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R M Kaelin

Publications and source records attributed to R M Kaelin.

12 recordsLinked to original sources
PubMed1997

[Prevention].

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Humans↗
PubMed1995

Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the influence of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. DESIGN: Data were collected prospectively over a 1-yr period (study year) and compared with previously collected prospective data recorded in our chronic obstructive pulmonary disease database during a 5-yr period. SETTING: The medical intensive care unit (ICU) of a university hospital. PATIENTS: Eighty-seven patients with chronic obstructive pulmonary disease. Fifteen patients had chronic obstructive pulmonary disease that required mechanical ventilation for acute exacerbation of their disease (study year), and 72 were patients with chronic obstructive pulmonary disease from the previously collected data. INTERVENTIONS: The ICU course (duration of mechanical ventilation, mortality) was recorded, as well as several respiratory parameters (pulmonary function tests and arterial blood gases in stable conditions, and nutritional status), and they were compared with an "index of nursing." MEASUREMENTS AND MAIN RESULTS: We developed an "index of nursing", comparing the effective workforce of the nurses (number and qualifications) with the ideal workforce required by the number of patients and the severity of their diseases. A value of 1.0 represented a perfect match between the needed and the effectively present nurses, whereas a lesser value signified a diminished available workforce. This index was compared with the complications and duration of weaning from mechanical ventilation. During the first 5 yrs, the duration of mechanical ventilation increased progressively from 7.3 +/- 8.0 to 38.2 +/- 25.8 days (p = .006). A significant inverse correlation between the duration of mechanical ventilation and the nursing index (p = .025) was found. In the sixth comparative year, the number of nurses increased (nursing index = 1.05) and the duration of mechanical ventilation decreased to 9.9 +/- 13 days (p < .001, yr 5 vs. yr 6). CONCLUSIONS: The quality of nursing appears to be a measurable and critical factor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease. Below a threshold in the available workforce of ICU nurses, the weaning duration of patients with chronic obstructive pulmonary disease increases dramatically. Therefore, very close attention should be given to the education and number of ICU nurses.

Aged↗
PubMed1992

[Continuous oxygen therapy at home. Observations of oxygen users after an instruction program].

The benefit of continuous domiciliary oxygen therapy (OCD) directly depends on the number of hours the oxygen is used daily. The observance of a correct regime is rarely met at present. For this reason we have done a prospective study for 24 months, assessing the compliance of 64 patients from 28 to 82 years of age. All these patients received a systematic and personal programme of education for 2 days in hospital. We subsequently measured, without the knowledge, either of the patient or the person caring from them, the quarterly oxygen usage. The mean duration of oxygen therapy was 14.7 +/- 3.6 hours. It remained stable during the 2 years of observation: 51% of the patients achieved a treatment of 15 hours or more and 10%, 10 hours or less. We did not find a significant correlation between the hours of compliance and the age, sex, FEV1, FVC and PaO2 or haemoglobin saturation. A significant statistical correlation with the PaCO2 was obtained. The more educated patients had better compliance levels than those of lesser education. The results obtained were better than those found in the literature at the present time. Perhaps it is explained by the level of education given. It cannot be excluded, however, that our severe criteria for the prescription of OCD has selected a population which was more susceptible to achieving good compliance. However, these results encourage the initiation of another prospective study using a control group to make a better assessment of the impact of education on the patient and his carers by the improved compliance in OCD.

Adult↗
PubMed1988

Diffuse interstitial lung disease associated with hydrogen peroxide inhalation in a dairy worker.

A 41-yr-old dairy worker, smoker of 40 cigarettes daily, presented with severe gas exchange impairment caused by interstitial lung disease, as shown by transbronchial biopsy. He was exposed chronically to an aerosol of hydrogen peroxide (41 mg/mm3; upper legal limit: 1.5 mg/mm3) which must be incriminated as the etiologic agent, since withdrawal from exposure resulted in improvement, and no other etiology could be identified.

Adult↗
PubMed1987

Failure to predict six-month survival of patients with COPD requiring mechanical ventilation by analysis of simple indices. A prospective study.

