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Biomedical subjects

R Stuttmann

Publications and source records attributed to R Stuttmann.

At least 19 recordsLinked to original sources
PubMed1997

[Noise in intensive care units. Noise reduction by modification of gas humidification].

Today, noise pollution is an evident and ubiquitous problem even in intensive care units. Noise can disturb the physiological and psychological balance in patients and staff. Especially intubated patients and those breathing spontaneously through a T-piece are exposed to the noise emitted by the nebuliser used to humidity the respiratory gas. This may make patients feel uncomfortable. To reduce noise pollution in the ICU a modified T-piece has been developed and investigated. In order to heat and humidity the respiratory gas a Conchaterm III unit (Kendall company) and a thermo flow cylinder (De Vilbiss company) is necessary. While respiratory gas is flowing, water is sucked out of the heated thermoflow cylinder and nebulised according to the Venturi-Bernoulli principle. To adjust the oxygen concentration of the respiratory gas a plastic ring must be turned to either close (98% oxygen) or open a valve allowing room air to mix (40% oxygen). Noise pollution of the unit varies with admixture of room air. With a new device--a special oxygen-air mixing chamber--the oxygen concentration of the respiratory gas can be adjusted outside the thermoflow cylinder, hardly producing any noise pollution. Therefore the principle of nebulisation could be changed to humidification. A thermoflow cylinder without the nebulisation unit allows the respiratory gas to flow through the thermoflow cylinder over heated and evaporating water, hardly causing any noise pollution. In both types of T-pieces the temperature of the respiratory gas is controlled and corrected by the Conchaterm unit. As the result of these modifications, noise pollution has been reduced from 70 dB(A) to 55 dB(A). In the modified T-piece, the quality of humidification has been evaluated with a fresh gas flow of 22 l/min and at a gas temperature of 37 degrees C, not only collecting condensed water but also lost water. The modified T-piece allows a physiological humidification of the respiratory gas. The modified T-piece is a simple and efficacious substitute. Patients and staff are protected from adverse noise effects and patient well-being might be improved.

Humans↗
PubMed1997

[Waiting for the crisis].

AIM OF THE STUDY: Experience in daily routine reveals that most of ICU patients usually go through "crisis" within 14 days of admission. Only few patients need remarkable more time to get to this point and it seems there is hardly anything to be done therapeutically to change the course of it. We therefore examined a large group of ICU patients in order to find reasons for this course or to spot them as an "entity of their own". METHODS: 1,861 ICU patients all being on IPPV for more than three days were included in the study. Every day 18 variables were taken down in a standardised way until the day IPPV was finished. We extracted 170 patients who were artificially ventilated for more than 40 days. For these patients we established mean values for each of the 18 variables during the first and the last 40 days of ventilation. In both groups we compared survivors to non-survivors. RESULTS: Mortality was almost the same in both groups (IPPV < 40 days vs. IPPV > 40 days). Survivors and non-survivors showed remarkable differences regarding extrapulmonary factors-in terms of total fluid amount and transfusion, state of abdomen, brain, liver and kidney function and circulation problems. Pulmonary factors revealed major differences only towards the end of the observation period. CONCLUSIONS: There seems to be an "entity of ist own", a small population of patients who arrive at the crucial turning point later. Pulmonary complications (pneumonia, ARDS) is not the reason but the expression of cause for prolonged ventilation. The key to the extrapulmonary origin of the crisis remains unknown, the only thing we can do is alleviate its manifestations.

Cause of Death↗
PubMed1995

Preoperative morbidity and anaesthesia-related negative events in patients undergoing conventional or laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the standard method for surgical treatment of non-malignant gall bladder disease. Well tolerated in otherwise healthy patients, it remains however, questionable whether the laparoscopic procedure in patients with severe pre-existing morbidity is associated with a higher incidence of negative intraoperative events than open cholecystectomy. Therefore, the incidence of negative intraoperative events was prospectively investigated in a series of 1,367 patients (319 with open cholecystectomy and 1,048 with laparoscopic cholecystectomy) who were analysed for occurrence of events such as hypertension, hypotension, arrhythmia, unusual bleeding and transfusion requirement, regurgitation or aspiration of gastric content and respiratory disorders. For further analysis the patients undergoing each operative procedure were divided into two subgroups with either preoperative ASA physical status I and II or III and IV. The study groups were comparable in sex and age. There were no intraoperative deaths. The frequency of hypertension, hypotension or arrhythmia alone and in combination was similar in both groups. The need for intervention was significantly more frequent in ASA class I/II patients with laparoscopic cholecystectomy. Respiratory disorders were rare. There was a significantly higher incidence of postoperative ventilatory support in patients with conventional cholecystectomy. Transfusion was required significantly less often in patients with laparoscopic cholecystectomy (0.19% versus 15.36%). CO2-pneumoperitoneum led to severe circulatory alterations in 7 healthy patients. The most severe negative event was a cardiac arrest in 1 female patient who was successfully resuscitated without any sequelae. In ASA-class III and IV patients intraoperative negative events were equally frequent and independent of the procedure. Severe preoperative morbidity per se seems to be no contraindication for laparoscopic cholecystectomy.

