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Biomedical subjects

K Geiger

Publications and source records attributed to K Geiger.

At least 37 records · Page 2Linked to original sources
PubMed1999

In vivo evaluation of a new method for chemical analysis of volatile components in the respiratory gas of mechanically ventilated patients.

Using the volatile anaesthetic isoflurane as a marker substance a gas chromatographic method for analysis of exhaled gas in mechanically ventilated patients was evaluated. Twelve patients with and 10 patients without preceding isoflurane exposure and seven blank respiratory circuits were investigated. Respiratory gas was sampled at four different sites in the respiratory tubing system. Analysis of volatile components was based upon adsorption onto activated charcoal, desorption by means of microwave energy, gas chromatographic separation and flame ionisation or mass spectrometric detection. Isoflurane concentrations in the blank respiratory circuits, in the control group, and in the inspiratory limb of patients with preceding isoflurane inhalation were at the limit of detection (<10(-12) mol/l). In the isoflurane group, isoflurane concentrations in the inspiratory and expiratory limb differed considerably. Using the method described, substances at very low concentrations could be identified as originating in the patient or as coming from the gas delivery system.

Adult↗
PubMed1999

The Traveling Shutter Wave analyses non-linear compliance during mechanical ventilation.

Mechanical ventilation is an important, often life-saving component of modern intensive care medicine. However, it may further aggravate pulmonary pathology by endinspiratory overdistension of the alveoli or by their endexpiratory collapse. To prevent both the ventilator may be adjusted based on the slope of the pressure-volume curve, named as compliance, which is often determined by a stepwise inflation of the lungs. This maneuver gained no widespread clinical acceptance because of being cumbersome and invasive. Therefore, we developed a modification of the well known interrupter technique - the Traveling Shutter Wave. A wave of short-term (300 ms) occlusions "travels" over the tidal volume range. Differential compliance is calculated by division of volume and pressure differences between two adjacent occlusion maneuvers. The technique is well suited for the clinical setting because the ventilatory pattern does not need to be changed. This manuscript describes the realization of the Traveling Shutter Wave as well as its application in two patients.

Feasibility Studies↗
PubMed1999

Reduction of the bacterial load by the silver-coated endotracheal tube (SCET), a laboratory investigation.

Microaspiration enabled by high-volume-low-pressure cuffed endotracheal tubes is the most likely explanation for ventilator-associated pneumonia. To decontaminate the secretion at the proximal end of the cuff we developed a silver-coated endotracheal tube (SCET). In an in vitro model we investigated the efficacy of SCET to lower the bacterial load of secretion and aspirate. We developed a continuously contaminated and mechanically ventilated oropharynx-larynx-lung model to investigate the reduction of the bacterial count by SCET compared to controls. The model was continuously contaminated via the oropharynx-larynx with Pseudomonas aeruginosa ATCC 27853. During the investigation period of 50 hours the bacterial count of oropharynx-larynx and lung was measured as colony-forming-units/ml. In addition, the characteristic curve of silver ion release of SCET was determined. SCET significantly reduced the bacterial count in oropharynx-larynx at all timepoints (p < 0.05). In lung the bacterial count was significantly lower beginning with the 36th hour of recording (p < 0.05). A reduction of greater than 2 log was found from 28 hours on in oropharynx-larynx and from 50 hours on in lung. The release of silver ions was very rapid and was described by a mono-exponential function with a time-constant tau of about 60 minutes and a saturation concentration of 200 +/- 80 microg/l. SCET showed a significant inhibition of growth of P. aeruginosa in the continuously contaminated and mechanically ventilated oropharynx-larynx-lung model. SCET by thus might be helpful in reducing ventilator-associated pneumonia.

Bacterial Infections↗
PubMed1998

Method for analysis of exhaled air by microwave energy desorption coupled with gas chromatography-flame ionization detection-mass spectrometry.

