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F Konrad

Publications and source records attributed to F Konrad.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Bronchoscopy for initial care following severe thoracic trauma--basically indicated?].

UNLABELLED: The study objective was to determine the usefulness of routine early (within 24 h after admission) and late (on the 3rd posttraumatic day) flexible fiberoptic bronchoscopy in patients with severe chest trauma. METHODS: By history, physical examination, and radiologic findings, we identified 15 consecutive patients, all of whom were anaesthetized, orally intubated, and mechanically ventilated. There was no change in ventilation, including FIO2, for bronchoscopy. The patients had continuous cardiovascular monitoring and peripheral pulse oximetry. The bronchoscope was inserted through a tight-fitting side port at the endotracheal tube connector. Pulse rate, mean arterial pressure, and arterial blood gases were recorded before, 1 min after, and 10 min after bronchoscopy, as were intracranial pressure (ICP) in 7 patients with an ICP probe (early bronchoscopy only) and the duration of the examination. Statistical significance was tested by means of the Wilcoxon test for correlating samples. Significance was assumed at P less than 0.05 in a two-sided test. RESULTS: Early bronchoscopy revealed two bronchial avulsions, two aspirations, and ruled out one suspected aspiration. Late bronchoscopy showed plugging of at least 3 segmental bronchi by clots in 4 patients, none of whom was able to expectorate effectively. In general, changes in the observed vital parameters were minimal. There was a significant but clinically irrelevant increase in mean pulse rate before and 1 min after early bronchoscopy. DISCUSSION: We conclude that bronchoscopy should always be considered in patients with severe chest trauma, the decision being based on typical radiological findings as well as clinical signs and symptoms. Given the proper indication, bronchoscopy supplies valuable information at minimal risk to the patient.

Adult↗
PubMed1992

[The elimination of carboxyhemoglobin--gender-specific and circadian effects].

We investigated sex-specific and circadian variations of carboxyhemoglobin (COHb) elimination in healthy volunteers. COHb elimination follows an exponential function with a baseline found in nonsmoking women at 1.72% and in nonsmoking men at 1.79% COHb saturation. During the day, the elimination half-life time (t1/2), determined by eleven hourly samples after stopping smoking was significantly (Wilcoxon-test, p less than .01) shorter in women (3.2 +/- .4 hours, mean +/- standard deviation, n = 7) than in men (4.5 +/- 0.4, n = 6). During the night, too, t1/2 calculated from 2-point measurements after the smoking halt was significantly (Wilcoxon-test, p less than .05) shorter in women (4.3 +/- 1.1, n = 4) than in men (8.0 +/- 1.6, n = 5). In men, t1/2 during the night was significantly longer (p less than .01, Wilcoxon-test) than during the day. The day/night difference may be caused by reduced alveolar ventilation during sleep. Less muscle mass and, therefore, less myoglobin as a depot for carbon monoxide may account for the shorter half-life time of carboxyhemoglobin in women. We conclude that these variations of COHb-elimination should be taken into account when a smoking halt is advised, for instance, preoperatively.

Carboxyhemoglobin↗
PubMed1991

[Carbomonoxyhemoglobin and methemoglobin in patients with and without a smoking history during ambulatory anesthesia. Consequences for the use of pulse oximetry].

Carboxyhemoglobin (COHb) and methemoglobin (MetHb) in venous blood were determined by oximetry in 1000 non-hospitalised preoperative patients. 370 of them were smokers (S), 630 non-smokers (NS). In addition, in five S we compared the oxygen saturation measured by pulse oximetry (SaO2, p) with that measured by in vitro oximetry (SaO2) and that calculated with reference to COHb (SaO2,korr). MetHb (0.66 +/- 0.21%, mean +/- standard deviation) was found to be of no relevance. COHb in S (5.12 +/- 2.25%, maximum 12.4%) was significantly higher than in NS (1.82 +/- 0.3%, range 0.9%-4.0%) and is therefore of importance in S for the oxygen transport and for the interpretation of SaO2, p, which overestimated SaO2 at a COHb level of 4.4 +/- 0.7% by 4.5 +/- 0.9%. The difference between SaO2, korr (calculated according to Forstner) differed from SaO2 by 0.66 +/- 0.5% only. We conclude that there is an indication for in vitro oximetry in non hospitalised smokers or cases of unknown smoking history. If oximetry is not available, both a reduction of O2-binding hemoglobin and an overestimation of SaO2 by pulse oximetry in an order of ten per cent should be taken into account. To compensate for dyshemoglobin fractions, pulse oximetry using more than two wavelengths is desirable.

