Effect of various neutrally adjusted ventilator assist (NAVA) gains on the relationship between diaphragmatic activity (Eadi max) and tidal volume

INTRODUCTION. Neurally Adjusted Ventilatory Assist (NAVA) is an assisted ventilatorymode in which the ventilator is driven by the electrical activity of the diaphragm (Eadi).NAVAimproves patient-ventilator synchrony [1] but little is known about how to set the NAVA gaini.e., how to choose the ratio between Eadi and delivered pressure. The aim of the present studywas to assess the relationship between Eadi and tidal volume (Vt) at various NAVA gainsettings and to evaluate whether modifying the gain influenced this relationship in non-invasivelyventilated (NIV) patients.METHODS. Prospective interventional study comparing 3 values of NAVA gain during NIV(20 min each). NAVA100 was set by the clinician according to the manufacturer's recommendations.In NAVA50 and NAVA150 the gain was set as -50% and +50% of NAVA100gain respectively. Vt and maximal Eadi value (Eadi max) were recorded. The ratio Vt/Eadi wasthen assessed for each breath. 5-95% range (range 90) of Vt/Eadi was calculated for eachpatient at each NAVA gain setting. Vt/Eadi ratio has the advantage to give an objectiveassessment Vt/Eadi max relationship independently from the nature of this relationship. Asmaller Range90 indicates a better matching of Vt to Eadi max.RESULTS. 12 patients were included, 5 had obstructive pulmonary disease and 2 mixedobstructive and restrictive disease. For NAVA100, the median [IQR] Range 90 was 32[19-87]. For NAVA150 Range 90 was 37 [20-95] and for NAVA50 Range 90 was 33 [16-92].That means that globally NAVA100 allowed a better match between Eadi max and Vt thanNAVA50 and 150. However, by patient, NAVA100 had the lowest Range 90 value for only 4patients (33%), NAVA150 for 2 (17%) and NAVA50 for 6 (50%) patients, indicating thatNAVA100 was not the best NAVA gain for minimizing Range 90 in every patients.Comparing the lowest Range 90 value to the next lowest for each patient, showed that 3 patientshad differences of less than 10% (one each for NAVA50, NAVA100 and NAVA150). Theremainder had differences from 17 to 24%, indicating that most patients (9/12 or 75%) had aclear better match between Eadi and Vt for one specific NAVA gain.CONCLUSIONS. Different NAVA gains yielded markedly different ability to match Vt toEadi max. This approach could be a new way to determine optimalNAVAgain for each patientbut require further investigations.REFERENCE. Piquilloud L, et al. Intensive Care Med 2011;37:263-71.

Neurally Adjusted Ventilatory Assist (NAVA) improves the matching of diaphragmatic electrical activity and tidal volume in comparison to pressure support (PS) under non invasive ventilation