A method for chemical analysis of volatile constituents in exhaled air of mechanically ventilated patients is described. Exhaled substances are adsorbed and concentrated onto activated charcoal, desorbed by microwave energy and transferred into a gas chromatograph for separation without prior cryofocusing. Substances are identified by flame ionisation detection and mass spectrometry. This method yields reproducible results and is well suited for clinical studies.

Acetylene↗
PubMed1998

Bees travel novel homeward routes by integrating separately acquired vector memories

The question of whether bees can take novel short cuts between familiar sites has been central to the discussion about the existence of cognitive maps in these insects. The failure of bees to show this capacity in the majority of previous studies may be a result of the training procedure, because extensive training to one feeding site may have eliminated or weakened memories for other sites that were previously trained. Here we present a novel approach to this problem, by rewarding honey bees, Apis mellifera carnica, at two feeding sites, one (Sm, 630 m southeast from the hive) at which they could feed in the morning, and the other (Sa, 790 m northeast) at which they could feed in the afternoon. We then displaced bees to Sa in the morning and to Sm in the afternoon either from the other feeding site or from the hive. Bees were also displaced to two novel sites, one at a completely unfamiliar location (S4) and another that was located halfway between the two feeding sites (S3). Bees displaced from either of the feeding sites never took novel short cuts; instead, they used the homeward directions that would have been correct had they not been displaced. Bees caught at the hive entrance, however, chose the correct homeward direction not only when displaced to both feeding sites, but also when displaced to S3, although not from S4. Control bees that had been trained to only one of the feeding sites were not able to travel directly home from S3 excluding the possibility that bees used landmarks close to the hive. This is the first evidence that bees take a novel short cut by activating two vector memories simultaneously. The potential mechanisms of integrating the two memories are discussed. Since bees took novel short cuts in only one direction (to the hive) and only when displaced from the hive (not the feeders), we conclude that inference of a cognitive map in bees would be premature. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1998

Application of a new method for analysis of exhaled gas in critically ill patients.

OBJECTIVE: Application of a new method for analysis of exhaled gas in critically ill patients. DESIGN: Open study. SETTING: Surgical intensive care unit of an university hospital. PATIENTS: Thirty-seven consecutive, critically ill, mechanically ventilated patients. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Chemical analysis of the patient's exhaled gas was based upon substance adsorption and concentration onto activated charcoal, microwave desorption and gas chromatographic separation. Patients with acute respiratory distress syndrome (ARDS) exhaled less isoprene than those without ARDS [9.8 (8.2-21.6) vs 21.8 (13.9-41.4) nmol/m2 per min [median (95% confidence interval)], p = 0.04]. In patients who developed pulmonary infection, pentane elimination increased from 0.4 (0.0-5.4) to 2.7 (0.6-6.1, p = 0.05) nmol/m2 per min and isoprene elimination decreased from 5.2 (0-33) to 5.0 (0-17, p = 0.05) nmol/m2 per min, resulting in a significant increase in pentane/isoprene ratio from 0.1 (0-0.3) to 0.4 (0-15, p = 0.007) when compared to patients without pulmonary infection. CONCLUSIONS: The new method allows quantitative analysis of human gas samples with low substance concentrations and is well suited for clinical studies which involve the investigation of metabolic processes in the lung and the body.

Adult↗
PubMed1998

Detection of endotracheal tube obstruction by analysis of the expiratory flow signal.

