Search PubMed⌕ Search

Biomedical subjects

H Benzer

Publications and source records attributed to H Benzer.

At least 55 records · Page 3Linked to original sources
PubMed1982

[Inversed ratio ventilation (IRV) following cardiosurgical procedures].

Based on our positive experiences with "Inversed Ratio Ventilation" (IRV) in the treatment of ARDS, we applied this ventilation technique in patients with risk lungs after cardiosurgical operations. Immediately, after switching from conventional ventilation mode (I/E ratio 1:2) to IRV (I/E 2:1), however significant hemodynamic reactions could be observed. Especially a significant decrease of cardiac output can be observed in this phase. IRV leads to an improvement of gas exchange and lung mechanics. These improvement become even more significant continuing IRV. A decreasing tendency of the negative hemodynamic effects can be observed parallel to lung mechanics improvement. Carefully managed respirators adjustment, "step-wise" prolongation of I/E ratio and closed observation on hemodynamic reactions leads to successful use of Inversed Ratio Ventilation in cardiosurgical patients too.

Air Pressure↗
PubMed1982

[Psychological stress factors in intensive care].

In three intensive care units we looked into the question whether there are environmental situations somewhat equally stressful for the patients using 52 stress items designed by ourselves for the study. The patients had to place the various items in a sequence of increasing annoyance just one day after discharge from the intensive care unit. The most annoying factor for all patients, almost independent of sex and diagnosis, was the item "lack of information and communication". The item "noise and unrest caused by the daily routine and the nursing staff of the intensive care unit" was put in the first place by patients aged more than 50 years. Helplessness and physical impairment are the most annoying factors reported by the ventilated patients. The item "dependence on technical devices" (e.g. ventilators, dialyzer etc.) was surprisingly quoted low by our patients. We conclude that a human orientated intensive care medicine approach should be developed. Further investigations concerning psychical care and help should be performed.

Critical Care↗
PubMed1981

[Postoperative therapy by means of acute parenteral alimentation (APA) with high doses of insulin and glucose after open heart surgery (author's transl)].

Immediately after open heart operations (extracorporeal circulation) 22 patients were investigated in 2 groups at the intensive care unit. Whereas the control group received Ringer lactate as postoperative infusion (RL-group), the 2nd group was given 50% glucose (0.5 g/kg/h) and insulin (250 U/1,000 cc) (GI-group). In case of need (blood glucose level) additional insulin up to 200 U/h, maximum 800 U/10 h, was supplied. On the 1st postoperative day 500 ml 10% crystalline amino acid solution was added. Before the start of postoperative infusion therapy postoperative serum insulin levels were low in spite of considerably elevated blood glucose levels (glucose utilisation disorder, insulin suppression). In contrast with the RL-group there was in the GI-group a significant decrease of FFA-serum level and cAMP serum level which developed during the infusion. Urine output and urinary glucose excretion was nearly equal in both groups. Urinary potassium excretion in the GI-group remained significantly one third lower than that of the RL-group, in spite of the potassium supply to the GI-group being nearly twice and serum potassium level approximately equal. Urinary sodium excretion of GI-group on the other hand was approximately 15% higher than that of RL-group. In relation to preoperative values postoperative urinary N-excretion of the GI-group was unchanged, whereas in RL-group the postoperative N-excretion was significantly 30% increased; in postoperative alpha-amino-N-excretion there was only a small difference between the groups, which indicates an insulin-modifiable increase in protein breakdown rather than a decreased protein synthesis. According to the obviously improved situation in energetic considerations, cell membrane potential restoration and N-balance resp. protein synthesis in the insulin treated group, the question is discussed whether this therapy (APA) which shifts metabolism to an anabolic state, is of a certain value as a therapeutic measure in the postshock phase.

Adult↗
PubMed1981

[Home-respirator treatment in idiopathic hypoventilation (author's transl)].

A report is given on a 66 years old patient with severe idiopathic hypoventilation. Two years ago the disease had developed rather suddenly with severe hypoventilation during sleep, accompanied by marked hypoxemia and hypercapnia with pCO2-values above 100mm Hg and respiratory acidosis. No pulmonary, cardiac or neurological disease was found. After failure of two attempts of stimulation of the phrenic nerve the patient was admitted to a respiratory intensive care unit and ventilated by a respirator during sleep. After improvement of this general condition he was discharged at first only in the daytime, later he could be discharged fully from the unit, after a respirator had been installed in his home. Now the patient is connecting himself to the respirator during sleep and since 20 months is so in a tolerable condition. The indications for home-respirator treatment are discussed.

Aged↗
PubMed1980

Rheospirography for determination of respiratory volume.

The method of rheospirography was investigated in 26 voluntary test persons. By means of a spirometric measuring method and after calibration, quantitative statements about size and changes of respiratory minute volume and inspiratory volume could also be evaluated. Computerizing the computation method, rheospirography is suitable for long-term monitoring in intensive care patients.

Computers↗
PubMed1980

[History of the early acute R.D.S. and description of a method to improve immediate postmortem fixation of the lung (author's transl)].