INTRODUCTION. Patient-ventilator asynchrony is a frequent issue in non invasivemechanical ventilation (NIV) and leaks at the patient-mask interface play a major role in itspathogenesis. NIV algorithms alleviate the deleterious impact of leaks and improve patient-ventilator interaction. Neurally adusted ventilatory assist (NAVA), a neurally triggered modethat avoids interferences between leaks and the usual pneumatic trigger, could further improvepatient-ventilator interaction in NIV patients.OBJECTIVES. To evaluate the feasibility ofNAVAin patients receiving a prophylactic postextubationNIV and to compare the respective impact ofPSVandNAVAwith and withoutNIValgorithm on patient-ventilator interaction.METHODS. Prospective study conducted in 16 beds adult critical care unit (ICU) in a tertiaryuniversity hospital. Over a 2 months period, were included 17 adult medical ICU patientsextubated for less than 2 h and in whom a prophylactic post-extubation NIV was indicated.Patients were randomly mechanically ventilated for 10 min with: PSV without NIV algorithm(PSV-NIV-), PSV with NIV algorithm (PSV-NIV+),NAVAwithout NIV algorithm (NAVANIV-)and NAVA with NIV algorithm (NAVA-NIV+). Breathing pattern descriptors, diaphragmelectrical activity, leaks volume, inspiratory trigger delay (Tdinsp), inspiratory time inexcess (Tiexcess) and the five main asynchronies were quantified. Asynchrony index (AI) andasynchrony index influenced by leaks (AIleaks) were computed.RESULTS. Peak inspiratory pressure and diaphragm electrical activity were similar in thefour conditions. With both PSV and NAVA, NIV algorithm significantly reduced the level ofleak (p\0.01). Tdinsp was not affected by NIV algorithm but was shorter in NAVA than inPSV (p\0.01). Tiexcess was shorter in NAVA and PSV-NIV+ than in PSV-NIV- (p\0.05).The prevalence of double triggering was significantly lower in PSV-NIV+ than in NAVANIV+.As compared to PSV,NAVAsignificantly reduced the prevalence of premature cyclingand late cycling while NIV algorithm did not influenced premature cycling. AI was not affectedby NIV algorithm but was significantly lower in NAVA than in PSV (p\0.05). AIleaks wasquasi null with NAVA and significantly lower than in PSV (p\0.05).CONCLUSIONS. NAVA is feasible in patients receiving a post-extubation prophylacticNIV. NAVA and NIV improve patient-ventilator synchrony in different manners. NAVANIV+offers the best patient-ventilator interaction. Clinical studies are required to assess thepotential clinical benefit of NAVA in patients receiving NIV.

Reliable tidal volume estimates at the airway opening with an infant monitor during high-frequency oscillatory ventilation.

OBJECTIVE: To assess the suitability of a hot-wire anemometer infant monitoring system (Florian, Acutronic Medical Systems AG, Hirzel, Switzerland) for measuring flow and tidal volume (Vt) proximal to the endotracheal tube during high-frequency oscillatory ventilation. DESIGN: In vitro model study. SETTING: Respiratory research laboratory. SUBJECT: In vitro lung model simulating moderate to severe respiratory distress. INTERVENTION: The lung model was ventilated with a SensorMedics 3100A ventilator. Vt was recorded from the monitor display (Vt-disp) and compared with the gold standard (Vt-adiab), which was calculated using the adiabatic gas equation from pressure changes inside the model. MEASUREMENTS AND MAIN RESULTS: A range of Vt (1-10 mL), frequencies (5-15 Hz), pressure amplitudes (10-90 cm H2O), inspiratory times (30% to 50%), and Fio2 (0.21-1.0) was used. Accuracy was determined by using modified Bland-Altman plots (95% limits of agreement). An exponential decrease in Vt was observed with increasing oscillatory frequency. Mean DeltaVt-disp was 0.6 mL (limits of agreement, -1.0 to 2.1) with a linear frequency dependence. Mean DeltaVt-disp was -0.2 mL (limits of agreement, -0.5 to 0.1) with increasing pressure amplitude and -0.2 mL (limits of agreement, -0.3 to -0.1) with increasing inspiratory time. Humidity and heating did not affect error, whereas increasing Fio2 from 0.21 to 1.0 increased mean error by 6.3% (+/-2.5%). CONCLUSIONS: The Florian infant hot-wire flowmeter and monitoring system provides reliable measurements of Vt at the airway opening during high-frequency oscillatory ventilation when employed at frequencies of 8-13 Hz. The bedside application could improve monitoring of patients receiving high-frequency oscillatory ventilation, favor a better understanding of the physiologic consequences of different high-frequency oscillatory ventilation strategies, and therefore optimize treatment.

Photometric Bgr survey of the distant clusters of galaxies CL 1613+3104 and CL 1600+4109

We present a set of photometric data concerning two distant clusters of galaxies: Cl 1613+3104 (z=0.415) and Cl 1600+4109 (z=0.540). The photometric survey extends to a field of about 4' x 3'. It was performed in 3 filters: Johnson B, and Thuan-Gunn g and r. The sample includes 679 objects in the field of Cl 1613+3104 and 334 objects in Cl 1600+4109.

