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Biomedical subjects

A Deller

Publications and source records attributed to A Deller.

33 records · Page 2Linked to original sources
PubMed1990

[Case report: lumen obstruction with a Magill tube].

A case is reported where a reusable red rubber tube was obstructed by a plastic capsule. This capsule was part of a washing machine for cleaning of reusable anaesthetic equipment. As a consequence we recommend the examination for free passage of each endotracheal tube before use.

Adult↗
PubMed1990

[Bacterial pneumonia in ventilated patients. The role of bronchoalveolar lavage in diagnosis and therapy].

In the diagnosis and treatment of bacterial pneumonia, the isolation and resistance pattern of the causative organisms are very relevant. Bronchoalveolar lavage (BAL) with quantitative culture is the best technique to obtain material for bacteriological investigations in nonintubated medical patients and in a baboon model. The present study was designed to clarify the following questions: What is the value of BAL compared to tracheal secretion (TS) in ventilated patients with regard to antibiotic therapy? Is it possible to distinguish colonization and infection by investigation of BAL? MATERIAL AND METHODS. In 34 ventilated patients, we studied the diagnostic and therapeutic value of BAL in comparison to TS. Thirteen patients suffered from pneumonia, 9 patients were colonized, and in 12 pneumonia was uncertain. These terms are defined as follows: 1. Pneumonia: temperature over 38.5 degrees C, leukocyte count over 12,000/mm3, infiltrate in the x-ray compatible with pneumonia, purulent tracheal secretion, positive bacteriological findings. All criteria must be fulfilled. 2. Colonized patients: mechanical ventilation more than 7 days, no signs of infection, isolation of the same bacteria species in two previously obtained tracheal secretions. 3. Uncertain pneumonia: not all criteria mentioned above were fulfilled. BAL was performed in the usual manner. The bronchoscope was wedged into a distal airway and 6 x 20 ml of sterile, nonbacteriostatic saline (0.9% NaCl) was instilled through the suction channel and subsequently aspirated. All investigation materials were immediately processed in the bacteriological laboratory. From the BAL specimen Giemsa and Gram preparations were performed to look for contamination from the throat and intracellular bacteria. RESULTS. Patients with pneumonia: In all patients the TS and BAL were positive. Cultures from BAL and TS were in agreement in 77% of the cases. In 10 patients intracellular bacteria (BAL) were present, in two patients the Gram preparation was nonapplicable because of destroyed cells. In one patient Haemophilus spp. could be isolated in the BAL (10(5)/ml BAL), but not in TS, which definitely influenced therapy. Colonized patients: In all patients TS and BAL were positive, with exact agreement in 33% of the cases. The concentration of isolated bacteria (BAL) was not as high in these patients as in the patients with pneumonia (median: 8 X 10(3) vs 6 X 10(4]. However BAL allowed no differentiation between colonization and infection in individual cases. Uncertain pneumonia: TS was positive in 8 patients, no TS could be obtained in 4. BAL was sterile in 4. Only in 2 bacteria greater than or equal to 10(4)/ml were isolated and both patients had intracellular bacteria. The results (BAL) influenced therapy in 5 cases (4 patients received no antibiotics; in 1 patient the antibiotics were modified). CONCLUSION. BAL is very helpful in patients suspected of having pneumonia and in sepsis of unknown origin when pneumonia should be excluded...

Adult↗
PubMed1989

Serum phospholipase A2 in intensive care patients with peritonitis, multiple injury, and necrotizing pancreatitis.

To study the source and role of circulating phospholipase A2 (PLA2) catalytic activity we monitored the serum from patients with necrotizing pancreatitis (n = 8), diffuse peritonitis (n = 6), and multiple injuries (n = 11). Immunoreactive PLA2 serum protein concentration was analysed using a fluoroimmunoassay based on an antibody against human pancreatic PLA2. Serum PLA2 catalytic activity was analysed using a radiochemical method based on a substrate with tritiated palmitic acid in beta position. In necrotizing pancreatitis immunoreactive PLA2 and PLA2 catalytic activity both increased. Obviously, in necrotizing pancreatitis the major part of serum catalytic activity stems from the pancreas. In patients with diffuse peritonitis and multiple injuries, as a rule, immunoreactive phospholipase A2 serum concentration appears to be within the normal range. In contrast, in these patients we demonstrated high serum catalytic PLA2 activity comparable to that in necrotizing pancreatitis. The source of catalytic PLA2 activity in peritonitis and multiple injuries seems not to be the pancreas. There was a correlation between pulmonary insufficiency and serum PLA2 catalytic activity in patients with necrotizing pancreatitis, peritonitis, and multiple injuries.