Adult↗
PubMed1995

Anaesthesia for laparoscopic closure of perforated peptic ulcer--any harm or benefit?

Laparoscopic closure of perforated peptic ulcer is technically feasible (1). Haemodynamic changes during laparoscopic operations are known and may have an adverse influence on outcome in patients who have peritonitis, are hypovolemic or even septic (2-4). A complete physiological understanding of CO2-inflation of an abdomen in diffuse peritonitis is still missing. The purpose of this study is to compare perioperative variables of general anaesthesia in patients undergoing open or conventional laparoscopic closure of perforated peptic ulcer.

Abdomen↗
PubMed1995

Haemodynamic changes during laparoscopic cholecystectomy in the high-risk patient.

Although laparoscopic cholecystectomy (LC) has become the standard surgical procedure for the treatment of gall stones, the question has still to be answered whether it is safe for critically ill patients with cardiac disease. 20 ASA-class III/IV patients were monitored during LC by means of a Swan-Ganz catheter. Commencement of anaesthesia led to a significant decrease of mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index. Increasing intra-abdominal pressure by insufflation of CO2 and surgical stimuli during gall bladder dissection induced an increase of pulmonary arterial occlusion pressure mean pulmonary artery pressure and central venous pressure (p = 0.05). Mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index remained below pre-induction values (p < 0.05). In 13 patients with high filling pressures the administration of nitroglycerine improved all parameters. In the post-anaesthetic care unit all parameters had returned towards baseline. In conclusion, LC may lead to temporary myocardial insufficiency. Nevertheless, LC seems to be safe provided that pathological alterations are recognised and treated.

Aged↗
PubMed1993

[Halothane absorption by dry soda lime].

Humidified soda lime is commonly used to eliminate carbon dioxide from the circulatory system. Little is known about adverse reactions to accidentally dried soda lime. Therefore, a case of unexpected absorption of halothane by dry soda lime is reported. These observations were confirmed by a simulation with relevance to anaesthetic practice. CASE REPORT. A 46-year-old ASA class I patient was scheduled for elective surgery. After induction of general anaesthesia with 500 mg thiopentone, followed by 100 mg suxamethonium, the trachea was intubated. The patient was ventilated with nitrous oxide in oxygen and 1.5 vol% of halothane for several minutes in the induction room. After being connected to a new circulatory system in the operating theatre, the patient was ventilated but, in addition inspiratory and expiratory anaesthetic gas concentrations were measured. Despite a vaporizer position of 1.5 vol% the inspiratory concentration of halothane was below 0.2 vol%. Disconnecting the tube, the typical odour of halothane was missing in the inspiratory line of the circulatory system, but was present in the fresh gas tube. Furthermore, the lower part of the soda lime canister was surprisingly hot. After removing both the absorbers, the inspiratory halothane concentration immediately normalized. The absorbers were replaced by canisters filled with fresh soda lime, and the anaesthesia was terminated without further complications. An absorption of halothane by dried soda lime was suspected. METHODS OF SIMULATION. In the first simulation four circulatory systems with two soda lime canisters each were perfused with 21 of oxygen for 48 h. In the second simulation four soda lime canisters placed in one circulatory system were perfused with 1 l for 120 h. For measurement of halothane absorption each canister was placed in a circulatory system. The canister was perfused with a fresh gas flow of 2 l of oxygen and a vaporizer position up to 1.3 vol% of halothane. By the time an equilibrium was reached, i.e., in- and outflow concentrations of halothane were equal for a 3-min period, further halothane vaporization was stopped. In a 30-s interval the soda lime temperature and the gas concentration entering and leaving the soda lime canister were registered. Subsequently, the humidity of the soda lime was determined. RESULTS. In the first simulation 6 of the 8 canisters showed a humidity of soda lime of 15.5% of 19%, with halothane being absorbed in one case. Normally, the equilibrium between in- and outflow gas concentration was reached after 3.5-4 min. In the remaining two canisters the humidity was 14% and 9%. Only a small amount of halothane vapour was absorbed. The halothane concentrations were in equilibrium after 10 to 13 min. The probes from the second simulation revealed a humidity of soda lime of 2% to 8.7%. Below a humidity of 4% the concentration of halothane leaving the canister was greatly reduced. It took 63 min to reach a steady state in the 2% humidity probe and the temperature rose to 43.1 degrees C. CONCLUSIONS. Accidental perfusion of the circulatory system with dry oxygen can cause a reduction in the humidity of soda lime. Dried soda lime delays the increase of halothane concentration in the inspiratory limb. The absorption of halothane is accompanied by an increase in the temperature of the soda lime. Therefore, in every situation lacking a sufficient anaesthetic level during inhalation anaesthesia, absorption of the vaporized anaesthetic must be excluded. Only dried soda lime can absorb halothane.

