RESUMEN
During diving, arterial Pco(2) (Pa(CO(2))) levels can increase and contribute to psychomotor impairment and unconsciousness. This study was designed to investigate the effects of the hypercapnic ventilatory response (HCVR), exercise, inspired Po(2), and externally applied transrespiratory pressure (P(tr)) on Pa(CO(2)) during immersed prone exercise in subjects breathing oxygen-nitrogen mixes at 4.7 ATA. Twenty-five subjects were studied at rest and during 6 min of exercise while dry and submersed at 1 ATA and during exercise submersed at 4.7 ATA. At 4.7 ATA, subsets of the 25 subjects (9-10 for each condition) exercised as P(tr) was varied between +10, 0, and -10 cmH(2)O; breathing gas Po(2) was 0.7, 1.0, and 1.3 ATA; and inspiratory and expiratory breathing resistances were varied using 14.9-, 11.6-, and 10.2-mm-diameter-aperture disks. During exercise, Pa(CO(2)) (Torr) increased from 31.5 +/- 4.1 (mean +/- SD for all subjects) dry to 34.2 +/- 4.8 (P = 0.02) submersed, to 46.1 +/- 5.9 (P < 0.001) at 4.7 ATA during air breathing and to 49.9 +/- 5.4 (P < 0.001 vs. 1 ATA) during breathing with high external resistance. There was no significant effect of inspired Po(2) or P(tr) on Pa(CO(2)) or minute ventilation (Ve). Ve (l/min) decreased from 89.2 +/- 22.9 dry to 76.3 +/- 20.5 (P = 0.02) submersed, to 61.6 +/- 13.9 (P < 0.001) at 4.7 ATA during air breathing and to 49.2 +/- 7.3 (P < 0.001) during breathing with resistance. We conclude that the major contributors to increased Pa(CO(2)) during exercise at 4.7 ATA are increased depth and external respiratory resistance. HCVR and maximal O(2) consumption were also weakly predictive. The effects of P(tr), inspired Po(2), and O(2) consumption during short-term exercise were not significant.
Asunto(s)
Dióxido de Carbono/sangre , Buceo/efectos adversos , Ejercicio Físico , Hipercapnia/etiología , Posición Prona , Fenómenos Fisiológicos Respiratorios , Adaptación Fisiológica , Adulto , Resistencia de las Vías Respiratorias , Presión Atmosférica , Espiración , Femenino , Humanos , Hipercapnia/sangre , Hipercapnia/fisiopatología , Inmersión , Inhalación , Masculino , Persona de Mediana Edad , Modelos Biológicos , Oxígeno/sangre , Consumo de Oxígeno , Presión Parcial , Ventilación Pulmonar , Espacio Muerto Respiratorio , Factores de Riesgo , Regulación hacia Arriba , Adulto JovenRESUMEN
Immersion pulmonary edema (IPE) is a condition with sudden onset in divers and swimmers suspected to be due to pulmonary arterial or venous hypertension induced by exercise in cold water, although it does occur even with adequate thermal protection. We tested the hypothesis that cold head immersion could facilitate IPE via a reflex rise in pulmonary vascular pressure due solely to cooling of the head. Ten volunteers were instrumented with ECG and radial and pulmonary artery catheters and studied at 1 atm absolute (ATA) during dry and immersed rest and exercise in thermoneutral (29-31 degrees C) and cold (18-20 degrees C) water. A head tent varied the temperature of the water surrounding the head independently of the trunk and limbs. Heart rate, Fick cardiac output (CO), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), and central venous pressure (CVP) were measured. MPAP, PAWP, and CO were significantly higher in cold pool water (P < or = 0.004). Resting MPAP and PAWP values (means +/- SD) were 20 +/- 2.9/13 +/- 3.9 (cold body/cold head), 21 +/- 3.1/14 +/- 5.2 (cold/warm), 14 +/- 1.5/10 +/- 2.2 (warm/warm), and 15 +/- 1.6/10 +/- 2.6 mmHg (warm/cold). Exercise values were higher; cold body immersion augmented the rise in MPAP during exercise. MAP increased during immersion, especially in cold water (P < 0.0001). Except for a transient additive effect on MAP and MPAP during rapid head cooling, cold water on the head had no effect on vascular pressures. The results support a hemodynamic cause for IPE mediated in part by cooling of the trunk and extremities. This does not support the use of increased head insulation to prevent IPE.
