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Biomedical subjects

H Andel

Publications and source records attributed to H Andel.

At least 19 recordsLinked to original sources
PubMed2006

Antithrombin deficiency and its relationship to severe burns.

Antithrombin (AT) is an important endogenous anticoagulant and exhibits marked anti-inflammatory properties. To evaluate the incidence of AT deficiency in severe burn and its correlation to the variables of the abbreviated burn severity index (ABSI), length of hospital stay (LOS) and mortality we collected data on the substitution of human plasma-derived AT concentrate in 201 consecutive patients suffering from severe burn. One hundred and eight patients (54%) developed AT deficiency during their hospitalisation and, according to our institutional practice, received substitution therapy by continuous infusion to maintain physiological plasma activity (70-120%). The mean administered dose served as a measure of AT deficiency. The percentage of patients in an AT deficient state was highest within the first 5 days after injury. It was 26% on day 1 and between 38% and 41% on days 2-5 and thereafter decreased constantly over time. A multiple regression analysis between the dependent variable mean administered dose of AT concentrate and the independent variables age, total body surface area burned (TBSA), gender, inhalation injury (INHAL), full thickness burn (FTB), LOS and mortality was performed. Age, gender and FTB showed no significant influence on the development of AT deficiency. Increasing TBSA and INHAL clearly increase the risk of developing AT deficiency (p-values 0.0001 and 0.037). The analysis also identified AT deficiency as an independent predictor of LOS and mortality (p-values 0.036 and 0.003). Development of AT deficiency is a frequent event after burn with significant correlation to TBSA and INHAL, increased mortality rates and longer hospital stays.

Anticoagulants↗
PubMed2006

Active warming as emergency interventional care for the treatment of pelvic pain.

OBJECTIVE: To assess whether local active warming can lessen acute pelvic pain of gynaecological origin compared with traditional methods in a prehospital setting. DESIGN: Prospective, randomised, single-blinded study. Setting. Prehospital emergency system. Population. Women calling emergency ambulance for pelvic pain. METHODS: Women were randomised in two groups: resistive heating (group 1) or passive warming (group 2), each treatment was initiated at the emergency site. MAIN OUTCOME MEASURES: Pain on visual analogue scale (VAS), anxiety and nausea, given as mean (SD). RESULTS: Prior to the interventions, all women were vasoconstricted and had comparable pain scores. Then, group 1 showed a significant (P < 0.01) reduction in pain (VAS: 72.2 [10.5] mm to 32.4 [18.0] mm), anxiety (VAS: 59.0 [10.9] mm to 37.5 [24.1] mm), nausea (VAS: 42.7 [6.2] mm to 21.6 [5.0] mm) and heart rate (101 [12] beats per minute [bpm] to 59 [8] bpm), as well as in the number of vasoconstricted women (from 19/19 (constricted/dilated) to 2/19 (constricted/dilated)), whereas scores in group 2 remained unchanged. There were no significant changes in blood pressure in either group. CONCLUSIONS: Local warming is an effective emergency care measure for acute pelvic pain.

Adult↗
PubMed2005

Lactate: early predictor of morbidity and mortality in patients with severe burns.

A severe burn results in a devastating and unique derangement called burn shock. Historically, resuscitation has been guided by a combination of basic laboratory values, invasive monitoring and clinical findings, but the optimal guide to the endpoint of resuscitation remains controversial. One-hundred sixty-six patients, who were admitted to our Burn Unit, were enrolled in this prospective study. Resuscitation of these patients was undertaken according to the current standard of care. Parkland formula was used as a first approximation of acquired fluid administration rates and fluid administration was adapted in order to meet clinical needs. The aim of this study was to evaluate if plasma lactate is a useful parameter to estimate the severity of a burn shock. One of the main objectives was to evaluate, if the lactate clearance adds additional information. The results of this study indicate that the initial lactate level (Day 0) is a useful parameter to separate survivors from non-survivors. Moreover, a significant marker of shock and resuscitation was observed in evaluating the lactate clearance on Day 1. A better chance of survival occurs when resuscitation results in a lactate clearance to normal values within 24h (survival was 68% if the lactate reached normal values, compared to 32% if the lactate level remained supra-normal). In summary, we believe that measuring lactate and lactate clearance may help to detect critically injured patients either for adequacy of treatment, or selection of other therapeutic options.

