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Biomedical subjects

J Kilian

Publications and source records attributed to J Kilian.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Comparative humidity measurements in semiclosed and semiopen systems with the additional use of artificial noses].

The administration of dry anesthetic gases for ventilation lasting more than 1 h leads to morphological changes of the tracheobronchial epithelium that may cause postoperative pulmonary complications. Therefore, additional humidification is suggested for ventilation during anesthesia, particularly when using semiopen breathing systems. Recommendations concerning the use of semiclosed systems are controversial: previous studies have shown sufficient humidification on the one hand, and insufficient water content in the inspired air on the other hand. In this study, comparative humidity measurements in a semiopen and a semiclosed system were carried out during anesthesia and mechanical ventilation. We particularly wanted to find out whether placement of the fresh gas inlet into the circle before or behind the soda lime canister influences the humidity of the inspired gas. In addition, we tested three types of "heat and moisture exchanges"--Engström "Edith", Siemens "Servo Humidifier", and Portex "Humid Vent". A total of 58 patients between 23 and 78 years of age were studied. They were divided into three groups. Group I: In 10 patients comparative humidity measurements were carried out using both a semiopen and a semiclosed system. Group II: The time course of water saturation during a 3-h period was determined in 10 patients ventilated with a semiopen and 8 patients ventilated with a semiclosed circle system. Group III: In 20 patients we tested the effect of "heat and moisture exchangers". All patients were intubated and ventilated with the Spiromat 656 and the Circle System 8 (Drger) that made ventilation in both a semiclosed and a semiopen system possible. The humidity measurements were carried out using a psychometric method.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Early measurement of intracranial pressure in polytrauma with associated craniocerebral trauma. II: Clinical and therapeutic aspects].

During the time from 1982/83 the intracranial pressure was continuously measured from patients who were polytraumatized and also had severe head injuries. In 53% of these cases the first readings could be obtained within 6 hours after the injury and in 33% first after 12 hours. During the time of evaluation this relationship shifted to earlier implantation. From 27% of these patients the intracranial pressure values fell into a range that instigated immediate therapeutical measures. This proves how important it is to have a direct reading from the intracranial pressure as soon as possible after injury. The aspects of therapy by increased intracranial pressure were discussed.

Accidents, Traffic↗
PubMed1986

[The behavior of intracranial pressure under spontaneous respiration or artificial respiration in hemorrhagic shock during volume substitution].

Haemorrhagic shock and cranial injury frequently present together in the polytraumatised patient. The effect of different forms of ventilation--spontaneous respiration, controlled normoventilation, and intubation followed by hyperventilation--on the raised intracranial pressure of young pigs given volume replacement subsequent to haemorrhagic shock, was therefore investigated. During volume substitution, the intracranial pressure (initially 30 mmHg) both of those animals breathing spontaneously and of those being ventilated rose significantly (44.6 and 49.2 mmHg respectively). In contrast, intubation and hyperventilation resulted in an initial fall in intracranial pressure to 18.6 mmHg, and a rise to just below initial values (27.4 mmHg) after volume replacement. A similar blood pressure rise was noted in all three groups but arterial PCO2 changes were analogous to those of intracranial pressure. In the presence of both haemorrhagic shock and cranial injury, volume replacement alone is not sufficient treatment, and can in some circumstances be dangerous. Early intubation and controlled hyperventilation course a fall in intracranial pressure secondary to decreasing the PCO2.

Animals↗
PubMed1985

The effect of ketamine on intracranial pressure during haemorrhagic shock under the conditions of both spontaneous breathing and controlled ventilation.

Seventeen piglets of both sexes, seven with O2/air-buprenorphine anaesthesia and controlled ventilation, and ten unanaesthetized animals with normal, spontaneous respiration, were used for the study. The intracranial pressure of both groups of animals was raised by insufflation of an epidural balloon and the arterial blood pressure was reduced to approximately 70% of the original value by controlled haemorrhage. 0.5 mg/kg body weight of ketamine was given intravenously, followed by a further dose of 2.0 mg/kg body weight of ketamine five minutes later. Both ketamine doses led to a significant rise in the intracranial pressure of those animals breathing spontaneously (31.8 mm Hg to 39.1 mm Hg). In contrast, the ventilated animals showed a significant reduction in intracranial pressure. No changes in arterial PCO2 were observed in this group, while those piglets breathing spontaneously had dangerous PCO2 rises. At both ketamine doses a significant correlation could be found between the PCO2 and the intracranial pressure.

Animals↗
PubMed1985

[The semi-closed filter circuit].

In a semi-closed circle system, the inspiratory and expiratory limbs are completely separated and part of the patient's expired air recirculates. CO2 rebreathing is prevented by CO2- absorption with soda lime, which is always incorporated in such a circle. The inspiratory and expiratory valves ensure that gas flow is unidirectional and also prevent rebreathing, even at tidal volumes of 10 ml and ventilation frequencies of 60 c . min-1. This circuit can be used as an universal anaesthetic system for all age groups, simply by changing the hoses and connecting pieces. The values of expiratory resistance are within the recommended limits of the ISO; prewarming and humidification of the inspiratory gas mixture are sufficient without additional equipment. Standard monitoring of the circuit such as measurement of inspiratory O2 concentration and ventilation pressure, including a disconnection alarm, can be used for all age groups; spirometry or end-tidal CO2 measurements ensure normoventilation. The fresh gas flow required in a semi-closed circle system is about 2-4 1 . min-1, so that costs and environmental contamination with anaesthetic gases are relatively low in comparison with a semi-open system.

Airway Resistance↗
PubMed1985

[Early measurement of intracranial pressure in polytrauma with associated craniocerebral trauma. I: Principles].

