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Biomedical subjects

H Burchardi

Publications and source records attributed to H Burchardi.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Septic shock with acute abdomen in idiopathic hemochromatosis].

The case of a patient with abdominal crisis and shock without any discernible origin who died 36 hours after hospital admission despite maximal therapy is described. Gram-negative sepsis, peritonitis and haemochromatosis with hepatic siderosis was the post-mortem diagnosis. We consider spontaneous peritonitis arising from translocation of normal intestinal flora (E. coli) through the intact wall of the gut combined with the impaired ability of the reticulo-endothelial system to remove endotoxin to be the causative factors. It is unknown whether the adrenal insufficiency due to siderophilic adrenal hypophysis and adrenal glands contributed to the fulminant course of the disease. Undiagnosed liver cirrhosis and especially haemochromatosis should therefore be included in the differential diagnostic considerations in patients presenting with these symptoms, and in whom no obvious cause for a septic focus can be found.

Abdomen, Acute↗
PubMed1992

[Polytrauma following a fall from a great height. The injury pattern and the intensive medicine aspects].

We report on 10 polytraumatised patients who were treated in an ICU after a free-fall injury. The injury pattern of these patients proved to be relatively uniform. Brain oedema occurred in many victims. Remarkable was the fact that 8 out of 10 patients developed a pneumothorax, but only three of them had rib fractures on the same side. All patients suffered from fractures of the extremities with the lower extremities being affected more often. Abdominal injuries were not of importance.

Abdominal Injuries↗
PubMed1992

[Endotracheal suctioning using a 24-hour continuous system. Can costs and waste products be reduced?].

Suctioning of the airways is often required in critically ill, intubated, or tracheotomised patients. In addition to the primary cost of these disposable materials, expenditures for waste disposal and environmental problems due to plastics should also be considered. In this study, the primary costs and amount of waste products of the closed suction system "Trach Care" were compared with a conventional disposable system. Other advantages and disadvantages of a closed suction system are discussed. METHODS. In this prospective, randomised investigation, both the open disposable suction system and the closed Trach Care system were used, in 60 patients (30 in each group) who were intubated for 1 week or more. During the first 7 days, we counted the number of times endotracheal suctioning was performed and measured the time it took. The costs of purchasing the systems, amounts of waste products, and costs of disposal were compared. RESULTS. The frequency of endotracheal suctioning was quite different from patient to patient and varied from 6 to 41 times per day. On average it was necessary 15 times per day per patient in both groups. Using the disposable system, a mean time of 3.5 min was measured in contrast to 2.5 min with the closed system. The costs of purchase were much lower with the disposable system taking into account all materials needed (17.36 DM vs 53.36 DM per day), whereas the weight of litter produced by the closed system was lower (429 g vs 745 g per day), the costs of disposal being accordingly different. During endotracheal suctioning O2 desaturation was not observed with the closed system, whereas in patients with acute respiratory failure O2 saturation fell rapidly from 90% to as far as 70% when a disposable system was used. CONCLUSION. The closed Trach Care suction system is more expensive to acquire, but may reduce the risk of exogenous nosocomial pneumonias as disconnections from the ventilator are minimised. The workload, weight of waste products, and costs of disposal are lower using the Trach Care system. From the physician's viewpoint, the main advantage of the Trach Care system becomes evident in patients with acute respiratory failure and patients with elevated intracranial pressure. In these cases, we now favor the Trach Care system as a matter of principle.

Anesthesiology↗
PubMed1992

Individualized dosage of gentamicin: a programmed pocket calculator is useful only when applied properly.

Various methods of gentamicin dosing were compared in order to evaluate factors that prevent achievement of therapeutic peak and trough plasma concentrations in every patient. When standard doses of 3 x 80 mg of gentamicin/day (i.e., 3 x 170 mumol/day) were administered, only 26% of peak and 51% of trough plasma concentrations were within the desired range. This percentage increased for peak levels to 54% (p less than 0.001) when physicians were instructed in the use of a programmed pocket calculator (PPC) and to 70% (p less than 0.001) when in addition the nursing staff was trained. The best results were achieved when dosing and blood sampling were supervised by a single trained person, 76% of initial peak and 71% of initial trough levels being within the therapeutic range. In this group of patients, further dosage adjustments by the PPC achieved 92% of peak levels in the desired range, while no patient had elevated trough levels. Analysis of the factors that led to these results revealed that neither the laboratory nor the PPC are limiting factors for optimal results. The goal of therapeutic plasma concentrations can be achieved, but requires appropriate attention to the accuracy of blood sampling and dosing. For this purpose, a special program, i.e., more than ordinary attention to drug therapy, is needed.

