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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: CABRERA, M.E., et al.: Can Current Minute Ventilation Rate Adaptive Pacemakers Provide Appropriate Chronotropic Response in Pediatric Patients? Since children have different activity patterns and exercise responses, uncertainty exists as to whether minute ventilation (MV) sensors designed for adults provide adequate chronotropic response in pediatrics. In particular, high respiratory rates (RR 〉 48 breaths/min), which are characteristic of the ventilatory response to exercise in children, cannot be sensed by MV rate responsive pacemakers. The purpose of this study was to evaluate the MV sensor rate response of the Medtronic Kappa 400 using exercise data from healthy children in a computer simulation of its rate response algorithm. Thirty-eight healthy children, ages 6–14, underwent a treadmill maximal exercise test. Subjects were divided based on body surface area (BSA) and MV rate response parameters were selected. Respiratory rates and tidal volumes were entered into the Kappa 400 rate response algorithm to calculate sensor-driven rates. Intrinsic heart rate (HR), oxygen uptake, and sensor-driven rates were normalized to HR reserve (HRR), metabolic reserve (MR), and sensor-driven reserve to compare across groups. Linear regression analysis among sensor-driven rate reserve, HRR, and MR was performed as described by Wilkoff. The mean slopes (± SD) of the relationships between the sensor-driven rate reserve and HRR were 1.06 ± 0.34, 1.07 ± 0.28, and 1.01 ± 0.19 for children with BSA 〈 1.10 m2, 1.10 〈 BSA 〈 1.40 m2, and BSA 〉 1.40 m2, respectively. High correlations were found between sensor-drive rates and HR responses and between sensor-drive rates and MV throughout exercise. No significant differences were noted between sensor-drive rates and HR using the Wilkoff model. From this study the authors conclude that: (1) MV is a good physiological parameter to control heart rate and (2) simulated sensor-driven rates closely match intrinsic HRs during exercise in healthy children, which supports the appropriateness of clinical validation in pediatric pacemaker patients.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Annals of biomedical engineering 19 (1991), S. 723-742 
    ISSN: 1573-9686
    Keywords: Cardiac output ; Acetylene-helium rebreathing ; Mathematical modeling ; Statistical analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract A noninvasive method to estimate cardiac output $$\dot Q$$ without special patient cooperation was developed by modifying a previous acetylene-helium (C2H2−He) rebreathing technique (ART). Estimation of $$\dot Q$$ using ART is based on a single-compartment model that is valid only under prescribed breathing; e.g., fast, deep breathing, and emptying of the rebreathing bag on each breath. To make the ART less dependent on subject cooperation, a more sophisticated mathematical model and estimation method are needed. For this purpose, we modeled the C2H2 and He concentration dynamics at the mouth over successive breaths using a multi-compartment model. This model takes into account the effects of breathing pattern, compartmental volumes, and gas solubility. From computer simulations and sensitivity analysis, we found that $$\dot Q$$ could be estimated from the available data with adequate precision. Our model and estimation method were tested on a group of six normal adult subjects, at rest and during submaximal exercise (75 watts). Estimates of $$\dot Q$$ from our new method (6.5±0.4 L/min at rest, 12.5±0.4 L/min at 75 watts) were in agreement with those obtained using a previous ART (7.0±0.3 L/min at rest, 12.6±0.5 L/min at 75 watts). We conclude that this approach promises to provide reliable estimates of $$\dot Q$$ in patients (e.g., children and elderly), at rest and during exercise, without the need of prescribed breathing patterns or changes in rebreathing bag volume.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Annals of biomedical engineering 26 (1998), S. 1-27 
    ISSN: 1573-9686
    Keywords: Hypoxia ; Metabolic control ; Energy metabolism ; Model O2 sensitivity ; Oxygen ; Lactate dynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract The mechanistic basis of the relationship between O2 and lactate concentration in muscle is not fully understood. Although hypoxia can cause lactate (LA) accumulation, it is possible for LA accumulation to occur without hypoxia. Nevertheless, during conditions of low O2 availability, blood and tissue LA accumulation are used as indicators of hypoxia. To provide a framework for analyzing changes in energy metabolism and its regulation, we developed a mathematical model of human bioenergetics that links cellular metabolic processes to whole-body responses. Our model is based on dynamic mass balances and mechanistic kinetics in muscle, splanchnic and other body tissues for many substrates (glycogen, glucose, pyruvate, LA, O2, CO2, etc.) and control metabolites (e.g., ATP) through coupled reaction processes. Normal substrate concentrations in blood and tissues as well as model parameters are obtained directly or estimated indirectly from physiological observation in the literature. The model equations are solved numerically to simulate substrate concentration changes in tissues in response to disturbances. One key objective is to examine and quantify the mechanisms that control LA accumulation when O2 availability to the muscle is lowered. Another objective is to quantify the contribution of different tissues to an observed increase in blood lactate concentration. Simulations of system responses to respiratory hypoxia were examined and compared to physiological observations. Model simulations show patterns of change for substrates and control metabolites that behave similarly to those found experimentally. From the simulations, it is evident that a large decrease can occur in muscle O2 concentration, without affecting muscle respiration ( $$U_{m,{\text{O}}_{\text{2}} } $$ ) significantly. However, a small decrease in $$U_{m,{\text{O}}_{\text{2}} } $$ (1%–2%) can result in a large increase in LA production (50%–100%). The cellular rate of oxygen consumption, $$U_{m,{\text{O}}_{\text{2}} } $$ , which is coupled to ATP formation and NADH oxidation, can regulate other processes (e.g., glycolysis, pyruvate reduction) with high sensitivity through its effects on ADP/ATP and NADH/NAD. Thus, although LA metabolism does not depend directly on O2 concentration, it is indirectly affected by $$U_{m,{\text{O}}_{\text{2}} } $$ , through changes in ADP/ATP, and NADH/NAD. Arterial LA concentration (Ca,LA) follows the pattern of change of muscle LA concentration (Cm,LA). Nevertheless, changes in Ca,LA, due to Cm,LA, are unlikely to be detected experimentally because changes in Cm,LA are small relative to the total LA concentrations in other tissues. © 1998 Biomedical Engineering Society. PAC98: 8710+e, 8722Fy
    Type of Medium: Electronic Resource
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