In West Germany, head injury is the major cause both of death following trauma and of irreversible cerebral damage. The successful management of these cases largely depends on the prevention and treatment of secondary rises in intracranial pressure. The only certain way of detecting such increases is with the invasive technique of intracranial pressure monitoring. The pressure module should be implanted as soon as possible, ideally, before extensive definitive surgical treatment is carried out. Ease of usage has led us to prefer epidural pressure monitoring systems. Being relatively easy to learn and apply, this form of monitoring should be used in all hospitals involved in the treatment of severe head injury.

Brain Edema↗
PubMed1984

[Parenteral administration of amino acids to septic patients].

The study investigates the status of plasma amino acids and their pathological changes under the specific conditions of sepsis in 20 intensive care patients, who were randomized into two groups with and without amino acid support. The study was designed to determine whether the concentration of the free amino acids in plasma or their relative proportions to each other determine the cellular uptake under septic conditions in such a way that would have relevance for the exogenous supply. Sepsis was defined as an increase in body temperature above 38 degrees C, a positive blood culture and changes in the white blood cell picture. Carefully standardized and quality-controlled low-pressure liquid chromatography was used along with a new procedure for data processing, based on personal physiological range with known ranges for individual amino acids. The concentrations of individual amino acids vary widely and did not allow a decision to be made about disturbance of homeostasis. The mean total concentrations varied between 1.27 mmol/l and 4.40 mmol/l. The range was similar whether amino acids were administered or not. This variation was also found in the branched chain amino acids, which were considered to have a specific importance in septic states. Valine varied between 114 mumol/l. The relative proportion of the individual amino acids to the whole amount of amino acids showed less variation and demonstrates that the oxidative action of the liver is able to correct any deviation from the normal and maintains the uptake of amino acids by the cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1984

[Acute coronary insufficiency during induction of anesthesia following anthracycline chemotherapy].

Cytostatic treatment with anthracyclines lines can lead to acute or chronic myocardial insufficiency. A cumulative dose of less than 500 mg/m2 body surface area can in general be regarded as safe. A case of acute cardio-circulatory insufficiency during induction of anesthesia is described, in which the total cumulative dose did not exceed 250 mg/m2 body surface area. The pathophysiological mechanisms occurring and the diagnostic and therapeutic measures necessary are discussed.

Anesthesia↗
PubMed1984

[Elevation of the upper part of the body in acute craniocerebral traumas. Possibilities and limits of intensive therapy].

13 cases of severe cerebral trauma were subjected to varying degrees of elevation of the upper trunk (0 degrees, 15 degrees, 30 degrees, 45 degrees) and to head-raising only (0 degrees, 15 degrees, 30 degrees). The intracranial pressure and mean arterial pressure were measured in these positions. On raising the upper half of the body by 15 degrees, intracranial pressure fell from a mean of 35.3 mm Hg to 28.7 mm Hg, and to 25.2 mm Hg on raising to 30 degrees. Further elevation to 45 degrees resulted in an increase in pressure. In contrast, the mean arterial pressure fell constantly as elevation increased, resulting in a decrease in cerebral perfusion pressure at levels above 30 degrees. In no cases did raising of the head alone result in a lowering of pressure. Instead, potentially dangerous increases were observed.

Adolescent↗
PubMed1984

[Energy metabolism and energy consumption of intensive care patients on respirators].

There are two main reasons for assessing energy turnover individually and as accurately as possible; firstly, the marked variation in available data on the degree to which energy turnover increases after severe trauma, and secondly accumulating evidence of the potential dangers of an inappropriately high so-called "hypercaloric" substrate dosage, which exceeds energy requirements. The energy turnover of 50 polytraumatized intensive care patients was therefore measured by indirect calorimetry and compared with norm values. Comparison of the median values revealed an approximately 50% higher energy turnover in the polytraumatized cases than calculated basal levels. The median values of our patients all lay within a similar range, but for each individual case we found marked differences between the energy turnover as measured by indirect calorimetry, and that estimated from norm tables. The oxygen consumption and CO2 production rates of 10 polytraumatized ventilated patients, measured at short time intervals, showed only minimal variations during the course of 24 h. The separate measurements carried out at hourly intervals varied by less than 10% when compared to an 1-h period of observation between 11 and 12 a.m. The oxygen consumption of a group of 40 polytraumatized, ventilated intensive care patients receiving various different i.v. infusions and parenteral nutrition regimens was, with an average of 382 +/- 47 ml/min, much higher than physiologically normal values. The energy turnover rate of these patients was correspondingly much higher than that of a fit person at rest, despite the fact that the rates measured were relatively low when compared to values found in the older literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Calorimetry, Indirect↗
PubMed1983

[Thromboembolism prevention in surgical medicine: heparin or heparin-dihydroergotamine?].

This review summarizes clinical studies on prevention of venous thromboembolism by heparin or heparin and dihydroergotamine. Advantages and disadvantages of both drugs are described. The value of low-dose-heparin can no longer be seriously disputed. Up to now, however, there is no clear evidence that heparin-dihydroergotamine improves the efficacy and reduces the frequency of complications. The later drug is a new approach still under investigation.

Clinical Trials as Topic↗
PubMed1983

[Coagulation disorders in acute cranio-cerebral injuries].

Marked coagulation defects which have a very high mortality rate can arise following acute head injury. Damage to brain tissue leads to the release of substances promoting coagulation which can enter the vascular system and activate the enzyme cascade leading to clot formation. The more widespread cerebral damage is, the greater is the likelihood of clinically relevant DIC occurring. By carrying out clotting tests and taking therapeutic measures where necessary, a potentially lethal outcome can be avoided.

Acute Disease↗