We analyzed the outcome of 39 consecutive acute exacerbations of chronic obstructive pulmonary disease (COPD) in 35 patients requiring mechanical ventilation, in order to identify the features related to survival. Patients were divided into those surviving less (group A; n = 14) and more (group B; n = 24) than six months. Pulmonary function tests, arterial blood gas levels either on admission or while in a steady state, and nutritional parameters were similar in both groups. Only the duration of mechanical ventilation was longer in group A when compared to group B. In patients dying while being ventilated or surviving less than ten days after extubation, only the forced vital capacity (FVC) was different when compared to the rest of group A. The duration of mechanical ventilation was not related to age or the forced expiratory volume in one second (FEV1). Only a multivariate analysis accounting simultaneously for eight parameters could separate with 78 percent accuracy the different groups of patients; however, following this analysis, 23 percent of the patients in group B could have been falsely classified as nonsurvivors and perhaps rejected for mechanical ventilation. We conclude that the six-month survival of patients with COPD who required mechanical ventilation for an acute exacerbation of their disease cannot be predicted from simple data generally available to the physician in charge at the time of intubation.

Aged↗
PubMed1986

Production of lymphocyte chemokinetic activity by stimulated alveolar macrophages.

While the presence of a lymphocytic parenchymal infiltrate is characteristic of several lung diseases, the mechanisms responsible for the focal accumulation of lymphocytes within the lungs remain unclear. Since alveolar macrophages secrete several substances that affect lymphocyte function, we examined supernatants of stimulated, cultured guinea pig alveolar macrophages for their ability to alter lymphocyte motility. Guinea pigs were immunized by footpad injection of ovalbumin (OVA) emulsified in complete Freund's adjuvant. Fourteen days later, alveolar macrophages were obtained by bronchial lavage or teasing the lung parenchyma, enriched by adherence to plastic, and incubated for 3 and 24 hours in culture medium alone or medium containing either latex beads, OVA, or human serum albumin (HSA). Conditioned medium was harvested and assayed for chemoattractant activity against rat splenic lymphocytes in modified Boyden chambers. Regardless of stimulus, there was no evidence of enhanced lymphocyte motility above control values in supernatants harvested at 3 hours. At 24 hours, alveolar macrophages from OVA-sensitized guinea pigs stimulated with latex or OVA generated significant amounts of lymphocyte migration stimulating activity (LCA) (250 +/- 25 and 247 +/- 24 percent of control migration, respectively) compared to cells incubated in medium alone or with HSA (162 +/- 23 and 147 +/- 14 percent, respectively). Antigen recognition appears to be related to the presence of cytophilic anti-OVA antibody on the surfaces of alveolar macrophages of sensitized guinea pigs. LCA is resistant to neuraminidase, chymotrypsin, and heating to 56 degrees C, and was chemokinetic for T-lymphocytes. it elutes from Sephadex G-100 in two regions: one at approximately 67,000 d, and a second at approximately 15,000 d. These studies indicate that following systemic immunization, the guinea pig alveolar macrophage can react to specific antigen or phagocytosis of inert particulates by secreting a chemokinetic factor for T-lymphocytes, and may play a role in the pathogenesis of some types of antigen-induced lung disease.

Animals↗
PubMed1984

Influence of ethanol on human T-lymphocyte migration.

Because ethanol consumption is associated with increased susceptibility to infection, we examined the effects of ethanol and its metabolite acetaldehyde on human T-lymphocyte migration, an important functional component of cellular inflammatory responses. With a modified Boyden chamber system, ethanol at 0.25% and 0.50% (vol/vol) inhibited spontaneous motility of human T-lymphocytes, in a noncytotoxic manner, to 65% +/- 7% (mean +/- SEM) and 62% +/- 7% of control values of migration, respectively. When T-lymphocyte migration was stimulated by colchicine (10(-5) mol/L), incubation with ethanol (0.25% and 0.50%, vol/vol) decreased migration to 80% +/- 4% and 66% +/- 8% of control values, respectively. Similar degrees of inhibition of migration were obtained with acetaldehyde at concentrations five to 10 times less than ethanol. Ethanol was similarly capable of inhibiting T cell migration induced by dibutyryl cyclic guanosine monophosphate, but it had no effect on stimulated migration induced by a human chemokinetic lymphokine. Our study demonstrates that ethanol, at concentrations achievable in vivo, is capable of depressing T-lymphocyte migration. This effect might contribute to the immunosuppression associated with ethanol consumption.

Acetaldehyde↗