New measurements of radial velocities in clusters of galaxies

Redshifts for 100 galaxies in 10 clusters of galaxies are presented based on data obtained between March 1984 and March 1985 from Calar Alto, La Palma, and ESO, and on data from Mauna Kea. Data for individual galaxies are given, and the accuracy of the velocities of the four instruments is discussed. Comparison with published data shows the present velocities to be shifted by + 4.0 km/s on average, with a standard deviation in the difference of 89.7 km/s, consistent with the rms of redshift measurements which range from 50-100 km/s.

Photometric and Spectroscopic Observations of the Cluster of Galaxies Abell 2390

Spectroscopic and photometric observations in a 6 arcmin x 6 arcmin field centered on the rich cluster of galaxies Abell 2390 are presented. The photometry concerns 700 objects and the spectroscopy 72 objects. The redshift survey shows that the mean redshift of the cluster is 0.232. An original method for automatic determination of the spectral type of galaxies is presented.

Photometric and spectroscopic survey of the cluster of galaxies Abell A2218

We present new photometric and spectroscopic observations of objects in the field of the cluster of galaxies Abell 2218. The photometric survey, centered on the cluster core, extends to a field of about 4 x 4 arcmin. It was performed in 5 bands (B,g,r,i and z filters). This sample, which includes 729 objects, is about three times larger than the survey made by Butcher and collaborators (Butcher et al., 1983, Butcher and Oemler, 1984) in the same central region of the field. Only 228 objects appear in both catalogues since our survey covers a smaller region. The spectral range covered by our filters is wider and the photometry is much deeper, up to magnitude 27 in r. The spectroscopic survey concerns 66 objects, on a field comparable to that of Butcher and collaborators. From our observations we calculate the mean redshift of the cluster, 0.1756, and its velocity dispersion, 1370 km/s. The spectral types are determined for many galaxies in the sample by comparing their spectra with synthetic ones from Rocca-Volmerange and Guiderdoni (1988).

Automatic selection of tidal volume, respiratory frequency and minute ventilation in intubated ICU patients as start up procedure for closed-loop controlled ventilation.

OBJECTIVE: Before a patient can be connected to a mechanical ventilator, the controls of the apparatus need to be set up appropriately. Today, this is done by the intensive care professional. With the advent of closed loop controlled mechanical ventilation, methods will be needed to select appropriate start up settings automatically. The objective of our study was to test such a computerized method which could eventually be used as a start-up procedure (first 5-10 minutes of ventilation) for closed-loop controlled ventilation. DESIGN: Prospective Study. SETTINGS: ICU's in two adult and one children's hospital. PATIENTS: 25 critically ill adult patients (age > or = 15 y) and 17 critically ill children selected at random were studied. INTERVENTIONS: To stimulate 'initial connection', the patients were disconnected from their ventilator and transiently connected to a modified Hamilton AMADEUS ventilator for maximally one minute. During that time they were ventilated with a fixed and standardized breath pattern (Test Breaths) based on pressure controlled synchronized intermittent mandatory ventilation (PCSIMV). MEASUREMENTS AND MAIN RESULTS: Measurements of airway flow, airway pressure and instantaneous CO2 concentration using a mainstream CO2 analyzer were made at the mouth during application of the Test-Breaths. Test-Breaths were analyzed in terms of tidal volume, expiratory time constant and series dead space. Using this data an initial ventilation pattern consisting of respiratory frequency and tidal volume was calculated. This ventilation pattern was compared to the one measured prior to the onset of the study using a two-tailed paired t-test. Additionally, it was compared to a conventional method for setting up ventilators. The computer-proposed ventilation pattern did not differ significantly from the actual pattern (p > 0.05), while the conventional method did. However the scatter was large and in 6 cases deviations in the minute ventilation of more than 50% were observed. CONCLUSIONS: The analysis of standardized Test Breaths allows automatic determination of an initial ventilation pattern for intubated ICU patients. While this pattern does not seem to be superior to the one chosen by the conventional method, it is derived fully automatically and without need for manual patient data entry such as weight or height. This makes the method potentially useful as a start up procedure for closed-loop controlled ventilation.