Biomarkers↗
PubMed2004

The influence of dressings and ointments on the qualitative and quantitative evaluation of burn wounds by ICG video-angiography: an experimental setup.

Burn wound depth is difficult to determine. Even for experienced investigators the exact differentiation between superficial and deep dermal burns is not always possible. Therefore, methods for objective and reproducible measurements estimating the depth of burn wounds are of great clinical interest. One technique that appears to be able to differentiate between superficial and deep dermal burn wounds is ICG video-angiography. Since burn wounds are often covered with dressings and ointments or soiled with blood, it is necessary to evaluate the influence of these substances on ICG video-angiography and its performance as a measurement method. The most commonly used ointments and dressings were tested. All studied substances had a massive influence on ICG video-angiography and its measurements. They caused decreases by absorption of up to 63 +/- 36% and thereby falsely reported deeper burn wounds. The results of this study, suggest that in clinical practice, all dressings, ointments and blood should be completely removed at least 10 min prior to measurement by ICG video-angiography to gain exact and reproducible results.

Angiography↗
PubMed2004

Use of subatmospheric pressure therapy to prevent burn wound progression in human: first experiences.

Thermal trauma causes two different types of injuries within the burn wound. First, an immediate and irreversible injury, and, second, a delayed and partly reversible injury. It is a very common observation in burned patients that areas that initially seemed to be partial thickness burns have to be regarded as full thickness within the next day or days. The impairment of blood flow within the zone of stasis is due to the impairment of the vascular patency at the microvascular level. This progression is closely correlated to the degree of oedema formation. The aim of the study was to demonstrate that applied, controlled subatmospheric pressure is useful to prevent the progression of partial thickness burn injuries. Therefore, seven patients (mean age, 44.2 years; S.D., 22.4 years) with bilateral partial thickness hand burns were included into this treatment protocol. The more intense injured hand was treated with controlled applied subatmospheric pressure (V.A.C. (ATS)), the other and less injured hand conservatively by use of silver sulphadiazine creme. In the V.A.C.-treated hand a massive hyperperfusion was observed, being a possible reason for the prevention of burn progression. Moreover, a noteworthy amount of fluid was removed from the burn wound and a clinically obvious oedema reduction was observed in comparison to the contralateral side. In summary, we are of the opinion, that patients with partial thickness or mixed thickness burn may benefit from the application of subatmospheric pressure by reducing oedema formation and increasing perfusion.

Adult↗
PubMed2004

[The use of subatmospheric pressure to prevent burn wound progression: first experiences in burn wound treatment].

Thermal injury applied to living tissue results in zones of injury. Cell death is complete in the zone of coagulation. Beneath this area, there is the zone of lesser injury, where most of the cells are initially viable. If this zone of stasis is not reversed, the burn wound will progress. One of the major aspects to prevent progression is to reduce the edema formation and to preserve microcirculation. We present our first experiences to prevent the progression by use of topical negative pressure. Within the last months, all patients with bilateral partial thickness hand burns were included into this treatment protocol. Within one patient, one hand was treated with the V.A.C. (KCI, Austria), the contra lateral one by use of Flammazine (Smith and Nephew, Germany). Our first observations and data indicate, that both important factors (edema and microcirculation) could be influenced positively by use of the V.A.C.

Angiography↗
PubMed2003

Treatment of patients with severe burn injuries: the impact of schizophrenia.

