Pressure on the tracheal mucosa from cuffed tubes.

During cuffed intubation, damage to the trachea is least likely when the lateral wall pressure exerted by the cuff does not exceed the mean capillary perfusion pressure of the mucosa. A study was carried out of eight different types of endotracheal tubes. At the seal point the traditional red rubber tube and the armoured latex and Softway tubes exerted pressures above the mean systemic arterial pressure. Although the Portex and Mallinckrodt tubes exerted pressures close to the mean capillary perfusion pressure, much higher pressures resulted if they were overinflated. The Lanz tube, however, with its over-pressure safety balloon, maintained a lateral wall pressure below the mean capillary perfusion pressure even when inflated considerably beyond the seal point. Endotracheal cuffs are often overinflated in clinical practice. Since cuff-induced tracheal damage is most influenced by the lateral wall pressure, these results suggest that the use of Lanz-type tubes should be mandatory in intensive care units or when a cuffed tracheostomy tube is required and they should also be considered for use in more routine anaesthetic practice.     

General tube law for collapsible thin and thick-wall tubes

Modeling the complex deformations of cylindrical tubes under external pressure is of interest in engineering and physiological applications. The highly non-linear post-buckling behavior of cross-section of the tube during collapse attracted researchers for years. Major efforts were concentrated on studying the behavior of thin-wall tubes. Unfortunately, the knowledge on post-buckling of thick-wall tubes is still incomplete, although many experimental and several theoretical studies have been performed. In this study we systematically studied the effect of the wall thickness on post-buckling behavior of the tube. For this purpose, we utilized a computational model for evaluation of the real geometry of the deformed cross-sectional area due to negative transmural (internal minus external) pressure. We also developed an experimental method to validate the computational results. Based on the computed cross-sections of tubes with different wall thicknesses, we developed a general tube law that accounts for thin or thick wall tubes and fits the numerical data of computed cross-sectional areas versus transmural pressures.     

Fabrication of elastomer arterial models with specified compliance.

A simple way of making elastic tubes using a mechanical lathe for precise control of the wall thickness is proposed in this study. These tubes are particularly useful for modeling properties of large arteries. Tubes with different geometric parameters and hence different elastic behavior have been made with a silicon elastomer (Rhodorsil RTV 1556). They have been created to be used for compliance measurements in hemodynamics research. Within a limited range of pressures, depending on the wall thickness, such tubes can be used to study models in which the compliance value is assumed to be constant.     

Comparison of pressure losses in steady non-Newtonian flow through experimental tapered and cylindrical arterial prostheses

The use of an arterial prosthesis with a tapered lumen has several important advantages; for example, improved stability of flow, increased wall shear and better matching of its size with that of the host vessel. Tapering may, however, lead to increased energy losses, particularly if the angle of taper is large and the flow is high. This study is concerned with the determination of pressure drop for steady and laminar converging flow through rigid wall models of tapered arterial grafts. The angles of taper examined ranged from 0.5° to 1.0°. Aqueous solutions of polyacrylamide, with non-Newtonian viscous properties similar to those of blood, were used. The pressure drops across the tapered tubes were measured and the data were measured and the data were related to the pressure loss in cylindrical tubes of equivalent dimensions. Expressions for the ratio of the pressure drop in a tapered tube to that in a cylindrical tube for steady flow of a power law fluid were derived; there was good agreement between the predicted and the measured pressure drop ratios over a wide range of flows. The results of this study may be applied to the design of tapered arterial grafts. The pressure losses to be expected in tapered bypass grafts having various dimensions can easily be computed.     

Hooked setae: tests of the anchor hypothesis

Abstract. We tested the hypothesis that hooked setae function as anchors in three species of tubiculous polychaetes ( Eudistylia vancouveri, Schizobranchia insignis , and Owenia fusiformis ). All maintained position within their tubes when exposed to high pressures (up to 100–200 kPa) applied from the posterior direction (where it would tend to cause the tips of hooks to embed in the tube wall). When pressure was applied in the opposite direction, where hooks would not tend to embed in the tube wall, the worms were expelled from their tubes at lower pressures (30–100 kPa). The ability of these worms to maintain their position within their tubes was independent of body size. On the basis of these findings we made three predictions. First, worms that use their hooked setae as anchors should have those hooks located on the body in greatest number and size on the segments associated with greatest worm diameter. Second, as worms increase in size, setal armory should increase in a predictable way. The force that can be applied to extract worms from their tubes by suction feeding fish or wave action would increase as the area subject to suction increases (proportional to the cross sectional area of the tube). Therefore, we predict that setal armory should also increase as a squared function. Third, hooks or uncini should show patterns of wear or loss and/or the worms' bodies should show scars or wounds where the setae are most used (e.g., where worm diameter is at its maximum). All of these predictions were supported by the data and indicate that hooked setae function as anchors for tubiculous polychaetes. This is important for understanding the biology of these animals and has implications for using hooked setae as characters in phylogenetic analyses.     

