We describe a method based on a Fabry-Perot interferometer at the tip of an optic fiber with a diameter of 0.25 mm for direct measurement of tracheal pressure in pediatric respiratory monitoring. The response time of the pressure transducer and its influence on the resistance of pediatric endotracheal tubes (internal diameter, 2.5 to 5 mm) during constant and dynamic flow at different ventilator settings in a lung model were measured. The transducer was positioned at Ϫ1.5 (inside), 0, and ϩ1.5 cm (outside) relative to the tip of the endotracheal tube and compared with a reference pressure inside the trachea. The clinical application of the transducer was tested in five pediatric patients. The response time of the transducer was 1.3 ms. The influence of the fiberoptic transducer on tube resistance was negligible during constant flow in inspiratory and expiratory directions for all endotracheal tubes tested. There was no difference in pressure measurements with the transducer positioned at or 1.5 cm below or above the tip of the endotracheal tube during dynamic measurements. During clinical circumstances insertion of the fiberoptic transducer was easy, recordings were stable, and the safety of the patient was not jeopardized. The fiberoptic transducer provided a reliable and promising way of monitoring tracheal pressure in intubated pediatric patients. The presence of the probe did not interfere with either pressure-flow relationship or patient care and safety. The technique is proposed for monitoring of respiratory mechanics and calculation of changes in tube resistance caused by kinking and secretions. Respiratory monitoring in pediatric intensive care is currently represented by proximal P/V loops obtained in ventilator software or intensive care monitors using flowmeters placed near the connection between the ventilator system and ETT. This is obviously insufficient as information gained from such P/V loops mainly stems from ETT resistance and performance of ventilator valves. We have previously demonstrated that monitoring respiratory mechanics by direct measurement of tracheal pressure offers considerable advantages compared with monitoring based on either measurements obtained proximal to the tube or tracheal pressures calculated by subtracting pressure needed to overcome flow-dependent tube resistance. In the adult setting tracheal pressure measurement is accomplished by introducing an air-or liquid-filled catheter into the ETT and connecting it to a conventional pressure transducer (1). In the pediatric setting it has generally been held to be impossible to use endotracheal catheters for continuous pressure measurement owing to the encroachment on cross-sectional area of the narrow pediatric tubes (2). Instead hydrodynamic models of varying complexity have been proposed for the calculation of tracheal pressure, i.e. the pressure fall across the ETT because of its resistance, based on measurements above the tube. Guttmann et al. (2)
A rotational acceleration impulse to a head, as occurs at traffic accidents, sport injuries, assaults and falls, induces a diffuse brain damage that eventually could result in persistent neuropsychiatric deficits and neurodegeneration. Emphasis has been concentrated on the relative motion of the brain inside the skull during head impact, whereas less attention has been paid to whether intracranial pressure changes are generated and, if so, the implications thereof. In the present experimental study we investigated in an animal model system, based on rabbits, if a sagittal, anterior-posterior rotational acceleration of a head generated intracranial pressure changes, recorded by fibre optic pressure sensors, inserted ipsilaterally in the parieto-temporal and the occipital lobes. Two levels of rotational acceleration were used in the experiments; one higher, corresponding to the threshold limit for moderate diffuse brain injury, and one lower, close to being noninjurious. Several pressure recordings were performed in each rabbit at the two acceleration levels. The pressure recordings invariably revealed the same general characteristics of rapid, positive and negative pressures within the brain, with variations in amplitude and duration, lasting for up to 10 ms. A major finding was the generation of powerful negative pressures, as low as 0.3 bars in absolute pressure. The most prominent difference in amplitudes of the negative peak pressures between the two applied acceleration levels was demonstrated at the parieto-temporal location. The presented pressure recordings are the first to disclose the generation of transient, powerful intracerebral pressures at rotational acceleration of the head, which must be considered in studies of brain injury generation and distribution as well as prevention.
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