Four patients treated in one ward of a psychiatric clinic were admitted to our burn unit within 2 months due to severe burn injuries. The patients showed signs of a self-mutilation epidemic. All four patients were female and the mean age was 28 years. The psychiatric diagnosis was schizophrenia in all patients (ICD 10: F20.9). The ignition of flammable liquid was the most common method and the mean burned TBSA was 33%. The mean severity score (ABSI) was 8 and the median hospital stay was 50 days. All patients were characterised by a prolonged hospital stay in comparison to patients without additional psychiatric pathology (median 31 days). This prolonged stay was based on a delayed wound healing, more operations, extended time for mobilisation and difficulties in co-operation. It is possible that in patients with schizophrenia, changes in nutrition, activity, sleep and drug use could influence their immune system profoundly. Anxiety and depression is also associated with the impairment of cellular and humoural immunity. Poor sleep reduces the production of an anabolic endocrine environment and sleep disturbances can interfere with macrophage and lymphocyte functions. Poor appetite leads to malnutrition, which is also capable of producing delayed wound healing. On the other hand, apathy and a general lack of motivation interfere with therapeutic strategies, because poor appetite and weight loss often occurs after neuroleptic withdrawal, which is correlated with clinical decompensation. Moreover, this "self-destructive" behaviour, which is acting on the immune system, might make a patient more susceptible to infection. All these aspects and side effects of schizophrenia combine to make the treatment of burned patients with schizophrenia a very special and difficult task.

Adult↗
PubMed2003

Hydrocortisone improved haemodynamics and fluid requirement in surviving but not non-surviving of severely burned patients.

Recent studies have shown that administration of hydrocortisone may lead to a reduction of catecholamines and to an improved outcome in septic patients. However, there are no data on the use of hydrocortisone in burn patients although in these patients reduction of vasopressors might be even more crucial for outcome due to improvement of skin perfusion. This study presents the first results on the impact of hydrocortisone administration in norepinephrine dependent severely burned patients. In a prospective cohort study fourteen consecutive severely burned patients received, 12h after norepinephrine dependency, a hydrocortisone bolus of 100mg followed by 0.18mg/(kgh) hydrocortisone. The course of the necessary norepinephrine dose, as well as the fluid balance was documented 12h prior and after the first dosage of hydrocortisone. Statistical analysis showed an unexpected increase of the required norepinephrine dosage. A statistical post hoc evaluation of surviving and non-surviving patients revealed a significant increase of norepinephrine in non-survivors whereas in survivors it was possible to reduce norepinephrine significantly. Furthermore, the median fluid requirement of surviving patients could be significantly reduced whereas in the group of non-survivors there was no change of volume needed. Our data suggests that hydrocortisone might be useful in selected patients with severe burn injuries. However, patients not responding to hydrocortisone administrations seem to have a poor prognosis. Our findings are in contrast to previously published data on septic patients, in whom hydrocortisone administration resulted in a reduction of norepinephrine. In burned patients the severity of trauma seems to have more profound influence on the pathophysiological mechanism of sepsis. Due to the high number of non-responders, the potential immune suppression and impaired wound healing caused by the side effects of hydrocortisone, further selection criteria seem to be necessary. A short ACTH-test might be considered prior to hydrocortisone administration to select patients who might benefit from this therapy. In summary, further prospective controlled studies will be necessary to establish hydrocortisone in the routine therapy of severely burned patients.

Adult↗
PubMed2003

Indocyanine green video angiographies help to identify burns requiring operation.

The key decision in the treatment of thermal injuries is the determination of the depth of the burn wound and the resultant decision on treatment options. The trend in the treatment of deep dermal and full thickness burns is toward very early excision and grafting to reduce the risk of infection, decrease scar formation, shorten hospital stay, and thereby reducing costs. Traditionally, this has involved serial clinical examinations, which involves primarily subjective judgment. Various objective examination techniques, supplementing the clinical diagnosis, have been suggested, but none has yet achieved widespread clinical acceptance. It has frequently been postulated that the blood flow in injured tissue indicates the extent of tissue damage. In this study, the clinical and scientific impact of indocyanine green (ICG) video angiography was tested in 20 patients. A wide range of depth of injury and etiology was included and analyzed. In all cases considered, video angiography was possible. The measurements and observations correlated well with the actual burn depth, which was assessed clinically (pre- and intraoperative assessment) and histologically (biopsies). In conclusion, ICG video angiography seems to be a practical method to describe vascular patency in a burn wound. The results indicate that ICG fluorescence angiography is a practical, accurate, and effective adjunct to clinical methods for estimating burn wound depth and thereby to assist in the rational assessment of treatment options. Furthermore, it allows an objective, qualitative and quantitative observation of the dynamic changes in burn wound depth, which are observed during the acute post-burn period, thereby indicating optimal timing of the first operation.

