Книги: "Preloads"

1

Woodend, Dianne. The effect of sucrose and safflower oil preloads on satiety, mood and memory. Ottawa: National Library of Canada, 2000.

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2

Bell, K. The effects of multiple preloads on subsequent low temperature fracture of a pressure vessel steel. Cambridge: TWI, 1997.

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3

Zeggeren, Alexandra Van. 5-hydroxytryptamine metabolism and feeding behavior in lean and obese Zucker rats after intragastric carbohydrate preloads. Ottawa: National Library of Canada, 1990.

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4

Crawford, James MacKenzie. Multiple boundary condition testing for preloaded membrane structures. [Toronto, Ont]: Graduate Dept. of Aerospace Science and Engineering, University of Toronto, 1994.

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5

Zhong, Cai, and United States. National Aeronautics and Space Administration., eds. Development of hypersonic engine seals: Flow effects of preload and engine pressures. [Washington, DC: National Aeronautics and Space Administration, 1993.

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6

Crombie, Carrie Anne. Effect of a sucrose preload on food intake subjective measures of appetite in 9 and 10 year old healthy children. Ottawa: National Library of Canada, 1992.

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7

Laine, Daniel Petri. Effect of axial preloads on confined concrete. 2004.

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8

Vince, Daniel, Branscomb Caleb, and United States. National Aeronautics and Space Administration., eds. The effects of tensile preloads on the impact response of carbon/epoxy laminates. [Washington, D.C: National Aeronautics and Space Administration, 1995.

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9

The effects of tensile preloads on the impact response of carbon/epoxy laminates. [Washington, D.C: National Aeronautics and Space Administration, 1995.

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10

United States. National Aeronautics and Space Administration., ed. The effects of compressive preloads on the compression-after-impact strength of carbon/epoxy. [Washington, D.C: National Aeronautics and Space Administration, 1994.

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11

United States. National Aeronautics and Space Administration., ed. The effects of compressive preloads on the compression-after-impact strength of carbon/epoxy. [Washington, D.C: National Aeronautics and Space Administration, 1994.

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12

G, Lance D., and United States. National Aeronautics and Space Administration. Scientific and Technical Information Program., eds. The effects of compressive preloads on the compression-after-impact strength of carbon/epoxy. [Washington, DC]: National Aeronautics and Space Administration, Office of Management, Scientific and Technical Information Program, 1992.

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13

G, Lance D., and United States. National Aeronautics and Space Administration. Scientific and Technical Information Program., eds. The effects of compressive preloads on the compression-after-impact strength of carbon/epoxy. [Washington, DC]: National Aeronautics and Space Administration, Office of Management, Scientific and Technical Information Program, 1992.

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14

D'Aulaire, Ingri, and Edgar Parin D'Aulaire. BENJAMIN FRANKLIN (preload). Doubleday Books for Young Readers, 1987.

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15

ROGET'S THESAURUS (21C) (preload). Delacorte Press, 1992.

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16

Esfahbod, Behdad. Preload: An adaptive prefetching Daemon. 2006.

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17

Ward, Phoenix. Preloaded: An Installed Intelligence Prequel Collection. Independently Published, 2018.

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18

United States. National Aeronautics and Space Administration., ed. Preloaded joint analysis methodology for space flight systems. [Washington, DC]: National Aeronautics and Space Administration, 1995.

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19

National Aeronautics and Space Administration (NASA) Staff. Preloaded Joint Analysis Methodology for Space Flight Systems. Independently Published, 2018.

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20

Development of hypersonic engine seals: Flow effects of preload and engine pressures. [Washington, DC: National Aeronautics and Space Administration, 1993.

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21

M, Johnston L., Czekalski B, and George C. Marshall Space Flight Center., eds. Effect of flange bolt preload on space shuttle main engine high pressure oxidizer turbopump housing analysis. [Huntsville, Ala.]: National Aeronautics and Space Administration, George C. Marshall Space Flight Center, 1991.

