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Biomedical subjects

N Mutz

Publications and source records attributed to N Mutz.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Continuous arteriovenous hemofiltration in interstitial pulmonary edema].

In a retrospective study 40 ICU patients, all underwent Continuous Arteriovenous Hemofiltration (CAVH) for acute pulmonary, acute renal insufficiency or both, were evaluated for lung function parameters and fluid balance. It could be shown that a group of patients suffering from pulmonary insufficiency and with a history of major trauma or obstetric complications mainly benefits from fluid control by means of CAVH, while diuretics were unable to perform the desired action.

Acute Kidney Injury↗
PubMed1985

[Effect of high-frequency ventilation on intracranial pressure].

The influence of respiratory frequency, tidal volume, inspiratory flow and ratio of inspiratory/expiratory time on ventilator-related intracranial pressure (ICP) fluctuations was studied in six patients with severe brain trauma. ICP fluctuations were found to be markedly reduced at frequencies of 20/min and usually eliminated at 30/min. We found an exponential correlation between ICP fluctuations and respiratory frequency, but there was no correlation between tidal volume and ICP. Central venous pressure amplitudes were found to be in linear correlation with respiratory frequency and tidal volumes as well. The amplitude of respiratory ICP fluctuations correlates with the length of expiratory time. Our findings demonstrate that artificial ventilation without ventilator-related fluctuations in ICP ("brain-protective" ventilation) may be performed by conventional volume-constant, time-cycled ventilators. To assess the therapeutic relevance of eliminating respirator-related fluctuations of the ICP course in brain-injured patients, we suggest that frequencies of 25-30/min and tidal volumes of 6-9 ml/kg body weight should be used.

Brain Injuries↗
PubMed1984

Intraoperative application of high-frequency ventilation.

High-frequency pulsation (HFP), a modified high-frequency jet ventilation (HFJV) technique, was applied intraoperatively as an alternative to conventional inter mittent positive-pressure ventilation in 16 patients undergoing major thoracic operations. Gas exchange and hemodynamic stability were maintained at a frequency of 300 cycle/min. Surgical maneuvers were easier because the lungs were almost completely immobilized.

Adult↗
PubMed1984

[High-frequency ventilation. Development of new ventilation systems--experimental and clinical results].

Based on the well known High Frequency Jet Ventilation (HFJV) two modified types of High Frequency Ventilation, Forced Diffusion Ventilation (FDV) and High Frequency Pulsation (HFP) have been developed. Both systems are designed to allow ventilation with very small volume portions in the upper range of HFV frequencies. In dog experiments sufficient gas exchange could be maintained during FDV up to frequencies 3000 per minute and even with an uninterrupted "continuous" jet entering the lungs on carina level. With this mode of ventilation lung could be kept in a resting position. Due to particular configuration of a pair of nozzles at the tip of a modified endotracheal catheter fresh gas is forced down the airways along the inner edges of bifurcations towards the lung periphery. At the same time stale gas leaves the lung via the remaining cross section of the airways. Thus a continuous scavanging process can be established without significant lung inflation. This mechanisms are not met during HFP. Therefore the range of frequencies achievable with this type of ventilation is significantly lower (250 to 500/min.) and "tidal volumes" are much higher. However, they are still beyond the anatomical dead space which suggest again a contribution of alternative mechanisms to gas transport. The impact of both types of HFV on gas exchange and pressure-flow conditions were studied in lung models as well as in animal experiments. FDV and HFP were also applied successfully to a group of 23 patients undergoing major lung surgery. In all patients it was possible to maintain excellent gas exchange throughout the whole surgical procedure. The exposure of the surgical field was much more quiet as compared to IPPV. Due to the small tidal volumes lung pressures can be kept much lower and gas losses via the open bronchi and lung surface are reduced dramatically.

Animals↗
PubMed1983

[A model for standardized treatment and therapeutic evaluation of severe ARDS. PIF and AaDO2 quotient with a demand-adapting respirator and a conventional respirator during ARDS].

In order to achieve a uniform, easy to teach and to manage respiratory management in severe adult respiratory distress syndrome (ARDS) a combined treatment--called "step by step scheme"--was settled. It was aimed towards a regulation of the arterial blood oxygen tension at levels between 90 and 130 mmHg and this was achieved by combination of PEEP and IRV in order to minimize the inspiratory fraction of oxygen. Nine patients underwent this schedule and Benzer's AaDO2 quotient as an estimation of lung function as well as PIF (PEEP X I:E X FiO2) as quantifying parameter for the "strength" of the respirator are calculated. AaDO2 Quotient showed no statistically significant differences but PIF performed a clearly marked day of maximum respiratory support during the clinical course. This seems to be a confirmation that a variable defined by therapeutic procedures may also be an estimation of a certain degree of sickness as a pure diagnostic parameter. In plotting AaDO2 quotient versus PIF characteristically formed loops result. These loops give some evidence about the interactions between improving or worsening ARDS and properly adjusted therapeutic efforts by means of a respirator. The diagram may be also helpful in deciding conventional respirator settings or weaning procedures and show marks, where one might consider to treat by new techniques like High Frequency Ventilation, extracorporeal devices or arteriovenous hemofiltration.

Adult↗
PubMed1983

[High frequency pulsation (HFP) enabling tracheo-broncheal suctioning without interrupting mechanical ventilation].

A new technique of tracheo-broncheal suctioning is presented which enables constant artificial ventilation with high frequency pulsation (HFP), a modification of high frequency ventilation. Beyond that the high frequency pulsation method permits ventilation of the patient with adjusted end-expiratory pressure. This technique prevents the decrease of arterial oxygen pressure which is usually seen in patients who are disconnected for some time from the respirator as well as during the suction procedure and during periods of decreased end-expiratory pressures.

Blood Gas Analysis↗
PubMed1982

[Intraoperative application of forced diffusion-ventilation (FDV)].

Forced diffusion ventilation (FDV), a modified high frequency jet ventilation (HFJV), was applied intraoperatively (mean duration: 126 min) in 14 patients (7 thoracic, 7 major abdominal surgery patients). Sufficient gas exchange could be achieved with extremely low tidal volumes (10-30 ml) at frequencies up to 1500/min. This resulted in an almost complete immobilization of the lungs allowing an excellent surgical exposure.

Abdomen↗
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

[Effect of arm splinting on the duration and possibility of monitoring invasive long-term pressure determination of the radial artery].

A special splint technique, which can improve continuous intraarterial blood pressure monitoring via the a. radialis is reported. This method could be applied successfully in 41 patients of the ICU up to 27 days. Cannulating the contralateral side because of catheter's dysfunction was necessary only in 6 patients. These observations could be seen in contrast to our results, using a conventional splint system, applied in 12 patients for comparison (maximal duration of catheter's placement: 9 days). Our experiences, using this special splint method of arm fixation, lead to the recommendation to use our method routinely in long-term monitored patients, with respect to a longer duration of catheter's intravasal placement, the possibility of undisturbed monitoring and a simple clinical handling.

Arteries↗
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↗
PubMed1981

[The clinical application of the "locus of resistance" method for axillary plexus block (author's transl)].

We describe a new method of axillary brachial plexus block, the principle of which is to verify the position of the needle in the perivascular tissue not by paraesthesia but by the "loss of resistance" measured when penetrating the perivascular sheath. This method has been developed from the well known "loss of resistance" technique used in epidural anaesthesia and has been tested in practice as well as in theory. This technique not only guarantees greater accuracy in locating the perivascular tissue, but also opens the possibility of decreasing the incidence of lesions of nerves and vessels.

Anesthesia, Epidural↗