Adsorption↗
PubMed1993

[Serum IgG concentrations and antibody titer of burn patients after preventive intravenous IgG substitution with a Pseudomonas immunoglobulin].

In a randomized clinical trial 30 patients with burn injury received supportive therapy with a Pseudomonas hyperimmunoglobulin (Psomaglobin N). The control group received no additional therapy. The patients of both groups were between 15 and 60 years of age and had a full-thickness burn of 30-70% of the body surface area with inhalational trauma being optional. The whole trauma was classified and scored with the 'Abbreviated Burn Severity Index' (which allows another extra score point for inhalational trauma). Both groups underwent the same intensive care unit treatment with preference to early wound excision and wound grafting following functional aspects of reconstructive surgery. Bacteriological monitoring was performed on suspicion of wound infection and bacteremia by taking wound swabs and blood cultures. The supportive treatment group received a total of 250 mg/kg hyperimmunoglobulin on days 3, 5, 7, 10, and 13. Of 30 patients in the control group 16 had an additional inhalation trauma, and 8 of those (50%) died (only 1 of 14 patients without inhalation trauma died). In the group receiving supportive treatment, 23 out of 30 patients had an inhalation trauma, and 8 of those (35%) died (1 of 7 patients without inhalation trauma). In both groups with inhalation injury, the patients were at risk of developing bacteremia: 13 of 23 of the immunoglobulin-treated patients and 12 of 16 patients of the control group. Bacteremic controls died at a lower score than bacteremic immunoglobulin-treated patients (8.6 vs. 10.3 points).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Prevention with pseudomonas immune globulin in burn injury patients with inhalation trauma: does it have an effect on lung function and outcome?].

In an evaluation of the effect of prophylactic application of Pseudomonas immunoglobulin on the immunoglobulin serum concentration, infection rate, lung function and mortality in major burn-trauma patients, a clinical, prospective, controlled and randomized trial along with an extensive literature review was carried out in the intensive care unit (ICU) of a major burn-trauma center at a major municipal hospital in the Federal Republic of Germany. A total of 60 patients suffering from major burn trauma were studied. Some of them exhibited inhalation injury as a secondary trauma. Inclusion criteria comprised an age of 15-60 years, burns covering 30%-70% of the body surface area, and second and third degree skin burns. In a randomized fashion, the consecutively admitted patients were assigned to either the study or the control group, each comprising 30 subjects. Study-group patients (PIG-GRP) received 250 mg/kg Pseudomonas immunoglobulin (Psomaglobin; Tropon-Cutter, Cologne, FRG) intravenously on days 3, 5, 7, 10 and 13 following the trauma, whereas controls (CON-GRP) received no prophylaxis. The immunoglobulin concentration was measured in serum on days 1, 3, 5, 7, 10, 13, 16, 19 and 28. From day 3 to day 13, significant higher values were found in study-group patients; however, this held true only for that subgroup of subjects in each group who displayed additional inhalation injury (PIG-SUBGRP = 23; CON-SUBGRP = 16). Immunoglobulin serum levels showed an earlier return to normal in the PIG-SUBGRP (day 7) than in the CON-SUBGRP (day 13). Blood cultures were taken on suspicion of septicaemia. In the above-described subgroups, the number of positive blood cultures was significantly reduced in the study patients (PIG-SUBGRP, 27 bacteremic subjects among a total of 70; CON-SUBGRP, 22 among a total of 36; P = 0.0045). In all, 21 subjects in the PIG-SUBGRP and 13 patients in the CON-SUBGRP were mechanically ventilated according to an adaptive scheme. The target value of pulmonary function was the O2 quotient (P(ALV)O2-P(ART)O2/P(ALV)O2), which was significantly closer to the normal value in the PIG-SUBGRP. Mortality was lower in the PIG-SUBGRP (34.8%, 8 patients) than in the CON-SUBGRP (50%, 8 subjects). In conclusion, prophylaxis with Pseudomonas immunoglobulin does not appear to be beneficial to burn trauma patients in general; however, it was shown to be effective in burn-trauma patients exhibiting inhalation injury.