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22

M, Johnston L., Czekalski B, and George C. Marshall Space Flight Center., eds. Effect of flange bolt preload on space shuttle main engine high pressure oxidizer turbopump housing analysis. [Huntsville, Ala.]: National Aeronautics and Space Administration, George C. Marshall Space Flight Center, 1991.

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23

Montgomery, Hugh, and Rónan Astin. Normal physiology of the cardiovascular system. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0128.

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Preload modulates contractile performance, and is determined by end-diastolic volume (EDV) and ventricular compliance. Compliance falls with increasing preload, muscle stiffness or ventricular hypertrophy, making central venous pressure (CVP) a poor surrogate for EDV. Responsiveness to fluid loading can be identified by seeking a change in stroke volume (SV) with changes in cardiac loading. Afterload, the force to be overcome before cardiac muscle can shorten to eject blood, rises with transmural pressure and end-diastolic radius, and inversely with wall thickness. Afterload, being the tension across the ventricular wall, is influenced by pleural pressure. Reductions in afterload increase SV for any cardiac work, as do reductions in vascular resistance. Resistance is modified by changes in arteriolar cross-sectional area. A rise in resistance increases blood pressure and microvascular flow velocity. Increased resistance may reduce CO if cardiac work cannot be augmented sufficiently. Flow autoregulationis the ability of vascular beds to maintain constant flow across varied pressures by adjusting local resistance.

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24

Paul, Lin, and United States. National Aeronautics and Space Administration. Scientific and Technical Information Program., eds. Influence of mass moment of inertia on normal modes of preloaded solar array mast. [Washington, DC]: National Aeronautics and Space Administration, Office of Management, Scientific and Technical Information Program, 1992.

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25

Stepway, Garmin. Garmin Approach S20, GPS Golf Watch with Step Tracking, Preloaded Courses, Black User's Manual. Independently Published, 2019.

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26

HHCHM, Garmin Stepway. Garmin Approach S20, GPS Golf Watch with Step Tracking, Preloaded Courses, Black User's Manual: Hhchm. Independently Published, 2019.

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27

S, Lake Mark, and Langley Research Center, eds. Analysis of a single-fold deployable truss beam preloaded by extension of selected face diagonal members. Hampton, Va: National Aeronautics and Space Administration, Langley Research Center, 1986.

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28

Analysis of a single-fold deployable truss beam preloaded by extension of selected face diagonal members. Hampton, Va: National Aeronautics and Space Administration, Langley Research Center, 1986.

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29

Voilliot, Damien, Jaroslaw D. Kasprzak, and Eduardo Bossone. Diseases with a main influence on right ventricular function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0060.

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As an important and independent predictive factor of morbidity and mortality, right ventricular (RV) function should be carefully assessed in patients with chronic obstructive lung disease, lung fibrosis, liver cirrhosis, or obesity. RV assessment requires a complete study of the ‘RV-pulmonary circulation unit’ with estimation of RV preload, RV intrinsic contractility, and RV afterload. Therefore, estimation of pulmonary arterial pressure, pulmonary vascular resistance, and left ventricular systolic and diastolic function should be included in this evaluation, in addition to conventional RV systolic function assessment. Three-dimensional echocardiography has emerged as an interesting tool in RV assessment and exercise echocardiography may be interesting in the risk stratification of patients.

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30

Weyker, Paul David, Christopher Allen-John Webb, and Tricia E. Brentjens. Hypovolemic Shock. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0097.

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Broadly defined, hypovolemia represents inadequate circulating plasma volume leading to decreased cardiac preload and thus decreased cardiac output and blood pressure. Many classification schemes have been proposed to categorize hypovolemia based on relative levels of decreased plasma volume. Common causes of hypovolemic shock during the perioperative period include hemorrhage and diuretic use. In general, studies support a conservative hemoglobin goal of about 7 g/dL as compared with a liberal goal of 10 g/dL in hemodynamically stable patients without active cardiac ischemia or risk factors. In patients with large volume blood loss, institutionally approved massive transfusion protocols can help provide blood products quickly. The trauma literature supports a balanced massive transfusion protocol using a 1:1:1 (plasma:platelet:red blood cell) strategy of transfusion.