Acute Disease↗
PubMed1989

[Pneumonia in artificially ventilated patients: the significance of Gram preparation und bronchoscopic specimen collection methods in diagnosis and therapy].

The value of the Gram preparation of tracheal secretion compared to bacterial culture was checked in 48 patients with lower respiratory tract infections under mechanical ventilation with regard to antibiotic therapy. In 20 patients attention was also paid to the information value of a bronchial secretion obtained bronchoscopically using a brush. In 34 patients (71%) there was an exact agreement between the result of the Gram preparation and that of the culture. The antibiotic therapy initially administered on the basis of the Gram preparation from the tracheal secretion had to be corrected in 6 patients (12.5%) according to the culture and resistance results and in 6 patients (12.5%) because clinical improvement had not occurred after three days. Only 67% of the bacteria found in the tracheal secretion were isolated also with the bronchoscopic brush technique. The antibiotic therapy was not altered on the basis of the result obtained by bronchoscopy in any case. We conclude that for calculated antibiotic therapy Gram preparation has great significance. Bronchoscopic methods of obtaining material did not influence antibiotic therapy in bacterial pneumonia.

Bacterial Infections↗
PubMed1989

[Decrease in paO2 following intratracheal application of a local anesthetic and a 0.9% sodium chloride solution. A prospective study on the use of fiberoptic bronchoscopy in ventilated patients during local anesthesia].

Flexible fiberoptic bronchoscopy of intubated patients can be performed in general or local anesthesia (LA). Up to now, no results have been published on the effects of LA for bronchoscopy in ventilated patients. We studied the hemodynamic changes caused by bronchoscopy under LA in mechanically ventilated patients and the effect of LA on the endoscopic decline in arterial pO2. Differences between the widely used agents lidocaine and oxybuprocaine hydrochloride were also studied. We found a decline in paO2 after the administration of LA and further investigated the influence of bronchial lavage on paO2. METHOD. A total of 70 ventilator patients, excluding patients with atelectasis, massive mucous-plug retention, and those under muscle relaxants, were examined in a surgical intensive care unit. In 40 long-term ventilator patients bronchoscopy was performed with either oxybuprocaine hydrochloride 1% (Novesin) (group 1; n = 20) or Lidocaine 1% (Xylocaine) (group 2; n = 20) (2-3 ml LA in repeated doses into the trachea and main bronchi; total amount 10 ml). We looked for hemodynamic changes and effects of LA on the bronchoscopic decline in paO2. In 15 long-term ventilator patients (group 3), LA was applied without bronchoscopy to investigate the duration of the LA-caused decline in paO2. In 15 intubated patients (group 4), the influence of intratracheal administration of 10 ml normal saline was examined. Patient data are shown in Table 2. Measurements were performed in groups 1 and 2 before and after LA, immediately after bronchoscopy and 15, 30, and 60 min after bronchoscopy and in groups 3 and 4 before and 5, 15, 30, and 60 min after LA. RESULTS. There was no effect on cardiocirculatory function during bronchoscopy in LA, but we found a decrease in paO2 after administration of LA in all patients (median in group 1 from 100 to 78 mmHg in group 2 from 104 to 86 mmHg). The subsequent bronchoscopy caused only a small, nonsignificant further decline in paO2. The administration of LA without bronchoscopy (group 3) was followed by a fall in paO2 from 86 +/- 12.5 to 69 +/- 11.7 mmHg (mean +/- SD) with oxybuprocaine hydrochloride and from 87 +/- 12.4 to 72 +/- 8.7 mmHg with lidocaine. Even after 30 min the paO2 had not returned to the initial value. The intratracheal application of 10 ml 0.9% NaCl caused a decline in paO2 from 101 +/- 20 to 78 +/- 12 mmHg (mean +/- SD), which also persisted for more than 30 min. CONCLUSIONS. The study shows that in ventilator patients undergoing fiberoptic bronchoscopy in LA, the administration of the LA is an essential factor in the decline in paO2 associated with bronchoscopy. A similar fall in paO2 is observed by intratracheal

Adolescent↗
PubMed1989

[Acute respiratory distress syndrome of the adult (ARDS) and artificial respiration--results in surgical intensive care patients].