Effect of initial stresses on the wave propagation in arteries

A theoretical analysis for the problem of wave propagation in arteries is presented. Blood is treated as a Newtonian, viscous incompressible fluid. On the basis of information derived from experimental investigations on the mechanical properties of wall tissues, the arterial wall is considered to be nonlinearly viscoelastic and orthotropic. The analysis is carried out for a cylindrical artery, under the purview of membrane theory, by taking account the effect of initial stresses. The motion of the wall and that of the fluid are assumed to be axisymmetric. Particular emphasis has been paid to the propagation of small amplitude harmonic waves whose wavelength is large compared to the radius of the vessel. By employing the equations of motion of the fluid and those for the wall, together with the equations of continuity, a frequency equation is derived by exploiting the conditions of continuity of the velocity of the arterial wall and that of blood on the endosteal surface of the wall. In order to illustrate the validity of the derived analytical expressions a quantitative analysis is made for the variations of the phase velocities as well as the transmission coefficient with frequency corresponding to different transmural pressures which relate to different initial stresses. Computational results indicate that phase velocities increase with the increase of transmural pressures.     

Compliance characteristics of the hind-limb arterial system of normal and hypertensive rabbits

Pressure transients resulting from square-wave changes in abdominal aortic blood flow rate were used to derive effective arterial compliance and peripheral resistance of the hind-limb circulation of anaesthetized rabbits. The model for deriving these parameters proved applicable if step changes in flow were kept less than 35% of mean flow. Under resting conditions, the effective hind-limb arterial compliance of normal rabbits averaged 3.46 X 10(-3) mL/mmHg (1 mmHg = 133.322 Pa). Hind-limb arterial compliance decreased with increasing pressure at low arterial pressures, but unlike compliance of isolated arterial segments, compliance did not vary at and above normal resting pressures. Baroreflex destimulation (bilateral carotid artery occlusion) caused an increase in effective hind-limb vascular resistance at 48.4% and a decrease of arterial compliance of 50.7%, so that the constant for flow-induced arterial pressure changes (resistance times compliance) was largely unchanged. Similarly, the arterial time constant for rabbits with chronic hypertension was similar to that for controls because threefold increases in hind-limb vascular resistance were offset by decreases in compliance. Reflex-induced decreases in arterial compliance are probably mediated by sympathetic nerves, whereas decreases associated with hypertension are related to wall hypertrophy in conjunction with increased vasomotor tone. Arterial compliance decreased with increasing pressure in hypertensive animals, but this effect was less pronounced than in normotensive rabbits.     

Artery buckling analysis using a four-fiber wall model

Artery bent buckling has been suggested as a possible mechanism that leads to artery tortuosity, which is associated with aging, hypertension, atherosclerosis, and other pathological conditions. It is necessary to understand the relationship between microscopic wall structural changes and macroscopic artery buckling behavior. To this end, the objectives of this study were to develop arterial buckling equations using a microstructure-based 4-fiber reinforced wall model, and to simulate the effects of vessel wall microstructural changes on artery buckling. Our results showed that the critical pressure increased nonlinearly with the axial stretch ratio, and the 4-fiber model predicted higher critical buckling pressures than what the Fung model predicted. The buckling equation using the 4-fiber model captured the experimentally observed reduction of critical pressure induced by elastin degradation and collagen fiber orientation changes in the arterial wall. These results improve our understanding of arterial stability and its relationship to microscopic wall remodeling, and the model provides a useful tool for further studies.     