A technique for immediate lung fixation on patients who die of ARDS is described. The advantages compared to the selective needle biopsy, the transthoracic circumscript fixation and the lung fixation organ removal are: 1. functional anatomical proportions are kept, 2. Artefact mainly caused by autolysis is avoided, 3. Simple performance and low costs. The results obtained with the described technique are presented. It is demonstrated that the changes in the initial shock phase correlate well with the pattern of its distribution. These changes are not uniform. Therefore we feel that the results with biopsy are somewhat doubtful.

Adult↗
PubMed1980

[Forced diffusion ventilation (FDV). Bases and clinical application (author's transl)].

A new concept for an alternative gastransport mechanism in the lungs is introduced. It is based on an enhancement of diffusive processes in the bronchial tree and allows gas exchange under quasi apnoic conditions. This enhancement is achieved by a modified high frequency jet ventilation technique utilizing frequencies up to 3000/min. The technical equipment used for this so called forced diffusion ventilation consists of a solenoid valve that interrupts the flow from a high pressure source with adjustable frequencies and impulse pause ratios. A special tracheal tube with an additional jet line implement in its wall carring a nozzle at its tip had to be developed. Animal experiments demonstrate that a sufficient gas exchange even with frequencies of 3000/min can be achieved with this FDV. Under this conditions the lung can be kept in its expiratory inflation level. This technique using frequencies of 350/min has been successfully applied to a patient suffering from multiple bronchopleural fistulas over 16 days. Also the mechanism of FDV is jet not quite clear, penetration of fresh gas into further generation of the bronchial tree, axial diffusion and convective transport due gas oscillations and the volume displacement of the beating heart seem to be responsible for the gas exchange.

Adult↗
PubMed1980

[Inversed ratio ventilation (IRV). Role of the respiratory time ratio in artificial respiration in ARDS].

Considering the advantages shown by the experiences of Reynolds on prolonged inspiration time it was suggested to study this type of ventilation also in ARDS. We tried the inverse ratio ventilation (IRV) in patients with ARDS and in postoperative cardiac surgical patients. An obvious improvement of gas transfer in the lung is seen and becomes better with increased duration of this type of ventilation. A better filling of various parts of the lung with longer time constants is achieved with prolonged inspiration. An effect similar to PEEP caused by an air trapping mechanism, can be seen with the shortening of expiration time. This air trapping mechanism is followed by autonomous adaption of PEEP for the local situation in various parts of the lung. A higher PEEP in poorly ventilated areas is automatically adjusted with IRV, than in areas with a short time constant (individual PEEP).

Biophysical Phenomena↗
PubMed1979

[Assessment of the cardiac output by impedance cardiography (differential rheography) to give optimum continuous positive pressure ventilation (author's transl)].

It is very important to know the cardiac output in artificial positive pressure ventilation for the determination of the exact dosage of dopamine and the endexpiratory pressure. Invasive monitoring of the cardiac output is not suitable for routine bedside use. In our study we looked into the question of whether the dosage of dopamine in continuous positive pressure ventilation could be controlled by impedance determination. Differential rheography, as described by Kaindl, Polzer, and Schuhfried, was used in the study. Relative changes in cardiac output after dopamine administration are shown with sufficient accuracy using the above-mentioned method.

Cardiac Output↗
PubMed1979

[The alveolar-arterial oxygen quotient. standard norms, clinical findings (author's transl)].

From the practical standpoint of view the A-aDO2 proved to be a good parameter for evaluation of global gas exchange. The endexspiratory oxygen pressure, recorded by mass spectrometry, is set equal to the alveolar oxygen pressure. Therefore it is possible for clinical use to have an on line monitoring of PETO2--PaO2. It is necessary to specify the pressure difference in dependence of the inspiratory oxygen pressure since the alveolo-arterial oxygen pressure difference increases with increasing inspiratory oxygen pressure concentration. For practical clinical purposes we come out with the relative ratio of the difference adjusted to the alveolar oxygen pressure. The alveolar-arterial oxygen quotient also called "quotient": formula: (see text) has proved to be a clinical suitable figure. For this quotient are no standard norms reported in the literature. This study was set up to evaluate the quotient in 9 healthy volunteers. The standard norms, found in our study, can basically used for practical clinical purposes. This quotient is demonstrated to be practicable in intensive care medicine (obstructive pulmonary disease, acute pulmonary failure, positive pressure ventilation).

Adult↗
PubMed1978

[Increasing incidence of Serratia marcescens bacteraemia in intensive care patients (author's transl)].

The incidence of serratia marcescens in an intensive care unit was investigated in course of several years. After a trial of Cephalosporin-Gentamycin prophylaxis, infection and death due to serratia rose dramatically. The significance of decreased resistance to infection, hygiene regimes as well as mode of administration of antibiotics is related to selection of this rare microorganism causing septicemia.

Adolescent↗
PubMed1978

[A rare cumulation of vena cava catheter complications in the same patient (author's transl)].

Two complications that occurred in connection with the use of CVP catheters in the SVC and IVC in one patient are described: 1. Extravascular injection in the superior mediastinum and in the extrapleural space. 2. Massive thrombosis of the IVC. The differential diagnosis of a wedening of superior mediastinum is discussed. Recommendations are made to prevent these complications.

Adult↗