Adolescent↗
PubMed1991

Improved determination of static compliance by automated single volume steps in ventilated patients.

A new method for determination the static compliance of the respiratory system is described ("static compliance by automated single steps"--SCASS). In 12 ventilated patients pressure/volume (P/V) curves were determined by automated repetitive occlusion (6 s) at single volume steps and compared to the conventional syringe method (SM). All measurements were corrected for effects of temperature, humidity and pressure (THP). SM was found to be significantly influenced by intrapulmonary gas exchange causing an effective mean volume deficit of 217.4 +/- 65.7 ml (BTPS) at the end of the deflation. In contrast to that, the short duration of occlusion in SCASS minimize the gas exchange effects. The methodical differences between both methods result in overestimation of the inflation compliance in the uncorrected SM (SMuncorr: 83.4 +/- 12.6; SCASS: 76.0 +/- 11.9 ml/cmH2O. p less than 0.01) and underestimation of the deflation compliance resp. (SMuncorr: 58.3 +/- 7.5; SCASS: 79.1 +/- 15.0 ml/cmH2O. p less than 0.005). In contrast to the P/V curves by SM no significant hysteresis was found by SCASS. Gas exchange seems to be the main reason for the hysteresis. Even after correcting gas exchange and THP effects a significant hysteresis remained. The SCASS method avoids these problems and allows furthermore an accurate checking of leaks.

Adult↗
PubMed1990

[The effect of selective decontamination on nosocomial infections, their causative agents and antibiotic resistance in long-term intubated intensive care patients].

During a 12-month period 45 long-term intubated patients were treated by topical application of non-absorbable antibiotics (tobramycin, polymyxin, amphotericin B) together with an initial short-term intravenous application of an antibiotic with only minimal activity against anaerobic intestinal flora. These patients were compared to 48 patients in the previous 12-month period who had only interventional antibiotic therapy in case of established infections. This selective decontamination of the digestive tract (SDD) reduced the colonisation of the respiratory tract, thus also decreasing incidence of nosocomial pneumonia. There were fewer urinary tract infections, while the incidence of wound infections and septicaemia was influenced to microorganism a lesser degree. The number of gram-negative isolated microorganism was reduced, leading to a shift towards gram-positive organisms, especially S. epidermidis. During the 12-month study period there was no change of antibiotic sensitivity of the isolated microorganisms. Although we encountered no problems associated with multiresistant pathogens, routine microbiological surveillance is strongly recommended to detect changes in antibiotic resistance at an early stage.

Administration, Topical↗
PubMed1990

[Organ failure in patients with multiple trauma. The effect of early osteosynthesis of fractures on complications].

The course of 225 multiple traumatized patients in our ICU with a mean age of 35 +/- 16.8 years, a mean ISS of 30 +/- 8.3 and an overall mortality of 18.2% was evaluated retrospectively. For comparable ISS the mortality was higher in patients over 65 years, and increased further with age. The most common causes of death were MOF (41.5%), severe head injury (34.1%), and acute respiratory failure (ARF) (19.5%). The mortality increased when two or more organ failures were present. 105 patients had fractures of the long bones; in 28 of these all fractures were stabilized primarily (during the first 24 hours). Organ failure was seen less frequently in these patients compared to those with secondary stabilization: ARF 10.7% vs. 51.9% (p less than 0.0004), acute renal failure 3.6% vs. 11.7%, liver failure 3.6% vs. 11.7%, sepsis 14.3% vs. 29.9%. Mortality was significantly lower in the patient with primarily stabilized fractures (7.1% vs. 24.7%, p less than 0.05). The study demonstrates that early stabilization of long bone fractures results in a more favourable course, and that this should be carried out whenever feasible.

Adolescent↗
PubMed1988

Effects of increased cardiac output on pulmonary blood flow distribution during lobar ventilation hypoxia and collapse.