Chlormequat chloride and ethephon affect growth and yield formation of conventional, naked and dwarf oat

Selostus: Kasvunsääteiden vaikutukset tavanomaisen, paljasjyväisen ja kääpiökauran kasvuun ja sadonmuodostukseen

Gaia photometry for white dwarfs

Context. White dwarfs can be used to study the structure and evolution of the Galaxy by analysing their luminosity function and initial mass function. Among them, the very cool white dwarfs provide the information for the early ages of each population. Because white dwarfs are intrinsically faint only the nearby (~ 20 pc) sample is reasonably complete. The Gaia space mission will drastically increase the sample of known white dwarfs through its 5-6 years survey of the whole sky up to magnitude V = 20-25. Aims. We provide a characterisation of Gaia photometry for white dwarfs to better prepare for the analysis of the scientific output of the mission. Transformations between some of the most common photometric systems and Gaia passbands are derived. We also give estimates of the number of white dwarfs of the different galactic populations that will be observed. Methods. Using synthetic spectral energy distributions and the most recent Gaia transmission curves, we computed colours of three different types of white dwarfs (pure hydrogen, pure helium, and mixed composition with H/He = 0.1). With these colours we derived transformations to other common photometric systems (Johnson-Cousins, Sloan Digital Sky Survey, and 2MASS). We also present numbers of white dwarfs predicted to be observed by Gaia. Results. We provide relationships and colourcolour diagrams among different photometric systems to allow the prediction and/or study of the Gaia white dwarf colours. We also include estimates of the number of sources expected in every galactic population and with a maximum parallax error. Gaia will increase the sample of known white dwarfs tenfold to about 200 000. Gaia will be able to observe thousands of very cool white dwarfs for the first time, which will greatly improve our understanding of these stars and early phases of star formation in our Galaxy.

Peduncle and fruit yield, in six cropping seasons, of early dwarf cashew tree clones irrigated with different water regimes

The objective of this work was to evaluate peduncle and fruit yield in clone MS 076 and in a clonal population of drip-irrigated, early dwarf cashew trees propagated by layering, in six cropping seasons. In order to meet the increased water requirements of the crop resulting from plant growth and development, irrigation during the dry season was performed daily according to the following water regime: 15 min/plant/day during the 1st year, 30 min/plant/day during the 2nd year, 45 min/plant/day during the 3rd year and 60 min/plant/day during all subsequent years. Water was supplied by one drip emitter/plant, at an (adjustable) flow rate of 36 L/h.The research was carried out in Fortaleza-Ceará, Brazil, and a random block design was utilized, with five replicates and split-plots. The clones were assigned to plots and the cropping seasons were considered as subplots. The clonal population was superior to the clone only with regard to number of nut shells (NNS), and solely in the first season. The clone was superior to the population as to NNS and peduncle yield (PY) in the second season, and also with regard to the three evaluated traits - NNS, PY, and nut shell yield, in the last three cropping seasons.

Barley Yellow Dwarf Virus (BYDV) y los áfidos en los arrozales levantinos: una prospección

Se ha llevado a cabo una prospección de las poblaciones emigrantes de áfidos alados en el área de La Albufera de Valencia, zona donde se da el «enrojat» del arroz, enfermedad causada por una raza del Barley Yellow Dwarf Virus, y se discute aquí el potencial presumible de las distintas especies como vectores de la enfermedad. Se muestrearon dos áreas con diferente incidencia de la enfermedad, obteniéndose 30 especies, de las que ocho están descritas como vectores de tales virus. Fueron mayores las capturas en las áreas donde se cultivaba el arroz por plantel y transplante con incidencia marcada de la enfermedad, que en otras de menor incidencia. La aparente homogeneidad de la zona hace difícil comprender la razón de tales diferencias. Entre los vectores conocidos de BYDV, sólo Rhopalosiphon padi L. y Hyaiopterus pruni (L) Geof. aparecieron al principio de la estación, cuando tiene lugar la infección, con poblaciones considerables. E1 primero es el vector conocido de la enfermedad. El segundo, es de las pocas especies que tiene niveles similares de captura en ambas áreas. Ninguno de los otros áfidos vectores capturados como alados parece verdaderamente importante para la transmisión a pleno campo por lo tardío de su llegada a los campos o por razones de su ciclo vital. Se ha intentado estudiar el potencial de Hyalopterus pruni, pulgón muy abundante en los carrizos como transmisor a corta distancia a partir de estas plantas. No se han obtenido resultados positivos ni a partir de la planta, ni a partir de áfidos alimentados en arroz o avena infectadas previamente con la enfermedad.

