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Biomedical subjects

J Eckart

Publications and source records attributed to J Eckart.

At least 37 records · Page 2Linked to original sources
PubMed1989

Indications for combined high frequency ventilation in clinical use.

A retrospective study of 20 surgical intensive care unit patients is reported. They were ventilated with continuous positive pressure ventilation (CPPV) and then switched to combined high frequency ventilation (CHFV). To find why there were variable responses to CHFV, the data of 20 patients were retrospectively evaluated with respect to respiratory index (RI), compliance (C) and extravascular lung water (EVLW). The results suggest that the indication line for CHFV was a C value greater than 45 ml/cmH2O and an EVLW value greater than 15 ml/kg BW.

Adult↗
PubMed1989

[Side effects and complications of parenteral nutrition].

Despite increasing advances in total parenteral nutrition, a lot of partly serious side effects have been seen. This includes among other things the lactic acidosis after high amounts of carbohydrates or the deficiency and excessive expenditure respectively, of thiamine in carbohydrate metabolism. Metabolic changes in bone system, especially with long term parenteral nutrition are reported by american groups. Cholestasis is often caused by intravenous feeding. In patients with malnutrition a carefully balanced supply of calories and phosphate should be offered. Without misuse of TPN, the rate of complications is very low.

Acid-Base Equilibrium↗
PubMed1987

[Clinical studies with fat emulsions containing LCT and MCT].

In an effort to supply energy carriers with a high utilization rate specifically in parenteral nutrition during postaggression metabolism, fat emulsions were developed containing long- and medium-chained triglycerides in a 1:1 ratio. The special advantage of the medium-chained fatty acids is, among other things, their low rate of accumulation and high oxidation rate in the organism. Using a graduated schedule, intensive-care patients who were being parenterally fed exclusively were administered either an MCT/LCT mixture or an LCT emulsion alone as a bolus injection and later continuously. Among other things, the behavior of the triglyceride concentrate and the individual fatty acids in serum and of individual lipid fractions, as well as the effect on various parameters of carbohydrate and fat metabolism, were measured. In addition, the oxidation rate of an MCT/LCT emulsion labelled with 13C was measured. The results of the comparative lipid studies were compared. The expected result-that the oxidation rate of medium-chained triglycerides exceeds that of long-chained triglycerides-was confirmed. It was surprising that the median oxidation rate with a continuous fat supply within a complete nutrition program was only 32 +/- 6.8%. Why some patients showed higher triglyceride levels with the MCT/LCT emulsion than with the supply of LCT alone is still unclear. It remains to be investigated whether the rapid splitting of medium-chained triglycerides leads to a temporary loss of activity of the lipoprotein lipase accompanied by a rise in triglycerides in serum. More research will be necessary before we know what role MCT/LCT emulsions will play in future. Such an emulsion would possibly be suitable in severely injured patients, whereby the MCT portion could preferentially supply the organism with energy carriers and the long-chained triglycerides structural components.

Critical Care↗
PubMed1983

[Essential fatty acids in the plasma of severely injured patients under parenteral feeding].

After a heavy injury there are characteristic changes of plasma lipids and lipoproteins. In 7 patients up to 40 days after major injury the fatty acids of cholesteryl esters, phospholipids and triglycerides in plasma under the influence of injury, parenteral nutrition with carbohydrates or fat, and protein-sparing therapy were determined by gas liquid chromatography. These patients' increased requirement for linoleic acid is further increased by up to more than 50 g per day by carbohydrate-rich parenteral nutrition, inhibiting lypolysis of linoleic acid from adipose tissue. Protein-sparing therapy without carbohydrates is not sufficient to cover the patients' increased requirement for linoleic acid. Thus, the early administration of fat emulsions in parenteral nutrition is recommended.

8,11,14-Eicosatrienoic Acid↗
PubMed1983

[Current status of parenteral feeding with fat emulsions. Clinical experiences with infected patients].

In sepsis the utilization of endogenous and administered fuel sources is sometimes impaired. The precise origin of this metabolic failure is currently unknown. In long term and severe septic processes an increased peripheral energy deficit appears accompanied by a drastically augmented muscle protein catabolism. Branched chain amino acids released by this protein breakdown, at least temporarily, meet the energy needs of the muscles. Ketone bodies as energy source for the muscle are not available because their production is diminished in sepsis. The question of whether or not fat emulsions can be administered to septic patients still remains unanswered, although some recent investigations have demonstrated that fat is utilized and oxidized by septic patients. Results from our patients indicate that a marked reduction of cholesterin ester quotient, an increase of total and VLDL triglycerides and a severe reduction of HLDL Cholesterin are particularly characteristic changes in lipid metabolism during sepsis. The proportional decrease of the linoleic acid levels in cholesterol esters of plasma observed in septic patients was even more pronounced followed severe injury. Together with others we believe that parenteral fat application is not contraindicated in sepsis. The decision to infuse fat emulsions depends more on the metabolic situation of a patient than on a specific diagnosis; in other words, a sufficient peripheral oxygen supply, the level of the serum triglycerides and the reaction of the blood glucose concentration to an intravenously administered fat emulsion are, among others, the decisive factors.