OBJECTIVE: Acute obstruction of endotracheal tubes (ETT) increases airway pressure, decreases tidal volume, increases the risk of dynamic hyperinflation by prolonging the duration of passive expiration, and prevents reliable calculation of tracheal pressure. We propose a computer-assisted method for detecting ETT obstruction during controlled mechanical ventilation. The method only requires measurement of the expiratory flow. DESIGN: Computer simulation; prospective study in two cases; retrospective study in one case and in seven patients with the adult respiratory distress syndrome (ARDS). SETTING: Laboratory of the Section of Experimental Anaesthesiology (University of Freiburg); surgical adult intensive care units in a university hospital (University of Basel) and in a university affiliated hospital (Zentralklinikum Augsburg). PATIENTS: 3 patients with partial ETT or bronchial obstructions and 7 ARDS patients. MEASUREMENTS AND RESULTS: Expiratory flow was measured using a pneumotachograph and integrated to obtain expiratory volume. The time-constant of passive expiration (tauE) as a function of expired volume [tauE(V(E)) function] was calculated from the expiratory volume/flow curve. We investigated the tauE(V(E)) function of data obtained from: (1) computer simulation of mechanically ventilated homogeneous and inhomogeneous lungs intubated with ETTs of different sizes; (2) one patient with an artificial ETT obstruction of 7.5 and 25% of the cross-sectional area of the ETT (case 1); (3) one patient with ETT obstruction due to secretions (case 2); (4) one patient with acute bronchial constriction (case 3); (5) seven ARDS patients who showed an increase in airway resistance of more than 2 cm H2O x s/l. It was found that an ETT obstruction caused an increase in tauE in early expiration (at high flow), whereas tauE in late expiration was virtually unchanged. The reason for this is the flow dependency of the increase in ETT resistance produced by ETT obstruction. Unlike ETT obstruction, an increase in pure airway resistance produced an increase in tauE throughout expiration. CONCLUSIONS: An ETT obstruction can be reliably distinguished from an increase in pure airway resistance by a characteristic pattern change in the tauE(V(E)) function, which can be detected easily even by an automated pattern recognition system.

Aged↗
PubMed1998

Effect of different doses of inhaled nitric oxide on pulmonary capillary pressure and on longitudinal distribution of pulmonary vascular resistance in ARDS.

Inhaled nitric oxide lowers pulmonary capillary pressure (PCP) in animals and in patients with acute respiratory distress syndrome (ARDS). A dose-response relationship in patients with ARDS has not yet been established. Therefore, we studied the effects of four concentrations of nitric oxide (1, 10, 20 and 40 volumes per million (vpm)) in random order, on PCP in 19 patients with ARDS. PCP was estimated by visual analysis of the pressure decay curve after balloon inflation of the pulmonary artery catheter. Haemodynamic and gas exchange variables were measured at each nitric oxide concentration. Patients were classified as responders when PCP decreased by at least 2 mm Hg after nitric oxide 20 vpm. In responders (n = 8), nitric oxide decreased PCP and post-capillary vascular resistance dose-dependently and changed longitudinal distribution of pulmonary vascular resistance with a maximum effect at 20 vpm. In non-responders (n = 11), PCP did not change. In both groups, the nitric oxide-induced decrease in pre-capillary vascular resistance was small with a maximum effect at 1 vpm. In ARDS, vasodilatation of pre-capillary vessels is achieved at low concentrations of nitric oxide, whereas the effect of nitric oxide on postcapillary vessels is variable. Higher concentrations may be required for optimal post-capillary vasodilatation in a subgroup of ARDS patients.

Adolescent↗
PubMed1998

Evaluation of forced oscillation technique for early detection of airway obstruction in sleep apnea: a model study.

The forced oscillation technique (FOT) is a non-invasive method which may be suitable for assessing upper airway obstruction in obstructive sleep apnea/hypopnea syndrome (OSAS) patients. The aim of this study was to determine in vitro if FOT can provide an early detection index of total or partial upper airway occlusion. A respiratory system analog was developed which includes an upper airway analog that allows simulation of upper airway collapse (thus mimicking the situation in patients with OSAS). We simulated different degrees of upper airway obstructions ranging from 0 (unobstructed airways) to 1 (total occlusion). Furthermore, we imitated the collapsible upper airway wall by means of elastic membranes with ten different wall compliances ranging from 3.3 x 10(-4) to 1 1/mbar. For the two stiffest rubber membranes (Cwall = 0.01 and 3.3 x 10(-4) l/mbar) the absolute value of the impedance (¿Z¿) showed a marked increase for obstructions greater than 0.6. For the two membranes with the highest wall compliances (Cwall = 0.03 and 1 1/mbar) obstructions with an increase in ¿Z¿ could not be detected before the obstruction reached 0.8. For degrees of obstruction less than 0.6 the phase angle of collapsible membranes with low compliance (stiff airway wall) were about 1.5pi which significantly differed from phase angles of 1.77pi measured in membranes with high compliance (elastic airway wall); p < 0.01. We hypothesized that stiffness of upper airway walls corresponds with their muscle tone, i.e., stiff airway walls are related with high muscle tone and vice versa. Thus, a decrease in upper airway muscle activity would cause an increase of upper airway wall elasticity that enables upper airway collapse. As a consequence the phase angle phi could be expected to change from values characterizing stiff membranes to values characterizing more elastic membranes which could be used as early indicator for obstructive respiratory events. We have frequently observed such changes in morphology of phi(t) data obtained from patients with OSAS.

