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Biomedical subjects

R Klose

Publications and source records attributed to R Klose.

At least 55 records · Page 3Linked to original sources
PubMed1981

Effects of PEEP on pulmonary mechanics and oxygen transport in the late stages of acute pulmonary failure.

In 23 patients with advanced stages of acute respiratory failure, the value of various parameters for estimating the efficiency of ventilation with PEEP were analysed. PEEP increments of 1 cm of water corresponded to an increase of PaO2 of 2 mmHg. The cardiac output decreased from 8.3 +/- 0.3 l/min mean value at ZEEP to 7.3 +/- 0.3 L/min at a PEEP of +15 cm H2O. Corresponding to this, the oxygen transport showed a decrease from 1042 +/- 62 ml/min to 894 +/- 115 ml/min. The total compliance of 34 ml/cm H2O at ZEEP is already significantly reduced (a sign of the severe respiratory failure) and falls still further at a PEEP of 15 cm H2O to 22 ml/cm H2O. No notable recruitment of non ventilated alveolar spaces can be expected, in spite of the slight increase in the arterial oxygen tension. Taking the "best PEEP" (PEEP with maximum oxygen transport) as a reference point, arterial and mixed venous oxygen tension increase, the cardiac output decreases above this point and the total respiratory compliance shows no obvious changes. In the advanced stage of severe respiratory failure one cannot use the mixed venous oxygen tension or the compliance to find the best PEEP. The danger of barotrauma by PEEP ventilation in cases of significantly reduced compliance has to be considered in the choice of the ventilation pattern. The arterial oxygen tension may lead to a wrong estimation of the total efficiency of PEEP.

Acute Disease↗
PubMed1981

[Human albumin or dextran 60 for the restoration of the blood volume, with special reference to the colloid osmotic pressure (author's transl)].

The high cost and limited availability of human albumin as a plasma substitute make it desirable to limit its use to special cases and to replace it by inexpensive and easily obtainable colloids. Patients about to undergo major abdominal surgery were given either human albumin or dextran 60 during the operation and for three days afterwards. Although both groups received the same quantity of colloidal plasma substitutes they differed significantly in respect to the serum albumin and protein concentrations. However, the osmotic pressure, for the maintenance of which the albumin fraction is mainly responsible, showed a marked fall in both groups, indicating that human albumin is not superior to dextran. All other parameters, particularly the clotting mechanism, remained within the normal range and did not differ between the two groups. The results of the study, in conjunction with the known facts regarding the metabolism and function of albumin, suggest that dextran 60 can adequately replace human albumin in a large number of cases. Great importance belongs to measurement of the colloid osmotic pressure.

Blood Proteins↗
PubMed1981

[The effect of prolonged inspiration time and PEEP on compliance and gas exchange in ventilated patients (author's transl)].

The effect of prolonged inspiration time and PEEP on compliance, haemodynamics and gas exchange was studied on 15 patients, who were ventilated because of respiratory distress syndrome. The patients were ventilated by the Servoventilator 900 BR connected with a calculation unit. The inspiration time varied from 35 to 70%, the PEEP from 0 to 20 cm H2O. All patients were ventilated with constant tidal volumes (10-15 ml/kg b.w.). The compliance rose from 48 ml/H2O (ZEEP) to 61,5 ml/cm H2O (PEEP + 8 ml H2O). A further increase of PEEP caused a decrease of compliance to 48 ml/cm H2O (PEEP + 20 cm H2O). A prolongation of inspiration time of up to 53% showed an augmentation of compliance from 48 ml/cm H2O to 53 ml/cm H2O. Both modes of assisted ventilation caused an improvement of alveolar ventilation. The simultaneous consideration of various parameters of gas exchange, compliance and haemodynamics guaranteed the optimal mode of ventilation and minimal side effects.

Carbon Dioxide↗
PubMed1981

[Mechanics of breathing during anaesthesia with controlled ventilation by means of the engström ecs 2000 respirator (author's transl)].

Compliance, resistance, gas flow, blood gas tension and intrapulmonary shunt volume were measured in 20 anaesthetized patients ventilated by the volume-controlled Engström respirator ECS 2000. All patients had neurosurgical or vascular procedures. Anaesthesia lasted for at least 180 minutes. 10 patients were ventilated with a tidal volume of 6 ml/kg bodyweight, another 10 with a tidal volume of 15 ml/kg bodyweight. During the whole period of observation compliance did not decrease significantly in either group and the intrapulmonary shunt volume and the blood gases remained practically unchanged. Ventilation with the large tidal volume was characterized by better compliance and oxygenation indicating that the mechanics of breathing and the intrapulmonary gas exchange benefit from larger tidal volumes. Due to the special features of the Engström respirator as regards air flow and pressure steady ventilation with a low tidal volume of 6 ml/kg bodyweight does not result in a significant decrease in compliance and an increase in shunt volume as is the case with other types of respirators.

Airway Resistance↗
PubMed1981

[Flow measurement in blood filters].

Flow rates of compatible mixed packed red cells passing through a 170 micrometers standard blood filter or one of three microfilters with different pore sizes were measured. In spite of the largest pore size of 170 micrometers, the standardfilter shows the slowest flow. The cascade filter "MF 10" with sieves of 200, 50, 20, ad 10 micrometers pore sizes has excellent flow rates due to its large surface area. The "microtrans" with cascades of 150, 50, 10 micrometers pore sizes, good filter properties, low filling volume, and reasonable flow rates seems to be an acceptable microfilter for routine clinical use. If the tube of the infusion system is cut off, then the blood flow increases its speed by about fivefold in spite of different filters.

Blood↗
PubMed1981

[Microaggregate formation in buffycoat-free packed red cells (author's transl)].