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31

Yarlagadda, Vamsi V., and Ravi R. Thiagarajan. Cardiac Disease in Pediatric Intensive Care. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0007.

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This chapter on cardiac disease in pediatric intensive care provides essential information on cardiovascular physiology, how to assess cardiovascular and hemodynamic status, and principles of treatment of congenital and acquired cardiac disease in children. The review of physiology includes definitions of preload, afterload, oxygen content, cardiac output, vascular resistance, blood pressure, and cardiopulmonary interactions. Formulas to calculate key parameters are provided. The authors also summarize the presentation and care of most common cyanotic and acyanotic congenital heart defects, including treatment of low cardiac output syndrome, clinical sequelae of cardiopulmonary bypass, and the key aspects of treating pre- and postoperative patients with single-ventricle lesions (e.g., hypoplastic left heart syndrome). All three stages of single-ventricle palliation are discussed, with management summaries of children undergoing the Norwood, bidirectional Glenn, and Fontan operations. Finally, the chapter includes a discussion of the clinical presentation and management of viral myocarditis and cardiomyopathy.

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32

Arulkumaran, Nishkantha, and Maurizio Cecconi. Cardiac output assessment in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0136.

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Haemodynamic monitoring facilitates effective resuscitation and the rapid assessment of the response to time-dependent vasoactive and fluid therapyin different shock states. Since the introduction of the pulmonary artery catheter, several minimally and non-invasive CO monitoring devices have been introduced to provide continuous monitoring and a dynamic profile of fluid responsiveness. Several of these monitors provide additional haemodynamic parameters including dynamic indices of preload and volumetric indices. Patient outcome is dependent accurate acquisition and interpretation of data and subsequent management. Whilst data from CO monitors offer valuable information on global hamodynamics, they do not preclude tissue hypoperfusion. Furthermore, there is no ‘ideal’ CO value for an individual patient, and the trend in haemodynamic parameters in response to therapy may be more informative than the absolute values. CO monitoring should be based upon the patient’s needs, the clinical scenario, and the experience of the treating physician.

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33

Kreit, John W. Cardiovascular–Pulmonary Interactions. Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0003.

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Intramural pressures within a tube or circuit determine the rate and direction of flow, whereas the transmural pressure of an elastic structure determines its volume. In Chapter 1, we applied these principles when talking about the pressure needed to overcome viscous forces and elastic recoil during ventilation. In this chapter, we use them to explain changes in blood flow between two portions of the circulatory system and changes in the volume and size of the heart chambers. Cardio–Pulmonary Interactions provides an overview of essential cardiovascular physiology as well as an in-depth discussion of how and why changes in pleural, alveolar, lung transmural, and intra-abdominal pressure during spontaneous and mechanical ventilation can alter right and left ventricular preload, afterload, and stroke volume, cardiac output, and blood pressure. The chapter also reviews the beneficial and detrimental effects of positive end-expiratory pressure (PEEP) on cardiovascular function.

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34

Vieillard-Baron, Antoine. Right ventricular function in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0135.

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Under normal conditions, the right ventricle (RV) virtually acts as a passive conduit. In critically-ill patients many situations induce uncoupling between the right ventricle and pulmonary circulation, leading to RV systolic dysfunction, then failure. Mechanical ventilation has a major impact by decreasing RV preload, but also significantly increasing RV afterload. RV function should thus always be interpreted and re-evaluated in the light of respiratory mechanics and ventilator settings. RV systolic function is key to the patient’s haemodynamic profile and must be monitored to achieve optimal haemodynamic management. Echocardiography is the best compromise between clinical effectiveness and invasiveness to monitor RV function. A limitation is its inability to monitor haemodynamics continuously. Acute cor pulmonale is defined by the combination of RV dilatation with paradoxical septal motion during systole. In conclusion, RV function monitoring is strongly recommended in many situations encountered in the intensive care unit, such as ARDS, septic shock, and pulmonary embolism. Many devices are available, but echocardiography constitutes the best compromise between accuracy and invasiveness.