Ambulatory Care↗
PubMed1991

[Pneumonia prevention in long-term mechanically ventilated patients: selective skin decontamination according to Stoutenbeek or prevention of colonization according to Unertl? A prospective randomized comparison of both treatments].

In a prospective randomised study, the effects of two different colonisation prophylaxis techniques on colonisation and pulmonary infection were investigated in 40 critically ill patients with long-term ventilatory support (greater than or equal to 4 days). 20 patients were selectively decontaminated with 4 x 100 g polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and with an antimicrobial sticky paste in the oropharynx (group I). 20 patients received 50 mg of polymyxin B and 80 mg of gentamicin dissolved in 10 ml of 0.9% saline at 6 h intervals into nose, oropharynx and stomach as well as 300 mg of amphotericin B in the oropharynx only (group II). All patients received cefotaxime systemically in the first 3 days. In group I gram-negative aerobic bacteria in the pharynx decreased from 35% to 0%, in group II from 40% to 10% and in the rectum from 80% to 61% (10% in the second week) in Group I and from 100% to 73% (33% in the second week) in group II. The decrease in gram-negative microorganisms was accompanied by an increase in the frequency of Staphylococcus epidermidis. In group I, two patients developed pneumonia and two patients urinary tract infections, in group II two patients suffered from pneumonia and 3 patients urinary tract infections. Both regimes are effective methods of prophylaxis for lowering colonisation with gram-negative aerobic bacteria and the frequency of pneumonia in patients requiring long-term mechanical ventilation. A possible selection of gram-positive bacteria must be appropriately monitored.

Adult↗
PubMed1991

[The value of criteria for pneumonia in the diagnosis of a ventilated pneumonia].

Reliable diagnosis of pneumonia in ventilated patients is frequently difficult, since there is no single specific criterion. In the present study, the following diagnostic criteria for pneumonia were checked in 25 ventilated patients: 1. temperature over 38.5 degrees C, 2. leukocytosis over 12,000/mm3, infiltration in the x-ray, 4. positive auscultatory findings, 5. purulent tracheal secretion (TS), 6. positive bacteriological findings (TS). Diagnosis of bacterial pneumonia was assumed if in the bronchoalveolar lavage (BAL) the concentration of a plausible causative organism was greater than or equal to 10(4)/ml and the "Bacterial Index" (BI) was greater than or equal to 6 (16). 15 patients fulfilled more than four criteria for pneumonia. In all patients the concentration of bacteria in the BAL was greater than or equal to 10(4)/ml (median 10(6)/ml, BI: 10). 10 patients fulfilled less than or equal to 4 criteria of pneumonia. In three of the patients, BAL was sterile, in four cases organisms less than 10(4) were isolated; none of these patients received antibiotics and diagnosis of pneumonia was not confirmed in the further course of illness. In three patients, bacteria greater than or equal to 10(4)/ml were isolated (BI 9, 10, 13); they improved under adequate antibiotic therapy. We conclude from these results that "as a rule" more than four of the criteria of pneumonia specified above should be present for diagnosis of pneumonia in ventilated patients in a surgical intensive-care ward. If there is any doubt, BAL should be performed to confirm the diagnosis.

Adult↗
PubMed1991

[Causes of death in intensive care surgical patients. A prospective study].

Infection and sepsis are generally considered as causally related to death in intensive care unit (ICU) patients, but in several studies a decrease in infection rates was not associated with lower mortality. We therefore investigated the causes of death in surgical ICU patients, with special regard to the relationship between infection and mortality. MATERIAL AND METHODS. During the investigation period of 6 months, 502 patients were treated in the ICU (cardiac surgery: 222, thoracoabdominal surgery: 125, vascular surgery: 84, others: 14). In all patients each antibiotic therapy and infection was documented, as was the sepsis score. Definitions of infection and bacteriological monitoring were described in detail previously. In all deaths, attention was paid to an infection that was causally related to or contributed to death. In unclear cases a postmortem examination was performed. RESULTS. Forty-two patients died (8.4%). During the first 4 days 23 patients died, 11 within 24 h, because of severe trauma with severe underlying disease (main reason for death: cardiac 30%, cerebral 32%). Infections were not significant in these patients. Nineteen patients suffered from 1 or more infections (total 30). They died after a median of 16 days. The leading cause of death was multiple organ failure. In 7 of these patients a life-threatening infection was the reason for admission and, later, death. In 8 patients a nosocomial infection was causally related to or contributed to death. In the 4 other patients a postmortem examination excluded an infection as being responsible for death. DISCUSSION. More than one-half of the deaths were caused by severe trauma or severe underlying disease. Nosocomial infections could only be related to death in 1.6% of the 502 treated ICU patients. The influence of new therapeutic regimens on infection and mortality can therefore only be investigated in multicenter trials.

