had on these criteria.We used MEDLINE to identify clinical trials in sepsis from 1976 to 2001. Clinical trials published after the consensus conference (ACC; from 1993 to 2001) were compared with trials published before the consensus conference (BCC; from 1976 to 1992).We identified 176 clinical trials (ACC, 119 trials; BCC, 57 trials). Clinical trials published ACC were more likely to utilize or reference a previously published standard for inclusion criteria (65% vs 11%, respectively; p < 0.001). The consensus conference definitions were the standards used in 69% of these trials. The utilization of specified values for WBC count, temperature (T), heart rate (HR), and respiratory rate (RR) was significantly increased in the ACC group compared to the BCC group, as follows: WBC count, 62% vs 26%, respectively (p < 0.001); T, 89% vs 56%, respectively (p < 0.001); HR, 77% vs 26%, respectively (p < 0.001); and RR, respectively 76% vs 28% (p < 0.001). ACC, clinical trials were less likely to require blood culture positivity (4 of 119 trials [3%] vs 9 of 57 trials [16%], respectively; p < 0.006) and were more likely to incorporate markers of acute organ dysfunction (81 of 119 trials [68%] vs 28 of 57 trials [49%], respectively; p < 0.03) in the inclusion criteria.(1) Since 1992 there has been a significant increase in the utilization of predefined sepsis criteria for patient enrollment in clinical trials, and this increase can be attributed to the existence of consensus conference definitions. (2) Compared to inclusion criteria BCC, inclusion criteria ACC were less reliant on blood culture positivity and were more likely to incorporate markers of organ dysfunction.

CHEMICAL IMMOBILIZATION OF RHEBOK (PELEA CAPREOLUS) WITH CARFENTANIL–XYLAZINE OR ETORPHINE–XYLAZINE

Twelve adult rhebok (Pelea capreolus) were immobilized using a combination of 0.4 mg/kg xylazine and either 0.01 mg/kg of carfentanil (n = 6) or 0.01 mg/kg etorphine (n = 6), delivered i.m. using a remote injection system. Induction and recovery times, heart rate, respiratory rate, rectal temperature, oxygen saturation, end-tidal CO2 (ETCO2), anesthetic depth, indirect blood pressure, and arterial blood gases were recorded. Rhebok were not intubated but nasal oxygen was administered. Forty minutes after induction, anesthesia was antagonized with naltrexone and yohimbine. Mean initial heart rate was significantly higher in the carfentanil group than in the etorphine group. Mean initial oxygen saturation was consistent with hypoxia in both the carfentanil group and the etorphine group. In both groups, arterial pH decreased and partial pressure of carbon dioxide increased during the first 15 min of anesthesia, and values were similar in both groups. These findings were consistent with respiratory acidosis and decreased ventilation. Values for respiratory rate, temperature, oxygen saturation, ETCO2, and blood pressure were similar for both groups at all time periods. During the first 5 min of anesthesia, rhebok in the carfentanil group were more responsive to stimuli than rhebok in the etorphine group. After administration of antagonists, time to first arousal was significantly shorter in the etorphine group than in the carfentanil group. Although cardiopulmonary values were similar for the two groups, rhebok in the carfentanil group were at a comparatively lighter plane of anesthesia, and some individuals in this group required additional manual and chemical restraint for medical procedures to be performed. In conclusion, for captive adult rhebok, 0.01 mg/kg of etorphine and 0.4 mg/kg of xylazine are recommended over 0.01 mg/kg carfentanil and 0.4 mg/kg xylazine because of qualitatively better anesthetic episodes and shorter recovery times.

Effects of shaolin internal Qigong on physiological changes

Objective: The physiological changes of the respiro-circulatory functions between skilled subject and unskilled subjects during the practice of Up-right Standing Posture of Shaolin Internal Qigong were compared. Method: The heart rate (HR), maximum oxygen uptake (VO2), respiratory efficiency (RE), and respiratory rate (RR), blood pressure, and lactic acid in the blood were measured. Results: The high correlations between the HR and the VO2 values obtained from the exhaustion test were observed in all subjects. The higher values than at the rest were observed in the average HR and the average VO2 during practicing the Up-right Standing Posture both in the skilled subject and unskilled subjects. However, both HR and VO2 levels were almost constant during the practice in both the skilled subject and unskilled subjects. The RE values changed in the time course of the practice, whereas the RR values were almost constant during the practice. The average RE showed different patterns between the skilled subject and unskilled subjects, the former increased and the latter decreased their RE levels. In addition, the average values of systolic and diastolic blood pressure of the skilled subject increased each 10 mmHg approximately at pre-and post-up-right Standing Posture, and the increasing tendency was also recognized in the unskilled subjects. The values of the lactic acid in the blood of the skilled subject increased slightly, whereas the average values of the unskilled subjects increased by 3.4 mmol/I. Conclusion: Shaolin Internal Qigong could improve respiratory efficiency by the maximum isometric muscle contraction while the skilled subject maintained “natural breathing”. In addition, Shaolin Internal Qigong was considered to influence the reflex system because it inhibited both blood pressure increase and respiratory rate change. Shaolin Internal Qigong fit very well with Tuina doctor training course for promoting the physical ability and manipulation abilities of them.