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35

Orenbuch-Harroch, Efrat, and Charles L. Sprung. Pulmonary artery catheterization in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0133.

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Haemodynamic monitoring is a significant component in the management of critically-ill patients. Flow-directed pulmonary artery catheters (PAC) are a simple and rapid technique for measuring several continuous or intermittent circulatory variables. The PAC is helpful in diagnosis, guidance of therapy, and monitoring therapeutic interventions in various clinical conditions, including myocardial infarction and its complications, non-cardiogenic pulmonary oedema and severely ill patients.The catheter is inserted through a large vein. The PAC is advanced, after ballooninflation with 1.5 mL of air, through the right ventricle across the pulmonary valve and into the pulmonary artery (PA). Finally, the catheter is advanced to the ‘wedge’ position. The pulmonary artery wedge pressure (PAWP) is identified by a decrease in pressure combined with a characteristic change in the waveform. The balloon should then be deflated and the PA tracing should reappear. Direct measurements include central venous pressure, pulmonary artery pressure, and PAWP, which during diastole represents the left ventricular end-diastolic pressure and reflects left ventricular preload. Cardiac output can be measured by thermodilution technique. Other haemodynamic variables can be derived from these measurements. Absolute contraindications are rare. Relative contraindications include coagulopathy and conditions that increase the risk of arrhythmias.

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36

Salor, Eustaquio Sánchez, Carlos Salvador Díaz, Juan María Gómez Gómez, Cláudia Teixeira, and Armando Senra Martins. Instituição da Gramática ampliada e explicada por António Velez. Tomo II: Morfologia II: género dos nomes. Sobre a declinação dos nomes. analogia e anomalia. Pretéritos e supinos. Imprensa da Universidade de Coimbra, 2020. http://dx.doi.org/10.14195/978-989-26-1661-2.

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Nascida a um tempo da renovação do humanismo, do qual bebeu o seu arreigamento ao texto e à autoridades de autores clássicos, e do programa pedagógico da Companhia de Jesus, a Instituição da gramática de Manuel Álvares, publicada em 1572, conheceu uma receção ampla no tempo (até ao séc. XIX) como no espaço (com várias edições europeias mas também no Oriente e no Novo Mundo). Na linha do programa pedagógico inaciano a obra conserva uma viva preocupação pela dimensão didática patente na procura de uma estrutura e de uma exposição que, não obstante prolixa exploração de aspetos particulares, têm em vista a compreensão do aluno e a sua capacidade recetiva. Tomando por base a versão ampliada e reformulada que o jesuíta, António Velez, deu aos prelos em 1598, este primeiro volume respeitante à Morfologia pretende dar a conhecer ao público um documento fundamental para a cultura portuguesa.

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37

Salor, Eustaquio Sánchez, Carlos Salvador Díaz, Juan María Gómez Gómez, Cláudia Teixeira, and Armando Senra Martins. Instituição da Gramática ampliada e explicada por António Velez. Tomo I: Morfologia I: paradigmas do nome, pronome e verbo. Rudimentos ou princípios básicos das oito partes da oração. Imprensa da Universidade de Coimbra, 2020. http://dx.doi.org/10.14195/978-989-26-1982-8.