Adult↗
PubMed2002

Serum cholinesterase activity reflects morbidity in burned patients.

Blood samples of 200 patients with thermal injuries were drawn apparently to determine the trend of the cholinesterase activity. In relation to the severity of the injury, a characteristic decrease was noted during the first days after admission. A recovery to normal values was achieved in all survivors (150 patients) after a proportionate period of time, but in the group of non-survivors (50 patients), no complete recovery to normal levels was found. Furthermore, a significant relationship between serum cholinesterase activity and the severity of morbidity was detected, the fall of the cholinesterase activity at the very beginning was significantly higher (P<0.004) in patients who died (1.3kU/l) than in patients who survived (0.7kU/l). Already 24h after admission, the mean activity was significantly lower (P<0.003) in non-survivors (2.5kU/l) than in survivors (3.2kU/l). It seems that the serum cholinesterase is a sensitive indicator for the morbidity of patients with severe burn injuries.

Analysis of Variance↗
PubMed2001

Influence of hypotensive and normotensive anesthesia on platelet aggregability and hemostatic markers in orthognathic surgery.

This prospective randomized study investigated the influence of normotensive and hypotensive general anesthesia on platelet aggregability, intraoperative blood loss and parameters of plasmatic coagulation during extensive orthognathic surgery. A total of 30 patients were randomly allocated for either normotensive anesthesia maintained by continuous infusion of propofol and remifentanil (NORMO, n=10) or hypotensive anesthesia, whereby hypotension was induced by increasing the infusion rate of remifentanil (HYPO-R, n=10) or by administration of nitroglycerin (HYPO-N, n=10). Whole blood platelet aggregability was significantly reduced during hypotension compared to normotensive anesthesia (P<.01, HYPO-N and HYPO-R vs. NORMO). Mean arterial blood pressure during hypotension correlated well with adenosinediphosphate- (R=.712, P<.001) and collagen-induced platelet aggregability (R=.685, P<.001). Within hypotensive study groups, postoperative fibrinogen levels were significantly different, whereas intraoperative platelet aggregability, postoperative platelet count, prothrombin time, activated partial thromboplastin time and antithrombin levels were not different. Normotensive anesthesia, however, caused significant decreases in platelet count (-29%), prothrombin time (-24%), fibrinogen (-41%) and antithrombin (-28%) and a significant prolongation in activated partial thromboplastin time (+21%) and thrombin time (+18%). There was a trend to reduced intraoperative blood loss in hypotensive study groups; however, differences were not significant. In conclusion, induced hypotension--independent of substances used for induction of hypotension--reduces intraoperative platelet aggregability, subsequently protecting the coagulation system against subclinical consumption coagulopathy. Induced hypotension-caused platelet dysfunction does not lead to an increased intraoperative blood loss, but quite on the contrary shows a trend to reduced intraoperative blood loss, possibly by preventing platelet-induced subclinical consumption coagulopathy.

Adult↗
PubMed2001

Impact of early high caloric duodenal feeding on the oxygen balance of the splanchnic region after severe burn injury.

Early enteral nutrition is recommended in burned patients. Depending on the amount administered, enteral feeding causes an increase of intestinal oxygen-demand. Although early moderate enteral nutrition has been shown to be beneficial, early high calorie enteral nutrition might lead to an imbalance of the O(2)-balance of the gut since intestinal perfusion is decreased after major burns. In 20 severely burned patients during the first 48 h of early high caloric duodenal feeding an assessment of the CO(2)-gap between the arterial and the gastric CO(2), as parameter for the intestinal O(2)-balance, was performed. Time points were prior to starting the enteral nutrition (BASE) subsequently every 30 min after increasing the amount of nutrition administered and from the 11th to the 48th h after beginning of nutrition in intervals of 6 h. In none of the patients was the CO(2)-gap increased during the rapid increase of enteral nutrition. On the contrary the CO(2)-gap decreased significantly. We conclude that high caloric duodenal feeding in the early hypodynamic postburn phase does not have adverse effects on the oxygen balance of the intestine.