Asunto(s)
Regulación de la Temperatura Corporal , Frío , Buceo/efectos adversos , Ejercicio Físico , Hemodinámica , Inmersión , Edema Pulmonar/etiología , Agua , Adulto , Presión Atmosférica , Dióxido de Carbono/sangre , Gasto Cardíaco , Presión Venosa Central , Extremidades , Femenino , Cabeza , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Circulación Pulmonar , Edema Pulmonar/sangre , Edema Pulmonar/fisiopatología , Presión Esfenoidal Pulmonar , Respiración , Adulto JovenRESUMEN
Diving-related pulmonary effects are due mostly to increased gas density, immersion-related increase in pulmonary blood volume, and (usually) a higher inspired Po(2). Higher gas density produces an increase in airways resistance and work of breathing, and a reduced maximum breathing capacity. An additional mechanical load is due to immersion, which can impose a static transrespiratory pressure load as well as a decrease in pulmonary compliance. The combination of resistive and elastic loads is largely responsible for the reduction in ventilation during underwater exercise. Additionally, there is a density-related increase in dead space/tidal volume ratio (Vd/Vt), possibly due to impairment of intrapulmonary gas phase diffusion and distribution of ventilation. The net result of relative hypoventilation and increased Vd/Vt is hypercapnia. The effect of high inspired Po(2) and inert gas narcosis on respiratory drive appear to be minimal. Exchange of oxygen by the lung is not impaired, at least up to a gas density of 25 g/l. There are few effects of pressure per se, other than a reduction in the P50 of hemoglobin, probably due to either a conformational change or an effect of inert gas binding.
Asunto(s)
Buceo/efectos adversos , Hipercapnia/fisiopatología , Hiperoxia/fisiopatología , Pulmón/fisiopatología , Ventilación Pulmonar , Resistencia de las Vías Respiratorias , Animales , Difusión , Hemoglobinas/metabolismo , Humanos , Hipercapnia/etiología , Hipercapnia/metabolismo , Hiperoxia/etiología , Hiperoxia/metabolismo , Pulmón/irrigación sanguínea , Rendimiento Pulmonar , Oxígeno/sangre , Circulación Pulmonar , Edema Pulmonar/etiología , Edema Pulmonar/fisiopatología , Espacio Muerto Respiratorio , Mecánica Respiratoria , Volumen de Ventilación Pulmonar , Relación Ventilacion-Perfusión , Trabajo RespiratorioRESUMEN
Achieving appropriate integration of control of multiple assistance devices for an individual is currently limited by available integrated systems. An overview of the provision process for Rehabilitation Integrated Systems (RIS) is presented which stresses the need for detailed assessment of the individual's abilities and requirements. A software system is described which integrates existing assistive applications on a PC in an attempt to provide a flexible RIS which can be tailored more precisely to an individual. This has required the use of both DOS and Windows applications and highlighted problems due to limitations of existing RISs, despite user requirements being taken fully into account. While Windows offers the opportunity to remove some compatibility problems, it is concluded that interfacing standards for both software and hardware are necessary to overcome the problems this approach engenders. For individuals who have to use 'intrinsically slow' user interfaces, it is identified that (i) the availability of quantitative comparisons of efficiency of selection methods and (ii) increased choice of selection methods is important.
Asunto(s)
Sistemas de Computación , Rehabilitación/métodos , Dispositivos de Autoayuda , Ingeniería Biomédica , Humanos , Rehabilitación/instrumentación , Programas Informáticos , Tecnología , Interfaz Usuario-ComputadorRESUMEN
Children with severe physical disabilities often require a range of technological devices to aid them with the fundamental tasks carried out in everyday life. These tasks areas may include mobility, communication, environment control and computer access for education. The most efficient, and often the most cost-effective, way of providing for these requirements is by the provision of a single, integrated system tailored to the individual's needs and abilities. BASIS, the Barnsley And Sheffield Integrated System, is an integrated control system based on a wheelchair-mounted personal computer (PC) and currently implements the following modules: wheelchair control; a spoken communication package; control of home equipment via infra-red; and a facility to run third-party software. The system presents a consistent and uniform environment to the user for selection and activation of these modules and can be controlled by one to four switches (scanning or directed access), a touch screen, a head pointer or a mouse. Safety considerations have played a central part in the design of the system. BASIS can be tailored to the user's requirements by editing a text file in software and by connecting the appropriate hardware modules to the serial and parallel ports. The graphical user interface has been designed for use by children and employs pictorial representation (icons) of available functions on a colour screen. These icons can be chosen from clip-art or drawn on computer drawing package. It is also possible to scan in and utilize drawings or photographs.(ABSTRACT TRUNCATED AT 250 WORDS)