The amounts of microaggregates of 200 non-selected units of buffycoat-free PRC were determined gravimetrically using a cascade of nylon mesh screen filters with pore sizes of 200, 50, 20 and 10 micrometers. In PRC the total amounts of amorphous debris are on average 2 to 3 times less than in stored whole blood. Nevertheless the quality of the buffycoat-free PRC is subject to immense variation in view of removed debris in individual cases. Microaggregates retained on the 20 and 10 micrometer filter sieves are still considerable, their order of magnitude is comparable to that found on the 200 micrometer sieves, so that a microfiltration is also necessary under 40 micrometers. Taking into account the necessity of eliminating all factors which contribute to the cause or severity of an acute pulmonary failure even buffycoat-free PRC should be transfused through microfilters.

Adolescent↗
PubMed1981

[Measurement of colloid osmotic pressure. Experience with the IL 186 Weil-Oncometer system].

The crystalloid colloid fluid controversy has increased the interest in colloidoncotic pressure (COP) of plasma as a significant parameter in fluid exchange. Equipments for direct measurement of COP are now available and their value has to be determined now. Based on own experiences the handling, advantages and disadvantages of the WEIL-Oncometer are described and recommendations for improving the system are made.

Colloids↗
PubMed1980

[Data processing system for patients requiring artificial ventilation (author's transl)].

In the surgical intensive care unit of the Mannheim medical Centre a computer program has been developed to assist in the management of patients suffering from ARDS. It is based on a Dietz MUL-TI-USER system. 34 parameters of pulmonary mechanics, hemodynamics and blood gases were recorded off-line routinely. From these data 8 parameters were calculated according to established physiological relationships. Apart fom normal data printout a terminal scope offers graphical display of the interaction of any two parameters chosen. Data may be averaged regarding single patients, groups of patients or time. Data may be stored as hard copies. Operating instructions are very simple. Off-line data feeding is of advantage regarding data allocation, Calibration and plausibility control. We report on the development of the off-line computer system and on clinical efficiency and accuracy of the system in the treatment of patients in respiratory distress.

Adult↗
PubMed1980

[Morphine epidurals for pain relief in obstetrics (author's transl)].

13 parturient women were given morphine epidurally analgesia for the relief of pain during labour. Complete analgesia was obtained in one woman and satisfactory analgesia in 8 patients. The results were poor in three cases and one woman did not react at all. The method is characterized by a fast onset, adequate pain relief and does not affect the maternal or foetal cardio-respiratory system.

Adolescent↗
PubMed1980

[Electrostimulation anaesthesia and neurolept anaesthesia for cholecystectomy. A comparative study (author's transl)].

In 26 patients, undergoing cholecystectomy under electrostimulation anaesthesia (ESA) (n = 14) and neurolept anesthesia (NLA) (n = 12) the effects on consumption of anaesthetic agents, mean arterial pressure, heart rate, blood gases, lung function, serum cortisol and awareness are compared. Consumption of anaesthetic agents was 21.6 per cent in ESA compared to 100 per cent in NLA. Mean arterial pressure, heart rate and serum cortisol were elevated in ESA compared to NLA, probably due to elevated stress. Awareness 4 hours after anaesthesia was higher in ESA, probably due to less persistence of anaesthetics. Blood gases 1 hour after operation were slightly better after ESA, as also were forced vital capacity and peak flow one day after operation. The results are discussed.

Anesthesia↗
PubMed1979

[The influence of sedation with diazepam and flunitrazepam during regional anaesthesia upon postoperative pulmonary performance (author's transl)].

In 32 patients between 53 and 86 years of age, undergoing transurethral prostatectomy, the influence of intraoperative sedation with Diazepam (5-10 mg) and Flunitrazepam (0,4-0,8 mg) on postoperative forced vital capacity, forced exspiratory volume (1 sec.) and peakflow, were measured, compared to placebo. We could not find a depression of these ventilatory parameters, in the three groups except peak-flow after sedation with Flunitrazepam in the evening after operation (p less than or equal to 0,05). We conclude that sedation during regional anesthesia does not impair the most important advantage of local anesthesia, the minor effect on ventilation, compared with general anesthesia.

Anesthesia, Conduction↗
PubMed1979

[Problems of nerve block during prolonged surgery on the upper extremities (author's transl)].

Regional anaesthesia secured by injecting the supraclavicular plexus was used for 34 reconstructive surgical operations on the fingers and hands. The operations lasted for 5 1/2-19 hours. The advantages and disadvantages of the technique are reviewed. In 5 cases other anaesthetic techniques had to be substituted because the patients, despite sedation, could not tolerate the forced position any longer. Motivation, intensive psychic support during the operation, optimum positioning and the use of suitable sedatives are pre-conditions for the success of nerve block for prolonged surgery.

Anesthesia, General↗
PubMed1979

[The effects of various anaesthetic techniques on central venous pressure during transurethral prostatectomy (author's transl)].

Central venous pressure was measured in 34 persons who had transurethral prostatectomy in general or regional anaesthesia. The aim of the investigation was to ascertain to what extent measurement of the central venous pressure as a parameter of blood volume can help towards the early diagnosis of hypervolaemia caused by the leakage of irrigation fluid into the patient's circulation. During general anaesthesia blood pressure and central venous pressure reached their maximum 10 minutes later and were significantly higher than was the case in regional anaesthesia. For detecting and preventing dangerous hypervolaemia during transurethral prostatectomy in general anaesthesia routine recording of the central venous pressure is recommended. The less severe reaction during regional anaesthesia on the circulation is probably attributable to a sympathicolytic effect and peripheral pooling. The early detection of the leakage syndrome is easier in the conscious patient.

Aged↗