Addition of nitrogen had no effect on yield and quality of apples in an high density orchard carrying a dwarf rootstock

The effect of N addition on apple yield and quality may vary according to the tree vigor. Apple trees developed over vigorous rootstocks had shown no response to N application in Brazil. In this study it was evaluated the effect of N addition to the soil on yield and quality of ´Royal Gala´ apples grafted on a dwarf rootstock (M.9). The orchard was planted in 1995 (2,857 trees ha-1) on an Oxisol containing 40 g kg-1 of organic matter and pH 6.0. The experiment was carried out from 1998 up to 2005. Treatments consisted of rates of N (0, 50, 100 and 150 kg ha-1 year-1 from 1998 to 2001, and respectively 0, 100, 200 and 300 kg ha-1 afterwards), all broadcasted within the tree row in two equal splits, at bud break and after harvest, as ammonium sulfate. Addition of N to the soil had no effect on fruit yield over the six years regardless of the applied rate. Averaged across treatments and years, fruit yield was 52.3 t ha-1. Nitrogen in the leaves (average of 24 g kg-1) or in the fruits (average of 346 mg kg-1) as well as some attributes related to fruit quality (color, firmness, acidity, soluble solids, physiological disorders) were unaffected by N addition. Some plant parameters related to tree vigor, however, grew higher with the increase on N rate. Thus, it is not necessary to apply N to deep Brazilian soils containing high organic matter in order to assure good fruit quality and yield on high-density orchards carrying dwarf rootstocks probably because the N required for tree growth and fruit production is supplied from soil organic matter decay.

End-tidal carbon dioxide monitoring using a naso-buccal sensor is not appropriate to monitor capnia during non-invasive ventilation.

BACKGROUND: In acute respiratory failure, arterial blood gas analysis (ABG) is used to diagnose hypercapnia. Once non-invasive ventilation (NIV) is initiated, ABG should at least be repeated within 1 h to assess PaCO2 response to treatment in order to help detect NIV failure. The main aim of this study was to assess whether measuring end-tidal CO2 (EtCO2) with a dedicated naso-buccal sensor during NIV could predict PaCO2 variation and/or PaCO2 absolute values. The additional aim was to assess whether active or passive prolonged expiratory maneuvers could improve the agreement between expiratory CO2 and PaCO2. METHODS: This is a prospective study in adult patients suffering from acute hypercapnic respiratory failure (PaCO2 ≥ 45 mmHg) treated with NIV. EtCO2 and expiratory CO2 values during active and passive expiratory maneuvers were measured using a dedicated naso-buccal sensor and compared to concomitant PaCO2 values. The agreement between two consecutive values of EtCO2 (delta EtCO2) and two consecutive values of PaCO2 (delta PaCO2) and between PaCO2 and concomitant expiratory CO2 values was assessed using the Bland and Altman method adjusted for the effects of repeated measurements. RESULTS: Fifty-four datasets from a population of 11 patients (8 COPD and 3 non-COPD patients), were included in the analysis. PaCO2 values ranged from 39 to 80 mmHg, and EtCO2 from 12 to 68 mmHg. In the observed agreement between delta EtCO2 and deltaPaCO2, bias was -0.3 mmHg, and limits of agreement were -17.8 and 17.2 mmHg. In agreement between PaCO2 and EtCO2, bias was 14.7 mmHg, and limits of agreement were -6.6 and 36.1 mmHg. Adding active and passive expiration maneuvers did not improve PaCO2 prediction. CONCLUSIONS: During NIV delivered for acute hypercapnic respiratory failure, measuring EtCO2 using a dedicating naso-buccal sensor was inaccurate to predict both PaCO2 and PaCO2 variations over time. Active and passive expiration maneuvers did not improve PaCO2 prediction. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01489150.