Adult↗
PubMed2001

The influence of deliberate hypotension on splanchnic perfusion balance with use of either isoflurane or esmolol and nitroglycerin.

UNLABELLED: Various techniques to induce deliberate hypotension (DH) have different influences on splanchnic perfusion. The aim of our study was to determine whether splanchnic perfusion is clinically impaired during DH by using either isoflurane (ISO) or a combination of esmolol and nitroglycerin (E/N). We randomized 16 patients undergoing elective maxillofacial surgery to receive either ISO (0.7%-1.8%) or E (105 g x kg(-1) x min(-1)) and N (1-6 mg/h) to induce DH. General anesthesia was performed in both groups by IV midazolam 0.07 mg/kg, fentanyl 0.003 mg/kg, propofol 1.5 mg/kg, and vecuronium 0.1 mg/kg followed by a propofol infusion with 6 mg x kg(-1) x h(-1). After the induction of anesthesia, a gastric tonometer (TRIP NGS Catheter) and a radial artery catheter were inserted. Baseline values of gastric intramucosal pH (pHi) were determined 60 min after placement of the catheter and before the induction of DH. The pHi values were calculated every 60 min until DH was discontinued. In both groups, DH was satisfactorily established. None of the pHi values calculated was less than 7.37 in the E/N or 7.41 in the ISO group. Arterial blood lactate levels did not increase in any of the patients. We conclude that neither method of producing DH compromises splanchnic tissue oxygen balance in healthy patients. Furthermore, overall organ perfusion was sufficient in both groups, because none of the patients showed an increase in blood lactate. IMPLICATIONS: Neither the isoflurane nor the esmolol/nitroglycerin method of producing deliberate hypotension compromises splanchnic tissue oxygen balance in healthy patients. Furthermore, overall organ perfusion was sufficient in both groups, because none of the patients showed an increase in blood lactate.

Adrenergic beta-Antagonists↗
PubMed2000

Depressive effect of isoflurane on motor evoked potentials in the Nubian goat.

PURPOSE: To determine the effect of isoflurane on motor evoked potentials (MEP) in a new animal model designed to verify the applicability of MEPs in brachial plexus surgery, and to compare the results with previous reports in other animals. METHODS: In seven goats, anesthesia was induced with 3 mg x kg(-1) ketamine i.v. and maintained with nitrous oxide 40% in oxygen and 2 microg x kg(-1) x hr(-1) fentanyl i.v.. The MEP were performed with two subcutaneous needle electrodes placed over the occiput (cathode) and the nasion (anode), with their plugs connected to the power output of a Digitimer D 180 electrical stimulator, connected to the trigger input of an electromyograph (model 8400, Cadwell Laboratories, Inc., Kennwick, Washington). Activation of the Digitimer caused central stimulation of the motor cortex, evoking baseline compound muscle action potentials (CMAPs) which were recorded from the left triceps muscle. Subsequently, isoflurane 2% was administered together with repeated central stimulation at 30 sec intervals. RESULTS: Onset of I- (indirect) waves increased from median 15,8 msec to median 26,8 msec P = 0,018 (latency increase ranged from: 9 to 11.5 msec), while peak-to-peak amplitudes decreased and subsequently disappeared. D- (direct) waves showed no latency increase, and finally disappeared as well. After disappearance of CMAPs, isoflurane administration was stopped and MEP repeated. The CMAPs reappeared (range: 210-360 sec) and regained initial peak-to-peak amplitudes and latencies. CONCLUSION: These animal studies suggest that isoflurane should not be used during the recording of MEPs.

Action Potentials↗
PubMed2000

Propofol without muscle relaxants for conventional or fiberoptic nasotracheal intubation: a dose-finding study.