Effects of transmural pressure and wall shear stress on LDL accumulation in the arterial wall: a numerical study using a multilayered model

The accumulation of low-density lipoprotein (LDL) is recognized as one of the main contributors in atherogenesis. Mathematical models have been constructed to simulate mass transport in large arteries and the consequent lipid accumulation in the arterial wall. The objective of this study was to investigate the influences of wall shear stress and transmural pressure on LDL accumulation in the arterial wall by a multilayered, coupled lumen-wall model. The model employs the Navier-Stokes equations and Darcy's Law for fluid dynamics, convection-diffusion-reaction equations for mass balance, and Kedem-Katchalsky equations for interfacial coupling. To determine physiologically realistic model parameters, an optimization approach that searches optimal parameters based on experimental data was developed. Two sets of model parameters corresponding to different transmural pressures were found by the optimization approach using experimental data in the literature. Furthermore, a shear-dependent hydraulic conductivity relation reported previously was adopted. The integrated multilayered model was applied to an axisymmetric stenosis simulating an idealized, mildly stenosed coronary artery. The results show that low wall shear stress leads to focal LDL accumulation by weakening the convective clearance effect of transmural flow, whereas high transmural pressure, associated with hypertension, leads to global elevation of LDL concentration in the arterial wall by facilitating the passage of LDL through wall layers.     

One-dimensional model for propagation of a pressure wave in a model of the human arterial network: comparison of theoretical and experimental results

Pulse wave evaluation is an effective method for arteriosclerosis screening. In a previous study, we verified that pulse waveforms change markedly due to arterial stiffness. However, a pulse wave consists of two components, the incident wave and multireflected waves. Clarification of the complicated propagation of these waves is necessary to gain an understanding of the nature of pulse waves in vivo. In this study, we built a one-dimensional theoretical model of a pressure wave propagating in a flexible tube. To evaluate the applicability of the model, we compared theoretical estimations with measured data obtained from basic tube models and a simple arterial model. We constructed different viscoelastic tube set-ups: two straight tubes; one tube connected to two tubes of different elasticity; a single bifurcation tube; and a simple arterial network with four bifurcations. Soft polyurethane tubes were used and the configuration was based on a realistic human arterial network. The tensile modulus of the material was similar to the elasticity of arteries. A pulsatile flow with ejection time 0.3 s was applied using a controlled pump. Inner pressure waves and flow velocity were then measured using a pressure sensor and an ultrasonic diagnostic system. We formulated a 1D model derived from the Navier-Stokes equations and a continuity equation to characterize pressure propagation in flexible tubes. The theoretical model includes nonlinearity and attenuation terms due to the tube wall, and flow viscosity derived from a steady Hagen-Poiseuille profile. Under the same configuration as for experiments, the governing equations were computed using the MacCormack scheme. The theoretical pressure waves for each case showed a good fit to the experimental waves. The square sum of residuals (difference between theoretical and experimental wave-forms) for each case was <10.0%. A possible explanation for the increase in the square sum of residuals is the approximation error for flow viscosity. However, the comparatively small values prove the validity of the approach and indicate the usefulness of the model for understanding pressure propagation in the human arterial network.     

Isotropy and anisotropy of the arterial wall

The passive biomechanical response of intact cylindrical rat carotid arteries is studied in vitro and compared with the mechanical response of rubber tubes. Using true stress and natural strain in the definition of the incremental modulus of elasticity, the tissue wall properties are analyzed over wide ranges of simultaneous circumferential and longitudinal deformations. The type of loading chosen is 'physiological' i.e. symmetric: the cylindrical segments are subjected to internal pressure and axial prestretch without torsion or shear. Several aspects pertaining to the choice of parameters characterizing the material are discussed and the analysis pertaining to the deformational behavior of a hypothetical compliant tube with Hookean wall material is presented. The experimental results show that while rubber response can be adequately represented as linearly elastic and isotropic, the overall response of vascular tissue is highly non-linear and anisotropic. However, for states of deformation that occur in vivo, the elasticity of arteries is quite similar to that of rubber tubes and as such the arterial wall may be viewed as incrementally isotropic for the range of deformations that occur in vivo.     

Effect of Methylcellulose on Rectal and Colonic Pressures in Treatment of Diverticular Disease

Six patients with diverticular disorder confirmed by barium-enema examination were given a six-month course of methylcellulose (Celevac) tablets; their rectal and rectosigmoid colonic pressures were measured before and afterwards. Open-tipped, fluid-filled, narrow-bore polyethylene tubes were used for pressure measurements and care was taken to site the tubes similarly in all patients before and after treatment. After methylcellulose treatment the mean rectosigmoid pressures had fallen to the same range as the mean rectal pressures, a highly significant reduction. Methylcellulose significantly reduces rectosigmoid pressures in diverticular disease.     