Airway Obstruction↗
PubMed1997

Respiratory comfort of automatic tube compensation and inspiratory pressure support in conscious humans.

OBJECTIVE: To compare the new mode of ventilatory support, which we call automatic tube compensation (ATC), with inspiratory pressure support (IPS) with respect to perception of respiratory comfort. ATC unloads the resistance of the endotracheal tube (ETT) in inspiration by increasing the airway pressure, and in expiration by decreasing the airway pressure according to the non-linear pressure-flow relationship of the ETT. DESIGN: Prospective randomized single blind cross-over study. SETTING: Laboratory of the Section of Experimental Anaesthesiology (Clinic of Anaesthesiology; University of Freiburg). SUBJECTS: Ten healthy volunteers. INTERVENTIONS: The subjects breathed spontaneously through an ETT of 7.5 mm i.d. Three different ventilatory modes, each with a PEEP of 5 cmH2O, were presented in random order using the Dräger Evita 2 ventilator with prototype software: (1) IPS (10 cmH2O, 1 s ramp), (2) inspiratory ATC (ATC-in), (3) inspiratory and expiratory ATC (ATC-in-ex). MEASUREMENTS AND MAIN RESULTS: Immediately following a mode transition, the volunteers answered with a hand sign to show how they perceived the new mode compared with the preceding mode in terms of gain or loss in subjective respiratory comfort: "better", "unchanged" or "worse". Inspiration and expiration were investigated separately analyzing 60 mode transitions each. Flow rates were continuously measured. The transition from IPS to either type of ATC was perceived positively, i.e. as increased comfort, whereas the opposite transition from ATC to IPS was perceived negatively, i.e. as decreased comfort. The transition from ATC-in to ATC-in-ex was perceived positively whereas the opposite mode transition was perceived negatively in expiration only. Tidal volume was 1220 +/- 404 ml during IPS and 1017 +/- 362 ml during ATC. The inspiratory peak flow rate was 959 +/- 78 ml/s during IPS and 1048 +/- 197 ml/s during ATC. CONCLUSIONS: ATC provides an increase in respiratory comfort compared with IPS. The predominant cause for respiratory discomfort in the IPS mode seems to be lung over-inflation.

Adult↗
PubMed1997

[Is ECMO out?].

Explore the source record for details and available documents.

Combined Modality Therapy↗
PubMed1997

The effects of desflurane on splanchnic hemodynamics and oxygenation in the anesthetized pig.

This study was designed to investigate the effects of desflurane on systemic and splanchnic hemodynamics, O2 delivery and O2 uptake, tissue oxygenation (as monitored by surface PO2 electrodes), and hepatic oxygen-dependent intermediary metabolism (hepatic lactate uptake, intestinal lactate production, ketone-body ratio) in the pig. We studied 11 anesthetized (i.e., ketamine, flunitrazepam, vecuronium) and ventilated domestic pigs (17-23 kg). After instrumentation, desflurane was administered randomly at 0.5 minimum alveolar anesthetic concentration (MAC) (4.2 vol %) and 1.0 MAC (8.3 vol %). Desflurane caused dose-dependent decreases in heart rate, mean arterial blood pressure, and cardiac output. Hepatic arterial blood flow was not affected at 0.5 MAC but decreased at 1.0 MAC. In contrast, portal and superior mesenteric arterial blood flow decreased at 0.5 MAC but did not show any further significant decrease at 1.0 MAC. Total hepatic blood flow decreased dose-dependently. Although O2 deliveries of whole body, liver, and small intestine were markedly reduced at both concentrations, respective O2 uptakes did not change significantly. The decreases in O2 deliveries were reflected by moderate disturbances in hepatic and small intestinal surface PO2. No evidence for severe tissue hypoxia could be detected. Desflurane had no adverse effects on hepatic and small intestinal metabolic function. These data indicate that hepatic and small intestinal O2 reserve capacity is impaired by desflurane.

