Biomedical subjects
Publications and source records attributed to A Frutiger.
A 68-year-old man, who had undergone laryngectomy six months earlier, was struck by lightning and developed pulmonary hemorrhage. This was attributed to pulmonary barotrauma due to a lightning blast via his tracheostoma.
This study addresses the frequency and circumstances of secondary transportation of intensive care patients in Switzerland by evaluation of a questionnaire sent to all recognized intensive care units. Surprisingly many critically ill (roughly speaking two full ICUs with 8 patients) are transferred daily between Swiss hospitals, which amounts to about 6000 transfers per year. Pediatric cases make up 1/4 of the transfers and follow a rather common pattern, since pediatric units prefer to pick up their patients in the primary hospital with their own personnel and also to transfer them later in the same way. For adult patients no common pattern is recognizable except as regards admissions, which are usually performed by the primary hospital's facilities. We suspect a considerable degree of improvisation around secondary transfers of adults. Well trained personnel, suitable ambulances, good communication and a reasonable degree of monitoring are desirable. Non invasive monitoring techniques are considered mandatory or at least helpful by most of the answering units, whereas invasive monitoring was generally judged superfluous. The large number of secondary patient transfers and their only moderately standardized organization patterns make further research desirable.
In a group of 59 consecutive ICU trauma patients with blunt chest injury and considerable injury severity (ISS = 29) a three-staged therapeutic approach was followed, depending seriousness of chest injury, overall injury severity and age. Stage 1: i.v. analgesia and conventional respiratory therapy. Stage 2: continuous epidural analgesia (local anesthetics and opiates) and intermittent CPAP (continuous positive airway pressure) by face mask. Stage 3: Endotracheal intubation and internal pneumatic stabilization of the chest, preferably spontaneous breathing. Only 44% of the patients needed intubation, and none died. The authors recommend this three-step approach towards blunt chest injury and serial rib fractures.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Prevention of gastrointestinal stress lesions by cimetidine or pirenzepine was investigated in a double blind study of trauma patients in an intensive care unit. Cimetidine or pirenzepine were administered intravenously to 55 consecutive randomized patients. All were checked by endoscopy on admission and 8 days later. 5 therapy failures were found in each group. Patients with more than 5 erosions and/or ulcerations were classified as failures. A side effect encountered was sinus tachycardia in 4 of 27 patients treated with pirenzepine. Overall, a trend towards fewer stress lesions was found in the pirenzepine protected group.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In three patients traumatic pulmonary pseudocysts were observed. In one the cause was a barotrauma due to hyperbaric oxygenation with positive end-expiratory pressure. In the other two an accident was the cause. Expectant management is always indicated because in most cases there is spontaneous regression, as long as there are no important complications. In ventilated patients mean and peak pressure values should be as low as possible.
In 10 randomly selected surgical ICU patients, a new regimen of total parenteral nutrition (TPN) using a so-called all-in-one (AIO) solution was tested prospectively. Another 10 patients receiving conventional TPN served as a control group. For a minimum of 7 days the patients were given either an AIO solution containing 40 g crystalline L-aminoacids, 38 g fat, 75 g sorbitol and 45 g xylitol in 1000 ml or a conventional TPN with glucose and aminoacids. The regimens were identical regarding caloric intake and Joule/N ratio. Amounts of infused solutions were adjusted according to patient's weight. Both regimens were well tolerated and side effects requiring interruption of the protocol did not occur. A set of 36 laboratory parameters underwent detailed statistical analysis. Efficiency of both regimens in improving nutritional status was documented. Comparing the two groups, we found only two important differences: glucose levels in the AIO group were lower than in the control group, and the bilirubin increase observed in both groups (probably a sign of cholestasis) was higher in AIO patients. Immediate postoperative or posttraumatic nutrition with an AIO solution was safe and simple to administer. Because glucose metabolism is only minimally overstrained, AIO compares favorably with conventional TPN and is a promising alternative when stress-induced glucose intolerance occurs.
In 27 patients intracranial pressure monitoring (ICP) was carried out for 4-5 days (severe head injury 23, hypoxia after cardiac arrest 3, brain tumor 1). Patients were included who reached a score of 8 or less on the Glasgow Coma Scale and who did not need immediate surgery. The measurements were done with epidural screws (20 patients) and with indwelling ventricular catheters 7). The individually highest ICPs were recorded 3-4 days after incident. 14 patients recovered completely, 3 remained slightly and 3 severely disabled, and 7 patients died. ICP monitoring permitted precise and rational therapeutic management but was of little value prognostically. Poor Glasgow scores were linked to high mortality. The advantages and disadvantages of the two ICP monitoring techniques are discussed. ICP monitoring is recommended as a useful and safe tool for titrated management of deeply comatose patients.
The Swiss Academy of Medical Sciences published its guidelines for brain death evaluation and removal of donor organs in 1968. Based on this, the authors have designed a formal written protocol for brain death certification with the object of establishing the diagnosis of brain death beyond doubt and within reasonable time. The protocol serves for identification of suitable organ donors.
Explore the source record for details and available documents.