Radial construction of an arterial wall

Some of the most serious diseases involve altered size and structure of the arterial wall. Elucidating how arterial walls are built could aid understanding of these diseases, but little is known about how concentric layers of muscle cells and the outer adventitial layer are assembled and patterned around endothelial tubes. Using histochemical, clonal, and genetic analysis in mice, here we show that the pulmonary artery wall is constructed radially, from the inside out, by two separate but coordinated processes. One is sequential induction of successive cell layers from surrounding mesenchyme. The other is controlled invasion of outer layers by inner layer cells through developmentally regulated cell reorientation and radial migration. We propose that a radial signal gradient controls these processes and provide?evidence that PDGF-B and at least one other signal contribute. Modulation of such radial signaling pathways may underlie vessel-specific differences and pathological changes in arterial wall size and structure. VIDEO ABSTRACT:     

Hearts, neck posture and metabolic intensity of sauropod dinosaurs

Hypothesized upright neck postures in sauropod dinosaurs require systemic arterial blood pressures reaching 700 mmHg at the heart. Recent data on ventricular wall stress indicate that their left ventricles would have weighed 15 times those of similarly sized whales. Such dimensionally, energetically and mechanically disadvantageous ventricles were highly unlikely in an endothermic sauropod. Accessory hearts or a siphon mechanism, with sub-atmospheric blood pressures in the head, were also not feasible. If the blood flow requirements of sauropods were typical of ectotherms, the left-ventricular blood volume and mass would have been smaller; nevertheless, the heart would have suffered the serious mechanical disadvantage of thick walls. It is doubtful that any large sauropod could have raised its neck vertically and endured high arterial blood pressure, and it certainly could not if it had high metabolic rates characteristic of endotherms.     

Tube flow of human blood at near zero shear

Pressure-velocity relations were obtained in vertical and horizontal glass tubes (I.D. 26 to 83 micron) perfused with normal human blood at feed hematocrits between 0.25 and 0.65. Perfusion pressures used corresponded to wall shear stresses up to 0.27 dyn cm-2. Red cell velocity measurements were made both immediately following implementation of perfusion pressure (with red cells still disaggregated) and in a steady state situation (with red cells aggregated). Analysis of the slopes of the linear relations between perfusion pressure and velocity showed apparent viscosity to decrease with the manifestation of red cell aggregation. In horizontal tubes, sedimentation and aggregation occurred simultaneously, and apparent viscosity increased due to axial asymmetry of cell concentration. Evidence for a yield shear stress (flow stagnation at positive driving pressure) was not observed.     

Non-invasive quantification of peripheral arterial volume distensibility and its non-linear relationship with arterial pressure

Arterial wall function is associated with different physiological and clinical factors. Changes in arterial pressure cause major changes in the arterial wall. This study presents a simple non-invasive method to quantify arterial volume distensibility changes with different arterial pressures.The electrocardiogram, finger and ear photoplethysmogram were recorded from 15 subjects with the right arm at five different positions (90°, 45°, 0°, ?45° and ?90° referred to the horizontal level). Arm pulse propagation time was determined by subtracting ear pulse transit time from finger pulse transit time, and was used to obtain arterial volume distensibility. The mean arterial blood pressure with the arm at the horizontal level was acquired, and changes with position were calculated using the hydrostatic principle that blood pressure in the arm is linearly related to its vertical distance from the horizontal level.The mean arm pulse propagation times for the five different positions were 88, 72, 57, 54 and 52 ms, with the corresponding mean arterial volume distensibility of 0.234%, 0.158%, 0.099%, 0.088% and 0.083% per mmHg. For all consecutive changes in arm position, arm pulse propagation time and arterial volume distensibility, were significantly different (all probability P<0.05). The slopes of arm pulse propagation time and arterial volume distensibility against arterial pressure decreased significantly between each consecutive arm position from 90° to ?45° (all P<0.01), indicating significant non-linearity.The experimental results fitted the physiological exponential model and Langewouters’ arctangent model well, and were also comparable to published data with arterial volume distensibility approximately tripling for transmural pressure changes from 101 to 58 mmHg.In conclusion, the inverse and non-linear relationship between arterial volume distensibility and arterial pressure has been quantified using a simple arm positioning procedure, with the greatest effect at low pressures. This work is an important step in developing a simple non-invasive technique for assessing peripheral arterial volume distensibility.     