Adolescent↗
PubMed1989

[The diagnostic significance of disordered gas exchange in inhalation trauma].

52 patients with burn injuries were prospectively investigated. In all cases intubation was necessary because of clinical signs of smoke inhalation. We studied whether a correlation could be established between the clinical signs and bronchoscopic findings and the degree of gas exchange disorder. The disturbed oxygenation was defined by the average alveolo-arterial oxygen quotient of the first 24 hours. The inhalation injury was classified by clinical signs and bronchoscopic findings (inhalation injury score). The average alveolo-arterial O2-quotient of the first 24 hours and the inhalation injury score showed a high correlation coefficient (r = 0.77). No correlation was seen between the severity of gas exchange disorder and the amount of burned body surface area (r = 0.20) respectively the age of the patients (r = 0.27). According to these results early onset of disorders in gas exchange after burn injury reflects smoke inhalation. Therefore the gas analysis from arterial blood can be a very helpful diagnostic method and allows to estimate the degree of pulmonary damage by inhalation injury.

Adolescent↗
PubMed1988

[Etomidate versus etomidate and hydrocortisone for anesthesia induction in abdominal surgical interventions].

The imidazole derivative etomidate has been shown to block (reversibly) adrenocortical steroid synthesis. Long-term sedation with etomidate has been associated with adrenocortical insufficiency and increased mortality in severely ill patients. The significance of adrenocortical blockade after a single induction dose of etomidate remains a matter of debate. This study was designed to analyze the role of glucocorticoid deficiency after a single induction dose of etomidate for major surgery. In a prospective controlled double-blind study, 20 consecutive patients scheduled for colorectal surgery were randomly allocated to either hydrocortisone substitution or placebo (glucose 5%). Hydrocortisone was given as a continuous infusion in a dose of 100 mg dissolved in 5% glucose over 10 h. We combined general anesthesia and epidural anesthesia (L3-4) using bupivacaine (0.5%). Induction of anesthesia: etomidate (0.2-0.3 mg/kg), fentanyl (0.1-0.2 mg), pancuronium (2 mg), and succinyl-choline (1.0-1.5 mg/kg), with endotracheal intubation and mechanical ventilation. Anesthesia was maintained at N2O/O2 2:1 and fluothane (0.4-0.6 vol%). At the end of surgery patients were extubated after oxygenation. In all patients blood pressure, heart rate, central venous pressure, and ECG were monitored continuously, both intra- and postoperatively. During induction, patients received 1,000 ml 0.9% NaCl, followed by continuous administration of 0.9% NaCl, 6 ml/kg per hour intraoperatively and 40 ml/kg per 24 hours post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Insufficiency↗
PubMed1987

[Pseudomonas immunoglobulin prophylaxis in patients with burn injuries].

Pseudomonas aeruginosa belongs to the most frequent pathogens isolated from patients with burns. In a mouse model for artificial burns it was found that prophylactic administration of a hyperimmune globulin with antibody titres against P. aeruginosa (Fisher immunotypes 1, 2, 4 and 6) reduced mortality. Therefore, the prophylactic administration of Pseudomonas immunoglobulin was examined in a prospective randomized study in two groups of 13 patients each. Severely burned patients with at least second degree burns over 30% to 70% of the total body surface area received 250 mg Pseudomonas immunoglobulin/kg body weight by the intravenous route between days 3 and 13. After treatment, plasma IgG levels were significantly raised between days 7 and 16 as compared to the controls, yet the incidence of infections caused by P. aeruginosa was not reduced. However, only two of the six infected patients, developed septicaemia, whereas in the control group, local Pseudomonas infection led to septicaemia in five out of seven patients. The number of septicaemic Staphylococcus aureus infections was also lower in patients on immunoglobulin prophylaxis, with two cases compared to four cases in the control group. Due to the limited number of cases studied, statistically significant results could not be obtained, however, there was a positive trend in favour of Pseudomonas immunoglobulin treatment.

Adolescent↗
PubMed1987

[Involvement of the growth hormone in rapid increases of the potassium concentration of the serum].