Anesthetics, Inhalation↗
PubMed1997

Hypoxic pulmonary vasoconstriction in nonventilated lung areas contributes to differences in hemodynamic and gas exchange responses to inhalation of nitric oxide.

BACKGROUND: Enhancement of hypoxic pulmonary vasoconstriction (HPV) in nonventilated lung areas by almitrine increases the respiratory response to inhaled nitric oxide (NO) in patients with acute respiratory distress syndrome (ARDS). Therefore the authors hypothesized that inhibition of HPV in nonventilated lung areas decreases the respiratory effects of NO. METHODS: Eleven patients with severe ARDS treated by venovenous extracorporeal lung assist were studied. Patients' lungs were ventilated at a fraction of inspired oxygen (F[I(O2)]) of 1.0. By varying extracorporeal blood flow, mixed venous oxygen tension (P[O2]; partial oxygen pressure in mixed venous blood [PV(O2)]) was adjusted randomly to four levels (means, 47, 54, 64 and 84 mmHg). Extracorporeal gas flow was adjusted to prevent changes in mixed venous carbon dioxide tension [PV(CO2)]). Hemodynamic and gas exchange variables were measured at each level before, during, and after 15 ppm NO. RESULTS: Increasing PV(O2) from 47 to 84 mmHg resulted in a progressive decrease in lung perfusion pressure (PAP-PAWP; P < 0.05) and pulmnonary vascular resistance index (PVRI; P < 0.05) and in an increase in intrapulmonary shunt (Q[S]/Q[T]; P < 0.05). PV(CO2) and cardiac index did not change. Whereas the NO-induced reduction in PAP-PAWP was smaller at high PV(O2), NO-induced decrease in Q(S)/Q(T) was independent of baseline PV(O2). In response to NO, arterial P(O2) increased more and arterial oxygen saturation increased less at high compared with low PV(O2). CONCLUSION: In patients with ARDS, HPV in nonventilated lung areas modifies the hemodynamic and respiratory response to NO. The stronger the HPV in nonventilated lung areas the more pronounced is the NO-induced decrease in PAP-PAWP. In contrast, the NO-induced decrease in Q(S)/Q(T) is independent of PV(O2) over a wide range of PV(O2) levels. The effect of NO on the arterial oxygen tension varies with the level of PV(O2) by virtue of its location on the oxygen dissociation curve.

Administration, Inhalation↗
PubMed1997

Large increase in cardiac output in a patient with ARDS and acute right heart failure during inhalation of nitric oxide.

BACKGROUND: Inhaled nitric oxide (NO), a selective pulmonary vasodilator, reduces pulmonary artery pressure in patients with acute respiratory distress syndrome (ARDS). In spite of the reduction of right ventricular afterload, the effect of NO on cardiac output remains unclear. METHODS: A patient with ARDS and echocardiographically determined severe acute right heart failure was treated with increasing concentrations of inhaled nitric oxide (NO). Haemodynamic and gas exchange variables were determined for each concentration of NO. NO treatment was continued for 3 days. RESULTS: During initial right heart failure, administration of NO resulted in a large increase (32%) in cardiac output in a dose-dependent manner. When right ventricular function had improved, inhalation of NO did not increase cardiac output. CONCLUSION: Our observations suggest that inhalation of NO is likely to increase cardiac output in ARDS when severe acute right heart failure is present.

Acute Disease↗