A prospective clinical trial was performed in an operative intensive care unit to examine the incidence and outcome of patients with adult respiratory distress syndrome (ARDS) and the outcome of intensive care patients on mechanical ventilation and the incidence of barotrauma and pulmonary infection. 161 mechanically ventilated patients showed an overall mortality of 19.9%. The mortality rate in the ARDS patients was 11 of 26. Most of these patients with ARDS died from multiorgan failure. Pulmonary infection was the most frequently registrated complication of mechanical ventilation. We conclude from these data that --according to the literature the outcome of surgical ICU patients on mechanical ventilation with and without ARDS is more favourable than that of medical ICU patients; --the interpretation of therapeutic results and of epidemiological data in ARDS patients is possible only by providing exact and detailed criteria; these should include compliance data; --evaluation of present ARDS therapy by comparison to previous data, even when the same criteria are applied, e.g. ECMO-criteria, may fail as the outcome of conventional therapeutic measurements - mechanical ventilation - may have improved. A controlled randomised trial might be more suitable for evaluation of alternative therapy in ARDS.

Adolescent↗
PubMed1988

[Alarms of medical-technical equipment in the surgical intensive care unit. A prospective study].

To test the need for a graded system of alarms on ICU we examined this aspect of present management by recording the number of devices and alarm-releasing facilities, the interpretation of alarms and type of response of the nursing staff. The data were recorded on multiphase basis at the operative ICU of a university hospital. The mean number of devices per patient was 4.3 and per room 11.5. The mean interval between 2 alarms was 5 min 30 s. In more than 50 per cent the first reaction of the staff was alarm-related. We conclude that the number of alarm signals should be reduced and unique signals used for each group of medical devices.

Equipment Failure↗
PubMed1988

[Does directed bronchoscopic bronchial cleansing have an advantage over conventional suctioning? A prospective study of hemodynamics, gas exchange and suction-induced mucosal lesions in long-term ventilated patients].

Hypoxic complications and epithelial damage to the trachea and bronchi during conventional blind suctioning have been described in the literature. Fiberoptic suctioning and examination of the trachea of each long-term ventilator patient as a routine method has been recommended in recent studies. We investigated the effect of a conventional tracheal suction technique compared to precise fiberbronchoscopic suction on cardiocirculatory function and gas exchange in mechanically ventilated patients. METHOD. In 40 long-term ventilator patients tracheobronchial toilet was performed either conventionally (group I; n = 20; 15 s of endotracheal suction with no mechanical ventilation during suctioning) or bronchoscopically (group II; n = 20; bronchoscope Olympus 1 T 10; mechanical ventilation during suctioning). Measurements were performed before, immediately after, and 1, 2, 5, and 15 min after suctioning. FIO2 was not changed before or after suctioning. In 12 long-term ventilator patients (greater than or equal to 8 days) we looked for tracheal mucosal lesions produced by conventional suctioning. RESULTS. There was no effect on cardiocirculatory function in either group (Figs. 1 and 2), but we found a decrease in arterial PO2 after suctioning in all patients (group I from 99 +/- 25 to 81 +/- 19 mmHg, group II from 104 +/- 23 to 80 +/- 17 mmHg [Fig. 3]). The time needed to re-establish the initial PaO2 after suctioning was significantly different in both groups. Whereas the PaO2 returned to the initial value within 2 min after conventional suctioning, we found a decrease in PaO2 in the bronchoscopic group even after 15 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Experiences with high-frequency jet ventilation in operations of the larynx and trachea].

60 ENT patients were ventilated with the high frequency jet ventilation method, using endotracheal catheters during 50 cases of laryngeal and 10 cases of tracheal surgery. Ventilation was carried out with equipment of type MK 800 (Acutronic Ltd.) using the following parameters; rate: 150/min, insufflation time: 30-40%, pressure: 0.7-2.1 bar, and flow minute volume (FMV) 7-23 1. Anaesthesia was carried out with flunitrazepam or diazepam, fentanyl and succinylcholine. Surgical view was very good indeed, thanks to the thin jet catheter (4.7 mm outer diameter) in the trachea. At the low "tidal volumes" and intratracheal pressure changes when a rate of 150/min was used, no movement of the vocal cords was seen, so that microsurgery was easy to perform. There were no cases of hypoxia. The median pO2 value was 193 mm Hg. When a flow minute volume of 200 ml/kg was used for patients with normal lung function, and 250 ml/kg for those with impaired function, ventilation was quite adequate. The quality of ventilation should always be checked, and corrected as necessary, by blood gas analyses. Hypoventilation occurred when the FMV was less than 250 ml/kg in patients with decreased lung function, when the tip of the catheter was inserted into a mainstem bronchus or near to the tracheostoma, or when gas escape was obstructed. Unhampered gas escape must be present at all times, because otherwise intratracheal pressure rises and ventilation becomes insufficient. If the pressure increase is marked under these circumstances it can even lead to a pneumothorax.

Adolescent↗