Electromagnetic flow probes were placed around the pulmonary artery and left lower lobe artery in anaesthetized open-chest dogs in order to measure possible changes in the ratio of lobar-to-total pulmonary blood flow (Ql/Qt) in response to changes in cardiac output produced by the opening of arterio-venous fistulae or fluid loading. Ventilation of the lobe with 7% oxygen or lobar collapse reduced Ql/Qt by 35% and 42%, respectively, but there were no significant changes in Ql/Qt in response to increases in Qt of 29-133%. It is concluded that the changes in Qt, pulmonary vascular pressures and mixed venous PO2 within the range studied did not influence Ql/Qt.

Animals↗
PubMed1987

[Acute lung failure--a critical analysis].

The Adult Respiratory Distress Syndrome (ARDS) is a clinical syndrome with acute progressive lung function deterioration based on increased pulmonary permeability and caused mostly by non-pulmonary lesions (like sepsis or polytrauma), occasionally also by pulmonary diseases (like pneumonia) or intoxications (e.g. by paraquat). In the complex, interactive pathomechanisms (e.g. complement activation, stimulation of the arachidonate metabolism) with release of numerous damaging mediators the massive accumulation of neutrophils in the lung plays an important role.

Capillary Permeability↗
PubMed1987

[Postoperatively developing serratus paresis as a legal problem].

It is demonstrated in five exemplary cases that a neuralgic amyotrophy with particular involvement of the long thoracic nerve was the cause of a postoperative serratus paresis. In any case liability claims, it is essential for an expert's opinion on postoperative serratus paresis to differentiate this pathology from intraoperative injuries caused by pressure. Above all the interval between operation and the first manifestation of symptoms, as well as the development of distinct pain count against an intraoperative plexus lesion.

Adult↗
PubMed1986

Continuous intravenous infusion of elastase in normal and agranulocytic minipigs--effects on the lungs and the blood coagulation system.

In order to investigate the acute effects on lung morphology, lung function, hemodynamic and blood coagulation system, elastase (330 units (U) kg-1 h-1) was continuously infused into 16 anesthetized and mechanically ventilated minipigs. Elastase infusion induced a disturbance of blood coagulation leading to hypocoagulability, a pulmonary leukostasis, interstitial edema, a progressive respiratory failure with prompt increase in pulmonary vascular resistance, decrease in systemic vascular resistance, increased venous admixture, and increased dead space ventilation. Agranulocytosis prevented interstitial edema but not disturbances in pulmonary or hemodynamic function or hypocoagulability. The results clearly indicate that elastase may be involved in the pathophysiology of acute lung failure and defects in the blood coagulation system.

Agranulocytosis↗
PubMed1986

Measurement of pulmonary capillary blood flow by a nitrous oxide rebreathing technique.

Measurements of pulmonary capillary blood flow by a nitrous oxide rebreathing technique (QN2O) were performed in 21 anesthetized and artificially ventilated minipigs with normal lungs and in nine minipigs with thrombin-induced (75-150 U kg-1 h-1) lung pathology. QN2O was calculated with the Hook-Meyer-formula and compared to cardiac output measurements (thermodilution, QT, or direct Fick's principle, QFick). The coefficient of variation in double QN2O measurements was 0.05. If the tidal volume to dead space ration (VD/VT) is normal, the nitrous oxide method works well, but when the efficacy of ventilation worsens, this gas uptake method fails to detect the circulation of the poorly ventilated parts of the lung. The mean ratio QN2O/QFick in pigs with normal lungs (58 measurements) was 1.00 +/- 0.10 (mean +/- s.d.). During thrombin infusion, the mean ratio QN2O/QT was 0.84 +/- 0.17 (n = 49). After corrections for shunt perfusion (Qs), the mean ration QN2O/(QT-Qs) was 0.89 +/- 0.17 (n = 49). QN2O/QT-Qs) decreased with increasing VD/VT. In measurements during thrombin infusion with VD/VT less than 0.33, the mean ratio QN2O/(QT-Qs) was 0.97 +/- 0.11 (n = 21), with a VD/VT between 0.33 and 0.44, the mean ratio QN2O (QT-QS) was 0.90 +/- 0.08 (n = 20), and with a VD/VT greater than or equal to 0.45, this ratio was 0.62 +/- 0.18 (n = 8). In the presence of only moderate functional inhomogeneities, this noninvasive rebreathing method will offer reliable data on pulmonary perfusion.

Anesthesia, Closed-Circuit↗