UNLABELLED: Endotracheal intubation has been performed during the administration of propofol anesthesia without neuromuscular blockade. In this study, we determined the propofol dose required for conventional nasotracheal or for fiberoptic nasotracheal intubation of all patients. Thirty-two patients undergoing maxillofacial surgery were randomly assigned to the conventional (n = 16) or to the fiberoptic (n = 16) intubation group. In both groups, anesthesia was induced by using IV fentanyl and IV titrated propofol according to clinical need (spontaneous respiration rate, verbal response). An endotracheal tube was placed nasally in the pharynx and the vocal cords visualized by using a fiberscope inserted via the tube. In the conventional group, the larynx was visualized additionally with a laryngoscope blade (Miller). In both groups propofol was titrated until the vocal cords opened. Patients were tracheally intubated, and the propofol dose was recorded. In all patients, the trachea could be intubated without the use of muscle relaxants. Considerable interindividual differences of dose requirements were observed. The amount of propofol required in the conventional group was significantly (P < 0.0001) larger (median +/- SD: 2.74 +/- 1.59 mg/kg; range 1.95-7.07 mg/kg) than in the fiberoptic group (1.37 +/- 0.59 mg/kg; 0.72-2.86 mg/kg). Hemodynamics remained stable in all patients. Postintubational hoarseness occurred in three patients of each group. Fiberoptic nasal intubation without a muscle relaxant can be facilitated with significantly smaller and more predictable dosages of propofol than conventional nasal endotracheal intubation. The possibility of titrating the propofol dose under assisted ventilation until the vocal cords open during fiberoptic nasotracheal intubation and the better predictability of the required dose favors the fiberoptic approach. IMPLICATIONS: In this study, contrary to all preceding studies using predefined doses of propofol and opioids, we determined the minimal required propofol dose in combination with fentanyl for conventional or fiberoptic nasotracheal intubation without muscle relaxants.

Adult↗
PubMed1999

[The influence of different therapeutic approaches on the survival of elderly burn patients].

The present study analyzes the outcome of 51 patients aged more than 65 years, who were admitted between 1993 and 1997 to a specific burns unit with the possibility of intensive care medicine including respirator therapy and hemofiltration. The results were compared to an historical control group treated between 1980 and 1990. The overall survival rate was 54 %. Analyzing the patients' mortality, an increase in the number of nurses, improvement of enteral nutrition and wound monitoring had more influence on the survival rates than respirator therapy, hemofiltration and catecholamines. This is in contrast to our experience with younger individuals. The positive influence of intensive care on survival was restricted only to a small number of cases. The group of patients who died on the intensive care unit showed a relatively long median survival time of 24 days. Septic multiorgan failure was the main cause of death.

Aged↗
PubMed1999

Progression of burn wound depth by systemical application of a vasoconstrictor: an experimental study with a new rabbit model.

The final depth of a necrosis resulting from burn trauma is determined within 3 days. The zone of stasis has the potential for complete regeneration or there may be ischemic influences that lead to necrosis. In our model, we examined the dermal influence of vasoconstrictors with reference to the development of burn necrosis. On the backs of New Zealand white rabbits (4.0-4.5 kg) standardized lesions were made with a heated aluminum stamp at 80 degrees C, 14 s in duration. The lesions were intradermal, whereby the border zone of the coagulated tissue was found in the middle two quarters of the dermis in 100% of untreated animals after 72 h. For dermal vasoconstriction epinephrine in a dose of 0.5 microg/kg/min was used. There were two groups of seven animals each. One group received epinephrine and the dosage was dependent on the clinical state of the animal. Several cycles were administered within a 3-day period. The reduction of skin perfusion was documented by Laser-Doppler-flowmetry. After 3 days, the skin with the lesions was excised and using a hematoxylin dye, a histological examination followed. The parameter used to determine the efficacy was the thickness of the uncoagulated part of the excised dermis. Over a period of 48 h, an average of 2.3 epinephrine cycles of average of 88 min per animal in duration resulted in an average reduction of skin diffusion of 41%. The uncoagulated part of the dermis in the epinephrine group was 28.6% average; in the control group, this was 43.5%. The statistical analysis revealed significant differences with a p-value of 0.0312 (significant, when value is less than 0.05). The test results indicate that temporary reduction of skin perfusion through external administration of vasocontrictors may lead to progression of burn necrosis in our animal model. Clinically, this result indicates that for patients with burn injuries and systemic inflammatory response syndrome who have insufficient volume therapy, the administration of vasocontrictors may produce similar results in the injured area.

Administration, Topical↗