Biomechanical adaptation of porcine carotid vascular smooth muscle to hypo and hypertension in vitro

Previous research in arterial remodeling in response to changes in blood pressure seldom included both hyper- and hypotension. To compare the effects of low and high pressure on arterial remodeling and vascular smooth muscle tone and performance, we have utilized an in vitro model. Porcine carotid arteries were cultured for 3 days at 30 and 170mmHg and compared to controls cultured at 100mmHg for 1 and 3 days. On the first and last day of culture, pressure-diameter and pressure-wall thickness curves were measured under normal smooth muscle tone using a high-resolution ultrasonic device. Last-day experiments included measurements where vascular smooth muscle was contracted or totally relaxed. From the data wall cross-sectional area, Hudetz elastic modulus and a contraction index related to the diameter reduction under normal smooth muscle tone were calculated. We found that although wall cross-sectional area (indicating wall mass) did not change much, Hudetz elastic modulus was significantly reduced in the 3-day hypotension group. Inspection of the wall contraction index suggests that this is due to a reduction in the vascular smooth muscle tone. Further, the peak of contraction index was found to be shifted to higher pressures in the 3-day 170mmHg group. We conclude that vascular smooth muscle performance adapts to both hypo- and hypertension at short time scales and can alter the biomechanics of the vascular wall in vitro.     

The role of the surrounding tissue in the propagation of waves through the arterial system.

A theoretical analysis of the flow in arteries is presented, taking into consideration the role played by the surrounding tissues in determining the speed of propagatoion and the damping of the blood pressure pulse. This study was undertaken (a) to exhibit a method of computing the flow properties with a more nearly accurate model, (b) to see if the displacement on the skin would be related to the arterial wall displacement, and hence to pressure, velocity and flow rate of blood in the artery, and if it is likely to be measurable. It was found that the pressure of the 'viscous' part in the surrounding tissue increases the pulse velocity and the damping of the wave over the values found by other models which considered only thick-walled elastic tubes with no surrounding tissue. This study also shows that measurements on the skin can provide information about changes in arterial circulation due to diseases such as: edema, arteriosclerosis and others where the Young's modulus for either the arterial wall or the surrounding tissues is altered.     

Pulmonary artery calcification in racehorses may be related to transient and repeated increases in arterial pressure during exercise

Calcification of the pulmonary artery has been found in a large number of racing horses. The majority of calcified lesions are found immediately distal to the primary arterial bifurcation. Increased arterial wall stress levels have been previously demonstrated at these locations, with the wall stress levels increasing under intra-luminal pressures associated with exercise. We hypothesize therefore that the formation of calcified lesions is mediated by transient and repeated increases in pulmonary artery intra-luminal pressure. The presence of calcified lesions would likely further exacerbate the levels of wall stress, leading to growth of the lesions. A level of wall stress may exist above which calcified lesions form, and a second level may exist above which the calcified lesions grow at an increased rate. A computer model of pulmonary artery wall stress with calcified lesions was created, and wall stress levels were found to be greatest at the periphery of the calcified lesions. Osteo/chondrocyte-like cells have also been found at the periphery of the calcified lesions and could be responsible for collagen deposition and lesion growth, mediated by local wall stress levels. These increased levels of wall stress could place racehorses at a greater risk of acute pulmonary arterial rupture at the site of the calcified lesions, due to the high levels of intra-luminal pressure within the pulmonary artery during exercise. The hypothesis may also have implications in the etiology of human vascular diseases.     

The principle of laplace and scaling of ventricular wall stress and blood pressure in mammals and birds

Maximum left ventricular wall stress is calculated at end-diastolic volume and systemic arterial diastolic blood pressure, according to a thick-walled model for the principle of Laplace. Stress is independent of body mass and averages 13.9 kPa (+/-2.3; 95% confidence interval) in 24 species of mammals weighing 0.025-4,000 kg and 15.5 kPa (+/-4.7) in 12 birds weighing 0.014-110 kg. Birds have higher arterial blood pressures and larger hearts than mammals. Systolic and diastolic arterial blood pressures increase with body mass according to M(0.05) in mammals, and heart mass increases according to M(1.06) in the same species, further supporting the principle. However, blood pressure in birds is independent of body mass, and heart mass scales isometrically. End-diastolic stress values, calculated according to Laplace, are about one-third of peak stresses recorded in isolated mammalian myocardial preparations.