Adult↗
PubMed1982

[Serum apolipoproteins and lipids in severe injury as influenced by nutrition. A pilot study].

In 10 patients with polytrauma and 2 patients with sepsis a relation of the severity of trauma and the change of lipoproteins has been found. Cholesterol and triglycerides as well as apolipoproteins A-I and B decrease significantly in the first days after the injury. During the following rise of cholesterol and triglycerides apolipoprotein A-I increases also to a concentration of lower normal range; apolipoprotein B remains lowered. Apolipoprotein C-III2 is determined in 3 patients and is increased. The concentration of apolipoprotein A-I decreases in three of five patients, who had parenteral fat administration. Apolipoprotein B increases during fat administration. The following fat free parenteral nutrition causes a decrease of apolipoprotein B again. The composition of lipoproteins is similarly changed in 2 patients with sepsis. The apolipoproteins as well as the lipids decrease more in patients who died later than in the case of reconvalescence, in which the increase of concentrations of lipids and apolipoprotein B may be accelerated with parenteral nutrition. Apolipoprotein A-I reacts variably, A-II is lowered.

Adolescent↗
PubMed1980

[Disturbances of lipoprotein and fatty acid metabolism in patients with heavy injuries (author's transl)].

Critically ill patients after a heavy accident suffer from major disturbances of hormones and metabolism. To study the origin of these alterations and the mechanisms of lipid transport through plasma in this critical situation plasma lipoproteins and fatty acid distribution were analyzed consecutively in four patients after a heavy accident and during convalescence up to 30 days. In all patients whole plasma cholesterol is reduced below 100 mg/dl, predominantly by a decrease of LDL-cholesterol, but HDL-cholesterol is also reduced. Triglycerides start with very low levels and the following increase of whole plasma triglycerides. Thus, a negative relationship between HDL-cholesterol and VLDL- as well as LDL-triglycerides was found. In HDL the ratio of cholesterol to phospholipids changes from 1.4 to 0.2, indicating major alterations in the composition of this lipoprotein fraction. Apolipoprotein B and total protein in lipoprotein fractions are also decreased by injury. Within 3-5 days linoleic acid levels are decreased in all lipid and lipoprotein fractions of plasma, but most pronounced in cholesterol esters. Arachidonic acid is only decreased in two patients in the phospholipid fraction. As parameter of essential fatty acid deficiency in tissues eicosatrienoic acid (C20:3/9) increases in phospholipids of plasma. Total parenteral nutrition with fat emulsions obtains good results in the normalization of plasma lipoproteins and fatty acid distribution by influencing the composition of VLDL, LDL, and HDL. A supply of up to 56 g linoleic acid per day is necessary to normalize linoleic acid and arachidonic acid levels in plasma lipids. After cessation of the acute reactions of circulation and metabolism fat emulsions can be used in total parenteral nutrition of patients after injury in an amount of 30-40% of energy.

Adolescent↗
PubMed1978

Factors influencing essential fatty acid requirement in total parenteral nutrition (TPN).

Twenty patients, after major injuries or elective abdominal surgery, were studied with respect to essential fatty acids in total serum and lipoprotein fractions. The regimen of total parenteral nutrition was altered in its content of energy, carbohydrates or fat. In all patients the linoleic acid levels decreased and the 20:3/20:4 ratio increased. Serum low density lipoproteins developed remarkable alterations of the biochemical composition and of morphology by electronmicroscopy. The degree of these alterations depended on the kind of illness, the amount of carbohydrates infused, special hormonal situation due to surgery and linoleic acid supply. As a consequence of these results, the supply of a sufficient amount of linoleic acid should be considered in every case of total parenteral nutrition.

Adolescent↗
PubMed1978

[Problems in massive transfusion].

The concept of massive blood transfusion is defined not by the number of units of blood administered but rather by the relationship of the number of blood units transfused to the normal blood volume of the recipient and the rapidity of administration. The composition of stored blood can lead to different metabolic disturbances, specifically in cases of massive transfusion. The importance of hyperkalemia, hypocalcemia and citrate intoxication as well as disturbances in the acid-base balance and blood coagulation as seen in cases of massive transfusion are analysed and the necessary therapeutical consequences discussed.

Acid-Base Imbalance↗