Adolescent↗
PubMed1991

[Risk factors in nosocomial pneumonia in intensive care patients. A prospective study to identify high-risk patients].

Sixteen risk factors for nosocomial pneumonia were prospectively studied in 582 intubated patients in a surgical intensive care unit (ICU) to identify patients at particularly high risk. Overall, pneumonias developed in 94 of the patients (16%). Significant risk factors for pneumonia were mechanical ventilation for more than 72 h, impaired consciousness or co-operation, specific therapeutic interventions as a marker of severe underlying diseases (dopamine/dobutamine greater than or equal to 5 micrograms/kg.min, barbiturate therapy for treatment of elevated intracranial pressure, continuous i.v. antiarrhythmic or antihypertensive drugs), and pre-existing pulmonary abnormalities (P less than 0.001). The acquisition of postoperative pneumonia was further associated with male sex, ASA class IV and a history of smoking, but statistical significance was lost after stepwise logistic regression. Longer operative procedures, thoracic or upper abdominal surgery, longer preoperative hospital stay, low serum albumin concentration on admission, prior antibiotics, old age, obesity, low weight, malignant disease, and steroid treatment did not influence the incidence of pneumonia. In this study we were able to identify a subpopulation of intensive care patients at particularly high risk for pneumonia.

Adolescent↗
PubMed1990

[Bronchoscopy in ventilated patients: full narcosis or local anesthesia?].

In a prospective, randomised trial bronchoscopy was performed either in local anaesthesia (LA) or general anaesthesia, each on 15 ventilated patients. LA was carried out with oxybuprocain-hydrochloride 1% in repeated doses injected into the trachea and main bronchi, general anaesthesia with midazolam, piritramide and vecuronium bromide. Measurements were performed before, 3 minutes after induction of anaesthesia, immediately after bronchoscopy and 15 and 60 minutes after bronchoscopy. There was no effect on cardiocirculatory function during bronchoscopy in both groups, but we found a decrease in paO2 from 97 to 80 mmHg (median) after application of LA. Subsequent bronchoscopy did not significantly influence paO2. The present study shows that in ventilation patients undergoing fibreoptic bronchoscopy, the application of LA will usually result in a decline of arterial oxygen tension. This procedure should therefore only be performed if general anaesthesia is undesirable, as e.g. in patients being weaned from ventilation.

Adolescent↗
PubMed1990

[Routine throat swabs in artificially ventilated patients: meaningful bacteriologic monitoring or a needless procedure?].

UNLABELLED: Organisms colonizing the oropharynx of patients in the intensive care unit (ICU) play an important role in the development of nosocomial infection. Thus, routine throat swab specimens of ICU patients are recommended to screen for potential pathogens [20]. This investigation was designed to clarify the value of throat swabs taken in addition to tracheal aspirates, urine cultures, and wound swabs with regard to antibiotic therapy in patients with pneumonia and other infections. MATERIALS AND METHODS. A total 627 intubated patients were examined in a surgical ICU during a 12 month period. Pharyngeal swabs, tracheal aspirates, urine cultures, and-if necessary-swabs from wounds and drains were taken immediately after admission to the ICU and routinely thereafter three times each week. DEFINITIONS: Early onset pneumonia: pneumonia occurring within 4 days; late onset pneumonia: pneumonia occurring after the 4th day. Intra-abdominal infection: diffuse or localized peritonitis or abdominal abscess. Wound infection: soft-tissue or bone infection. Corresponding organisms: the same species of bacteria with the same sensitivity pattern (Table 1). RESULTS. Sixty-eight of the patients developed pneumonia. 37 had early onset pneumonia. In 22 of these patients, throat and tracheal specimens had been obtained 2-3 days before the pneumonia was diagnosed. In these specimens, the causative organisms for the subsequent pneumonia were isolated in the throat in 60% of cases and in tracheal secretions in 40% (Table 3). In 35 patients with late onset pneumonia, the causative bacteria were found in 66% of the cases in the throat swabs obtained 2-3 days before the diagnosis was made, in tracheal aspirates in 74% (Table 4). Throat swabs obtained at admission to the ICU from already infected patients or from patients who developed an infection were significantly more colonized with potentially pathogenic micro-organisms (Fig. 1). In 4 patients with early onset pneumonia the results of the throat swab cultures influenced antibiotic therapy, but none of the throat culture results influenced the therapy of the patients with late onset pneumonia or other infections (intra-abdominal infection, wound infection, urinary tract infection). CONCLUSIONS. The throat swab taken at admission may indicate patients at risk for infection. However, throat cultures taken routinely thereafter, parallel with tracheal aspirate cultures, do not provide additional information that is diagnostically or therapeutically helpful. Therefore, throat swab cultures are not necessary for routine bacteriological monitoring. For the prevention of colonization by local administration of antimicrobial agents, regular throat cultures are mandatory.