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Nascida a um tempo da renovação do humanismo, do qual bebeu o seu arreigamento ao texto e à autoridades de autores clássicos, e do programa pedagógico da Companhia de Jesus, a Instituição da gramática de Manuel Álvares, publicada em 1572, conheceu uma receção ampla no tempo (até ao séc. XIX) como no espaço (com várias edições europeias mas também no Oriente e no Novo Mundo). Na linha do programa pedagógico inaciano a obra conserva uma viva preocupação pela dimensão didática patente na procura de uma estrutura e de uma exposição que, não obstante prolixa exploração de aspetos particulares, têm em vista a compreensão do aluno e a sua capacidade recetiva. Tomando por base a versão ampliada e reformulada que o jesuíta, António Velez, deu aos prelos em 1598, este primeiro volume respeitante à Morfologia pretende dar a conhecer ao público um documento fundamental para a cultura portuguesa.

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38

Raghunathan, Karthik, and Andrew Shaw. Crystalloids in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0057.

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‘Crystalloid’ refers to solutions of crystalline substances that can pass through a semipermeable membrane and are distributed widely in body fluid compartments. The conventional Starling model predicts transvascular exchange based on the net balance of opposing hydrostatic and oncotic forces. Based on this model, colloids might be considered superior resuscitative fluids. However, observations of fluid behaviour during critical illness are not consistent with such predictions. Large randomized controlled studies have consistently found that colloids offer no survival advantage relative to crystalloids in critically-ill patients. A revised Starling model describes a central role for the endothelial glycocalyx in determining fluid disposition. This model supports crystalloid utilization in most critical care settings where the endothelial surface layer is disrupted and lower capillary pressures (hypovolaemia) make volume expansion with crystalloids effective, since transvascular filtration decreases, intravascular retention increases and clearance is significantly reduced. There are important negative consequences of both inadequate and excessive crystalloid resuscitation. Precise dosing may be titrated based on functional measures of preload responsiveness like pulse pressure variation or responses to manoeuvres such as passive leg raising. Crystalloids have variable electrolyte concentrations, volumes of distribution, and, consequently variable effects on plasma pH. Choosing balanced crystalloid solutions for resuscitation may be potentially advantageous versus ‘normal’ (isotonic, 0.9%) saline solutions. When used as the primary fluid for resuscitation, saline solutions may have adverse effects in critically-ill patients secondary to a reduction in the strong ion difference and hyperchloraemic, metabolic acidosis. Significant negative effects on immune and renal function may result as well.

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39

Sidhu, Kulraj S., Mfonobong Essiet, and Maxime Cannesson. Cardiac and vascular physiology in anaesthetic practice. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0001.

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This chapter discusses key components of cardiovascular physiology applicable to clinical practice in the field of anaesthesiology. From theory development to ground-breaking innovations, the history of cardiac and vascular anatomy, as well as physiology, is presented. Utilizing knowledge of structure and function, parameters created have allowed adequate patient clinical assessment and guided interventions. A review of concepts reveals the impact of multiple physiological variables on a patient’s haemodynamic state and the need for more accurate and efficient measurements. In particular, it is noted that a more reliable index of ventricular contractility is the end-systolic elastance rather than the ejection fraction. Constant direct preload assessment has not yet been achieved but continues to be determined through surrogate variables, and continuous cardiac output monitoring for oxygen delivery, although advancing, has limitations. Considering the effect of compound factors perioperatively, especially heart failure, modifies the goals and interventions of anaesthetists to achieve improved outcomes. Therefore, medical management prior to surgery and complete assessment through history, physical examination, and diagnostic tests are a priority. This chapter also details the expectations following volume expansion to augment haemodynamics during surgery, the concept of functional haemodynamic monitoring, and limitations to the parameters applied in assessing fluid responsiveness. Challenging the accuracy of conventional indices to predict volume status led to the use of goal-directed therapy, reducing morbidity and minimizing length of hospital stay. The mainstay of this chapter is to reinforce the relevance of advances in haemodynamic monitoring and homeostasis optimization by anaesthetists during surgery, using fundamental concepts of cardiovascular physiology.

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