As a rule, the infusion of arginine hydrochloride is followed by an increase in serum potassium. The investigation is concerned with the short-term effect of growth hormone, which can be stimulated by arginine (0.6 g/kg body weight), on potassium concentrations in rats and patients with cerebral death. The administration of human somatotropin causes a significant rise in potassium concentrations in patients with cerebral death (0.4 IU/kg body weight) and in rats (4.0 IU/kg body weight). In comparison, the infusion of arginine hydrochloride will produce only a slight increase in serum potassium in both hypophysectomized rats and patients after cerebral death. Four of the ten animals even exhibited decreases in serum potassium content. Investigations of the cationic property of arginine are used to interpret the potassium increases in the extracellular space. The transport of amino acids through the cell membrane, which can be affected by somatotropin, is put forward as a further explanation. All findings are based on measurements carried out 10-30 min after termination of the infusion.

Anesthesia↗
PubMed1987

[What is the benefit of subglottic suction?].

Bronchopulmonary infections are the main cause of morbidity and mortality in intensive care wards. Since the usual anatomical and physiological barrier is missing in the intubated patient, oropharyngeal secretion will reach the subglottic space between glottis and upper rim of the low-pressure cuff. Starting from there, continuous microaspiration between cuff and tracheal mucosa leads to bacterial contamination of the upper respiratory tract. In patients with a disturbed immune system from that point on colonization and infection may follow. Therefore one is called upon to search for measures to prevent infection in ventilated patients. Selective decontamination of oropharynx and gastrointestinal tract has been described as an effective method. Others are recommending the application of aminoglycosides in the tracheobroncheal system. Removing retained secreted material is a general surgical principle. Therefore we tested the practicability and effectiveness of a continuous subglottic drainage. At this point we are mainly interested in its clinical aspects and in the method. We investigated the subglottic drainage in 10 intensive care patients who were on long-term mechanical ventilation and had undergone tracheostomy. All patients had an Ultratracheoflex cannula Nr. 9-11 (Rüsch Company, West Germany). It was modified by a suction catheter Ch. 12 (Uno Plast Company, West Germany): We cut two additional small holes in the curved catheter tip and attached the catheter with this part above the cuff at the dorsal convexity to the tracheoflex cannula (see illustration 1). An infusion pump was used for suctioning secretion from the subglottic space by an ordinary infusion set and at a suction flow of 100-125 ml/h.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1986

Missing effect of etomidate on testosterone secretion in man.

We studied the effect of low dosage (0.26 mg/kg as a single induction dose) and high dosage (30 mg/h for long term sedation) etomidate on serum testosterone and serum luteinizing hormone (LH) concentrations in males. During high dose etomidate we found inhibition of both 11 beta-hydroxylase and cholesterol-side-chain cleavage enzyme with unresponsiveness of progesterone, 17 alpha OH-progesterone and 11-deoxycortisol to stimulation with ACTH. However, neither high dosage nor low dosage etomidate had any influence on serum testosterone or LH concentrations. We conclude that, in contrast to other substituted imidazole derivatives, etomidate does not interfere with testicular testosterone synthesis. It therefore may be possible to find clinically useful imidazole derivatives with endocrine actions confined to either the adrenals or the testes.

17-alpha-Hydroxyprogesterone↗
PubMed1985

Effect of a single bolus of etomidate upon eight major corticosteroid hormones and plasma ACTH.

In a prospective controlled trial we investigated the effect of an induction dose of etomidate (0.26 mg/kg i.v.) on plasma ACTH, progesterone, 17 alpha OH-progesterone, 11-deoxycortisol, cortisol, cortisone, corticosterone, 11-deoxycorticosterone, and aldosterone in seven males undergoing general anaesthesia. Seven other male patients receiving thiopentone at induction (5.0 mg/kg i.v.) served as controls. Plasma ACTH concentrations rose higher in the etomidate group (346 +/- 124 vs. 117 +/- 74 pg/ml, mean +/- SEM), but the difference was not significant. After etomidate we found a clear suppression of plasma cortisol (P less than 0.01), cortisone (P less than 0.01), corticosterone (P less than 0.01), and aldosterone (P less than 0.05) compared to corticosteroid levels after induction with thiopentone. Plasma 11-deoxycortisol and 11-deoxycorticosterone concentrations were grossly elevated 210 min after etomidate (91 +/- 28 nmol/l and 7.04 +/- 0.47 nmol/l, respectively, P less than 0.01) demonstrating inhibition of 11 beta-hydroxylation of both glucocorticoid and mineralocorticoid intermediates. In contrast, no significant difference in plasma progesterone and 17 alpha-OH-progesterone levels was found between the two groups indicating that the cholesterol-side-chain cleavage enzyme is less sensitive to etomidate than 11 beta-hydroxylase. Our results suggest that after induction of anaesthesia with a single bolus of etomidate, inhibition of other enzymes in the corticosteroid-synthetic pathway (e.g. cholesterol-side-chain cleavage enzyme) is of little clinical relevance.

17-alpha-Hydroxyprogesterone↗