Adolescent↗
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

[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

[Frequency of colonization and pneumonia and development of resistance in long-term ventilated intensive-care patients subjected to selective decontamination of the digestive tract].

Colonization of the oropharynx with potentially pathogenic microorganisms (PPM) is a highly significant factor in the pathogenesis of bacterial pneumonia in intensive care patients. Via colonization of the oropharynx, bacteria pass into the tracheobronchial tree, where they can give rise to pneumonia after overcoming pulmonary resistance mechanisms. By a new, prophylactic antibiotic treatment schedule consisting in selective decontamination of the digestive tract (SDD) with locally applied nonabsorbable antibiotics, Stoutenbeek achieved drastic lowering of the colonization and infection rate in trauma patients. In the present study, we wanted to check whether this new prophylactic antibiotic schedule can be applied on a surgical intensive care ward in all patients with long-term ventilation, irrespective of the diagnosis, and whether it affords advantages over a conventional antibiotic schedule. MATERIALS AND METHODS. All patients on a surgical intensive care ward in whom it was expected that mechanical ventilation would be necessary for more than 4 days were included in the study. During the first 6 months 83 patients were investigated, in whom antibiotics were only administered when the presence of infection had been confirmed, in accordance with generally accepted guidelines (control group). In the second 6-month period, 82 patients were selectively decontaminated with 4 x 100 mg polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and in an antimicrobial paste in the oropharynx (SDD group). The SDD schedule entailed systemic administration of cefotaxime in the first 3-4 days. RESULTS. In the control group, enterobacteria/Pseudomonas spp. were isolated significantly more frequently than in the SDD group (P less than 0.001): in the pharyngeal smear in up to 53%, in the tracheal secretion up to 36%, and in the rectal smear in up to 93% of the patients In the SDD group in the 1 week the frequency of gram-negative aerobic bacteria in the pharynx decreased from 33% to 5%, in the tracheal secretion from 23% to 14% and in the rectum from 86% to 52% (24% in the second week). However, the decrease in gram-negative microorganisms was accompanied by significant increase in the frequency of Staphylococcus epidermidis and enterococci. The SDD schedule proved to be effective with regard to the rate of infection. In the control group, 35 patients developed pneumonia (42%) as against 5 patients receiving SDD prophylaxis (6%). The duration of mechanical ventilation in the patients with pneumonia was 5 days longer than in patients without pneumonia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
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

[Monitoring of bronchoscopy in artificially ventilated patients using peripheral pulse oximetry--a useful monitoring method?].

In the present study, flexible bronchoscopy was monitored by means of peripheral pulse oximetry in 62 artificially ventilated patients of a surgical intensive-care ward. The study was designed to establish whether falls of arterial oxygen saturation due to bronchoscopy can be detected at an early stage and whether they can possibly be influenced by an appropriate investigation technique. 270 comparative measurements of hemoglobin oxygen saturation were carried out; the oxygen saturation directly measured in the arterial blood served as reference value. The statistical analysis revealed a correlation of r = 0.85. In ten patients, there was an impairment of respiratory function and hypoxemia due to bronchoscopy. In all cases, this could be detected in good time from the fall of oxygen saturation. Pulmonary impairment was partially prevented or further impairment was avoided by an appropriate technique of investigation.

Adolescent↗